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A Call to Action: The Lancet Oral Health Series

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Last week, The Lancet published a press release detailing the results of their Series on Oral Health. The release outlines the public health implications of long-ignored oral health interventions, particularly their impact on under-served populations, and highlights emerging evidence concerning the food and beverage industry’s influence on research and professional organizations.  

A component of a larger awareness and knowledge translation and exchange effort, the press release details the series’ key focus areas, including:

  • Oral diseases present a major global public health burden, affecting 3.5 billion people worldwide, yet oral health has been largely ignored by the global health community, according to a new Lancet Series on Oral Health
  • With a treat-over-prevent model, modern dentistry has failed to combat the global challenge of oral diseases, giving rise to calls for the radical reform of dental care
  • The burden of oral diseases is on course to rise as more people are exposed to the underlying risk factors of oral diseases, including sugar, tobacco and alcohol
  • Emerging evidence of the food, beverage, and sugar industry’s influence on dental research and professional bodies raises fresh concern.

Oral disease: types and causes

  • The key oral health conditions include: dental caries (tooth decay) [localised destruction of dental hard tissues (enamel and dentine) by acidic by-products from the bacterial fermentation of free sugars]; periodontal (gum) disease [chronic inflammatory conditions that affect the tissues surrounding and supporting the teeth]; and oral cancer [squamous cell carcinoma is the most common type of oral cancer].
  • The main cause of periodontal disease is poor oral hygiene leading to an accumulation of pathogenic microbial biofilm (plaque) at and below the gingival margin. Tobacco use is also an important independent risk factor for periodontal disease.
  • The major risk factors for oral cancers are tobacco use, alcohol consumption, and areca nut (betel quid) chewing. In many high-income countries (HIC), human papilloma virus (HPV) infection is responsible for a steep rise in the incidence of oropharyngeal cancers among young people.
  • Oral diseases can lower quality of life in many ways, including pain, infections, problems with eating and speaking, diminished confidence, and disruption to social, work, and school activities.

The global burden of oral disease

  • The most recent data from 2015 confirm that untreated caries in the permanent dentition remain the most common health condition globally (34·1%).
  • A 4% decrease in the number of prevalent cases of untreated dental caries occurred globally from 1990 (31,407 cases per 100 000) to 2017 (30,129 cases per 100 000).
  • The global burden of untreated dental caries for primary and permanent dentition has remained relatively unchanged over the past 30 years.
  • Epidemiological evidence indicates that lifetime prevalence of dental caries has decreased in the past four decades, but this is mainly in HIC, with the most substantial decrease seen in 12-year-old children.
  • Data from 2018 show that oral cancer has the highest incidence among all cancers in Melanesia and south Asia among males, and is the leading cause of cancer-related mortality among males in India and Sri Lanka.

Inequalities in oral disease

  • Case-control studies showed a consistent association between low socioeconomic status and oral cancer in both LMIC and HIC, even after adjustment for behavioural confounders.
  • Extreme oral health inequalities exist for the most marginalised and socially excluded groups in societies, such as homeless people, prisoners, those with long term disabilities, refugees, and indigenous groups, which serves as a classic example of a so-called cliff edge of inequality
  • Indigenous children, even in HIC (Australia, Canada, New Zealand, and USA), are particularly vulnerable, with the prevalence of early childhood caries ranging from 68% to 90%.

Prevention

  • WHO recommends that free sugars intake should be restricted to less than 10% of total energy highlighting that for further benefits, restriction in sugar consumption should be now more than 5% of total energy; however, many countries do not meet these guidelines.
  • While topical fluorides are proven clinical preventive agents, caries will still develop in the presence of free sugars above 10% of total energy intake. Even where exposure to fluoride is optimal, evidence suggests that free sugars exposure as low as of total energy may still carry a risk of caries.

About The Lancet Series on Oral Health

Led by UCL researchers, the series gathers 13 academic and clinical experts from 10 countries to better understand why oral diseases have persisted globally over the last three decades despite scientific advancements in the field. The series also investigates why oral disease prevalence has increased in low- and middle-income countries, and among socially disadvantaged and vulnerable people, no matter where they live.

More to come

The Series on Oral Health focuses on two areas each associated with emerging research.

  1. Oral diseases: a global public health challenge (R G Watt et al)
  2. Ending the neglect of global oral health: time for radical action (R G Watt et al)

Each article serves the broader strategy and effort to generate engagement and awareness among health professionals and researchers and the general public as well as policy makers, government, NGO’s and other policy makers.

Over the coming weeks, CDA Oasis will highlight the research, news, messaging, and social media communications from the Lancet in our own series of videos, articles, infographics and expert interviews. Stay tuned!

 

In the meantime, check out our recent articles on oral healthcare access, volunteerism in dentistry, person-centered care, at more:

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Until next time!

CDA Oasis Team

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1 Comment

  1. David Okamura July 23, 2019

    I would strongly urge that Dr Brian Novy be consulted regarding caries prevention protocols,. Having attended
    a couple of his presentation at the annual ODA spring meetings. I would deem Dr Novy as a leading global authority on caries etiology and prevention . On the website Dentaquest you will see several tips he offers to help reduce the risk of caries one of which is to get people to drink sugar beverages through a straw

    Reply

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