Ending the neglect of global oral health: time for radical action

Abstract

75Oral diseases are a major global public health problem affecting over 3.5 billion people. 76Dentistry however has failed to tackle this problem. A fundamentally different approach is 77 now needed. In this second paper on oral health, we present a critique of dentistry 78 highlighting its key limitations and the urgent need for system reform. In high-income 79 countries (HIC) the current treatment-dominated, increasingly high-tech, interventionist and 80 specialised approach, is failing to tackle the underlying causes of disease and is not 81 addressing oral health inequalities. In low-and middle-income countries (LMIC) the 82 limitations of "westernised" dentistry are most acutedentistry is often unavailable, 83 unaffordable and inappropriate to the majority of these populations, but particularly the rural 84 poor. Rather than being isolated and separated from the mainstream health care system, 85 dentistry needs to be more integrated with primary care services in particular. The global 86 drive for universal health coverage (UHC) provides an ideal opportunity for this. Dental care 87 systems should focus more on promoting and maintaining oral health and achieving greater 88 oral health equity, rather than the interventionist treatment approach that currently dominates. 89Sugar, alcohol and tobacco use and their driving social and commercial determinants are the 90 underlying causes of oral diseases, common risks shared with a range of other non-91 communicable diseases (NCDs). Coherent and comprehensive regulation and legislation is 92 needed to tackle these shared risk factors. In this paper we focus on the need to reduce sugars 93 consumption through the adoption of a range of upstream policies designed to combat the 94 corporate strategies used by the global sugar industry to promote sugar consumption and 95 profits. At present the sugar industry is influencing dental research, oral health policy and 96 professional organisations through its well-developed corporate strategies. There is a pressing 97 need to develop clearer and more transparent conflict of interest policies and procedures to 98 limit and clarify the influence of the sugar industry on research, policy and practice. 99

Yarning about oral health: perceptions of urban Australian Aboriginal and Torres Strait Islander women

“…Yet this approach is unlikely to be achieved while treatment is prioritised before prevention. Our study lends weight to the growing call for radical reforms to the current model of oral health [49,50]. Watt et al and Cohen et al have indicated that the present treatment focus on individuals is harming those that are most vulnerable and unable to afford care [49,50].…”

“…Our study lends weight to the growing call for radical reforms to the current model of oral health [49,50]. Watt et al and Cohen et al have indicated that the present treatment focus on individuals is harming those that are most vulnerable and unable to afford care [49,50]. Indeed, all our participants reported poor oral health as adults and within the wider study population, 75.5% of participants had self-reported decayed, missing or filled teeth [24].…”

“…In other studies, Indigenous adults have reported considerable negative oral health issues including high levels of caries, tooth loss and pain [4]; this is supported by national data that demonstrates a disparity in oral health between Indigenous and non-Indigenous people [26]. Watt et al and Cohen et al argue that within dentistry, prevention should be prioritised, and the responsibility of oral health disseminated amongst a primary care team [49,50]. In addition to increasing the accessibility of oral health services, this approach would likely improve the regularity at which Indigenous Australian women received oral health information and education.…”

A scoping review on social justice education in current undergraduate dental curricula

“…Recently, there has been a worldwide shift in certain educational components within healthcare fields . This is due in part to the newfound understanding of the role that social components—such as empathy and intersectionality—play in the provision of healthcare, including dental care .…”

Inference and visualization of phenome-wide causal relationships using genetic data: an application to dental caries and periodontitis

“…Dental diseases are good examples of complex diseases which are associated with a range of poor health outcomes and are hypothesized to be both a cause and consequence of ill health 1 but the limitations of conventional epidemiological methods do not exclude confounded association. In the context of recent calls to prioritize prevention and early interventions, address the global health problem of dental diseases and overcome isolation between dentistry and medicine 2,3 , there is a need to locate dental diseases in the context of causal flow through the human phenome. Conversely, lipid biomarkers such as low-density lipoprotein cholesterol (LDL-C) are good examples of traits which are known to have effects on human health including cardiovascular disease 4,5 and may act as a positive control for contemporary epidemiological methods which aim to identify causal relationships.…”