Abstract The aim of this multicenter study was to explore the early-life sugar consumption and dietary practices in Latin America as well as to investigate the association between breastfeeding duration and the age at which foods and beverages with added sugars are introduced. A cross-sectional study was conducted with 805 1- to 3-year-old children from 10 Latin American countries, as a complementary study to the Research Observatory for Dental Caries of the Latin American Region (OICAL). A Food Frequency Questionnaire previously tested in different countries was applied to children’s mothers and data on breastfeeding and age at introduction of sugary foods and beverages was collected. Statistical analysis included the Kruskal-Wallis test and Poisson regression with robust variance, with the calculation of crude and adjusted mean ratios (MR) and 95% of confidence intervals (CI). The average age at introduction of sugary foods and beverages was 10.1 months (95%CI 9.7–10.4) and 9.6 (95%CI 9.2–9.9) months, respectively, with a significant variation between countries (p < 0.001). The average daily frequency of sugary foods-beverages was 3.3 times per day (95%CI 3.1–3.5) and varied significantly between countries (p = 0.004). Breastfeeding duration of over six months was associated with an increase in the age of introduction of sweet drinks (16%; MR 1.16; 95%CI 1.05–1.28) and foods (21%; MR 1.21; 95%CI 1.10–1.33). In conclusion, most children from vulnerable settings in Latin America start consuming sugary products in the first year of life and a high frequency of consumption was reported through early childhood. Additionally, breastfeeding contributes to a delay in the introduction of sugary products. earlylife introduced crosssectional cross sectional 80 1 3yearold yearold 3 old OICAL. OICAL . (OICAL) childrens s collected KruskalWallis Kruskal Wallis variance (MR 95 CI. CI (CI) 101 10. 95CI 9.7–10.4 97104 9 7 4 96 6 9. 9.2–9.9 9299 2 respectively p 0.001. 0001 0.001 0 001 0.001) foodsbeverages 33 3. 3.1–3.5 3135 5 0.004. 0004 0.004 004 0.004) 16% 16 (16% 1.16 116 1.05–1.28 105128 05 28 21% 21 (21% 1.21 121 1.10–1.33. 110133 1.10–1.33 1.10–1.33) conclusion childhood Additionally 8 (OICAL (CI 9.7–10. 9710 9.2–9. 929 000 0.00 00 3.1–3. 313 (16 1.1 11 1.05–1.2 10512 (21 1.2 12 11013 1.10–1.3 9.7–10 971 9.2–9 92 0.0 3.1–3 31 (1 1. 1.05–1. 1051 (2 1101 1.10–1. 9.7–1 97 9.2– 0. 3.1– ( 1.05–1 105 110 1.10–1 9.7– 9.2 3.1 1.05– 1.10– 9.7 1.05 1.10 1.0

Abstract The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants’ agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions. Spanishspeaking speaking countries process 8 ≥ 0 predefined pre defined participants agreement participate academicprofessional AssociationsPanel Panel (Associations-Panel) 12 b DentalSchoolsPanel (Dental-Schools-Panel) 263 1 c PeerPanel (Peer-Panel) 4 Europe Colombia Caribbean USA Spain evidence domains (MC . (SC) ConsultationAgreement Consultation Agreement stepwise step wise AssociationsPanel. Panel. eg e g googleform google form workshops. workshops workshops) onsite site voting PeersPanel. PeersPanel Peers Peers-Panel (Associations-Panel 11 91.6% 916 91 6 112 426 42 42.6% 100%. 100 100% 100%) 9 (Dental-Schools-Panel 26 (Peer-Panel (SC 91.6 42.6 2 91. 42.

RESUMEN: Objetivo: La caries dental continúa siendo uno de los grandes desafíos de salud pública en los países de ingresos bajos y medios, en particular para los jóvenes, que a menudo se enfrentan a barreras de acceso a la atención médica y odontológica. El objetivo de este estudio es determinar la prevalencia y severidad de la caries dental entre jóvenes estudiantes varones en Costa Rica. Diseño del estudio: se realizó un estudio transversal con 428 estudiantes varones costarricenses de entre 12 y 22 años, que asistieron a un internado de asistencia social sin fines de lucro llamado Ciudad de los Niños en 2019. Tres examinadores calibrados realizaron un examen clínico siguiendo el Sistema Internacional de Detección y Evaluación de Caries. (ICDAS-II). Resultados: La prevalencia de caries se estimó en 83%, el 15% ha perdido un diente debido a caries dental, el 61% tiene al menos un diente obturado, el 36% tiene al menos un diente obturado y con caries. Las lesiones de caries más frecuentes fueron los códigos 2-Inactivo (46,7%) y el código 1-Inactivo (23,8%). CPOD indicó un índice medio utilizando códigos ICDAS-II 1-6>0 de 7,89. Usando ICDAS-II 3-6>0 como umbral, el índice disminuye a 3,94. Finalmente, los primeros molares permanentes inferiores y superiores resultaron ser los dientes más afectados. Conclusiones: La experiencia de la caries dental representa una carga de salud pública significativa en los jóvenes, que requiere un mejor acceso a la atención médica dental pública.

ABSTRACT: Objective: Dental decay is a public health challenge in Low- and Middle- Income Countries, particularly for young people, often confronted to healthcare access barriers. The aim of this study was to determine the prevalence and severity of dental caries among young male students in Costa Rica. Study design: A cross-sectional study was performed in 428 Costa Rican male students aged 12-22 years, who attended a nonprofit social welfare boarding school in 2019. A clinical examination was ran by three calibrated examiners following the International Caries Detection and Assessment System (ICDAS-II). Results: Caries prevalence was estimated at 83%, 15% have lost a tooth due to dental decay, 61% have at least one filled tooth, 36% have at least one filled and decayed tooth. The most frequent caries lesions were codes 2-Inactive (46.7%) and code 1-Inactive (23.8%). DMFT indicated a mean index using ICDAS-II 1-6>0 codes of 7.89. Using ICDAS-II 3-6>0 as threshold, the index decreases to 3.94. Finally, the lower and upper first permanent molars were found to be the most affected teeth. Conclusions: Dental caries experience represents a significant public health burden in young people, requiring better access to public dental healthcare.