Oral health is a key indicator of overall well-being and general quality of life. Speaking, eating, smiling and laughing are such fundamentals in the enjoyment of life, that any injury, disease or impediment has repercussions throughout the entire body.
The Global Burden of Disease Study of 2017 estimated that worldwide, oral diseases affect 3.5 billion people. The International Agency for Research on Cancer tells us that cancers of the oral cavity, and cancers of the lip are among the top 15 most common cancers with almost 200,000 global deaths a year.
The Global Burden of Disease is a powerful resource for understanding the changing health challenges that are faced across the planet, in the 21st century. Conducted by the Institute for Health Metrics and Evaluation (IHME), the GBD gives the most comprehensive, observational epidemiological study to date. By tracking both within, and between countries, the Global Burden of Disease provides important data for clinicians, researchers and policy makers that promotes accountability, and improves lives worldwide.
Oral disease includes dental caries, periodontal disease, tooth loss, oral cancer, oral manifestations of HIV infection, oro-dental trauma, birth defects such as cleft lip and palate and noma – a gangrenous disease of young children that rapidly destroys the hard and soft tissue of the face.
Most oral diseases and conditions share risk factors with other leading, noncommunicable diseases: cardiovascular, cancer, chronic respiratory, as well as diabetes. Risk factors also include tobacco use, alcohol consumption and diets high in free sugars; all of which are on the increase at a global level.
Self-reported changes in smoking and alcohol consumption following France’s lockdown in March 2020 had 26.7% of current smokers report an increase in tobacco consumption while 18.6% reported a decrease; for 54.7% there was no change. The increase in tobacco use was mostly associated 18–34 year-olds, with a high level of education, and suffering anxiety.
For drinkers, 10.7% reported an increase; 24.4% reported a decrease. This was concentrated across an age range of 18 to 49, of people in cities with populations of more than 100,000 inhabitants, in the category of high socio-professional, and in a depressive mood.
There is a long regarded and proven relationship between oral and general health. Diabetes is linked with the development and progression of periodontitis, and vice versa. Gum disease has an accepted causal link with heart disease, and to not understand the relationship between high sugar consumption, obesity, diabetes and dental cavities is to have lived undisturbed with a gravel floor and rubble roof.
Oral diseases are a major health burden for many countries because of the way they affect an entire lifetime. Living in a Third World country is challenging enough without pain, discomfort, disfigurement and malnourishment from the inability to eat properly.
Like being undernourished isn’t enough.
Globally, cavities in permanent teeth is the most common condition, suffered by more than 2.3 billion people; some having already been one of the more than 530 million children with caries of their milk teeth.
From Afghanistan and Bangladesh to the likes of Belize and the Marshall Islands, changes in living conditions because of climate impact, the pandemic, ‘natural’ disasters and increasing urbanisation is reflected the prevalence of oral disease. This is on top of 10% of the global population affected by severe gum disease and ultimately, tooth loss.
Poor access to oral health care services, the marketing of high-sugar food and beverages, as well as tobacco and alcohol products, is a growing contributor to oral ill health.
Treatment is expensive and rarely part of universal health coverage: so much so, that only Austria, Mexico, Poland, Spain and Turkey have it.
Universalism in health and welfare systems refers to services and benefits available to all, or to whole categories of people – such as the aged – as a right. Universalism contrasts selectivism, which focuses services and benefits on those people who are in most need and who typically cannot afford to pay; hence means testing.
So in all of this, the world’s high-income countries, with the exception of the aforementioned four, refuse to acknowledge and accept the high cost borne by the community as an added consequence of untreated dental problems. In every one of these remaining countries, the mystery of universal health care moves further into the unknown with the mouth somehow residing on its own, with little or no attachment, relevance or relationship to the rest of the body.
This is despite the fact that these governments are acutely aware that most oral health conditions are largely preventable, and that virtually no critical point is ever reached with early-stage treatment.
And also despite the science that now tells us the importance of oral microbiome as a direct influence on organ and vascular health.
Oral microbiome is an extraordinary and expanding field of research because of its critical role in both oral and systemic diseases. Microbiome rests within biofilms throughout the oral cavity, and forms an ecosystem that can maintain a state of equilibrium and therefore good health; or imbalance and illness. However, certain imbalances in this state of equilibrium allow pathogens to manifest and cause disease. Disruption of the oral microbiome leads to dysbiosis: the combined reduction in microbial diversity and loss of beneficial bacteria.
Identifying the microbiome in health is the first step in human microbiome research, and understanding the alteration of function and metabolism in diseased states.
Although microbiome research is quite nascent, it’s exponential. Massive amounts of research is being done, and data is continuously added. There is much development in identifying consistent patterns, and accumulating concrete data that identifies further, various biomarkers so that being able to target therapies and personalise pharmaceuticals will bring the ultimate in disease management.
In May 2021 the World Health Assembly approved an historic Resolution on oral health. The Resolution urges Member States to address the key risk factors shared by oral, and other noncommunicable diseases. It recommends a shift from the traditional curative approach to a preventive approach. This includes the promotion of oral health within the family, schools, and workplaces; and includes timely, comprehensive and inclusive care within the primary health-care system.
Clear agreement emerged that oral health should be firmly embedded within the noncommunicable disease agenda and that oral health-care interventions should be included in universal health coverage programmes.
The World Health Assembly delegates asked that by 2022, the World Health Organisation (WHO) is to draft a global strategy to tackle oral diseases. It’s to be considered by WHO governing bodies in 2023 how this global strategy is to translate into action for oral health. There is to be the development of best interventions in oral health; and to explore the inclusion of noma – fatal for 90% of children affected – within the roadmap for neglected tropical diseases 2021-2030.
WHO has been asked to report back on progress and results until 2031, as part of the consolidated report on noncommunicable diseases.
September 2021 brought the release of Mobile technologies for oral health: an implementation guide, which provides comprehensive instructions on how to complement existing oral health initiatives and oral health systems with mobile technologies.
The initiative focused on the prevention of noncommunicable diseases through health messages to mobile phones.
The new product is one of a set developed through the Be He@lthy Be Mobile programme, run by the WHO and the International Telecommunication Union. Since the establishment of the programme a decade ago, a range of handbooks have been released on topics from diabetes to cervical cancer, hypertension and dementia.
The new handbook on oral health goes several steps further than simply texting oral health messages to the general public. It provides guidance and training for health workers in early detection of oral health conditions, the collection of epidemiological data, and the monitoring of quality patient care.
The handbook has four modules, designed as adaptable components that, according to the specific needs of any country, can be implemented collectively or individually, as stand-alone activities or integrated into existing disease programmes.
This is how important oral health is. To the individual body, the communal body, the national body and the worldwide one.
Do your part. Take care of your oral health. Those 6-monthly dental check-ups ease a tiny burden from the world, and a large one from your shoulders.
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