Putting Teeth on the Global Agenda for Oral Health 
Most people can’t afford to see a dentist because of the cost.

Global health leaders need to prioritize action against oral diseases – which impact nearly half of the world’s population.

While noncommunicable diseases (NCDs), which cause some 74% of all deaths, are getting increased attention from global health influencers, there is one elephant in the room that has received insufficient attention to date. Oral disease.

That’s despite the fact that oral diseases may be the most prevalent of all NCDs – affecting some 3.5 billion people, or nearly half the world’s population.

Notwithstanding some recent progress, political recognition of the need to adequately fund and respond to the public health implications of that disease burden remains painfully slow.

While we are finally seeing the leading NCDs, including, diabetes, cardiovascular and respiratory diseases, cancers and even mental health, in conversations at all levels of political discourse, oral health still falls off the agenda too often.

Today on World Oral Health Day, it is worth reminding our leaders of the significant challenge oral disease represents globally.

Worldwide oral diseases account for about 1 billion more cases than all five of the leading NCDs combined. An estimated 2.5 billion people suffer from untreated dental caries. Tooth decay can have all kinds of manifestations: it can make sleeping and eating painful and difficult, and over longer periods it can cause abscesses that convert into severe infections. On rare occasions, it can result in death. There’s a societal cost too: work and schooling can often be affected.

The occurrence of oral diseases, which are mostly preventable and treatable, is increasing globally, increasing by 50% over the past three decades. It’s a rate that outpaces population growth and occurs mainly in low- and middle-income countries.

Awareness growing – but not fast enough

The situation is changing – although not rapidly enough.

The adoption by World Health Organization (WHO) Member States of a historic inaugural  resolution on oral health at the World Health Assembly in 2021 drew an important line in the sand.

And the recent launch of the Global Oral Health Status Report (GOHSR) now gives for the first time considerably more accurate data on the global burden of oral diseases and unsurprisingly paints a picture of high disease burden amongst the most vulnerable and disadvantaged population groups within and across societies.

The recent development by the WHO of a comprehensive Global Strategy on Oral Health (2023-2030), with a bold vision for universal coverage of oral health services by 2030 was another milestone.

The plan, which is set to be adopted this year at the 76th session of the World Health Assembly, calls on governments to ensure that “80% of the global population is entitled to essential oral healthcare services.”

This would be achieved through, among other measures, countries prioritizing the integration of oral health into their national health services and ensuring there are enough trained dental health professionals. But this also implies making dental services affordable to those who need it.

Major constraints stopping so many people on low incomes from seeing a dentist include the lack of access to appropriate care and the catastrophic cost associated with the oral health services that may be available.

We need a reset.

Bringing oral health into the NCDs ‘fold’

Bringing oral health into the NCDs ‘fold’ is important for a number of reasons.

Firstly, good oral health is a vital part of our daily lives. It allows us to do the basics of talking, breathing, chewing and smiling. It ultimately helps with our self-esteem. But good oral health rests mainly on prevention and the failure to do so can lead to oral diseases that if left unattended can have severe physical and mental impacts. Everyone knows just how painful a simple toothache can be.

Secondly, the inequalities in the global oral disease burden to a large degree mirror the same imbalances found across the range of chronic diseases globally. They require coordinated responses. But at the same time they need to be flexible: the GOHSR has revealed the extent of national and regional differences in oral health challenges. Therefore, there is no ‘one-size-fits all’ and national oral health policies need to be tailored according to local epidemiology and dynamics.

Thirdly, it’s no surprise that oral diseases disproportionately affect the poor and the vulnerable: bad or rotten teeth as well as missing teeth are more often than not a sign of under-privilege. Most impacted are people on low incomes, people living with disabilities, the elderly living alone or in care homes, refugees, prison inmates, those living in remote and rural communities and other marginalized groups. Ultimately this affects millions of people in terms of self-esteem and their “public” persona and can, on many occasions, affect their job prospects too. Even for those people able to obtain treatment, the costs are often high and can lead to significant economic burden.

Fourthly, all those drivers most commonly associated with other NCDs – alcohol consumption, tobacco use, consumption of trans fats and processed foods high in salt and sugars – have a similar impact on people’s oral health. Therefore, it makes no sense to be talking about how to respond to a certain set of chronic diseases without including the most prevalent NCD: oral disease.

Relationship between oral health and general health

Lastly, and perhaps the least understood is the relationship between oral and general health and the associations between different NCDs.

There is a growing body of science pointing towards potential links between poor oral health and a number of noncommunicable diseases. The most solid research has identified a strong relationship with diabetes, and increasing evidence suggests a link with cardiovascular disease.

This growing understanding of the broader health impacts of oral disease together with the dramatic increase in its global burden mean it is time to rethink our priorities.

Looking towards the next milestone, the UN High Level Meeting on Universal Health Coverage (UHC) is set to convene in September on the sidelines of the UN General Assembly.

If governments are truly genuine about their resolve to fight NCDs by driving momentum towards the idea of universal health coverage, then reconfiguring priorities around oral health will be inescapable. Public health systems will need to adjust through expanded private and public insurance policies and programmes that enable people to access a dentist in the same way they would a doctor or other healthcare professional. This in essence is the true meaning of UHC.

Ihsane Ben Yahya is the FDI World Dental Federation President and Dean of the Dental Faculty at the Mohammed VI University of Health and Sciences in Casablanca, Morocco

Katie Dain Is the CEO of the NCD Alliance.

Image Credits: Atikah Akhtar/ Unsplash, World Dental Federation , NCD Alliance.

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