ABSTRACT
The aim of this article is to present the latest document of the World Health Organization, the Global Report on Oral Health, published in November 2022. The objectives and sections of the report are briefly presented, as well as the structure of each chapter. The information presented is the reference point for tracking the evolution of the oral health profile of the member countries of the World Health Organization, in the period 2022-2032. The conclusion of the presented report shows the impact of oral diseases and the need for urgent actions at the community level.
Key words: oral health, report, primary care, action plan.
Recently, the World Health Organization (WHO) published a report on the state of oral health at global level, which provides a comprehensive picture of the impact of oral cavity diseases, the resources available to obtain and preserve it, and the future challenges in the field of community dentistry (1). The report analyzes the latest data on the main oral diseases, risk factors, health challenges and reform opportunities in dental care. It also includes the first country profiles with key oral health information for each Member State, including Romania, which will serve as a basis for tracking progress over time during the period 2022-2032 (2). The report concludes that the state of oral health worldwide is alarming and requires urgent actions.
The report is considered a reference point for decision-makers and an orientation for stakeholders from different sectors toward better prioritization of oral health in a global, but also local, national context. Integrating oral health promotion and care into primary healthcare is a central focus of the report, and the WHO is committed to providing guidance and support to Member States to help achieve this, considering that most oral diseases can be prevented and treated properly, especially if they are diagnosed in the early stages.
Oral diseases are among the most common non-communicable diseases worldwide, affecting about 3.5 billion people. Their burden is increasing, especially in low- and middle-income countries. Good oral health is essential for eating, breathing and speaking; in addition, it contributes to good overall health, well-being and confidence in interacting with others. However, it should also be remembered that the occurrence of oral diseases is also due to inequalities in access to dental care. Disadvantaged people are more at risk of developing oral diseases and their consequences. Cost-effective preventive and clinical interventions are available, along with addressing common risk factors for oral diseases and general diseases.
The biggest challenge in the vision of WHO is to ensure that all people, wherever they live and regardless of the income, have the knowledge and tools for proper oral care and access to curative medical services when they need it, but also to preventive interventions. For this to happen, all countries need trained staff in the field of oral health promotion, and oral health services must be included in national health insurance packages, either free of charge or at a price that people can afford. The adoption by the member states of the WHO of an oral health resolution at the World Health Assembly in 2021 was an important step. The development and adoption of a comprehensive global oral health strategy with a vision for universal oral health coverage by 2030 was another milestone. The Global oral Health Action Plan, to be discussed in 2023, will include a monitoring framework with clear targets to be achieved by 2030. These policies will provide a pathway to oral health for all.
Oral health varies over time, from early life to old age, is an integral part of general health and supports individuals in participating in life in society and achieving their potential (3). WHO defines oral health as the state released from chronic pain in the oral and facial region, from oral cancer, from the existence of oral lesions, congenital defects, from periodontal diseases, dental decay lesions and loss of dental units and other disorders that can affect the oral cavity. Moreover, oral health encompasses psychosocial dimensions such as self-confidence, well-being and the ability to socialize and work without pain, discomfort or embarrassment (4).
In other words, oral health means more than healthy teeth, with an increasing emphasis on psychosocial and quality of life implications.
The preamble to the report on the state of oral health worldwide was the adoption of a resolution last May by the World Health Assembly (5). Resolution 74.5 recognizes that oral health should be integrated into the agenda on non-communicable diseases and that dental treatments should be included in national health insurance packages (5). The resolution, adopted with great support from all countries involved, called for a comprehensive set of measures, including the following:
– develop a global strategy for oral health by 2022;
– addition of a global oral health action plan by 2023, accompanied by a global monitoring framework with indicators to be reported regularly by 2031;
– defining the best oral health goals as part of the Global Action Plan for the prevention and control of non-communicable diseases;
– practical guidance and technical support in the context of the implementation of the Minamata Convention for the gradual elimination of the use of dental amalgam as filling material;
– continuous up to date in order to ensure permanent dental services, including in emergency situations;
– inclusion of noma in the 2023 review process to take into account also the neglected diseases to date.
Going back to the global oral health report, it has three general objectives:
I. highlighting the importance of public health and the impact of oral diseases throughout life;
II. contributing to the process of implementation of World Health Assembly Resolution 74.5 on oral health at global, regional and national level by providing reference information;
III. encourage the commitment and action of governments, United Nations organizations and other structures, such as non-governmental organizations (NGOs), academic institutions, philanthropic foundations, private sector entities and other stakeholders, to address oral diseases in the context of global health agendas.
The overall oral health report comprises four sections, namely:
- Section 1 highlights oral diseases as largely preventable global public health problems, focusing on their burden, risk factors and common determinants, and their impact on individuals, populations, health systems and the economy globally;
- Section 2 detailing the latest burden and trend data for the five main oral conditions – untreated tooth decay, severe periodontal disease, edentulism and cancer in the oral cavity – and other conditions of relevance to dental public health;
- Section 3 examines the main challenges and opportunities related to health systems: a challenge for oral and community health professionals; a challenge related to oral health information and persistent issues of relevance to public dental health, including an important focus on primary oral care.
- Section 4 places the report as part of a global process to improve oral health and connects it to the public.
The structure of the chapters of the global report on the state of oral health is as follows:
1. Oral diseases – global public health problems
1.1 Oral diseases: increasing global burden;
1.2 Common determinants and risk factors of oral diseases:
1.2.1 Social and political determinants of oral health: economic and health policies, globalization, urbanization, social classes, income, education level, gender, race, ethnicity, psychosocial factors, environmental conditions, access to medical services;
1.2.2 Commercial determinants of oral health – corporate sector activities that promote products that adversely affect health, for example tobacco or alcohol products and consumption of foods with high sugar content;
1.2.3 Joint approach for oral and general risk factors (cardio-vascular diseases, cancers, diabetes, chronic respiratory and neurological diseases);
1.2.4 Common risk factors of importance for public health (tobacco consumption in all its forms, excessive alcohol consumption, inadequate diet, poor hygiene, sedentary lifestyle, environmental pollution).
1.3 Individual and population impact of oral diseases throughout life: pain, discomfort, functional limitation, fear oranxiety of dental treatments and the dentist, impairment of children’s growth, learning ability, number of hours lost from school and work for visits to the dental office for treatments (and especially on emergency), social isolation, etc.
1.3.1. The relationship between oral health and general health and finally the influence on the quality of life (QoL).
1.4 Global inequalities in the burden of oral disease;
1.5 Inequalities in access to dental services;
1.6 Global costs and economic impact of oral diseases.
2. Burden of the main oral diseases recognized as dental public health problems
2.1 Dental caries:
2.1.1 the burden of untreated dental caries;
2.1.2 prevalence and number of cases of untreated caries on temporary teeth;
2.1.3 dental caries of temporary teeth – trends in the years 1990–2019;
2.1.4 prevalence and number of caries cases for permanent teeth;
2.1.5 dental caries of permanent teeth – trends in the years 1990–2019;
2.1.6 the risk factors, determinants and impact of dental caries.
2.2 Severe periodontal disease
2.2.1 global burden of severe periodontal disease. Periodontal diseases include gingivitis, a superficial and reversible inflammation of the gums which, in the presence of some factors such as tobacco use, systemic diseases or a compromised immune response, can progress to periodontitis, with loss of attachment, increased mobility and ultimately loss of teeth. Only severe periodontal disease, defined as the presence of a pocket greater than 6 mm in depth, is a public health condition (6, 7);
2.2.2 trends of severe periodontal disease in the period 1990-2019;
2.2.3 inequalities and the relationship with general health status.
2.3 Edentulism
2.3.1 global burden of tooth loss;
2.3.2 trends in disease burden during 1990-2019.
2.4 Oral cancer
2.4.1 global and regional burden of oral cavity cancer;
2.4.2 trends over time;
2.4.3 specific risk factors for oral cancer.
2.5 Other oral conditions relevant from the point of view of public health:
2.5.1 congenital malformations;
2.5.2 noma;
2.5.3 dental trauma.
3. Oral health challenges and opportunities for all community health services:
3.1 models of oral health care;
3.2 oral and community health workforce;
3.3 fluorides and their role in oral health:
3.3.1 fluoride toothpaste;
3.3.2 water fluoridation.
3.4 information on oral health and challenges in research activity to monitor the evolution and trend of oral diseases over time, identify dental treatment needs, exposure to known risk factors, priorities, inequalities:
3.4.1 supervision,
3.4.2 monitoring and evaluation,
3.4.3 research in the field of oral and community health needs to allow obtaining databases that facilitate comparisons between different countries.
3.5 aspects relevant to public health in the field of oral health care:
3.5.1 the Minamata convention on the use of mercury and amalgam;
3.5.2 dental care assistance;
3.5.3 pandemic preparedness and response;
3.5.4 antimicrobial resistance and infection prevention and control;
3.5.5 digital technologies for oral health.
3.6 refocusing on primary oral health care and health insurance, with a focus on oral health literacy and sustainable dental practice.
4. The road to oral health insurance.
Self-care is defined as an autonomous action to preserve or improve health; is a fundamental aspect of wellness that helps individuals to gain greater control over their health. Oral diseases are largely preventable; therefore, adopting sustained self-care practices is a key aspect of maintaining good oral health. Motivating individuals and communities to make healthy choices can significantly improve oral health throughout life (8). Brushing teeth twice a day with a fluoride toothpaste is a key personal oral hygiene behavior that is part of the daily habits. Such health-promoting habits should be encouraged in education and the workplace, as well as within families and communities (9). Schools and kindergartens have a particularly important role in the development of healthy behaviors, as emphasized in various WHO publications, including the new WHO and UNESCO standards for health promotion in educational institutions (10-12).
The provision of dental services and the practice of dentistry face several challenges, seen as opportunities for reform and improvement. A particular challenge is reducing the use of dental amalgam as a filling material in accordance with the Minamata Convention. This will require a major change in routine practice in the dental office, but will contribute to the sustainability of dental practice, along with other measures to protect the planet’s resources.
The COVID-19 pandemic has challenged oral health services and led to major disruption of dental services in most countries. Issues related to preparedness for future pandemics and the resilience of dental care services need to be addressed to ensure dental services without increased risk of infection.
In addition, the growing threats to public health caused by antimicrobial and antibiotic resistance combined with challenges in infection prevention and control require continued and increased attention in the field of dental care.
Finally, digital technologies extend their scope and challenge health promotion and dental healthcare, including the dentistr-patient relationship and, not least, the importance of personal data protection.
The recognition of oral diseases as global public health problems will continue to generate momentum and action from all stakeholders, guided by the strategic principles and objectives outlined in the global oral health strategy: progress on oral health governance, oral health promotion, prevention, community health workforce, dental services, oral health information systems, and oral health research agendas (13). Progress in all these areas will only be possible through the concerted and synergistic efforts of all stakeholders, including governments, the United Nation Organization, intergovernmental bodies, NGOs, professional associations, youth and student organizations, patient groups, academia, research institutions and the private sector (14). With ambitious targets to be achieved by 2030, aligned with the priority for primary dental care and the focus on non-communicable diseases, there is hope that substantial progress will be made globally to eliminate inequities in oral health status and profile.
As it was stated at the beginning, the report is completed by national health profiles with essential information on general health and oral health for each WHO member state. These are available as a separate online resource on the organization’s website (15). Data sources, indicator definitions and references mentioned is also provided.
Information presented is useful in the context of the future monitoring framework aimed at tracking the implementation of the Global Action Plan on Oral Health Status by 2023-2030.
References:
- Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: World Health Organization; 2022.
- https://www.who.int/publications/m/item/oral-health-rou-2022-country-profile.
- A75/10 Add.1. Draft global strategy on oral health. In: Seventy-fifth World Health Assembly, Geneva, 22–28 May 2022. Provisional agenda item 14.1. Geneva: World Health Organization; 2022 (https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_10Add1-en.pdf, accessed 30 November 2022).
- www.who.int.
- WHA74.5. Oral health. In: Seventy-fourth World Health Assembly, Geneva, 24 May – 1 June 2021. Summary and verbatim records. Geneva: World Health Organization; 2021 (WHA74/A74.R5; https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_R5-en.pdf, accessed 30 November 2022).
- Global burden of disease 2019 (GBD 2019) results [online database]. Seattle: Institute of Health Metrics and Evaluation (IHME); 2020 (https://vizhub.healthdata.org/gbd-results/, accessed 30 November 2022).
- Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res. 2014;93(11):1045–53.
- Delivering better oral health: an evidence-based toolkit for prevention. London: Public Health England, 2021
(https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention, accessed 30 November 2022).
- Benzian H, Garg RM, Monse B, Stauf N, Varenne B. Promoting oral health in children and adolescents. In: Das P, Horton R, editors. Disease control priorities volume, third edition. Washington: World Bank; 2017:211–20.
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- Making every school a health-promoting school: global standards and indicators. Geneva: World Health Organization; Paris: United Nations Educational, Scientific and Cultural Organization; 2021 (https://www.who.int/publications/i/item/9789240025059, accessed 30 November 2022).
- Ross DA, Plummer ML, Montgomery P, Kohl K, Siegfried N, Saewyc E et al. World Health Organization recommends comprehensive school health services and provides a menu of interventions. J Adolesc Health. 2021;69(2):195–6.
- Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S et al. Ending the neglect of global oral health: time for radical action. Lancet. 2019;394(10194):261–272.
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- https://www.who.int/team/noncommunicable-diseases/global-status-report-on-oral-health-2022.
