Neglect by global health community fuelling oral health crisis: Lancet study

Oral diseases present a major global public health burden and these are the most prevalent disease condition in India for the past 30 years, according to a study published in the Lancet on Friday (July 19).

According to a Lancet Series on oral health, it affects around 3.5 billion people worldwide and in low-income countries, the current situation is most bleak, with even basic dental care unavailable and most diseases remaining untreated. Oral health has been isolated from traditional healthcare and health policies for too long, despite the major global public health burden of such diseases, it said.

Failure of the global health community to prioritise the burden of oral health has led to calls from Lancet Series authors for the radical reform of dental care, tightened regulation of the sugar industry, and greater transparency around conflict of interests in dental research.

“In India, oral disorders are the most prevalent disease condition, and have remained so for the past 30 years. Prevalence of oral cancer is highest in South Asian countries,” the study stated.

The Lancet Series on Oral Health led by University College London (UCL) researchers brought together 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, and why prevalence has increased in low – and middle-income countries (LMIC), and among socially disadvantaged and vulnerable people, no matter where they live.

In addition to lower quality of life, oral diseases have a major economic impact on both individuals and the wider health care system. Aggregate direct treatment costs due to dental diseases in South Asia stands at almost $12.84 billion, the study said.

“Dentistry is in a state of crisis. Current dental care and public health responses have been largely inadequate, inequitable, and costly, leaving billions of people without access to even basic oral health care.”

“While this breakdown in the delivery of oral healthcare is not the fault of individual dental clinicians committed to caring for their patients, a fundamentally different approach is required to effectively tackle to the global burden of oral diseases,” Professor Richard Watt, Chair and Honorary Consultant in Dental Public Health at UCL and lead author of the series said.

In high-income countries (HIC), dentistry is increasingly technology-focused and trapped in a treatment-over-prevention cycle, failing to tackle the underlying causes of oral diseases. Oral health conditions share many of the same underlying risk factors as non-communicable diseases, such as sugar consumption, tobacco use and harmful alcohol consumption.

“In middle-income countries the burden of oral diseases is considerable, but oral care systems are often underdeveloped and unaffordable to the majority. In low-income countries the current situation is most bleak, with even basic dental care unavailable and most disease remaining untreated,” the study stated.

Manu Raj Mathur, Head-Health Policy and Additional Professor, Public Health Foundation of India, and one of the authors of the study, said, “Recently, the Indian government announced the Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana, which aims at strengthening primary health care and providing financial protection to the most vulnerable section of the society. It is aimed at creating awareness, screening and symptomatic care for oral diseases, counselling for tobacco cessation and referral to tobacco cessation centers.”

Emerging evidence of industry influence on research agendas contributes to the plausibility that major food and beverage brands could view financial relationships with dental research organisations as an opportunity to ensure a focus on commercial applications for dental caries interventions, Watt said.

The Lancet Series authors argue that a pressing need exists to develop clearer and more transparent conflict of interest policies and procedures, and to restrict and clarify the influence of the sugar industry on dental research and oral health policy.

“India is taking some bold steps in launching and implementing a Universal Health Coverage Programme. A new iteration of Oral Health Policy for the country is also on the anvil. The Lancet Series comes at a very crucial time for the country as it highlights the importance of oral health for overall health and well-being and presents a strong argument to include oral health care in the comprehensive primary care programme as well as covered under the national health insurance scheme,” Mathur said.

Dr Jocalyn Clark, an Executive Editor at The Lancet, said that dentistry is rarely thought of as a mainstream part of healthcare practice and policy, despite the centrality of the mouth and oral cavity to peoples well-being and identity.

“A clear need exists for broader accessibility and integration of dental services into healthcare systems, especially primary care, and for oral health to have more prominence within universal health coverage commitments. Everyone who cares about global health should advocate to end the neglect of oral health,” Clark said.