Oral health has been isolated from traditional healthcare and health policy for too long, despite the major global public health burden of oral diseases, fuelling an oral health crisis, according to a Lancet Series on Oral Health, published in The Lancet.
Failure of the global health community to prioritise the global burden of oral health has led to calls from Lancet Series authors for the radical reform of dental care, tightened regulation of the sugar industry, and greater transparency around conflict of interests in dental research.
Oral diseases, including tooth decay, gum disease and oral cancers, affect almost half of the global population, with untreated dental decay the most common health condition worldwide. Lip and oral cavity cancers are among the top 15 most common cancers in the world. In addition to lower quality of life, oral diseases have a major economic impact on both individuals and the wider health care system. The treatment of oral diseases cost €90bn per year across the EU, the third most expensive condition behind diabetes and cardiovascular diseases.
In England, nearly a quarter (23%) of five-year old children have tooth decay but very stark inequalities exist. For example, decay levels are 20 times higher in Pendle, in the north west of England compared to Waverley in the south east; and children living in the most deprived households have much higher decay (33.7%) compared to children living in the least deprived homes (13.6%). Amongst six to ten year-old children tooth extractions are the most common reason for admission to hospital for a general anaesthetic – in England in 2017-18 nearly 23,000 six to ten year olds were admitted for this procedure.
The Lancet Series on Oral Health led by UCL researchers brought together 13 academic and clinical experts from 10 countries, including the UK, to better understand why oral diseases have persisted globally over the last three decades, despite scientific advancements in the field, and why prevalence has increased in low- and middle- income countries (LMIC), and among socially disadvantaged and vulnerable people, no matter where they live.
In high-income countries (HIC), dentistry is increasingly technology-focused and trapped in a treatment-over-prevention cycle, failing to tackle the underlying causes of oral diseases. Oral health conditions share many of the same underlying risk factors as non-communicable diseases, such as sugar consumption, tobacco use and harmful alcohol consumption. In middle-income countries the burden of oral diseases is considerable, but oral care systems are often underdeveloped and unaffordable to the majority. In low-income countries the current situation is most bleak, with even basic dental care unavailable and most disease remaining untreated.
Coverage for oral health care in LMIC is vastly lower than in HIC with median estimations ranging from 35% in low-, 60% in lower-middle, 75% in upper middle, and 82% in high income countries.
The burden of oral diseases is on course to rise, as more people are exposed to the main risk factors of oral diseases. Sugar consumption, the underlying cause of tooth decay, is rising rapidly across many LMIC. While sugary drinks consumption is highest in HIC, the growth in sales of sugary drinks in many LMIC is substantial. By 2020, Coca-Cola intend to spend US$12 billion on marketing their products across Africa in contrast to WHO’s total annual budget of $4.4 billion (2017).
Writing in a linked commentary, Cristin E Kearns of the University of California and Lisa A Bero of the University of Sydney raise additional concerns with the financial links between dental research organisations and the industries responsible for many of these risk factors.
Lancet Series authors argue a pressing need exists to develop clearer and more transparent conflict of interest policies and procedures, and to restrict and clarify the influence of the sugar industry on dental research and oral health policy.
Lancet Series authors have called for wholesale reform of the dental care model 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 LMIC knowledge.