Oral health has been isolated from traditional healthcare and health policy for too long, despite the major global public health burden of oral diseases, according to a Lancet Series on Oral Health, just published in The Lancet.
Failure of the global health community to prioritise the global burden of oral health has led to calls for the radical reform of dental care, tightened regulation of the sugar industry, and greater transparency around conflict of interests in dental research.
Oral diseases, including tooth decay, gum disease and oral cancers, affect almost half of the global population, with untreated dental decay the most common health condition worldwide. Lip and oral cavity cancers are among the top 15 most common cancers in the world.
In Ireland, vulnerable children and adults have more untreated dental disease, and poorer oral health related quality of life compared to the general population in Ireland. Older adults in Ireland with an intellectual disability are twice as likely to be edentulous – have no teeth – compared to the general population.
In addition to lower quality of life, oral diseases have a major economic impact on both individuals and the wider health care system. The treatment of oral diseases costs €90 billion per year across the EU, the third-most expensive condition behind diabetes and cardiovascular diseases.
The Lancet Series on Oral Health brought together 13 academic and clinical experts from 10 countries to better understand why oral diseases have persisted globally over the last three decades, despite scientific advancements in the field, and why prevalence has increased in low- and middle- income countries (LMIC), and among socially disadvantaged and vulnerable people, no matter where they live.
A tipping point for global oral health
Chair and Honorary Consultant in Dental Public Health at University College London and lead author of the Series, Professor Richard Watt, said: “Globally dentistry is in a state of crisis. Current dental care and public health responses have been largely inadequate, inequitable, and costly, leaving billions of people without access to even basic oral health care. While this breakdown in the delivery of oral healthcare is not the fault of individual dental clinicians committed to caring for their patients, a fundamentally different approach is required to effectively tackle to the global burden of oral diseases.”
In high-income countries (HIC), dentistry is increasingly technology-focused and trapped in a treatment-over-prevention cycle, failing to tackle the underlying causes of oral diseases. Oral health conditions share many of the same underlying risk factors as non-communicable diseases, such as sugar consumption, tobacco use and harmful alcohol consumption.
Professor Blánaid Daly, Dublin Dental University Hospital & School of Dental Sciences, Trinity College Dublin, and a co-author of the Series said:
While there have been substantial improvements in the population’s oral health across Ireland, vulnerable groups, such as the very young, people with disabilities, frail older people and marginalised groups, continue to experience poor oral health and large gaps in their access to routine dental care.
In middle-income countries the burden of oral diseases is considerable, but oral care systems are often underdeveloped and unaffordable to the majority. In low-income countries the current situation is most bleak, with even basic dental care unavailable and most disease remaining untreated.
Coverage for oral health care in LMIC is vastly lower than in HIC with median estimations ranging from 35% in low-, 60% in lower-middle, 75% in upper middle, and 82% in high income countries.
Professor Blánaid Daly added:
It is essential that the implementation of the new oral health policy ‘Smile Agus Slainte’ (April 2019) delivers on the goal of enabling vulnerable groups to access oral healthcare and improve their oral health.
Sugar, alcohol and tobacco industries fuel global burden
The burden of oral diseases is on course to rise, as more people are exposed to the main risk factors of oral diseases. Sugar consumption, the primary cause of tooth decay, is rising rapidly across many LMIC.
While sugary drinks consumption is highest in HIC, the growth in sales of sugary drinks in many LMIC is substantial. By 2020, Coca-Cola intend to spend US$12 billion on marketing their products across Africa in contrast to WHO’s total annual budget of $4.4 billion (2017).
Professor Watt said: “The use of clinical preventive interventions such as topical fluorides to control tooth decay is proven to be highly effective, yet because it is seen as a ‘panacea’, it can lead to many losing sight of the fact that sugar consumption remains the primary cause of disease development.
“We need tighter regulation and legislation to restrict marketing and influence of the sugar, tobacco and alcohol industries, if we are to tackle the root causes of oral conditions.”
Radical reform of dental care is needed
Lancet Series authors have called for wholesale reform of the dental care model in five key areas:
- Close the divide between dental and general healthcare
- Educate and train the future dental workforce with an emphasis on prevention
- Tackle oral health inequalities through a focus on inclusivity and accessibility
- Take a stronger policy approach to address the underlying causes of oral diseases
- Redefine the oral health research agenda to address gaps in LMIC knowledge
Executive Editor at The Lancet, Dr Jocalyn Clark, said: “Dentistry is rarely thought of as a mainstream part of healthcare practice and policy, despite the centrality of the mouth and oral cavity to people’s well-being and identity. A clear need exists for broader accessibility and integration of dental services into healthcare systems, especially primary care, and for oral health to have more prominence within universal health coverage commitments. Everyone who cares about global health should advocate to end the neglect of oral health.”