Despite the major global public health burden of oral diseases, oral health has been largely ignored by the global health community, according to a series of articles on oral health published in The Lancet.
India is no exception. There is a shortage of dentists in the country that has resulted in many Indians simply never receiving an oral health check-up despite the high burden of diseases such as oral cancer in the country. This issue, as with many in India, is often found to be pronounced along the urban-rural divide, with far fewer dentists being found in India’s rural areas.
Sugar as an underlying risk factor
A key concern in India, as well as on a global level, are rising levels of sugar consumption. Western nations are currently campaigning for large companies such as Coca-Cola to reduce sugar amounts within their products. While sugar consumption rates are currently highest in these countries, there are efforts to curb the issue.
There are no such measures in place in most low to middle income countries (LMICs). Africa is currently a key measuring point in the growth of sugary products in LMICs. By 2020, Coca-Cola intends to spend around US$12 billion on marketing their products across Africa. To put this in perspective, the World Health Organization’s (WHO) total annual budget was US$4.4 billion in 2017.
“Sugar consumption is the primary cause of tooth decay. The UK population is consuming far too much sugar – considerably higher than the Department of Health and WHO recommends,” said Professor Richard Watt, Chair and Honorary Consultant in Dental Public Health at UCL and lead author of the study. “A particular concern is the high levels of sugar in processed commercial baby foods and drinks which encourage babies and toddlers to develop a preference for sweetness in early life. We need tighter regulation and legislation to restrict the marketing and promotion of sugary foods and drinks, if we are to tackle the root causes of oral conditions.”
Dentistry in crisis
Professor Watt highlights that dentistry is facing issues — though differing depending on circumstance — across the globe. In high-income nations, access to technology is improving the services provided by dentists. However, while treatment options are typically both abundant and effective, focus is being placed on treatment rather than prevention. This has left dentistry in a state where it is failing to address the underlying issues.
Across LMICs, issues typically result from a lack of access to oral health services. Where available in middle-income nations, the services of dentists are often expensive, resulting in a system where only the wealthy are able to avail their services. This has allowed oral health issues to proliferate within impoverished communities. As an example, the Gadchiroli district of Maharashtra – whose population is accounted for largely by tribal people – shoulders a significant burden of oral cancer. Access to oral health examinations could improve outcomes for individuals in this district.
In low-income nations, the problem is far more simple; there are typically little or no oral health services available. This presents a bleak situation in which even basic dental care is unavailable and oral health issues remain untreated, resulting in numerous other health concerns as a result.
Oral health intrinsically linked to overall wellbeing
Dental health is a useful indicator of a person’s overall health, with many severe illnesses such as bacterial endocarditis being linked to deficiencies in oral health. It is also an aspect of a person’s health that is, for the most part, easily manageable through basic hygiene measures such as brushing the teeth.
Poor oral health has been found to be correlated with numerous noncommunicable conditions (NCDs). Those with a serious gum condition — typically brought on through poor oral hygiene — were found to be forty percent more likely to have a chronic condition such as heart disease or diabetes.
Common conception is that oral health exists almost entirely unconnected to a person’s health in general. This misconception is perhaps fuelled by the typical check-up by dentists as opposed to doctors. It is thus seen as less of a pressing matter.
This, as the Lancet study shows, is untrue. Oral diseases, including tooth decay, gum disease and oral cancers, were found to 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 fifteen most common cancers in the world.
More must be done to highlight that oral health is not an isolated issue that does not have further implications for the health of the rest of the body. Improving access, however, is a considerable undertaking. Raising awareness of the risks of poor dental health — such as the consumption of high amounts of sugar — could at the very least become a form of damage limitation to the communities with no oral health care at all.
