Abstract
Background
Oral disorders, including caries of permanent teeth, periodontal diseases, edentulism, and other oral conditions, are important contributors to nonfatal health loss among women of childbearing age (WCBA). However, their long-term burden in South Korea remains insufficiently characterized. This study aimed to assess temporal and age-specific patterns of oral disorder burden among South Korean WCBA, identify demographic and epidemiological drivers, and project future trends through 2045.
Methods
Data for South Korean WCBA aged 15–49 years from 1990 to 2023 were obtained from GBD 2023. Prevalence, incidence, DALYs, and corresponding age-standardized rates were analyzed. Temporal trends were assessed using Joinpoint regression, demographic and epidemiological contributions using decomposition analysis, and future burden through 2045 using Nordpred.
Results
From 1990 to 2023, prevalent and incident cases decreased by 14% and 18%, respectively, whereas DALYs increased by 2%. Age-standardized prevalence and incidence rates declined, while the age-standardized DALY rate increased from 134.08 to 137.47 per 100,000 population. DALYs increased with age and were highest among women aged 45–49 years. Other oral disorders and caries of permanent teeth were major contributors to DALYs among younger women, whereas the contribution of periodontal diseases increased markedly with age and became increasingly important among older WCBA. Population contraction was the principal contributor to declining prevalence and incidence, whereas age-structure changes were the main driver of increased DALYs. By 2045, DALYs are projected to decline to approximately 12,383, with an age-standardized DALY rate of 66.81 per 100,000 population.
Conclusion
Oral disorder burden among South Korean WCBA was characterized by declining prevalence and incidence but persistent disability. These findings highlight the need to complement caries prevention in younger women with strengthened periodontal screening, preventive dental care, and long-term management, particularly among women aged 35–49 years.
Keywords: oral disorders, women of childbearing age, global burden of disease, disability-adjusted life years, Joinpoint regression, decomposition analysis
Introduction
In recent decades, oral disorders have become a major source of nonfatal chronic disease burden worldwide and an important public health issue among women of childbearing age (WCBA).1 Oral disorders include dental caries, periodontal disease, tooth loss, and other oral functional impairments.2 They are closely associated with dental plaque biofilm, sugar intake, oral hygiene, fluoride exposure, host susceptibility, dental service accessibility, and socioeconomic factors.3,4 Although oral disorders rarely cause death directly, they can lead to tooth pain, gingival bleeding, impaired chewing, tooth loss, reduced quality of life, psychosocial distress, and increased healthcare costs.1
Among WCBA, hormonal changes related to menstruation, pregnancy, and lactation may affect gingival inflammation, the oral microbiome, salivary composition, and dietary behaviors, thereby increasing the risk of oral disorders.5 Pregnancy-related vomiting, delayed dental visits, postpartum dietary changes, and caregiving stress may further aggravate oral health burden.
In South Korea, lifestyle changes, westernized dietary patterns, increased consumption of sugar-sweetened beverages and refined carbohydrates, delayed childbearing, and low fertility have made oral health among WCBA increasingly important.6 Although South Korea has a relatively well-developed healthcare system, work stress, irregular diet, frequent snacking, sedentary behavior, metabolic abnormalities, and unequal use of preventive dental services may continue to contribute to oral disease burden.7 Disparities in oral health knowledge, fluoride use, regular dental check-ups, and dental service accessibility may also lead to unequal burden across socioeconomic groups.8,9 Importantly, preventive oral healthcare in South Korea is not specifically structured around the needs of WCBA. Although national oral health programs and dental screening services are available, routine preventive dental care for women of reproductive age is generally not integrated with reproductive, preconception, or maternal healthcare. Preventive services may therefore remain largely dependent on individual awareness and voluntary dental attendance, resulting in lower uptake among women with limited time, lower socioeconomic status, or reduced access to dental care.10 In addition, targeted education regarding oral health before pregnancy, periodontal disease prevention, dietary counseling, and the potential interactions between oral and systemic or reproductive health remains insufficient. These gaps suggest a need for more proactive, life-course-oriented oral health strategies that integrate regular dental assessment, risk-based prevention, and oral health education into primary and reproductive healthcare for WCBA.
Therefore, based on Global Burden of Disease Study 2023 (GBD 2023) data, this study assessed temporal trends in prevalence, incidence, and disability-adjusted life years (DALYs) due to oral disorders among WCBA in South Korea from 1990 to 2023. Joinpoint regression was used to evaluate trends, decomposition analysis to quantify the contributions of population growth, aging, and epidemiological change, and the Nordpred model to project future burden. This study provides evidence for improving oral health management, prevention strategies, and healthcare resource allocation for WCBA in South Korea.
Methods
Data Sources and Disease Definition
Data were obtained from the Global Burden of Disease Study 2023 (GBD 2023), which provides standardized estimates of disease burden from 1990 to 2023 across 204 countries and territories.11 Estimates were generated using standardized modeling and uncertainty frameworks, with 95% uncertainty intervals (UIs) defined by the 2.5th and 97.5th percentiles of 1000 posterior draws.12
In GBD 2023, oral disorders comprise four conditions: caries of permanent teeth, periodontal diseases, edentulism, and other oral disorders.1 Given that women of childbearing age (WCBA) were defined as females aged 15–49 years, the burden in this population was primarily related to caries of permanent teeth and periodontal diseases, while caries of deciduous teeth was not relevant to this age range.5,13–15
We extracted prevalence, incidence, disability-adjusted life years (DALYs), and corresponding age-standardized rates (ASRs) for overall oral disorders in South Korean WCBA from 1990 to 2023.16 Disease-specific estimates were also examined to characterize the contributions of individual oral conditions. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs). As oral disorders are predominantly nonfatal, their DALYs were mainly driven by YLDs.
Trend Analysis
Temporal trends in the age-standardized rate (ASR) of oral disorders among WCBA in South Korea were first assessed using the estimated annual percentage change (EAPC).14 A log-linear regression model was fitted as follows: ln(rate) = α + β × year. The EAPC was calculated as: EAPC = 100 × (eβ − 1). An EAPC greater than 0 indicates an increasing trend, whereas an EAPC less than 0 indicates a decreasing trend.
Joinpoint Regression Analysis
Joinpoint regression analysis was performed to further evaluate temporal changes in the burden of oral disorders among WCBA in South Korea from 1990 to 2023.11 This method identifies statistically significant inflection points in time-series trends and divides the full study period into several segments with distinct changing patterns.
The analysis was conducted using the Joinpoint Regression Program developed by the National Cancer Institute. The model allowed a maximum of five joinpoints. The optimal number of joinpoints was selected using permutation tests and model-fit criteria. For each time segment, the annual percent change (APC) was calculated. The average annual percent change (AAPC) was further estimated to summarize the overall trend across 1990–2023.
Decomposition Analysis
Decomposition analysis was performed to quantify the relative contributions of population growth, population aging, and epidemiological change to changes in prevalence, incidence, and DALYs of oral disorders among WCBA in South Korea.17
Using the Das Gupta decomposition method, the total change in prevalence, incidence, and DALYs between 1990 and 2023 was decomposed into three components. Population growth reflects changes caused by changes in the total size of the WCBA population. Population aging reflects changes caused by shifts in the age structure within WCBA. Epidemiological change reflects changes in age-specific rates, which may be related to changes in dietary patterns, oral hygiene behaviors, fluoride exposure, preventive dental care, socioeconomic conditions, diagnosis, and treatment.
Counterfactual scenarios were constructed by holding two factors constant while allowing one factor to change. This approach allowed us to estimate the independent contribution of each factor to the overall change in prevalence, incidence, and DALYs due to oral disorders. A positive contribution indicates that the factor increased the disease burden, whereas a negative contribution indicates that the factor reduced the disease burden.
Forecasting Analysis
Future DALYs of oral disorders among WCBA in South Korea were projected using the Nordpred model based on an age–period–cohort framework.18 This model incorporates age effects, period effects, and birth cohort effects to estimate future disease burden trends.
The Nordpred R package was used to predict prevalence, incidence, and DALYs due to oral disorders over the next two decades. All data cleaning, statistical analyses, and figure generation were performed using R software.
Results
Burden of Oral Disorders Among WCBA in South Korea, 1990–2023
Over the past 34 years, among WCBA in South Korea, the number of prevalent cases of oral disorders decreased from 4,430,535.59 (95% UI: 3,278,540.77 to 6,017,949.53) in 1990 to 3,801,723.12 (95% UI: 2,856,968.04 to 5,123,533.74) in 2023, representing a 14% decrease. Incident cases declined from 6,611,991.72 (95% UI: 5,157,233.03 to 7,936,726.95) in 1990 to 5,448,610.96 (95% UI: 4,204,724.40 to 6,640,919.49) in 2023, representing an 18% decrease. In contrast, DALY cases increased slightly from 16,523.43 (95% UI: 9,240.72 to 26,752.42) in 1990 to 16,877.70 (95% UI: 9,328.78 to 27,970.24) in 2023, corresponding to a 2% increase.
The age-standardized prevalence rate (ASPR) of oral disorders decreased from 34,871.14 (95% UI: 25,838.68 to 47,227.82) per 100,000 population in 1990 to 33,329.78 (95% UI: 24,976.59 to 45,073.01) per 100,000 population in 2023, with an EAPC of −0.12 (95% CI: −0.15 to −0.08). The age-standardized incidence rate (ASIR) declined from 51,236.99 (95% UI: 39,890.06 to 61,654.95) per 100,000 population in 1990 to 50,266.07 (95% UI: 39,135.47 to 60,792.90) per 100,000 population in 2023, with an EAPC of −0.01 (95% CI: −0.03 to 0.02). By contrast, the age-standardized DALY rate (ASDR) increased from 134.08 (95% UI: 74.91 to 218.00) per 100,000 population in 1990 to 137.47 (95% UI: 76.66 to 226.74) per 100,000 population in 2023, with an EAPC of 0.07 (95% CI: 0.06 to 0.08) (Table 1).
Table 1.
All-Age Numbers and Age-Standardized Rates of Prevalence, Incidence, and Disability-Adjusted Life Years (DALYs) for Oral Disorders Among WCBA in South Korea, 1990–2023
| Indicator | 1990_Cases (95% UI) |
2023_Cases (95% UI) |
Percentage Change | 1990_ASR_per 100000 (95% UI) |
2023_ASR_per 100000 (95% UI) |
EAPC (95% CI) |
|---|---|---|---|---|---|---|
| Prevalence | 4,430,535.59 (3,278,540.77–6,017,949.53) | 3,801,723.12 (2,856,968.04–5,123,533.74) | −0.14 | 34,871.14 (25,838.68–47,227.82) | 33,329.78 (24,976.59–45,073.01) | −0.12 (−0.15--0.08) |
| Incidence | 6,611,991.72 (5,157,233.03–7,936,726.95) | 5,448,610.96 (4,204,724.4–6,640,919.49) | −0.18 | 51,236.99 (39,890.06–61,654.95) | 50,266.07 (39,135.47–60,792.9) | −0.01 (−0.03–0.02) |
| DALYs | 16,523.43 (9240.72–26,752.42) | 16,877.7 (9328.78–27,970.24) | 0.02 | 134.08 (74.91–218) | 137.47 (76.66–226.74) | 0.07 (0.06–0.08) |
Age Distribution of Oral Disorders Among WCBA in South Korea, 2023
In 2023, the age-specific burden of oral disorders among WCBA in South Korea varied by indicator (Figure 1A–C). Prevalence was lowest in the 15–19 years group, with 309,185 cases, increased with age, and peaked among women aged 45–49 years, with 691,196 cases. Incident cases showed a different pattern, with the highest number observed in the 25–29 years group, with 903,207 cases, followed by the 40–44 years group, with 849,201 cases. DALY cases increased steadily with age, rising from 904 cases in the 15–19 years group to 4,204 cases in the 45–49 years group.
Figure 1.
Age-specific burden of oral disorders among women of childbearing age (WCBA) in South Korea, 2023. (A) Number of prevalent cases across 5-year age groups. (B) Number of incident cases across 5-year age groups. (C) Number of disability-adjusted life years (DALYs) across 5-year age groups. These panels illustrate the age distribution of the oral disorder burden among WCBA and identify the reproductive-age groups contributing most substantially to the absolute burden.
Age-Specific Trends, 1990–2023
In 2023, among WCBA in South Korea, the numbers of prevalent and incident cases of oral disorders in the 40–49 age group were higher than those in 1990. DALY cases among women aged 35–49 years were also higher in 2023 than in 1990. However, the prevalence rate in 2023 was markedly higher than that in 1990, whereas incidence and DALY rates showed no substantial differences between 1990 and 2023 (Figure 2A–C).
Figure 2.
Age-specific comparisons of the burden of oral disorders among WCBA in South Korea between 1990 and 2023. (A) Age-specific prevalence cases and rates. (B) Age-specific incidence cases and rates. (C) Age-specific DALYs and rates. The comparison of absolute numbers and age-specific rates distinguishes changes in the population-level burden from changes in the underlying age-specific epidemiological burden over the study period.
Joinpoint Regression Analysis, 1990–2023
Joinpoint regression analysis showed that from 1990 to 2023, the ASPR and ASIR of oral disorders among WCBA in South Korea showed decreasing trends, with AAPCs of −0.14 and −0.06, respectively (Figure 3A and B). In contrast, the ASDR showed an increasing trend, with an AAPC of 0.08 (Figure 3C). The fastest increases in ASPR and ASIR occurred during 2018–2021, with APCs of 0.36 and 1.11, respectively. The fastest increase in ASDR occurred during 1990–1995, with an APC of 0.34.
Figure 3.
Joinpoint regression analysis of age-standardized prevalence, incidence, and DALY rates attributable to oral disorders among WCBA in South Korea, 1990–2023. (A) Age-standardized prevalence rate (ASPR). (B) Age-standardized incidence rate (ASIR). (C) Age-standardized DALY rate (ASDR). Joinpoint regression identifies periods with statistically distinct temporal trends and estimates the annual percentage change (APC) for each segment. An asterisk (*) indicates a statistically significant APC (P < 0.05).
Decomposition Analysis of Changes in Oral Disorder Burden, 1990–2023
Decomposition analysis showed that over the past 34 years, aging was the main contributor to the increase in DALYs due to oral disorders among WCBA in South Korea, followed by epidemiological change.
For prevalence, epidemiological change contributed −186,873.64 cases (29.72%), aging contributed 65,112.81 cases (−10.35%), and population growth contributed −507,051.64 cases (80.64%), resulting in an overall decrease of 628,812.46 prevalent cases (Figure 4A). For incidence, epidemiological change contributed −120,592.47 cases (10.37%), aging contributed −300,415.57 cases (25.82%), and population growth contributed −742,372.72 cases (63.81%), resulting in an overall decrease of 1,163,380.76 incident cases (Figure 4B). For DALYs, epidemiological change contributed 442.94 DALYs (125.03%), aging contributed 1,975.67 DALYs (557.68%), and population growth contributed −2,064.34 DALYs (−582.71%), resulting in an overall increase of 354.27 DALYs (Figure 4C).
Figure 4.
Decomposition of changes in the absolute burden of oral disorders among WCBA in South Korea from 1990 to 2023. Changes in (A) prevalent cases, (B) incident cases, and (C) DALYs were decomposed into the contributions of population growth, changes in age structure, and epidemiological change. Positive contributions indicate factors increasing the absolute burden, whereas negative contributions indicate factors reducing it.
Forecasting of Oral Disorder Burden, 2024–2045
Forecasting analysis indicated that from 2024 to 2045, the numbers of prevalent cases, incident cases, and DALYs due to oral disorders among WCBA in South Korea are expected to decline year by year. ASPR and ASDR are also projected to decrease gradually, whereas ASIR is expected to increase over time.
By 2045, the number of prevalent cases of oral disorders among WCBA in South Korea is projected to reach 2,642,607, with an ASPR of 15,206.61 per 100,000 population (Figure 5A). The number of incident cases is projected to reach 4,285,113, with an ASIR of 25,765.22 per 100,000 population (Figure 5B). DALYs are projected to decrease to 12,383, with an ASDR of 66.81 per 100,000 population (Figure 5C).
Figure 5.
Projected burden of oral disorders among WCBA in South Korea through 2045. (A) Projected number of prevalent cases and age-standardized prevalence rate (ASPR). (B) Projected number of incident cases and age-standardized incidence rate (ASIR). (C) Projected number of DALYs and age-standardized DALY rate (ASDR). The projections illustrate the expected future trajectories of both the absolute and age-standardized burden, allowing demographic changes in case numbers to be distinguished from changes in the underlying epidemiological rates.
Age-Specific Composition of Oral Disorder DALYs
In 2023, the DALY burden of oral disorders among WCBA in the South Korea showed a clear age-related pattern, increasing progressively with age and reaching its highest level among women aged 45–49 years (Figure 6A). The composition of oral disorders also varied substantially across age groups. Among younger women, DALYs were predominantly attributable to other oral disorders and caries of permanent teeth. With increasing age, both the absolute burden and relative contribution of periodontal diseases increased markedly, making them an increasingly important contributor in older age groups. The contribution of edentulism remained relatively low but increased at older ages. In contrast, the relative contributions of other oral disorders and caries of permanent teeth generally declined with age (Figure 6B).
Figure 6.
Age-specific composition of DALYs attributable to oral disorders among WCBA in South Korea, 2023. (A) Absolute DALYs by 5-year age group and oral disorder category. (B) Percentage contribution of each oral disorder category to total DALYs within each age group. Oral disorders were classified as periodontal diseases, other oral disorders, edentulism, and caries of permanent teeth. The figure illustrates how the relative contribution of specific oral disorders varies across reproductive age groups and identifies the conditions responsible for the greatest disability burden at different ages.
Discussion
This study systematically evaluated the long-term burden, age-specific patterns, disease composition, demographic drivers, and future trends of oral disorders among women of childbearing age (WCBA) in South Korea from 1990 to 2023. Prevalent and incident cases decreased by 14% and 18%, respectively, whereas DALYs increased slightly by 2%. Meanwhile, the age-standardized prevalence rate declined and the age-standardized incidence rate remained broadly stable, while the age-standardized DALY rate increased modestly. This divergence suggests that declining disease frequency has not translated into a comparable reduction in long-term disability.19
The persistence of DALYs may partly reflect the chronic and cumulative nature of oral disorders.20 Dental caries and periodontal diseases can cause persistent pain, impaired mastication, periodontal destruction, and tooth loss when inadequately prevented or treated.21 Age-specific analyses further showed that DALYs were concentrated among older WCBA, peaking at 45–49 years. Disease composition also shifted with age: caries of permanent teeth and other oral disorders contributed relatively more among younger women, whereas periodontal diseases became increasingly prominent among women aged 35–49 years. This pattern is consistent with cumulative periodontal damage across the reproductive life course and may partly explain why disability did not decline in parallel with prevalence and incidence.22,23
Decomposition analysis provides an important explanation for the decline in absolute case numbers. Population change was the principal contributor to reductions in prevalence and incidence, whereas changes in age structure and epidemiological factors limited improvements in DALYs. Because the study was restricted to women aged 15–49 years, the aging component primarily reflects redistribution within WCBA toward older reproductive-age groups rather than conventional population aging. Thus, contraction of the reproductive-aged female population may reduce absolute case numbers even without proportional improvements in age-specific disease risk or disability. Absolute reductions should therefore be interpreted together with age-standardized rates and demographic changes.24
Whether these trends are specific to WCBA or reflect broader improvements in South Korean oral health remains uncertain. Improvements in oral hygiene, preventive care, and dental service availability may have benefited the wider population; however, the present study did not directly compare WCBA with age-matched men, children, older women, or the total population.7 Different groups may follow distinct trajectories because caries is more prominent at younger ages, whereas periodontal destruction and tooth loss accumulate later in life. Therefore, the decline observed among WCBA should not be interpreted as evidence of a uniform population-wide reduction in oral disease burden. Comparative analyses across age and sex groups are warranted.8
Socioeconomic and healthcare-related inequalities may further influence these trends. Despite South Korea’s developed healthcare system, preventive dental service utilization may vary by income, education, employment, oral health literacy, and geographic accessibility.6 Moreover, oral healthcare is not necessarily integrated systematically into women’s reproductive and life-course healthcare. For younger WCBA, caries prevention through fluoride use, reduced free sugar intake, oral hygiene promotion, and regular dental assessment should remain fundamental. For women aged 35–49 years, greater emphasis should be placed on periodontal risk assessment, early treatment, and long-term maintenance.25 Integrating basic periodontal screening and oral health counseling into routine health examinations, preconception care, or reproductive health services may facilitate earlier intervention and help prevent irreversible tooth loss and functional impairment.7
Forecasting suggests a generally favorable trajectory through 2045, with prevalent cases, incident cases, DALYs, ASPR, and ASDR projected to decline. However, ASIR is projected to increase. The coexistence of declining absolute incidence and increasing age-standardized incidence suggests that future reductions in case numbers may continue to be influenced by demographic contraction rather than uniform improvement in underlying disease risk. Future surveillance should therefore consider both absolute and age-standardized measures.
This study has several limitations. First, the analysis was based on GBD model-derived estimates rather than direct clinical measurements. Second, individual-level factors such as oral hygiene, sugar intake, dental service use, pregnancy history, smoking, and socioeconomic status could not be directly assessed. Finally, projection results should be interpreted cautiously because future trends depend on demographic change, healthcare policy, behavioral factors, and model assumptions.
Conclusion
In conclusion, oral disorder burden among WCBA in South Korea was characterized by declining prevalence and incidence but persistent disability, with periodontal disease contributing increasingly at older reproductive ages. Population contraction accounted for an important part of the decline in absolute cases, emphasizing that falling case numbers do not necessarily indicate equivalent improvements in underlying disease risk. Future strategies should combine caries prevention in younger women with strengthened periodontal prevention and management among women aged 35–49 years. Specifically, routine periodontal screening could be incorporated into women’s health examinations and reproductive healthcare visits for this age group, while high-risk women could be offered regular periodontal assessment, individualized oral hygiene counseling, and timely referral for periodontal treatment. Integrating these measures into women’s life-course health services may help reduce persistent oral disability and prevent progression to more severe periodontal disease.
Acknowledgments
We sincerely appreciate all the participants of the GBD 2023 for their contribution.
Data Sharing Statement
The datasets analyzed in this study are publicly available through the Global Health Data Exchange (GHDx) at http://ghdx.healthdata.org/gbd-results-tool. Further information or requests regarding the data should be directed specifically to the corresponding author, Haochen Gao (Email: sarah_517@163.com).
Ethics Approval
This study is a secondary analysis of publicly available, anonymized, aggregated data from the Global Burden of Disease (GBD) 2023 study. The GBD 2023 study received ethical approval from the University of Washington Institutional Review Board (IRB ID: STUDY00009061), with informed consent obtained as applicable. As our analysis involves no individual-level data, it is exempt from additional ethics review in accordance with Article 32 of China’s Measures for Ethical Review of Life Science and Medical Research Involving Human Subjects (February 18, 2023).
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors declare no competing interests.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets analyzed in this study are publicly available through the Global Health Data Exchange (GHDx) at http://ghdx.healthdata.org/gbd-results-tool. Further information or requests regarding the data should be directed specifically to the corresponding author, Haochen Gao (Email: sarah_517@163.com).