Oral health cases have increased by about a billion over the last 30 years, which according to the World Health Organisation is a clear indication that several people do not have access to appropriate oral health care, which includes prevention, risk protection and restorative and rehabilitative services.
In a first-ever comprehensive overview, the Global Oral Health Status Report analysed key areas and markers throughout 194 countries.
Noting that the consequences of untreated oral diseases are severe and debilitating, the report noted that the costs are often high and can lead to significant economic burden.
“Oral health has long been neglected in the global health agenda. Our biggest challenge now is ensuring that all people, wherever they live and whatever their income, have the knowledge and tools needed to look after their teeth and mouths, and access to prevention and care when they need it. For this to happen, all countries need sufficient staff trained in oral health, and oral health services must be included in national health coverage packages, either free of charge or at a price that people can afford,” said World Health Organization Director General Dr Tedros Adhanom Ghebreyesus. He said that the report provided a comprehensive picture of the oral disease burden, the resources available for oral health, and the challenges ahead.
GLARING INEQUALITIES
The report highlights unequal access to oral health services, with vulnerable and disadvantaged populations most affected.
People on low incomes and with disabilities; older individuals living alone or in care facilities; those in remote and rural communities; and people from minority groups, carry a higher burden of oral diseases, according to WHO.
From cardiovascular diseases to diabetes and mental disorders, the pattern of inequality parallels other noncommunicable diseases (NCDs). And risk factors common to NCDs such as high sugar intake, tobacco, and alcohol also contribute to the global oral health crisis.
“WHO is committed to providing guidance and support to countries so that all people, wherever they live and whatever their income, have the knowledge and tools needed to look after their teeth and mouths, and to access services for prevention and care when they need them”, Tedros assured.
THE CASES
Over the last 30 years, 1 billion additional people were affected by oral diseases, more than the estimated population growth during the same period. Globally, there were an estimated 2.5 billion cases of dental caries of deciduous and permanent teeth, 1 billion cases of severe periodontal disease and 370 million cases of edentulism in 2019. More than 370 000 new cases of lip and oral cavity cancer are diagnosed and more than 170 000 people die from these cancers every year.
BARRIERS TO SERVICES
Only a small percentage of the global population is covered by essential oral health services, and those with the greatest need often have the least access.
The report outlines key barriers to oral health services, including high out-of-pocket expenditures, which often leads to catastrophic costs and financial burden for families and communities.
Additionally, highly specialized providers use expensive high-tech equipment and these services are not integrated with primary health care models.
Moreover, poor information and surveillance systems, combined with low priority for oral health research, are bottlenecks to developing more effective interventions and policies.
CHANGING THE TRAJECTORY
However, opportunities for improved global oral health include adopting a public health approach by addressing common risk factors.
These involve promoting a well-balanced diet low in sugars, stopping tobacco use, reducing alcohol consumption, and improving access to fluoride toothpaste.
Other solutions outlined in the report support making oral health part of national health services; redefining oral health workforces to respond to population needs; expanding oral health service coverage; and collecting and integrating oral health data into national health monitoring systems.
ACHIEVING THE VISION
Placing people at the heart of oral health services is critical “to achieve the vision of universal health coverage for all individuals and communities by 2030”, said Bente Mikkelsen, WHO Director for Noncommunicable Diseases.
By providing baseline information to help countries monitor implementation progress along with timely and relevant feedback to national decision-makers, she described the report as “a starting point”.
“Together, we can change the current situation of oral health neglect”.
SOME FACTS
- Untreated dental caries (tooth decay) in permanent teeth is the most common health condition according to the Global Burden of Disease 2019.
- Treatment for oral health conditions is expensive and usually not part of universal health coverage (UHC).
- Most low- and middle-income countries do not have sufficient services available to prevent and treat oral health conditions.
- Oral diseases are caused by a range of modifiable risk factors common to many noncommunicable diseases (NCDs), including sugar consumption, tobacco use, alcohol use and poor hygiene, and their underlying social and commercial determinants.
Prevention
The burden of oral diseases and other noncommunicable diseases can be reduced through public health interventions by addressing common risk factors.
These include:
- promoting a well-balanced diet low in free sugars and high in fruit and vegetables, and favouring water as the main drink;
- stopping use of all forms of tobacco, including chewing of areca nuts;
- reducing alcohol consumption; and
- encouraging use of protective equipment when doing sports and travelling on bicycles and motorcycles (to reduce the risk of facial injuries).
Adequate exposure to fluoride is an essential factor in the prevention of dental caries.
Twice-daily tooth brushing with fluoride-containing toothpaste (1000 to 1500 ppm) should be encouraged.