overview
Most oral health conditions are largely preventable and can be treated in their early stages. Most cases are tooth decay (cavities), periodontal disease, tooth loss and oral cancers. Other oral diseases of public health importance are orofacial clefts, noma (severe gangrenous disease that starts in the mouth and mainly affects children) and oral-dental trauma.
The WHO Global Oral Health Status Report (2022) estimated that oral diseases affect nearly 3.5 billion people worldwide, with 3 out of 4 affected people living in middle-income countries. Worldwide, an estimated 2 billion people suffer from caries of permanent teeth and 514 million children suffer from caries of primary teeth.
The prevalence of major oral diseases continues to increase worldwide with increasing urbanization and changes in living conditions. This is mainly due to insufficient exposure to fluoride (in water and oral hygiene products such as toothpaste), the availability and affordability of foods high in sugar, and poor access to oral care services in the community. The marketing of foods and drinks high in sugar, as well as tobacco and alcohol, have led to increased consumption of products that contribute to oral health conditions and other NCDs.
Dental caries (caries)
Dental caries occurs when plaque forms on the surface of a tooth and converts free sugars (all sugars added to food by the manufacturer, cook or consumer, plus naturally occurring sugars in honey, syrups and fruit juices) contained in food and drinks in acids that destroy the tooth over time. Continued high intake of free sugars, insufficient exposure to fluoride and lack of plaque removal by brushing can lead to tooth decay, pain and sometimes tooth loss and infection.
Periodontitis (gingivitis).
Periodontal disease affects the tissues that surround and support the teeth. The disease is characterized by bleeding or swollen gums (gingivitis), pain and sometimes bad breath. In its most severe form, the gum can pull away from the tooth and the supporting bone, causing the teeth to loosen and sometimes fall out. Severe periodontal disease is estimated to affect approximately 19% of the global adult population, representing more than 1 billion cases worldwide. The main risk factors for periodontal disease are poor oral hygiene and tobacco use.
Total tooth loss (total tooth loss)
Tooth loss is generally the end point of a lifelong history of oral disease, mainly advanced dental caries and severe periodontal disease, but can also be due to trauma and other causes. The estimated global average prevalence of complete tooth loss is nearly 7% among people aged 20 years and older. For people aged 60 and over, a much higher global prevalence of 23% has been estimated. Tooth loss can be psychologically traumatic, socially damaging and functionally limiting.
Mouth cancer
Oral cancer includes cancers of the lip, other parts of the mouth and the oropharynx and is collectively ranked as the 13u the most common cancer worldwide. The global incidence of lip and oral cavity cancer is estimated to be 377,713 new cases and 177,757 deaths in 2020. Oral cancer is more common in men and the elderly, more lethal in men compared to women, and varies significantly by socioeconomic conditions.
The use of tobacco, alcohol and areca nuts (betel quid) are among the main causes of oral cancer. In North America and Europe, human papillomavirus infections are responsible for an increasing proportion of oral cancers among young people.
Periodontal trauma
Oral trauma results from injury to the teeth, mouth and oral cavity. The latest estimates indicate that 1 billion people are affected, with a prevalence of about 20% for children up to 12 years of age. Oral trauma can be caused by oral factors such as misalignment of teeth and environmental factors (such as unsafe playgrounds, risky behaviour, traffic accidents and violence). Treatment is expensive and time-consuming and can sometimes even lead to tooth loss, resulting in complications for facial and psychological development and quality of life.
Noma
Noma is a severe gangrenous disease of the mouth and face. It mainly affects children aged 2-6 who are malnourished, infected with infectious diseases, living in extreme poverty with poor oral hygiene or with weakened immune systems.
Noma is found primarily in sub-Saharan Africa, although outbreaks have been reported in Latin America and Asia. Noma begins as a soft tissue lesion (lesion) of the gums. It then develops into an acute necrotizing gingivitis that progresses rapidly, destroying the soft tissues and further progressing to affect the hard tissues and skin of the face.
According to the latest estimates (since 1998) there are 140,000 new cases of noma per year. Without treatment, noma is fatal in 90% of cases. Survivors suffer severe facial disfigurement, have difficulty speaking and eating, endure social stigma, and require complex surgery and rehabilitation. When noma is detected at an early stage, its progression can be stopped quickly through basic hygiene, antibiotics and improved nutrition.
Cleft lip and palate
Orofacial clefts, the most common congenital malformations of the craniofacial face, have a worldwide prevalence of between 1 in 1000–1500 births, with wide variation in different studies and populations (1). Genetic predisposition is a major cause. However, poor maternal diet, smoking, alcohol and obesity during pregnancy also play a role. In low-income settings, there is a high neonatal mortality rate. If cleft lip and palate are properly treated with surgery, full recovery is possible.
Risk factors
Most oral diseases and conditions share modifiable risk factors such as tobacco use, alcohol consumption and an unhealthy diet high in free sugars that are common to the top 4 NCDs (cardiovascular disease, cancer, chronic respiratory disease and diabetes).
Furthermore, diabetes has been linked bidirectionally to the development and progression of periodontal disease (2). There is also a causal link between high sugar consumption and diabetes, obesity and tooth decay.
Oral health disparities
Oral diseases disproportionately affect poor and socially disadvantaged members of society. There is a very strong and consistent relationship between socioeconomic status (income, occupation and educational level) and the prevalence and severity of oral disease. This association exists from early childhood to older age and in populations in high-, middle-, and low-income countries.
Prevention
The burden of oral disease and other noncommunicable diseases can be reduced through public health interventions addressing common risk factors.
These include:
- promoting a well-balanced diet low in free sugars and rich in fruit and vegetables, and favoring water as the main drink;
- cessation of use of all forms of tobacco, including areca nut chewing;
- reducing alcohol consumption; and
- encouraging the use of protective equipment when doing sports and traveling on bicycles and motorcycles (to reduce the risk of facial injuries).
Adequate exposure to fluoride is an essential factor in the prevention of dental caries.
Brushing teeth twice a day with toothpaste containing fluoride (1000 to 1500 ppm) should be encouraged.
Access to oral health services
The uneven distribution of oral health professionals and the lack of adequate health facilities to meet the needs of the population in most countries means that access to primary oral health services is often low. The cost of oral health care can be a significant barrier to accessing care. Paying for necessary oral health care is one of the main reasons for catastrophic health costs, resulting in an increased risk of poverty and financial hardship.
WHO response
The World Health Assembly approved a Resolution on oral health in 2021 at the 74th World Health Assembly. The resolution recommends a shift from the traditional curative approach to a preventive approach that includes the promotion of oral health in the family, schools and workplaces and includes timely, comprehensive and inclusive care within the primary health care system. The resolution affirms that oral health should be firmly integrated into the NCD agenda and that oral care interventions should be included in universal health coverage programmes.
In 2022, the World Health Assembly endorsed the Global Oral Health Strategy with a vision of universal oral health coverage for all individuals and communities by 2030. A detailed action plan is under development to help countries translate global strategy in practice. This includes a monitoring framework to track progress, with measurable targets to be achieved by 2030.
bibliographical references
1. Salari N, Darvishi N, Heydari M, Bokaee S, Darvishi F, Mohammadi M. Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2021? S2468-7855(21)00118X. doi:10.1016/j.jormas.2021.05.008.
2. Wu, Cz., Yuan, Yh., Liu, Hh. et al. Epidemiological relationship of periodontitis and type 2 diabetes mellitus. BMC Oral Health 20, 204 (2020).
