Dental Caries Among Twelve-Year-Old Puerto Ricans: 1997 and 2011

An oral health reform was implemented in PR between 1994 and 2000 to provide third-party health insurance to the medically indigent population (more than 40% of the overall population).

Objectives: To estimate the national prevalence of dental caries and the mean DMFT index among twelve-year old Puerto Ricans in 2011 and compare the findings to 1997. 

Methods: An island-wide study was conducted from November 2010 through May 2011 using a probabilistic sample of schools, stratified by region and school type. NIDCR diagnostic criteria were employed for DMFT. Exams were conducted by three calibrated examiners. A similar methodology was employed in 1997.

Results: 1,550 schoolchildren were examined, 47% males and 53% females.  Caries prevalence has reduced from 81% in 1997 to 71% in 2011. Mean DMFT was also lower in 2011 (2.6) compared to 1997 (3.8). This reduction was observed both in private (mean DMFT=1.63 vs. 3.0 in 1997) and public schools (mean DMFT=2.7 vs. 4.0 in 1997). In 2011, the decayed component accounted for 35% of the DMFT, while filled and missing teeth accounted for 64% and 2% respectively. In 1997, the corresponding components were 42%, 50% and 8% respectively. 

Conclusions: There was a 10% reduction in caries prevalence and a 34% reduction in the mean DMFT score from 1997 to 2011. We observed a 7% reduction in the decayed component and 6% reduction in the missing component; the filled component increased by 14%. The implementation of the Oral Health Reform in PR may have influenced the reduction of caries prevalence and may suggest that access to dental services has improved. Still, dental caries prevalence is high in Puerto Rico and a health disparity between public and private school attending children persists. A population-based fluoride program may decrease the decayed component of the index and the overall caries prevalence.