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Oral Health – Very Important but Often Forgotten

by  Richard Skolnik     Jun 1, 2022
Skolnik_DentalHealth_BLOG_SW

A worldwide problem

More than 3.5 billion people, or about 44 percent of the world’s population, suffer from oral health diseases. Tooth decay, (dental caries), of the permanent teeth, is the most prevalent such disease. In fact, it was estimated that in 2016 more than 2.4 billion people suffered dental caries in permanent teeth and 500 million children had caries of their primary teeth.

In addition, oral diseases are universal. They range from dental caries to disfiguring diseases like noma (necrotizing ulcerative stomatitis). They also cause substantial disability and an enormous loss of productivity. Moreover, oral health services are very limited in many low-income countries and often beyond the reach of marginalized groups. Even some high-income countries don’t include oral health in universal health coverage.

Oral diseases comprised about 1 percent of all DALYs globally among both sexes and all age groups in 2019. This was about the same number of DALYs attributable to colorectal cancer or endocrine, blood, and metabolic disorders. It was also more than the DALYs attributable to breast cancer or leukemia. However, despite the obvious importance of oral health, until fairly recently key actors in global health paid relatively little attention to oral health disorders.


Let's carve out some time for oral health

We have many topics to cover in global health courses. In addition, we never have enough time to cover all that we want. Nonetheless, I want to suggest that we should ensure that we carve out some time for oral health, given that it is among the most common and the most neglected health issues. I also suggest that we focus on oral health on the same questions Global Health 101 examines for all burdens of disease:

What’s the problem?
Who gets it?
Why do they have this problem?
Why should we care?
What can be done in doable, sustainable, cost-effective, and fairways to address the problem?

Most of our students will be familiar with “the basics” of oral health from their own experience. However, few of them will be familiar with the relationship between too many sweets, tooth loss, and mouth pain and trouble eating, and undernutrition. They will probably also be unaware that dental caries can be transmitted from mother to child. The children of mothers with active dental caries, for example, may have a three times higher risk for early childhood caries compared to children of mothers without dental caries. Almost no students will know about noma.


A good place to start

Thus, a good place to start would be to expose our students to background pieces on oral health. These could include, for example, WHO basic information and fact sheets on oral health. The Lancet had in 2019 a two-part series on oral health that is also very important.  
 
Once students have a better understanding of the nature of oral health conditions, it will be important for them to examine the burden of such conditions and how they vary in different settings. For this, I would encourage them to explore the GBD Compare website of the Institute of Health Metrics and Evaluation at levels 3 and 4, focusing on DALYs. The IHME also prepared a systematic review of the burden of oral health disorders from 1990 to 2017, which should be of interest. The Atlas of the International Dental Federation can also be of value.

In terms of addressing oral health issues, one might want to focus their students, for example, on getting oral health on the global health agenda; integrating oral health into universal health coverage; and addressing specific oral health concerns, including prevention of dental caries or periodontal disease; and, prevention, early diagnosis, and treatment of oral cancers and noma.

The Lancet articles cited above can also be very helpful in examining how we might address oral health issues, both institutionally and technically. In addition, WHO has a draft strategy for addressing oral health.

In the end, despite the many demands on our courses, we need to be sure that our students see oral health as an integral part of general health and well-being. We also need to be sure that our students apply to oral health the same concepts and frameworks that they use to address other health issues.

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Oral Health – Very Important but Often Forgotten

by  Richard Skolnik     Jun 1, 2022
Skolnik_DentalHealth_BLOG_SW

A worldwide problem

More than 3.5 billion people, or about 44 percent of the world’s population, suffer from oral health diseases. Tooth decay, (dental caries), of the permanent teeth, is the most prevalent such disease. In fact, it was estimated that in 2016 more than 2.4 billion people suffered dental caries in permanent teeth and 500 million children had caries of their primary teeth.

In addition, oral diseases are universal. They range from dental caries to disfiguring diseases like noma (necrotizing ulcerative stomatitis). They also cause substantial disability and an enormous loss of productivity. Moreover, oral health services are very limited in many low-income countries and often beyond the reach of marginalized groups. Even some high-income countries don’t include oral health in universal health coverage.

Oral diseases comprised about 1 percent of all DALYs globally among both sexes and all age groups in 2019. This was about the same number of DALYs attributable to colorectal cancer or endocrine, blood, and metabolic disorders. It was also more than the DALYs attributable to breast cancer or leukemia. However, despite the obvious importance of oral health, until fairly recently key actors in global health paid relatively little attention to oral health disorders.


Let's carve out some time for oral health

We have many topics to cover in global health courses. In addition, we never have enough time to cover all that we want. Nonetheless, I want to suggest that we should ensure that we carve out some time for oral health, given that it is among the most common and the most neglected health issues. I also suggest that we focus on oral health on the same questions Global Health 101 examines for all burdens of disease:

What’s the problem?
Who gets it?
Why do they have this problem?
Why should we care?
What can be done in doable, sustainable, cost-effective, and fairways to address the problem?

Most of our students will be familiar with “the basics” of oral health from their own experience. However, few of them will be familiar with the relationship between too many sweets, tooth loss, and mouth pain and trouble eating, and undernutrition. They will probably also be unaware that dental caries can be transmitted from mother to child. The children of mothers with active dental caries, for example, may have a three times higher risk for early childhood caries compared to children of mothers without dental caries. Almost no students will know about noma.


A good place to start

Thus, a good place to start would be to expose our students to background pieces on oral health. These could include, for example, WHO basic information and fact sheets on oral health. The Lancet had in 2019 a two-part series on oral health that is also very important.  
 
Once students have a better understanding of the nature of oral health conditions, it will be important for them to examine the burden of such conditions and how they vary in different settings. For this, I would encourage them to explore the GBD Compare website of the Institute of Health Metrics and Evaluation at levels 3 and 4, focusing on DALYs. The IHME also prepared a systematic review of the burden of oral health disorders from 1990 to 2017, which should be of interest. The Atlas of the International Dental Federation can also be of value.

In terms of addressing oral health issues, one might want to focus their students, for example, on getting oral health on the global health agenda; integrating oral health into universal health coverage; and addressing specific oral health concerns, including prevention of dental caries or periodontal disease; and, prevention, early diagnosis, and treatment of oral cancers and noma.

The Lancet articles cited above can also be very helpful in examining how we might address oral health issues, both institutionally and technically. In addition, WHO has a draft strategy for addressing oral health.

In the end, despite the many demands on our courses, we need to be sure that our students see oral health as an integral part of general health and well-being. We also need to be sure that our students apply to oral health the same concepts and frameworks that they use to address other health issues.

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