Caries decline and national regulation in European countries.
Level 4 - case-series / case-control
Level 4 by design analogy: multi-country ecological and historical trend analysis.
PubMed 41885127 · doi:10.3290/j.qi.b6967758
What was done
The study analyzed 45-year longitudinal trends in dental caries among 5–7-year-olds (primary dentition) and 12-year-olds (permanent dentition) across seven Western and Eastern European countries (Denmark, Switzerland, Germany, Slovenia, Austria, Croatia, and Serbia). Trends were evaluated alongside national legal regulations, healthcare governance taxonomy, financial and delivery structures, caries preventive strategies, and general economic data.
What was found
Denmark and Switzerland implemented regulations in the 1970s and reached ~1 DMFT in 12-year-olds by 1990, while Germany implemented equivalent regulations in 1989 and reached 1.2 DMFT by 2010; all three countries reached 0.5 DMFT in the latest surveys. Slovenia and Austria implemented fewer regulations and exhibited less pronounced declines. Croatia and Serbia experienced 1990s territorial conflicts and delayed declines, remaining > 2 DMFT in 12-year-olds in 2020. In primary dentition (5–7-year-olds), Denmark's early national strategy from tooth eruption onward resulted in 1 dmft in 6-year-olds after 2005, whereas values in the other six countries remained at least twice as high.
Why it matters
The findings illustrate how formal national public health policies, early-life preventive frameworks, and economic stability correspond to large, lasting reductions in childhood dental caries at the population scale.
Limits
The study is ecological and observational, precluding direct causal attribution. Individual participant sample sizes and standardized confidence intervals are not reported in the abstract. Data collection methods and epidemiological reporting for the primary dentition varied substantially across countries, and analyses could not fully isolate policy impacts from broader socioeconomic shifts, fluoride access, or nutritional changes.
Cited by
- contradicts In Denmark, the average person has a quarter of a cavity per person for life.