Pediatrics · Medical Literature
Dental caries experience in Indigenous children and adolescents: a systematic review and meta-analysis assessing worldwide disparities and time trends (1968-2024).
Abstract
To summarize the evidence on the global experience of dental caries among Indigenous children and adolescents worldwide using decayed, missing, and filled teeth indices for deciduous (dmft) and permanent (DMFT) dentitions. A systematic review of the PubMed, SciELO, Embase, and Scopus databases was conducted. The search included studies with primary data on dmft and DMFT in Indigenous populations worldwide published until February 9, 2026. The pooled means (95% CI) of dmft and DMFT were calculated using a random-effects meta-analysis. Subgroup analyses and meta-regression explored heterogeneity through sociodemographic, geographic and time variables. A total of 95 studies from 19 countries were included in the systematic review, 59 of which provided data for meta-analysis. The pooled mean for dmft was 3.75 (3.58-3.92) and for DMFT was 2.36 (2.18-2.55). Considerable heterogeneity was detected in pooled analyses for dmft and DMFT. Both indices were higher in studies from North America (dmft = 5.23 [4.61-5.86]; DMFT = 4.74 [2.28-7.20]) than in those from Oceania and Asia (dmft = 3.30 [3.11-3.50]; DMFT = 1.74 [1.57-1.91]). Multivariate meta-regression revealed that dmft increased as the percentage of female participants rose (β = 0.10, p-value = 0.030). Additionally, DMFT increased with increasing age (β = 0.40, p-value < 0.001) and decreased with increasing HDI (β=-3.13, p-value = 0.034). No statistically significant differences in caries experience were found across the study periods. For nearly six decades, Indigenous children and adolescents worldwide have consistently experienced dental caries affecting approximately two to four teeth. Disparities in dental caries were observed across age, sex, and national human development levels. The persistence of dental caries underscores the urgency of implementing effective preventive strategies that are culturally adapted to Indigenous contexts.
Clinical relevance
This systematic review and meta-analysis addresses a critical global oral health equity gap by synthesizing nearly six decades (1968–2024) of data on dental caries burden in Indigenous pediatric populations across 19 countries. Indigenous children and adolescents represent a historically underserved population with known barriers to dental care access, cultural-linguistic challenges, and social determinants of poor oral health. The persistence of caries burden over this timeframe without statistically significant improvement underscores an urgent, unresolved public health crisis demanding culturally adapted clinical and policy interventions.
Key findings
1. Pooled mean dmft (deciduous dentition) across 59 studies included in meta-analysis was 3.75 (95% CI: 3.58–3.92), indicating an average of nearly 4 deciduous teeth affected per child. 2. Pooled mean DMFT (permanent dentition) was 2.36 (95% CI: 2.18–2.55), reflecting substantial caries burden extending into adolescence. 3. Significant geographic disparity was identified: North American Indigenous populations had markedly higher indices (dmft = 5.23 [95% CI: 4.61–5.86]; DMFT = 4.74 [95% CI: 2.28–7.20]) compared to Oceania and Asia (dmft = 3.30 [95% CI: 3.11–3.50]; DMFT = 1.74 [95% CI: 1.57–1.91]). 4. Multivariate meta-regression demonstrated that dmft increased significantly with a higher proportion of female participants (β = 0.10, p = 0.030), suggesting a sex-based differential in early childhood caries experience. 5. DMFT increased significantly with increasing age (β = 0.40, p < 0.001) and decreased significantly with higher national Human Development Index (HDI) (β = −3.13, p = 0.034), implicating socioeconomic and developmental determinants in caries trajectory. 6. No statistically significant temporal trend in caries experience was detected across the nearly six-decade study period, indicating stagnation in oral health outcomes for this population despite global advances in preventive dentistry.
Practice implications
Clinicians caring for Indigenous pediatric patients should apply heightened caries risk stratification, initiating preventive interventions — including fluoride varnish, silver diamine fluoride, and dietary counseling — as early as tooth eruption, given pooled dmft levels approaching 4 affected teeth per child globally and exceeding 5 in North American cohorts. Given that DMFT rises significantly with age and is inversely associated with HDI, pediatric and general practitioners in lower-HDI settings should prioritize early interception and community-level prevention programs tailored to local Indigenous cultural contexts rather than relying on standard-of-care models developed for non-Indigenous populations. The absence of measurable improvement over nearly six decades mandates advocacy for policy-level investment in culturally adapted, community-based oral health programs for Indigenous communities, moving beyond individual clinical encounters to address upstream social determinants of oral health.