After Many Missed Opportunities, Oral Health Gets Long Overdue Attention from WHO

Dental services, including regular check-ups, were among the most disrupted essential health services during the COVID-19 lockdowns. People´s reticence to visit a dentist during normal times was exacerbated by fear of venturing into an open clinic or simply not being able to, due to restrictions. 

Dental hesitancy has always been around but over two years into the pandemic, it´s now a lot worse. This hesitancy is also echoed at the policy level. Oral health has, until very recently, been considered the “ugly duckling” of global health efforts. 

The World Health Organization (WHO) has only ever passed a special resolution on oral health twice in its history: most recently, ironically, in the midst of the COVID-19 pandemic in 2021.

The new global oral health strategy, approved by governments at 75th WHO World Health Assembly last week is a step in the right direction, and it is long overdue.

Oral health is essential for overall health

It´s a perfect time to double down on just why responding to the global oral health epidemic is in our broader (health) interests. Getting people back into dental clinics and protecting their oral health is essential to safeguarding their overall health, well-being, and quality of life.

All those factors that can make people vulnerable to chronic non-communicable diseases (NCDs) such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes are equally risky for one´s oral health. 

High sugar consumption, harmful alcohol use and tobacco are just as bad for our bodies as they are for our mouths. The impact in pure numbers is alarming: there were some 3.5 billion cases of oral diseases and other oral conditions in 2017. 

For the last three decades, the combined global prevalence of dental caries (tooth decay), periodontal (gum) disease and tooth loss has stood at 45% – higher than any other NCD.

Ignoring the problem makes no sense, financial or otherwise. Worldwide, oral diseases accounted in 2015 for $ 357 billion in direct costs and US$ 188 billion in indirect costs. In the same year, $96.2 billion was spent on the treatment of oral diseases across the European Union, the third-highest total among NCDs, behind diabetes and cardiovascular diseases.

“Without good oral health, you’re not healthy,” former US Surgeon-General David Satcher once said, and he was right. The largely siloed approach to dealing with oral health makes no policy sense either, especially when we consider the evidence.

Junk food and tooth decay

We know that bacteria and inflammation associated with periodontal disease are linked to cardiovascular disease, rheumatoid arthritis, and adverse effects in pregnancy.

We also know that people living with diabetes experience improved blood glucose levels if their periodontal (gum) disease is managed correctly.

Knowing what we know about poor oral health – that it is preventable and if addressed can help improve our overall health – only begs the question as to why more is not being done to integrate it into other NCD programmes?

The pending ban on television and online advertising of junk food in the UK before 9pm is a great example of encouraging better diet. So too is the campaign by UK footballer Marcus Rashford to promote healthier school lunches. 

But they are missed opportunities. With forethought, both interventions could have included some key messages for children and parents around the connection between a healthy diet and good oral health. Future campaigns could better highlight the need to prioritize oral health promotion in schools, communities and workplaces as well as ensure access to the millions of people who cannot afford the basics, such as fluoridated toothpaste.

We need to globally re-think how we talk about and tackle oral diseases. In the vast majority of countries, even essential oral health services are not part of universal health coverage

Oral diseases are noncommunicable diseases and need to be treated as such. Advocates have long argued that investment in prevention produces strong economic returns and saves millions of lives. 

COVID-19 has reinforced the huge economic and human cost of not doing so: people living with chronic diseases like diabetes, cancer and cardiovascular were at much higher risk of becoming seriously ill, hospitalized, or dying from SARS‑CoV‑2.

At the same time, the pandemic is just a microcosm of the bigger picture: our past failure to address oral disease in a substantive way and to view it as an NCD like any other. 

Prof Ihsane Ben Yahya

Prof Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco.

Dr Greg Chadwick

Dr Greg Chadwick is the President-elect of FDI World Dental Federation and Dean at East Carolina University, School of Dental Medicine, United States.

Image Credits: Caroline LM/ Unsplash, FDI World Dental Federation.

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