WHO report presents opportunities to improve state of global oral health

Report provides comprehensive picture of oral disease burden, progress in 194 countries

The status of global oral health is alarming and requires urgent action, according to a new Global Oral Health Status Report released Nov. 18 by the World Health Organization that provides the first-ever comprehensive picture of oral disease burden with data profiles for 194 countries, including the U.S.

The report, which underscores that oral health continues to be one of the WHO’s priorities, reviews the most recent data on major oral diseases, risk factors, health system challenges and opportunities for reform, and is intended to serve as a reference for policymakers and a wide range of stakeholders to guide advocacy towards better prioritization of oral health globally, regionally and nationally.

ADA President George R. Shepley, D.D.S., said that the report shows how the global burden oforal diseases and conditions affects the most vulnerable and disadvantaged populations.

“Oral health is integral to overall health,” said Dr. Shepley. “The first step to improving access to oral health services is recognizing those individuals across the globe facing the burdens of oral diseases and conditions. This report shows how overlooked essential oral health care services are in some countries, and how this global action plan is necessary to track and manage these inequalities and deliver necessary care. The American Dental Association supports policies and programs that reduce oral health inequities, ensure meaningful oral health access and improve the overall health of individuals.”

The report shows that almost half of the world’s population — 3.5 billion people — suffer from oral diseases, with 75% of those 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, said Tedros Adhanom Ghebreyesus, Ph.D., WHO director-general, in a WHO news release.

“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,” he said. “WHO 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.”

The report includes opportunities for stakeholders and policymakers 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 effectiveand affordable fluoride toothpaste.
• Planning oral health services as part of national health 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 health care workers to expand oral health service coverage.
• 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, M.D., WHO director for noncommunicable diseases, in the news release. “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.”

Habib Benzian, D.D.S., Ph.D., co-director of the NYU Dentistry WHO Collaborating Center for Quality improvement and Evidence-based Dentistry and research professor at the NYU College of Dentistry, was a member of the report’s editorial board.

“I wish I had a simple answer for the complex problem of oral health,” Dr. Benzian said during a Nov. 18 news conference announcing the report’s release. “First, I think the key message for me of the report is that the burden of [oral] disease is at an all-time high for mankind, and that continuing business as usual, is no longer an option. My second point is that the data tells us that the current approaches to oral health care and to prevention are not providing adequate coverage for people and populations.”

Dr. Benzian said it was important to widely make the case for oral health as a public good.

“Therefore we, call for oral health services integrated with primary health care as a core public governmental responsibility,” he said. “Everyone should have access to services that address fundamental essential oral health needs. We also need a new emphasis on prevention and self-care. This includes that we lookat effective models on how to engage with the private sector and private providers in expanding and improving coverage for oral health. All of this is part of the roadmap towards universal health coverage for oral health by 2030, [and] this report is an intricate part.”

Brian O’Connell, B.D.S., Ph.D., president of the International Association for Dental Research, said at the report launch that he acknowledged the importance of the global oral healthstatus report in highlighting many of the challenges, for having good data is essential for research, and research provides the evidence needed to address those challenges.

“It is sobering, though, to see from the reportthat oral diseases are still so prevalent, maybe more so than ever before, and so clearly map onto levels of income and opportunity around the world,” he said. “I can assure you that the IADR is fully supportive of the integration of oral health research in mainstream, general health, and our members have been actively involved, for example, in the work on health determinants, common risk factors on health inequalities, preventive strategies and, of course, cost effectiveness and monitoring of prevention policies.”

Dr. Benzian told ADA News that the inequalities described in the report are “staggering, in terms of disease burden and increase, in terms of resources spent on oral health care, in terms of workforce and many other aspects. We live in a highly divided and unequal world when it comes to health—oral health is no exception and perhaps even more pronounced with regard to inequalities.”

He added, “Given that many, if not most, oral diseases are largely preventable, I would encourage U.S. dental professionals to embrace what we call in the report a ‘promotive and preventive’ model of care. Dentists canplay a role educating their communities about common risk factors for oral disease, including sugar consumption, tobacco use and alcohol use. Moreover, there are highly effective, non-invasive ways to treat caries that are cost-effective and do not require an expensive clinic setup. We hope that our candid diagnosis of challenges and problems initiates a broad societal, professional and political discussion. Stakeholders — including policymakers and oral health providers — must realize that continuing “business as usual” is not an option.”

Earlier this year, the WHO adopted a global strategy on oral health with a vision of universal health coverage for oral health for all individuals and communities by 2030. A detailed action plan is under development to help countries translate the global strategy into practice.