The message for World Oral Health Day this year is “A Happy Mouth is … A Happy Body”. Put another way, a Healthy Mouth is essential for a Healthy Body. But how many of us truly has a healthy mouth? The evidence points to the answer being far too few. The global burden of oral disease is simply immense.
To share just a few key facts:
- 3.5 billion people worldwide are affected by oral diseases [1].
- Tooth decay is the most widespread chronic disease worldwide and a major global public health challenge.
- Over 3 billion people have untreated tooth decay affecting primary (milk) and permanent teeth.
- 19% of adults globally have severe gum disease [1].
- There are major inequalities in oral health, both between and within countries. In all cases the prevalence of oral disease follows the social gradient. The lower an individual’s position in the gradient, the more severe their disease and health outcomes will be.
The scale of oral disease is such that dental care costs us half a trillion dollars a year, consistently ranking as one of the top four health expenditures on government budgets, with $357 billion in direct costs. This is to say nothing of the economic impact of missed workdays and reduced productivity, estimated at an additional $188 billion in 2015 [2].
Furthermore, the evidence points to the conclusion that, despite the best efforts of the dental profession, the prevalence of tooth decay, gum disease and tooth loss has not changed over the last 30 years. A radical reappraisal of the current approach to the management of oral disease is called for, one that recognizes that the major oral diseases are the result of exposure to the same social determinants and common risk factors as the other major noncommunicable diseases (NCDs). Diets high in sugar, tobacco use, and alcohol abuse are particularly important in this regard.
Changing behaviors to focus on prevention
In common with the other NCDs, oral disease cannot simply be eradicated through treatment alone. Instead, health systems should incorporate population-level prevention; oral health should be included in all universal healthcare packages, and there should be much closer integration of oral health and general health. There will need to be a significant shift in health behaviours in which we accept responsibility for maintaining our own oral health, rather than being passive recipients of care. For this to be achieved there needs to be an improvement in oral health literacy, both among health professionals and the population at large. In addition to delivering the population-level objectives outlined above, significant changes in behaviour will be required, not just of individuals but from the oral health sector itself with a person-centred approach that focuses on disease prevention from the outset.
The behavior change required will be significant. In order to empower people to change their behaviour, it is imperative that they are sufficiently oral health literate. Education attainment level is the most powerful driver of the social gradient, and health outcomes are determined by an individual’s position on the gradient. Those with higher levels of educational attainment are more likely to adopt good self-care practices and benefit from higher overall wellbeing, which means fewer health related expenses. Paradoxically, rather than levelling out the social gradient, there is a danger that improving health literacy may deepen the care divide unless this disparity is actively managed.
Improving global oral health: a major challenge but a major opportunity
The current exclusion of oral health services from public healthcare packages leaves people at an unnecessarily high risk of catastrophic health expenditures. As important as it is to change behaviours, we must equally push for regulatory change to address the upstream determinants of oral disease including education, accessibility of healthy foods and good self-care routines.
We have come a long way towards putting oral health back on the global health agenda, with the approval in May 2021 of a landmark World Health Organisation resolution to establish a Global Strategy for Oral Health, properly situating it in the wider context of Non-Communicable Disease and Universal Health Coverage (UHC)[2]. Now that we have a vision and target set for 2030, the challenge is to build on evidence-based research to make the case for including oral health as part of UHC benefits packages and national NCD intervention strategies [3].
Our first steps will be to define a set of safe, cost-effective interventions to prevent and treat the most common oral diseases at an early stage. Oral health literacy empowering effective self-care will play an important role here and, as we go about integrating dentists, dental nurses and oral hygienists into health care more generally, we can further enhance collaboration with pharmacists and mid-level community health providers to ensure people are properly empowered with the tools they will need across their life course.
We will also engage with the private sector and civil society to drive reform in regulations surrounding unhealthy commodity industries, notably tobacco, alcohol and sugar, to arrest the continued promotion of harmful goods [4].
Ultimately, we are generators of our own health and should not be resigning ourselves to the ‘inevitability’ of disease but must instead come to expect excellent oral health across our life course. This is how important the theme of health awareness is for World Oral Health Day and why we need to better integrate oral health into our overall health by including it in UHC packages. Self-care underlines all these efforts, and we need a workforce that is educated in both, to deliver better health outcomes for all.
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Author biography
Professor Williams is Professor Emeritus of Global Oral Health in the Faculty of Medicine and Dentistry, Queen Mary University of London. Previously he was Dean of the Faculty of Medicine, Health and Life Sciences and Professor of Pathology at the University of Southampton between 2004-10 and then Vice Provost between 2010-11.
He is currently Chair of the FDI Vision 2030: Delivering Optimal Oral Health for All Implementation and Monitoring Expert Group and a Member of the Oral Health Observatory Task Team.
Since June 2020 he has been a Member of the Expert Advisory Group of the Global Self-Care Federation, which represents associations and manufacturers in the self-care industry and is committed to promoting sustainable growth and better global health outcomes for all.
He was President of the International Association for Dental Research (IADR) between 2009-10. During his Presidency, he was the driving force behind the IADR Global Oral Health Inequalities Research Agenda (GOHIRA) initiative. This sets out the research agenda to generate the evidence for a strategy that will reduce inequalities in oral health within a generation. This agenda is a key IADR strategic priority and is being implemented through the IADR Global Oral Health Inequalities Research Network. He was one of the founders of the Network and its President from 2014-17.
[1] Oral Health Key Facts. World Health Organization 2023.
[3] Vision 2030 : Delivering Optimal Oral Health for All. FDI World Dental Federation 2021.
[4] Why and How to Integrate Oral Health into the NCD and UHC Responses. NCD Alliance 2021.