Oral diseases - including tooth decay, gum disease, and oral cancers - are major global public health problems affecting half of the world’s population, but they have gone largely unnoticed. A new special series on oral health presents an “urgent need for radical reform” of oral healthcare to prioritize prevention and integrate dentistry into primary care. The series – published in The Lancet - is comprised of two papers co-authored by Habib Benzian, DDS, MScDPH, Ph.D., the associate director of global health and policy for NYU College of Dentistry’s World Health Organization (WHO) Collaborating Center for Quality-improvement, Evidence-based Dentistry - the only WHO Collaborating Center on oral health in the Americas.
“This immense disease burden is an important starting point to rethink the current oral healthcare approach, which leaves large parts of the world’s population without access to even basic dental care,” says Benzian, who is also an adjunct professor at NYU’s Colleges of Dentistry and Global Public Health. “By dedicating a special series to oral health, The Lancet is creating visibility and urgency for a long-overlooked public health crisis, and my co-authors and I offer solutions to improve global oral health and reduce inequalities.”
The papers report that oral healthcare is dominated by treatment including high-tech, high-cost interventions in high-income countries, rather than tackling the underlying causes of disease and preventing it. In low and middle-income countries, however, dentistry is largely unavailable and unaffordable. It also examines the need to reduce sugar, alcohol, and tobacco consumption to improve oral health and other chronic conditions. Sugar is recognized as the leading cause of tooth decay. The authors call for the adoption of a range of policy changes to protect and improve health, including taxing sugary drinks and stronger regulation on advertising targeting children.
It also explores the problematic rift among oral healthcare, mainstream healthcare, and health policy. The series provides recommendations for system-wide reforms. “Oral healthcare is isolated from mainstream healthcare,” Benzian continued. “Thus we need a fundamentally different approach that integrates the two. A reformed oral healthcare system needs to incentivize prevention, embrace a wider team of health professionals, including primary care and mid-level providers, use evidence-based treatments, and respond to the diverse needs of local populations. The growing global momentum towards universal health coverage provides a unique opportunity to reform oral healthcare.
Efforts in Brazil and Thailand have demonstrated that major reforms are possible and can benefit oral health. Countries like France have embraced the principles of universal health coverage and are now changing their systems to include oral healthcare in innovative ways.” “Prevention is a key factor in reforming oral healthcare, and it is currently underutilized,” added Richard Niederman, DMD, chair of the Department of Epidemiology & Health Promotion at the NYU College of Dentistry and director of the WHO Collaborating Center. “Our studies of cavity prevention programs for U.S. children show that these programs prevent tooth decay, improve school attendance and performance, and are cost-effective and cost-saving.”
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