Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A systematic review and meta-analysis

Background: Understanding of socioeconomic context might enable more efficient evidence-based preventive strategies in oral health. Aim: The study assessed the caries-related socioeconomic macro-factors in 12-year-olds across European countries. Design: This systematic review involved epidemiological surveys on the caries status of 12-year-olds from 2011 to 2022. DMFT was analyzed in relation to gross national income (GNI), United Nations Statistical Division geographical categorization of European countries (M49), unemployment rate, Human Development Index (HDI), and per capita expenditure on dental health care. A meta-analysis was performed for countries reporting data on DMFT, stratified by GNI, and geographical location of European countries, using a random-effects model. Results: The study involved 493 360 children from 36 countries in the geographic region of Europe. The analysis confirmed a strong negative correlation between income and caries experience (p < .01). Children living in higher-income countries showed 90% lower odds of poor oral health than in middle-income countries. Children living in West Europe showed 90% lower odds of poor oral health than children living in East Europe. Conclusion: The strong effect of macro-level socioeconomic contexts on children's oral health suggests favoring upstream preventive oral health strategies in countries with economic growth difficulties, Eastern and Southern parts of Europe.