A new Global Oral Health Status Report published by the World Health Organization (WHO) provides the first-ever comprehensive picture of oral disease burden with data profiles for 194 countries, giving unique insights into key areas and markers of oral health that are relevant for decision-makers. [1]

The report shows that almost half of the world’s population (45% or 3.5 billion people) suffer from oral diseases, with 3 out of every 4 affected people living in low- and middle-income countries. Global cases of oral diseases have increased by 1 billion over the last 30 years—a clear indication that many people do not have access to prevention and treatment of oral diseases.

“Oral health has long been neglected in global health, but many oral diseases can be prevented and treated with the cost-effective measures outlined in this report,” explained Tedros Adhanom Ghebreyesus, MD, the Director-General of the World Health Organization.

“We are is committed to providing guidance and support to countries so that all people, wherever they live and whatever their income, have the knowledge and tools needed to look after their teeth and mouths, and to access services for prevention and care when they need them,” Ghebreyesus added.

A Rapid increase of oral diseases
The most common oral diseases are dental caries (tooth decay), severe gum disease (gingiva), tooth loss and oral cancers.

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Untreated dental caries is the single most common condition globally, affecting an estimated 2.5 billion people. Severe gum disease  ̶  a major cause of total tooth loss  ̶  is estimated to affect 1 billion people worldwide.

In turn, about 380,000 new cases of oral cancers are diagnosed every year.

Because in the Western World gingiva is a rare disease, most commonly affecting the elderly population, reporting on the disease is sparse and often grouped with other sub-sites of oral cancer. This makes it difficult to interpret the result as well as understand the  prognostic factors and the possible treatment options.[2]

However, in contrast to occurrence in the Western World, the lack of oral hygiene results in  oral cancers being one of the most common cancers in some high-risk areas of the world.  These oral cancers are generally preventable forms of cancer, since most of the different risk factors identified, including tobacco use, alcohol consumption, and betel nut chewing, are behaviors that increase the likelihood of the disease. [3]

The WHO report underscores the glaring inequalities in access to oral health services, with a huge burden of oral diseases and conditions affecting the most vulnerable and disadvantaged populations. People on low incomes, people living with disabilities, older people living alone or in care homes, those living in remote and rural communities and people from minority groups carry a higher burden of oral diseases.

This pattern of inequalities is similar to other noncommunicable diseases such as cancers, cardiovascular diseases, diabetes, and mental disorders. Risk factors common to noncommunicable diseases such as high sugar intake, all forms of tobacco use, and harmful use of alcohol all contribute to the global oral health crisis.

Barriers to delivering oral health services
Only a small percentage of the global population is covered by essential oral health services, and those with the greatest need often have the least access to services. The key barriers to delivering access to oral health services for all include:

  • Oral health care requires high out-of-pocket expenditures. This often leads to catastrophic costs and significant financial burden for families and communities.
  • The provision of oral health services largely relies on highly specialized providers using expensive high-tech equipment and materials, and these services are not well integrated with primary health care models.
  • Poor information and surveillance systems, combined with low priority for public oral health research are major bottlenecks to developing more effective oral health interventions and policies.

Improving global oral health
The report showcases many promising opportunities to improve the state of global oral health including:

  • adopting a public health approach by addressing common risk factors through promoting a well-balanced diet low in sugars, stopping use of all forms of tobacco, reducing alcohol consumption and improving access to effective and affordable fluoride toothpaste.
  • planning for equitable oral health services as part of national health planning and improving integration of oral health services in primary health care as part of universal health coverage.
  • redefining oral health workforce models to respond to population needs and expanding competencies of non-dental healthcare workers to expand oral health service coverage; and
  • strengthening information systems by collecting and integrating oral health data into national health monitoring systems.

“Placing people at the heart of oral health services is critical if we are to achieve the vision of universal health coverage for all individuals and communities by 2030,” said Bente Mikkelsen, MD, Director for Noncommunicable Diseases at the World Health Organisation.

“This report acts as a starting point by providing baseline information to help countries monitor progress of implementation, while also providing timely and relevant feedback to decision-makers at the national level. Together, we can change the current situation of oral health neglect,” she concluded.

[1] Global oral health status report: towards universal health coverage for oral health by 2030. World Health Organisation (WHO). Online. Last accesses on November 18, 2022.
[2] Bark R, Mercke C, Munck-Wikland E, Wisniewski NA, Hammarstedt-Nordenvall L. Cancer of the gingiva. Eur Arch Otorhinolaryngol. 2016 Jun;273(6):1335-45. doi: 10.1007/s00405-015-3516-x. Epub 2015 Feb 4. PMID: 25649283.
[3] Abati S, Bramati C, Bondi S, Lissoni A, Trimarchi M. Oral Cancer and Precancer: A Narrative Review on the Relevance of Early Diagnosis. Int J Environ Res Public Health. 2020 Dec 8;17(24):9160. doi: 10.3390/ijerph17249160. PMID: 33302498; PMCID: PMC7764090.

Featured image: Dental supplies and their reflection on a glass countertop. Photo courtesy: Ibrahim Boran on Unsplash

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