Viengsavanh Inthakoun1 , Hue Vang1 , Amphayvan Homsavath2 , MaibounSimalavong 2 , Phetmany Sihavong1 , Phimfa lee Sayaxang 1 , Anhtana Photsavang1 , Chanthanome Mingboupha2 , Khanphet Laungamath1 , VimonlakBouphavanh1 , Vatthana Latsomphou3 , Fongsamod Daoungnuvong4 , Thongsavanh Vetsuvan5 , Bounthon Bounmanatham5 , Phetlamphay Sidanumon2 , Amplaivanh homsavath2 , Viengkham Keohavong3 , Manivone phanthavong6
1Department of Dental Basic Sciences, Faculty of dentistry, University of Health Sciences, Lao PDR
2Division of Academic, Faculty of dentistry, University of Health Sciences, Lao PDR
3Department of Prosthodontic, Faculty of dentistry, University of Health Sciences, Lao PDR
4Department of Restorative, Faculty of dentistry, University of Health Sciences, Lao PDR
5Department of Oral Surgery, Faculty of dentistry, University of Health Sciences, Lao PDR
6Division of Clinical, Faculty of dentistry, University of Health Sciences, Lao PDR
Corresponding Author Email: viengsavanh.inthakoun@gmail.com
DOI : https://doi.org/10.51470/AMSR.2025.04.02.103
Abstract
Background: The purpose of this systematic review was to determine the prevalence of dental caries in primary and permanent teeth among children aged 3 to 15 years in Laos between 2002 and 2024. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar. Databases were searched using relevant keywords to identify studies related to dental caries in the Lao population. The inclusion criteria were manuscripts published in English from 2002 to May 2024. MetaEssentials software was used to analyze data separately for primary and permanent teeth. Random-effects and ixed-effects models were applied depending on the level of heterogeneity. Forest plots were used to evaluate caries prevalence in both dentitions. Results: A total of 6,212 participants from 12 studies were included in the metaanalysis. The prevalence of dental caries in primary teeth showed a mean decayed, missing, and illed teeth (dmft) index of 5.76 (95% conidence interval [CI]: 2.55–14.06), with an average prevalence of 98.3%. For permanent teeth, the mean DMFT index was 1.31 (95% CI: 1.66–4.27), with an average prevalence of 44.8%. Conclusion: These results demonstrate that the prevalence of dental caries in Laos is high. However, the available data do not provide comprehensive coverage of dental caries across all regions of Lao PDR. Therefore, future research should focus on assessing caries prevalence in a wider range of geographical regions throughout Laos.
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1. Introduction
Dental caries is one of the most common chronic diseases worldwide, affecting billions of people across all age groups. Globally, an estimated 2 billion individuals suffer from caries in permanent teeth, while approximately 514 million children are affected in their primary dentition [1]. This significant global burden reflects the persistent challenges related to oral hygiene practices, dietary patterns, and access to preventive dental care. In Laos, several studies have reported a high prevalence of dental caries among children aged 3–15 years. Previous research indicates that the prevalence reaches 95.87% in primary teeth and 86.13% in permanent teeth among school-aged children [2]. Similarly, a study conducted in 2010 showed that 82% of Lao children aged 3–5 years had primary tooth decay, with a mean dmft score of 5.5 [3]. Another investigation in 2013 revealed a prevalence of 93.6% for dental caries in permanent teeth [4]. These findings collectively demonstrate a substantial oral health challenge affecting Lao children across different age groups. The World Health Organization (WHO) has emphasized the importance of improving oral health at both community and population levels, recognizing childhood caries as a significant public health concern requiring urgent attention. Despite multiple individual reports, there is considerable variability in the reported prevalence of dental caries across different regions of Laos. Moreover, to date, no systematic review has comprehensively synthesized the available evidence on dental caries in the Lao population. Therefore, this systematic review and meta-analysis were undertaken to estimate the overall prevalence of dental caries in Laos by analyzing published data from 2002 to 2024. By consolidating existing findings, this review aims to provide a clearer understanding of the caries burden in the country and to support future oral health policymaking and intervention strategies.
- Aims and objective
Participants from the age 3 – 15 years from different part of Laos were covered in this meta-analysis of 11 studies
- Methodology
This systematic review was designed to be as a comprehensive followed the PRISMA guideline (5). The searched database included PubMed, web science, Scopus, Google scholar search strategy for each database by using key worlds to exact data, with free- text words. Study focused of review to determine the prevalence of Dental caries with mean of dmft and DMFT in children 3- to 15-year-old in Laos
Included Criteria
The eligibility criteria, there are any type of observational study design was evaluated in this review such as the prevalence of participants from 3 to 15 years old by using dmft, DMFT,WHO pro forma 1997, PUFA, by cross-sectional study, case control, prospective and retrospective study .Studies has to be published on 2002 until 2024.
Exclusion criteria
Studies were excluded if the data measured the incidence of other oral conditions, and did not consider dental caries , and no mention of dfmt/ DMFT with SD detail. studies written in other language were excluded.
Data collection process
Identified studies were collected and checked by the three reviewers. The studies found total 1780 that include from PubMed, and web sciences, the Endnote X7 was used for check the duplicate, with 1735 studies were removed. 45 with full text read studies were further screen, and 29 studies were reported for age interval than 3 to 15 years Studies and mention with special needs for treatment. 16 Full text articles were eligibility, 4 Non availability of standard deviation of dmft/ DMFT score and not availability of average dmft/DMFT scores. Finally, 12 studies were suitable for satisfy of this meta-analysis (Fig.1)
Data analysis
The statistical program Meta-Essentials software (6) was used for analysis. The meta-analysis using Random
effect or fixed effect model. If heterogeneity was present, then the random effect model was used. The fixed effect was used when the heterogeneity was absence. Forest plots were used for demonstrated the effect of each study.
The investigate publication bias were constructed by funnel plot and Egger’s test for small study effect was performed to assess the degree of asymmetry by P<0.05 was considered as significant.
Data extraction
The details of information were extracted from those publications, the data of tooth decay were separating by primary and permanent teeth in the table (table 1) and (table 2). Eight articles included both primary and permanent teeth (Sun-Gil Park et al,2023, Yong soo Park et al,2023, Dong-Hyeon Kim et al, 2023, Jae-Geun Ka et al,2019,Sjobbe Besseling et al, 2013,Nithasack Phommavongsa et al, 2014, Nithasack Phommavongsa et al, 2015, Nithasack Phommavongsa et al, 2016) (2) ,(7), (8), (9), (4) , (10) , while only two study reported caries in primary teeth ( Sakpaseuth S et al, 2010, Homsavath et al, 2024) (3),(11), and two articles reported caries in permanent teeth(Gisela Ladda Tayanin et al, 2002, Nanna Jurgensen et al, 2009) (12), (13)
Primary Teeth
Seventeen studies reported caries in primary teeth and were included in the meta-analysis. The total combined sample size was 2,465 participants. Across these studies, the overall prevalence of caries in primary teeth was 98.3%, with reported values ranging from 82% to 95.87%. A heterogeneity assessment was performed prior to constructing the forest plot. The heterogeneity test showed P = 0.02 and an I² value of 43.58%, indicating moderate and statistically significant heterogeneity. Therefore, a random-effects model was applied to estimate the pooled prevalence (Fig. 2). The pooled mean dmft score for primary teeth in children aged 3–8 years was 5.76 with a 95% confidence interval (CI: 2.55–14.06). A funnel plot was generated to assess publication bias (Fig. 3). Visual inspection revealed a relatively symmetrical distribution of data points, suggesting the presence of publication bias. Egger’s regression test was further used to evaluate funnel plot asymmetry, and the result indicated P < 0.01, confirming significant publication bias.
Permanent Teeth
Thirty-six studies reporting dental caries in permanent teeth were included in the meta-analysis. The total sample size across these studies was 3,747 participants. The proportion of individuals with caries in permanent teeth showed an average prevalence of 44.8%, with reported values ranging from 35.3% to 93.6%. A heterogeneity test was performed prior to constructing the forest plot. The results indicated P = 0.11 and an I² value of 23.11%, demonstrating low and statistically insignificant heterogeneity. Therefore, a fixed-effects model was applied to calculate the pooled prevalence (Fig. 4). The pooled mean DMFT score for permanent teeth among children aged 6–15 years was 1.31, with a 95% confidence interval (CI: 1.66–4.27). A funnel plot was also generated to evaluate publication bias (Fig. 5). The distribution of data points suggested potential publication bias. Egger’s regression test was applied to assess funnel plot symmetry, yielding P < 0.01, confirming the presence of significant publication bias.
- Discussion
This study aimed to systemic review studies to evaluating the prevalence of dental caries in Laos from 2002 to 2024. There were identified 12 studies, as well as for primary and permanent and mixed dentition separate in to two groups, this systematic review and meta-analysis set out to evaluated of the combined variance prevalence of dental caries in Lao population. In 1999 the fluoride concentration in the drinking waters has been estimated in some provinces of Lao People’s Democratic Republic, however the drinking water fluoride has low concentration was 0.0 and 0.5ppm in some place in Laos (14), even though the oral health program such as toothbrush education, fluoride mouth rinsing program, fluoride topical application, and sealand in primary school were provide (15). Most of studies on dental caries were high in various geographical area.
The present study in 3 – 15 years with 98.3% under 6 years and 44.8% in patients above 6 years, this finding is congruence with result of the study in 2019 was reported that the prevalence of dental caries with 82% among 1161 student 6-10 years in Vientiane (16) , similarly in the India 2005 among children 5-7 years old(17), the decayed primarly teeth index was 94.30%, and studied in 2014 among 12 and 15 year the prevalence of permanent teeth in 47.80 and 44%(18). With high percentage of dental caries in children with untreated dental caries in primary dentition was significantly highest in underweight children (19). The included of this present review showed of heterogeneity I2 =43.58 and 23.11 for primary teeth and permanent teeth, respectively, With proportion 5.76 ( 2.55 – 14.06 )and 1.31 ( 1.66 – 4.27) Heterogeneity index had significant in outcome of dmft and DMFT, this more higher than reported in Saudi children 2023 with dmft index 4.14 (3.11-5.18) and permanent teeth was lower with DMFT1.28(0.93-1.64)(20)
The strength of current review is the low heterogeneity between the studies include for analysis. However, there were some limitations such as some of them did not mention age groups of participants , number of articles was limited , reported with this mention limitations, future studies should focus on factors correlate with prevention and need for nation level base for equal representative of urban and rural of whole country
- Conclusion
The average score of dmft/DMFT in primary and permanent teeth , the carie proportion 5.76 rang from2.55 to 14.06 and 1.31 from 1.66 to 4.27 for primary teeth and permanent teeth. This indicates that the prevalence of dental caries in Laos is high, however, the current data do not provide all dental caries in whole of Laos. This study indicated to measure of prevention should be strategies to reduce prevalence of dental caries for Lao population.
References
4. Besseling S, Ngonephady S, van Wijk AJ. Pilot survey on dental health in 5–12‐year‐old school children in Laos. Journal of Investigative and Clinical Dentistry. 2013;4(1):44-8.
15. 임지현. Comparison of a 2-year oral health program using sealant and 1.23% acidulated phosphate fluoride gel in primary school students of Vientiane, Laos. International Journal of Clinical Preventive Dentistry. 2016;12(1):31-6.