Oral health has been neglected worldwide

Dentistry 'in a state of crisis' - experts
  • Deborah Condon

Oral diseases, including tooth decay, gum disease and oral cancers, affect almost half of the world's population, yet oral health continues to be isolated from traditional healthcare and health policies around the world, experts have warned.

This issue has been highlighted in a series on oral health that was written by 13 academic and clinical experts from 10 countries, including Ireland. The series has been published in the medical journal, The Lancet.

According to the experts, almost half of the global population is affected by various oral diseases, with untreated dental decay the most common health condition worldwide. Cancers of the lip and oral cavity are also among the top 15 most common cancers in the world.

In Ireland, vulnerable children and adults have poorer oral health overall, and more untreated dental disease, compared to the general population, while older adults with an intellectual disability are twice as likely to have no teeth compared to the general population.

However, oral diseases also have a major economic impact. The treatment of oral diseases costs €90 billion per year in the EU, making it the third most expensive condition to treat after diabetes and cardiovascular disease.

The experts set out to determine why oral diseases have persisted worldwide over the last three decades despite scientific advancements in this area. They also looked at why the prevalence of oral disease has increased in low and middle-income countries, and among socially disadvantaged and vulnerable people, no matter where they live.

"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 healthcare.

"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 the global burden of oral diseases," commented the series' lead author, Prof Richard Watt, of University College London.

The series highlighted that in high-income countries, such as Ireland, dentistry is increasingly focused on technology, but is also trapped in a ‘treatment-over-prevention cycle', which fails to tackle the underlying causes of oral diseases.

This is an issue that has been highlighted by the Irish Dental Association for a number of years. Cutbacks introduced during the recession meant that many people were foregoing even basic dental check-ups due to the costs involved, and were only attending a dentist when their problem was already at a serious stage.

Meanwhile, according to co-author of the series, Prof Blánaid Daly of the Dublin Dental University Hospital and School of Dental Sciences at Trinity College Dublin, while there have been big improvements in the oral health of people 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".

The series also noted that in middle-income countries, the burden of oral diseases is large, but oral care systems are often inadequately developed and most people cannot afford them anyway.

In low-income countries, even the most basic dental care is unavailable to most people and the majority of oral diseases remain untreated.

The series highlighted that the burden of oral disease is set to increase, as more people are exposed to the main risk factors, such as sugar consumption, which is the main cause of tooth decay.

While the consumption of sugary drinks is highest in high-income countries, consumption is rising rapidly in low and middle-income countries. In fact, the series points out that by 2020, Coca-Cola intends to spend $12 billion on marketing their products across Africa. To put this into context, the World Health Organization's total annual budget in 2017 was $4.4 billion.

"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," Prof Watt commented.

The experts have called for the major reform of dental care 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 the knowledge of low and middle-income countries.

"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 wellbeing and identity. Everyone who cares about global health should advocate to end the neglect of oral health," insisted Dr Jocalyn Clark, executive editor of The Lancet.

Meanwhile, Prof Daly said that in Ireland, it is "essential" that the implementation of the new oral health policy, Smile Agus Sláinte, which was launched in April, "delivers on the goal of enabling vulnerable groups to access oral healthcare and improve their oral health".

For more on Smile Agus Sláinte, click here.


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