Oral diseases are the most common form of noncommunicable disease (NCD) in the world. Globally, these conditions affect almost 3.5 billion people – almost half of the world’s population.

Long a neglected subject in global health circles, oral diseases affect about 1 billion more people than all five main NCDs – mental disorders, cardiovascular disease, diabetes, chronic respiratory diseases and cancers – combined, and global case numbers have increased by 1 billion over the last 30 years. Today, the WHO team responsible for its oral health agenda is still made up of just 3 people.

“It’s a huge burden,” Dr Benoit Varenne, WHO team lead for oral health strategy told Health Policy Watch. “And that burden is increasing, especially in low- and middle-income countries.”

And the world has begun to take notice. The WHO’s Global Oral Health Status Report published Friday reflects a new focus on the importance of oral diseases. Encompassing data from 194 countries, the report is the first comprehensive overview of oral disease burden worldwide.

It follows the direction set out by the World Health Assembly’s adoption of a watershed resolution on oral health in 2021, which agreed the objective of universal health coverage for oral health services by 2030.

“The adoption by WHO Member States of a historic resolution on oral health at the World Health Assembly in 2021 was an important step forward,” said WHO Director-General Dr Tedros Ghebreyesus. “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.”

First comprehensive global report spotlights glaring inequalities

Three out of every four people affected by oral health conditions live in low- and middle-income countries. Oral diseases are part of the NCD family, but have yet to be well integrated into the global NCD agenda. 

“All oral diseases show strong social gradients, disproportionately affecting the most vulnerable and disadvantaged population groups,” the report found. “People on low incomes, people living with disabilities, people who are refugees, older people living alone or in care homes, in prison or living in remote and rural communities, children and people from minority and other socially marginalized groups generally carry a higher burden.”

The patterns of inequality present in the distribution of oral disease burden globally are comparable to those seen with cancers, cardiovascular diseases, or diabetes. Oral health also shared the common risk factors of all forms of tobacco and alcohol use, as well as high sugar intake. 

“One of the key messages of this report is that we are part of NCD family because we are share the common risk factors with other major NCDs,” Varenne said.  “We have to invest on this upstream population based strategy in collaboration with other programs and in countries.”

Inequalities also exist at the sub-national level. Public and private services tend to be over-concentrated in wealthy urban areas due to the need for expensive technology to administer care, often leaving rural regions with no access to even the most basic oral health services.

Back to basics: essential care too often overlooked by oral health systems

Oral diseases are largely preventable. On paper, the ideal oral health system should focus on the delivery of preventative care, and support patients with education in self-care practices to promote independence. Essential care is the most critical, but the current model being practiced around the work focuses on the complex.

“Most of the countries built their oral care system on the dental care models from high income countries that are based on high-technologies and specialized providers.” said Dr Benoit Varenne, leader of WHO’s oral health team. “And the workforce is more or less all concentrated in urban areas.”

Emulation of the high-income country model frequently results in “system-level failures in the model of care and provision of oral health services” which largely rely on expensive high-tech equipment and materials, highly specialized providers and too few midlevel providers,” the report notes.  

The reliance on a model contingent on a highly specialized workforce – with many roles requiring up to 7 years of education – does a disservice to the provision of simple, non-invasive pain relief of prevention treatments to populations lacking access to sophisticated oral care facilities. 

The report emphasizes the benefits of training other health professionals in the provision of essential oral health services to increase access in non-urban areas, and alleviate the stark inequality in the distribution of the highly-specialized workforce. 

At the time of writing, Sub-Saharan Africa and parts of Southeast Asia reported the lowest absolute numbers of professional-to-population ratios for oral health care in the world. 

“We hope the approaches outlined in the report will improve the situation and reduce inequalities,” Varenne said.