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Oral Health WORLD
WIDE
A report by FDI World Dental Federation
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CONTENTSStark facts about oral health ........................................5
Introduction ...............................................7
What is oral health? ...................................7
What is the connection between oral health and general health? .................7
What is the burden of oral diseases? .........................................14
What are the economic impacts of oral diseases? ........................................16
What are the inequalities and disparities in oral health? ................................................16
Why are oral diseases neglected internationally? ..........................................17
How does oral health relate to the Millennium Development Goals? ...............17
How can oral health be improved? .............18
Conclusion ..................................................22
References ..................................................23
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³2UDO�GLVHDVHV�DUH�FDXVHG�RU�LQÀXHQFHG� by the same preventable risk factors as over 100 noncommunicable diseases”
5
STARK FACTS ABOUT ORAL HEALTHORAL CONDITIONS ARE THE MOST COMMON CONDITIONS OF HUMANKINDAs part of the recent international collaborative Global Burden of Disease Study (1990-2010), untreated tooth GHFD\�ZDV�LGHQWL¿HG�DV�WKH�PRVW�FRPPRQ�FRQGLWLRQ�DPRQJ�291 diseases studied.
WORLDWIDE, BETWEEN 60 AND 90% OF SCHOOLCHILDREN HAVE DENTAL CARIES0RVW�RI�WKH�GLVHDVH�UHPDLQV�XQWUHDWHG��'HQWDO�GHFD\�FDXVHV�SDLQ��UHVXOWV�LQ�PLVVHG�GD\V�LQ�VFKRRO�DQG�ZRUN�DQG�XVXDOO\�UHTXLUHV�FRVWO\�WUHDWPHQW��ZKLFK�LV�RIWHQ�QRW�DRUGDEOH�RU�DYDLODEOH��7KH�JRRG�QHZV��WKH�PRVW�FRPPRQ�FKURQLF�GLVHDVH�RI�KXPDQNLQG�LV�ODUJHO\�SUHYHQWDEOH�WKURXJK�VLPSOH�DQG�FRVW�HHFWLYH�PHDVXUHV��
ORAL CANCER IS THE WORLD’S 8TH MOST COMMON CANCER AND THE 3RD MOST COMMON CANCER IN SOUTHEAST ASIA/RZ�LQFRPH�FRXQWULHV�FDUU\�WKH�ELJJHVW�EXUGHQ�DV�RUDO�FDQFHU�LV�WZLFH�DV�SUHYDOHQW�WKHUH�FRPSDUHG�WR�PRVW�KLJK�LQFRPH�FRXQWULHV��7KH�ULVN�RI�RUDO�FDQFHU�LV����WLPHV�KLJKHU�ZKHQ�WREDFFR�XVH�DQG�DOFRKRO�FRQVXPSWLRQ�DUH�FRPELQHG�DQG�WKHVH�WZR�ULVN�IDFWRUV�DUH�HVWLPDWHG�WR�DFFRXQW�IRU�FDXVLQJ�DERXW�����RI�RUDO�FDQFHUV��
50% OF GUM DISEASE IS CAUSED BY TOBACCO USE+DOI�RI�DOO�OLIHWLPH�VPRNHUV�ZLOO�GLH�IURP�D�VPRNLQJ�UHODWHG�disease.
90% OF CHILDREN WITH NOMA DO NOT RECEIVE CARE AND HAVE LOW CHANCES OF SURVIVAL1RPD�LV�D�GLV¿JXULQJ�JDQJUHQRXV�GLVHDVH�PRVWO\�DHFWLQJ�\RXQJ�FKLOGUHQ�LQ�6XE�6DKDUDQ�$IULFD��7KH�GLVHDVH�LV�D�UHVXOW�RI�H[WUHPH�SRYHUW\��SRRU�K\JLHQH��PDOQXWULWLRQ�DV�ZHOO�DV�FRPSURPLVHG�LPPXQLW\�DQG�RWKHU�IDFWRUV��6LPSOH��EXW�HDUO\�WUHDWPHQW�FDQ�VDYH�OLYHV��
25% OF ALL GENETIC BIRTH DEFECTS ARE CRANIOFACIAL MALFORMATIONS7KH�PRVW�FRPPRQ�FRQJHQLWDO�PDOIRUPDWLRQV�LQFOXGH�FOHIW�OLS�DQG�SDODWH��:LWK�FRPSOH[�VXUJHU\�DQG�ORQJ�WHUP�UHKDELOLWDWLRQ�QRUPDO�JURZWK�DQG�IXQFWLRQ�FDQ�EH�UHVWRUHG�
30% OF PEOPLE WORLDWIDE AGED 65–74 YEARS HAVE LOST ALL THEIR NATURAL TEETH/LYLQJ�ZLWKRXW�WHHWK�VHYHUHO\�DHFWV�TXDOLW\�RI�OLIH�DQG�FDQ�OHDG�WR�XQKHDOWK\�GLHWV��PDOQXWULWLRQ�DQG�VRFLDO�LVRODWLRQ��
MILLIONS OF WORK AND SCHOOL DAYS LOST,Q�������RUDO�GLVHDVHV�UHVXOWHG�LQ�����PLOOLRQ�GD\V�RI�ZRUN�DQG�����PLOOLRQ�GD\V�RI�VFKRRO�ORVW�LQ�WKH�8QLWHG�6WDWHV�DORQH��,Q�7KDLODQG��GHQWDO�SUREOHPV�FDXVHG�������KRXUV�RI�VFKRRO�lost per 1,000 children in 2008. Thus, oral diseases are PDMRU�FDXVHV�RI�HFRQRPLF�DQG�VRFLDO�ORVV�IRU�LQGLYLGXDOV�and countries.
THE BURDEN OF ORAL DISEASES IS HIGHER AMONG POOR AND DISADVANTAGED POPULATION GROUPS$OO�RUDO�GLVHDVHV�DUH�OLQNHG�WR�VRFLR�HFRQRPLF�VWDWXV�±�WKH�SRRU�DQG�GLVDGYDQWDJHG�VXHU�IURP�D�KLJKHU�EXUGHQ�ZKLOH�DW�WKH�VDPH�WLPH�KDYLQJ�OHVV�DFFHVV�WR�DSSURSULDWH�FDUH��
ORAL DISEASES SHARE RISK FACTORS WITH OTHER NONCOMMUNICABLE DISEASES2UDO�GLVHDVHV�DUH�FDXVHG�RU�LQÀXHQFHG�E\�WKH�VDPH�SUHYHQWDEOH�ULVN�IDFWRUV�DV�RYHU�����QRQFRPPXQLFDEOH�GLVHDVHV��1&'V���RI�ZKLFK�WKH�PRVW�SUHYDOHQW�DUH�KHDUW�disease, diabetes, cancer and chronic respiratory disease. 7DFNOLQJ�VXFK�FRPPRQ�ULVN�IDFWRUV�DV�WREDFFR�XVH��KLJK�VXJDU�LQWDNH��DQG�ODFN�RI�SK\VLFDO�DFWLYLW\�ZLOO�UHGXFH�WKH�EXUGHQ�RI�D�QXPEHU�RI�KLJK�LPSDFW�GLVHDVHV�
BRUSHING TEETH TWICE DAILY USING FLUORIDE TOOTHPASTE HELPS TO PREVENT TOOTH DECAY AND GUM DISEASE5HJXODU�WRRWKEUXVKLQJ��DW�OHDVW�LQ�WKH�PRUQLQJ�DIWHU�EUHDNIDVW�DQG�LQ�WKH�HYHQLQJ�EHIRUH�JRLQJ�WR�VOHHS��XVLQJ�ÀXRULGH�WRRWKSDVWH�LV�KLJKO\�HHFWLYH�LQ�SUHYHQWLQJ�WRRWK�GHFD\�DQG�JXP�GLVHDVH��2WKHU�VLPSOH�PHDVXUHV�DOVR�FRQWULEXWH�WR�PDLQWDLQLQJ�JRRG�RUDO�KHDOWK��HDWLQJ�D�KHDOWK\�GLHW�ORZ�LQ�VXJDU��DYRLGLQJ�VXJDU\�VQDFNV�EHWZHHQ�PHDOV��DQG�UHJXODU�GHQWDO�FKHFN�XSV�KHOS�WR�SUHYHQW� oral diseases.
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INTRODUCTION2UDO�GLVHDVHV�DUH�DPRQJ�WKH�PRVW�FRPPRQ�GLVHDVHV�RI�KXPDQNLQG��\HW�WKH\�UHFHLYH�OLWWOH�DWWHQWLRQ�LQ�PDQ\�FRXQWULHV�ZLWK�ZHDN�KHDOWK�FDUH�V\VWHPV��'HVSLWH�D�KLJK�VRFLDO�DQG�HFRQRPLF�EXUGHQ�IURP�RUDO�GLVHDVHV�WKH\�DUH�FRQVLGHUHG�D�QHJOHFWHG�DUHD�RI�LQWHUQDWLRQDO�KHDOWK��:RUOG�Oral Health Day provides an opportunity to increase DZDUHQHVV�RI�WKH�SRRU�VWDWH�RI�RUDO�KHDOWK�LQ�PDQ\�SODFHV� DQG�RHUV�DQ�RFFDVLRQ�WR�KLJKOLJKW�UHDOLVWLF�DQG�FRVW�HHFWLYH�VROXWLRQV�IRU�KHDOWK�FDUH�V\VWHPV�DQG� LQGLYLGXDOV�DOLNH�
WHAT IS ORAL HEALTH?2UDO�KHDOWK�LV�PRUH�WKDQ�GHQWDO�KHDOWK��,W�LQFOXGHV�KHDOWK\�JXPV��KDUG�DQG�VRIW�SDODWH��OLQLQJV�RI�WKH�PRXWK�DQG�WKURDW��WRQJXH��OLSV��VDOLYDU\�JODQGV��FKHZLQJ�PXVFOHV��DQG�XSSHU�DQG�ORZHU�MDZV��*RRG�RUDO�KHDOWK�HQDEOHV�XV�WR�VSHDN��VPLOH��NLVV��EUHDWKH��ZKLVWOH��VPHOO��WDVWH��GULQN��HDW��ELWH��FKHZ��VZDOORZ�DQG�H[SUHVV�IHHOLQJV��7KH�RUDO�FDYLW\�SOD\V�D�FHQWUDO�UROH�IRU�LQWDNH�RI�EDVLF�QXWULWLRQ�DQG�SURWHFWLRQ�DJDLQVW�PLFURELDO�LQIHFWLRQV��
7KH�:RUOG�+HDOWK�2UJDQL]DWLRQ��:+2��GH¿QHV�RUDO�KHDOWK�DV�³D�VWDWH�RI�EHLQJ�IUHH�IURP�PRXWK�DQG�IDFLDO�SDLQ��RUDO�and throat cancer, oral infection and sores, periodontal �JXP��GLVHDVH��WRRWK�GHFD\��WRRWK�ORVV��DQG�RWKHU�GLVHDVHV�DQG�GLVRUGHUV�WKDW�OLPLW�DQ�LQGLYLGXDO¶V�FDSDFLW\�LQ�ELWLQJ��FKHZLQJ��VPLOLQJ��VSHDNLQJ��DQG�SV\FKRVRFLDO�ZHOOEHLQJ´�>�@��2UDO�KHDOWK�LV�D�KXPDQ�ULJKW��DQ�LQWHJUDO�SDUW�RI�JHQHUDO�KHDOWK�DQG�HVVHQWLDO�IRU�RYHUDOO�ZHOOEHLQJ�>�@�
WHAT IS THE CONNECTION BETWEEN ORAL HEALTH AND GENERAL HEALTH? 2UDO�KHDOWK�DQG�JHQHUDO�KHDOWK�KDYH�FORVH�OLQNDJHV��2Q�WKH�RQH�KDQG��RUDO�KHDOWK�FDQ�EH�FRPSURPLVHG�E\�D�QXPEHU�RI�FKURQLF�DQG�LQIHFWLRXV�GLVHDVHV�ZKLFK�VKRZ�V\PSWRPV�LQ�WKH�PRXWK��2Q�WKH�RWKHU�KDQG��RUDO�GLVHDVHV�FDQ�OHDG�WR�LQIHFWLRQ��LQÀDPPDWLRQ��DQG�RWKHU�VHULRXV�LPSDFWV�RQ�RYHUDOO�KHDOWK��7KXV��PDLQWDLQLQJ�JRRG�RUDO�KHDOWK�LV�FUXFLDO�WR�VXVWDLQ�JHQHUDO�KHDOWK�DQG�YLFH�YHUVD�
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Oral bacteria are associated with infective endocarditis (inflammation of the heart’s inner lining).
THE MOUTH CAN REFLECT THE STATE OF GENERAL HEALTH. CONVERSELY, ORAL DISEASES CAN HAVE AN IMPACT ON GENERAL HEALTH.
Gum disease can be the starting point for noma.
Edentulousness (loss of teeth) within the elderly population results
in impaired ability to chew and can lead to malnutrition.
Dental infections
have been associated with higher increased risk for pneumonia.
The mouth may be a reservoir for bacteria associated
with stomach ulcers.
Gum disease
can complicate diabetes.
Oral bacteria are associatedwith infective arthritis.
Gum disease has been associated with higher risk of low-birthweight babies.
Gum disease has been associated with higher risk of pre-term babies.
Gum disease has been associated with higher risk of cardiovascular disease.
IMPACTS OF ORAL CONDITIONS ON GENERAL HEALTH
Figure 1: Impacts of oral conditions on
general health. [3]
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Leukaemia may result in oral ulcers.
Diabetes can result in delayed wound healing and worsening of gum disease.
Tetracycline antibiotic
use by pregnant mothers or children can result in an enamel
malformation and staining of the children’s teeth.
HIV / AIDS
often manifestsin the mouth.
Low blood sugar
level can be detected by acharacteristic odour.
Measles is usually detected by characteristicspots on the inner cheeks.
Tuberculosis
may show as a characteristic ulcer of the tongue surface
or other oral tissues.
Xerostomia
(dry mouth due to lack of saliva)results in rapid dental decay.
Tetanus infection mayresult in lockjaw.
Scurvy, a vitamin C deficiency,can result in swollen, bleeding
gums and tooth loss.
Down Syndrome often includes an enlarged tongue.
Drug abuse is often associated with severe caries and tooth loss.
Bulimia often causes characteristic tooth erosions (from gastric acid).
Various genetic syndromes cause malformation of teeth and jaws.
Stress and psychological disorders
can lead to grinding, clenching and TMJjoint problems.
Syphilis during pregnancy can result in characteristic tooth and palate malformation in the child.
IMPACTS OF SYSTEMIC DISEASE ON ORAL HEALTH
Figure 2: Impacts of systemic disease
on oral health. [3]
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Obesity
Cancers
Heart diseases
Respiratory diseases
Dental caries
Periodontal diseases
Oral diseases
Trauma
Bad Diet
Stress
Lack Of Control
Relates to individual’s capacity to influence their own living
and working condition.
Lack Of Hygiene
Smoking
COMMON RISK FACTORSCOMMON RISK FACTORS
Alcohol
Lack Of Exercise
Injuries
RISK FACTORS FOR IMPAIRED HEALTH
Figure 3. Common risk factor
approach to oral health. [3]
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WHAT ARE THE RISK FACTORS FOR ORAL DISEASES?
2UDO�GLVHDVHV�DUH�UHODWHG�WR�D�QXPEHU�RI�ULVN�IDFWRUV�DQG�GHWHUPLQDQWV�WKDW�DUH�FRPPRQ�WR�PDQ\�RWKHU�FKURQLF�diseases, particularly cardiovascular diseases, cancer, FKURQLF�UHVSLUDWRU\�GLVHDVHV�DQG�GLDEHWHV��0DMRU�ULVN�IDFWRUV�LQFOXGH�WREDFFR�XVH��KLJK�VXJDU�DQG�DOFRKRO�FRQVXPSWLRQ��DV�ZHOO�DV�EURDGHU�GHWHUPLQDQWV�VXFK�DV�VRFLR�HFRQRPLF�VWDWXV�ZKLFK�LQÀXHQFH�RUDO�DQG�JHQHUDO�KHDOWK��7KXV��D�FRPPRQ�DSSURDFK�WR�UHGXFH�DQG�SUHYHQW�WKHVH�ULVNV�ZLOO�QRW�RQO\�LPSURYH�RUDO�KHDOWK�EXW�ZLOO�DOVR�KDYH�D�YDVW�LPSDFW�RQ�WKH�JOREDO�EXUGHQ�RI�1&'V��KHDOWK�V\VWHPV�DQG�JHQHUDO�GHYHORSPHQW�SURJUHVV�
Sugar intake 7KHUH�LV�D�GLUHFW�OLQN�EHWZHHQ�WKH�TXDQWLW\�DQG�IUHTXHQF\�RI�VXJDU�FRQVXPSWLRQ�DQG�LQFUHDVHG�ULVN�IRU�WRRWK�GHFD\��W\SH���GLDEHWHV�DQG�REHVLW\��%DFWHULD�LQ�WKH�PRXWK�PHWDEROLVH�VXJDUV�LQWR�ODFWLF�DFLG�ZKLFK�FDXVHV�GHFD\�RI�WHHWK�WKURXJK�GHPLQHUDOL]DWLRQ�RYHU�WLPH�
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TOBACCO USE7REDFFR�XVH�LQ�DOO�IRUPV���EH�LW�VPRNHG��VXFNHG��FKHZHG�RU�VQXHG���LV�GDQJHURXV�IRU�RYHUDOO�KHDOWK�DQG�D�ULVN�IDFWRU�for oral diseases. It can lead to oral cancers, especially LQ�FRPELQDWLRQ�ZLWK�KLJK�DOFRKRO�FRQVXPSWLRQ��DQG�SHULRGRQWDO�GLVHDVHV��6PRNLQJ�GXULQJ�SUHJQDQF\�FDQ�DOVR�OHDG�WR�FRQJHQLWDO�GHIHFWV�VXFK�DV�FOHIW�OLS�DQG�SDODWH�LQ�FKLOGUHQ�ZLWK�ORQJ�WHUP�HHFWV�HLWKHU�IURP�WUHDWPHQW�RU�GHIRUPDWLRQ��,W�DHFWV�TXDOLW\�RI�OLIH�LQ�PDQ\�ZD\V�LQFOXGLQJ�EDG�EUHDWK��KDOLWRVLV��DQG�VWDLQLQJ��GHFUHDVHG�ZRXQG�KHDOLQJ��VXSSUHVVHG�LPPXQH�UHVSRQVH�WR�RUDO�LQIHFWLRQ��SURPRWLRQ�RI�JXP�GLVHDVH�LQ�GLDEHWLFV�DQG�KDV�DQ�DGYHUVH�DHFW�RQ�WKH�KHDUW�DQG�OXQJV��,W�LV�HVWLPDWHG�WKDW�RYHU�KDOI�WKH�FDVHV�RI�JXP�GLVHDVH�LQ�86$�DUH�FDXVHG�E\�VPRNLQJ�>�@�DQG�WKDW�����RI�FDQFHUV�RI�WKH�RUDO�FDYLW\�DUH�FDXVHG�E\�WREDFFR�XVH�>�@��
Low socio-economic status $V�ZLWK�JHQHUDO�KHDOWK��RUDO�KHDOWK�GHWHULRUDWHV�ZLWK�GHFUHDVLQJ�VRFLR�HFRQRPLF�VWDWXV��7KH�GLVSDULWLHV�DUH�YLVLEOH�DV�SHRSOH�DORQJ�D�GHFUHDVLQJ�VRFLDO�JUDGLHQW�YLVLW�WKH�GHQWLVW�OHVV�RIWHQ��KDYH�IHZHU�¿OOLQJV��PRUH�PLVVLQJ�WHHWK��KLJKHU�WREDFFR�FRQVXPSWLRQ��KLJKHU�UDWHV�RI�RUDO�FDQFHU��KLJKHU�UDWHV�RI�FDULHV�DQG�XQWUHDWHG�GHFD\��DQG�KLJKHU�UDWHV�RI�JXP�GLVHDVH�WKDQ�WKRVH�ZLWK�KLJKHU�VRFLR�HFRQRPLF�VWDWXV��7KHVH�GLHUHQFHV�DUH�VHHQ�ERWK�ZLWKLQ�and between countries.
EFFECTS OF TOBACCO USE ON ORAL HEALTH. [3]• Oral cancer.
�� 6PRNHU¶V�SDODWH� � �OHVLRQ�DW�URRI�RI�PRXWK��
• Periodontal diseases.
�� 3UHPDWXUH�WRRWK�ORVV�
�� *LQJLYLWLV�
�� 6WDLQLQJ�
• Bad breath (halitosis).
�� /RVV�RI�WDVWH�DQG�VPHOO�
Tobacco can lead to oral cancers,
especially in combination
with high alcohol consumption
14
WHAT IS THE BURDEN OF ORAL DISEASES?'HQWDO�FDULHV�LV�WKH�PRVW�FRPPRQ�FKLOGKRRG�GLVHDVH�DQG�1&'�ZRUOGZLGH��%HWZHHQ����DQG�����RI�FKLOGUHQ�DUH�DHFWHG�EXW�WKH�PDMRULW\�RI�GHQWDO�GHFD\�UHPDLQV�XQWUHDWHG�GXH�WR�LQDSSURSULDWH��XQDRUGDEOH�RU�unavailable oral health care services. Generally, rates DUH�KLJKHVW�LQ�PLGGOH�LQFRPH�FRXQWULHV�ZKHUH�VXJDU�FRQVXPSWLRQ�LV�LQFUHDVLQJ�ZKLOH�DFFHVV�WR�SUHYHQWLRQ� and care is low.
8QWUHDWHG�WRRWK�GHFD\�ZDV�WKH�PRVW�SUHYDOHQW�GLVHDVH�FRQGLWLRQ�DPRQJ�����GLVHDVHV�VWXGLHG�LQ�WKH�*OREDO�Burden of Disease Study (1990-2010). The burden of RUDO�FRQGLWLRQV�ZDV�IRXQG�WR�EH�FRPSDUDEOH�WR�PDQ\�1&'V��³LQFOXGLQJ�PDWHUQDO�FRQGLWLRQV��PLOG�K\SHUWHQVLYH�KHDUW�GLVHDVH��VFKL]RSKUHQLD�RU�WKH�WRWDOLW\�RI�KDHPRJORELQRSDWKLHV�DQG�KDHPRO\WLF�DQHPLDV´�>�@�
(VWLPDWLRQV�VKRZ�WKDW�DERXW�������RI�SRSXODWLRQV� DUH�DHFWHG�E\�VHYHUH�SHULRGRQWDO��JXP��GLVHDVHV�>�@�� 3HULRGRQWDO�GLVHDVHV�DUH�WKH�OHDGLQJ�FDXVH�IRU�WRRWK�ORVV��
2UDO�FDQFHU�LV�DPRQJ�WKH��th�PRVW�FRPPRQ�FDQFHUV�LQ�WKH�ZRUOG�DQG�UDQNV�DV�WKH�WKLUG�PRVW�FRPPRQ�LQ�6RXWK�$VLD��0HQ�VKRZ�KLJKHU�LQFLGHQFH�DQG�PRUWDOLW\�UDWHV�WKDQ�ZRPHQ�>�@��$ERXW���������QHZ�FDVHV�RI�RUDO�FDQFHU�ZHUH�GLDJQRVHG�LQ�������7KLV�QXPEHU�LV�H[SHFWHG�WR�ULVH�DV�WKH�PDLQ�ULVN�IDFWRUV��WREDFFR�XVH�DQG�DOFRKRO�FRQVXPSWLRQ��DUH�LQFUHDVLQJ�
7KH�:+2�HVWLPDWHV�DERXW���������SHRSOH�WR�EH�DHFWHG�E\�QRPD��FRQFHQWUDWLQJ�LQ�WKH�JHRJUDSKLF�UHJLRQV�RI�6XE�6DKDUDQ�$IULFD��$VLD�DQG�6RXWK�$PHULFD��1RPD�LV�D�GLV¿JXULQJ�JDQJUHQH�WKDW�UDSLGO\�VSUHDGV�DQG�GHVWUR\V�IDFLDO�VRIW�WLVVXH�DQG�ERQH��,W�LV�SULPDULO\�DVVRFLDWHG�ZLWK�SRYHUW\��SRRU�K\JLHQH��PDOQXWULWLRQ�DQG�FRPSURPLVHG�LPPXQLW\��0DLQO\�FKLOGUHQ�XS�WR�WKH�DJH�RI�VL[�\HDUV� VXHU�IURP�WKLV�GLVHDVH�DQG�LI�OHIW�XQWUHDWHG�LW�LV�IDWDO� LQ�����RI�FDVHV��
$ERXW�����RI�+,9�SRVLWLYH�SHRSOH�DUH�DHFWHG�E\�RUDO�IXQJDO��EDFWHULDO�RU�YLUDO�LQIHFWLRQV�UHVXOWLQJ�LQ�D�JURZLQJ�EXUGHQ�IRU�IUDJLOH�RUDO�KHDOWK�FDUH�V\VWHPV��2UDO�GLVHDVHV�UHODWHG�WR�+,9�$,'6�FDQ�LQFOXGH�RUDO�OHVLRQV�VXFK�DV�FDQGLGLDVLV�DQG�KHUSHWLF�XOFHUV�OHDGLQJ�WR�SDLQ��GLVFRPIRUW�DQG�D�FRQVWDQW�VRXUFH�RI�RSSRUWXQLVWLF�LQIHFWLRQV��7ZR�WKLUGV�RI�WKH�ZRUOG¶V�+,9�SRVLWLYH�FKLOGUHQ�and adults live in Sub-Saharan Africa [3], where access to RUDO�KHDOWK�FDUH�LV�VHYHUHO\�OLPLWHG��
80% or more 60%-79% 40% - 59% Fewer than 40% no dataPercentage of 6-19 year olds
with dental decay latest avalaible
1982-2007
World average: 70%Highest: Argentina 100%Lowest: Japan 16%
IMPACT OF ORAL DISEASES
DENTAL DECAY
CANADA
USA
MEXICOCUBA
HAITIJAMAICA
ECUADOR
BRAZIL
URUGUAYCHILE
BOLIVIA
ARGENTINA
PANAMACOSTA RICA
NICARAGUAHONDURAS
ST. & VICENT
UKIRELAND
NORWAY SWEDEN
ICELAND FINLAND
BARBADOS
GUYANATRINIDAD & TOBAGO
SIERRA LEONE
GHAN
ABE
NIN
GUINEA-BISSAU
CAPE VERDE SENEGAL
MOROCCOTUNISIA
LIBYA
NIGER
NIGERIA
DEMOCRATICREPUBLIC OF CONGO
ZAMBIA
NAMIBIA
SOUTH AFRICALESOTHO
MOZAMBIQUE
MADAGASCAR
MAURITIUS
SEYCHELLES
MALDIVES
SPAIN
FRANCE
GERMANYBELGIUM
NETHERLANDPOLAND
ESTONIALATVIA
LITHUANIABELARUS
UKRAINE
ITALYGRECE
BULGARIAROMANIA
AUSTRIA
PORTUGAL
BURUNDI TANZANIA
KENYA
ETHIOPIA
SUDAN YEMEN
SAUDI ARABIABAHRAIN
JORDAN
TURKEYCYPRUS LEBANON
ISRAEL
CHINA
MONGOLIA
JAPAN
MARSHALL ISLANDS
TONGA
SOUTH KOREA
AUSTRALIA
NEW ZEALAND
PAPUANEW GUINEA
MALAYSIA
SRI LANKA
MYANMAR
CAMBODIAVIETNAM
LAOSBANGLADESH
INDIA
NEPAL
PHILIPPINES
INDONESIA
BRUNEI
EGYPTOMAN
AFGHANISTAN
UZBEKISTAN
IRANKUWAIT
IRAQ
ZIMBABWE
GAMBIA
ANTIGUA & BARBUDA
Figure 4: World map of percentage of 6-19-year-olds with dental decay [3]
15
80% or more 60%-79% 40% - 59% Fewer than 40% no dataPercentage of 6-19 year olds
with dental decay latest avalaible
1982-2007
World average: 70%Highest: Argentina 100%Lowest: Japan 16%
IMPACT OF ORAL DISEASES
DENTAL DECAY
CANADA
USA
MEXICOCUBA
HAITIJAMAICA
ECUADOR
BRAZIL
URUGUAYCHILE
BOLIVIA
ARGENTINA
PANAMACOSTA RICA
NICARAGUAHONDURAS
ST. & VICENT
UKIRELAND
NORWAY SWEDEN
ICELAND FINLAND
BARBADOS
GUYANATRINIDAD & TOBAGO
SIERRA LEONE
GHAN
ABE
NIN
GUINEA-BISSAU
CAPE VERDE SENEGAL
MOROCCOTUNISIA
LIBYA
NIGER
NIGERIA
DEMOCRATICREPUBLIC OF CONGO
ZAMBIA
NAMIBIA
SOUTH AFRICALESOTHO
MOZAMBIQUE
MADAGASCAR
MAURITIUS
SEYCHELLES
MALDIVES
SPAIN
FRANCE
GERMANYBELGIUM
NETHERLANDPOLAND
ESTONIALATVIA
LITHUANIABELARUS
UKRAINE
ITALYGRECE
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16
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$V�ZLWK�FKURQLF�GLVHDVHV��WKH�SRRU�DQG�GLVDGYDQWDJHG�DUH�DHFWHG�GLVSURSRUWLRQDWHO\��3HRSOH�LQ�GHSULYHG�FRPPXQLWLHV��FHUWDLQ�HWKQLF�PLQRULWLHV��KRPHOHVV�SHRSOH��housebound or disabled individuals, children and the HOGHUO\�DUH�RIWHQ�QRW�VXFLHQWO\�FRYHUHG�E\�RUDO�KHDOWK�FDUH��,PSDLUHG�PRELOLW\��LQDGHTXDWH�SXEOLF�WUDQVSRUW��SHUFHLYHG�RU�UHDO�FRVW�RI�GHQWDO�WUHDWPHQW�DQG�SRRU�attitudes to oral health are further barriers to oral health FDUH�IRU�PDQ\��,OOQHVV�DQG�SRYHUW\�FDQ�KDYH�D�UHLQIRUFLQJ�HHFW�DQG�OHDG�WR�D�YLFLRXV�FLUFOH�ZKHUH�SRRU�SRSXODWLRQV�KDYH�D�KLJKHU�ULVN�RI�EHLQJ�DHFWHG�E\�GLVHDVH�ZLWK�OHVV�access to health care.
,QFUHDVLQJ�SULYDWLVDWLRQ�RI�RUDO�KHDOWK�VHUYLFHV�LQ�PDQ\�FRXQWULHV�DV�D�UHVXOW�RI�UHGXFHG�JRYHUQPHQW�VSHQGLQJ�LV�OLNHO\�WR�GHFUHDVH�WKH�DFFHVVLELOLW\�DQG�XQLYHUVDOLW\�RI�RUDO�KHDOWK�FDUH�DQG�PD\�LQFUHDVH�LQHTXDOLWLHV�
WHAT ARE THE ECONOMIC IMPACTS OF ORAL DISEASES? (YHQ�WKRXJK�PRVW�RUDO�GLVHDVHV�DUH�SUHYHQWDEOH��DOPRVW�HYHU\RQH�LV�OLNHO\�WR�EH�DHFWHG�GXULQJ�WKH�OLIHWLPH��2UDO�GLVHDVHV�KDYH�D�VLJQL¿FDQW�LPSDFW�RQ�WKH�TXDOLW\�RI�OLIH�RI�LQGLYLGXDOV��WKHLU�SDUWLFLSDWLRQ�LQ�VRFLHW\�DQG�HFRQRPLF�SURGXFWLYLW\�DV�ZHOO�DV�RQ�KHDOWK�V\VWHPV��PDNLQJ�RUDO�GLVHDVHV�D�VLJQL¿FDQW�SXEOLF�KHDOWK�FRQFHUQ��
(YHQ�WKRXJK�WKHUH�LV�QR�FRPSUHKHQVLYH�GDWD�RQ�HFRQRPLF�FRVWV�RI�RUDO�GLVHDVHV�JOREDOO\��WKH�:+2�HVWLPDWHV�WKDW�WKH\�DUH�WKH�IRXUWK�PRVW�H[SHQVLYH�FRQGLWLRQ�WR�WUHDW�±�LI�D�FXUDWLYH�DSSURDFK�LV�WDNHQ��UDWKHU�WKDQ�D�IRFXV�RQ�SUHYHQWLRQ��7KH�H[SHQGLWXUH�RQ�GHQWDO�FDUH�DV�SHUFHQWDJH�RI�WRWDO�KHDOWK�H[SHQGLWXUH�LV�RIWHQ�ORZHU�WKDQ����DQG�FDQ�JR�DV�ORZ�DV������LQ�0RQJROLD�FRPSDUHG�WR����LQ�WKH�8QLWHG�6WDWHV��ZKLFK�VSHQW�PRUH�WKDQ�86������ELOOLRQ�RQ�oral health care in 2009).
,Q�DGGLWLRQ�WR�GLUHFW�H[SHQVHV�IRU�FXUDWLYH�WUHDWPHQW��indirect costs caused by poor concentration and absence GXH�WR�RUDO�GLVHDVH��UHVXOW�LQ�PLOOLRQV�RI�VFKRRO�DQG�ZRUN�KRXUV�WR�EH�ORVW�DQQXDOO\�DFURVV�WKH�ZRUOG�ZLWK�QHJDWLYH�ORQJ�WHUP�HFRQRPLF�LPSDFW�KDPSHULQJ�LQGLYLGXDO�DQG�VRFLHWDO�SURJUHVV�DQG�GHYHORSPHQW��,Q�������RUDO�GLVHDVHV�UHVXOWHG�LQ�����PLOOLRQ�GD\V�RI�ZRUN�DQG�����PLOOLRQ�GD\V�RI�VFKRRO�ORVW�LQ�WKH�8QLWHG�6WDWHV��,Q�7KDLODQG��������KRXUV�school were lost per 1,000 children in 2008 due to dental SUREOHPV�>�@��
WHAT ARE THE INEQUALITIES AND DISPARITIES IN ORAL HEALTH? ,Q�JHQHUDO��DOPRVW�DOO�IXQFWLRQV�RI�D�KHDOWK\�GHQWLWLRQ�FDQ�EH�UHVWRUHG�ZLWK�PRGHUQ�WUHDWPHQW�PHWKRGV��+LJK�LQFRPH�FRXQWULHV�KDYH�DGYDQFHG�RUDO�KHDOWK�V\VWHPV�WKDW�RHU�preventive and curative services to patients. A decline in FDULHV�KDV�EHHQ�REVHUYHG�>�@�DV�D�UHVXOW�RI�SXEOLF�KHDOWK�PHDVXUHV�LQFOXGLQJ�WKH�HHFWLYH�XVH�RI�ÀXRULGHV��FKDQJLQJ�OLYLQJ�FRQGLWLRQV��OLIHVW\OHV�DQG�LPSURYHG�VHOI�FDUH�practices. However, advances in oral health science have QRW�\HW�EHQH¿WWHG�SRRU�DQG�GLVDGYDQWDJHG�SRSXODWLRQV�worldwide. Widespread inequalities and disparities UHPDLQ�ERWK�ZLWKLQ�DQG�EHWZHHQ�FRXQWULHV�
In low and middle-income countries, but also in a number of high-income countries, the treatment of oral diseases UHPDLQV�XQDRUGDEOH�RU�inaccessible for large segments of society.
17
Renal, oral and eye diseases pose a major health burden for many countries and [...] these diseases share common ULVN�IDFWRUV�DQG�FDQ�EHQH¿W�from common responses to noncommunicable diseases.
WHY ARE ORAL DISEASES NEGLECTED INTERNATIONALLY?'HVSLWH�WKH�PDJQLWXGH�RI�RUDO�GLVHDVHV�DQG�WKHLU�V\VWHPLF�OLQNDJHV�ZLWK�RWKHU�LOOQHVVHV��RUDO�KHDOWK�LV�FRPPRQO\�QHJOHFWHG�LQ�WKH�SROLWLFDO�GHYHORSPHQW�DUHQD��7KLV�ZLGH�disconnection between the international health discourse DQG�WKH�DUHD�RI�JOREDO�RUDO�KHDOWK�LV�UHODWHG�WR�D�VHW�RI�FRPSOH[�XQGHUO\LQJ�LVVXHV��$PRQJ�WKHVH�DUH�WKH�ODFN�LQ�GH¿QLQJ�DQG�HVWDEOLVKLQJ�WKH�QHJOHFW�RI�JOREDO�RUDO�KHDOWK�DV�D�SUREOHP�DQG�WKH�OLPLWHG�DYDLODELOLW\�RI�FRPSUHKHQVLYH�DQG�UHOLDEOH�GDWD�RQ�RUDO�GLVHDVHV�RQ�D�JOREDO�VFDOH�EDVHG�RQ�UHFRJQLVHG�LQGLFDWRUV��,Q�DGGLWLRQ��LQVXFLHQW�DOLJQPHQW�RI�DFWRUV�LQ�WKH�¿HOG�RI�JOREDO�RUDO�KHDOWK�LV�DW�WKH�FRUH�RI�WKH�SUREOHP�ZKLFK�LV�DOVR�OHDGLQJ�WR�D�ODFN�RI�concerted action and advocacy in the political arena [9].
$JDLQVW�WKLV�EDFNGURS��WKH�UHFHQW�8QLWHG�1DWLRQV�3ROLWLFDO�'HFODUDWLRQ�RQ�3UHYHQWLRQ�DQG�&RQWURO�RI�1RQFRPPXQLFDEOH�'LVHDVHV��1&'V��DGRSWHG�E\�KHDGV�RI�VWDWH�GXULQJ�D�+LJK�OHYHO�0HHWLQJ�RI�WKH�81�*HQHUDO�$VVHPEO\�LQ�1HZ�<RUN�LQ�6HSWHPEHU������ZDV�D�ELJ�VWHS�IRUZDUG�VLQFH�LW�UHFRJQLVHG�RUDO�GLVHDVHV�DV�VLJQL¿FDQW�SXEOLF�KHDOWK�SUREOHPV�IRU�WKH�¿UVW�WLPH�>��@��,Q�DUWLFOH����RI�WKH�'HFODUDWLRQ��0HPEHU�6WDWHV�UHFRJQL]H�WKDW��³UHQDO��RUDO�DQG�H\H�GLVHDVHV�SRVH�D�PDMRU�KHDOWK�EXUGHQ�IRU�PDQ\�FRXQWULHV�DQG�WKDW�WKHVH�GLVHDVHV�VKDUH�FRPPRQ�ULVN�IDFWRUV�DQG�FDQ�EHQH¿W�IURP�FRPPRQ�UHVSRQVHV�WR�QRQFRPPXQLFDEOH�GLVHDVHV´�>��@� The 3ROLWLFDO�'HFODUDWLRQ�WKXV�LQWHJUDWHV�RUDO�GLVHDVHV�LQWR�WKH�international health discourse and underlines the need for JRYHUQPHQWV�DQG�WKH�LQWHUQDWLRQDO�KHDOWK�FRPPXQLW\�WR�VWUHQJWKHQ�WKHLU�HRUWV�WR�WDFNOH�1&'V�LQFOXGLQJ�WKH�RUDO�GLVHDVH�EXUGHQ�E\�LQWHJUDWHG�DQG�LQWHUVHFWRUDO�DSSURDFKHV�WRJHWKHU�ZLWK�1&'V��7KLV�ZLQGRZ�RI�RSSRUWXQLW\�QHHGV�WR�EH�XWLOL]HG�WR�FUHDWH�PRPHQWXP�DQG�FRQVWUXFWLYH�GLDORJXH�WR�LPSURYH�RUDO�KHDOWK�
HOW DOES ORAL HEALTH RELATE TO THE MILLENNIUM DEVELOPMENT GOALS?2UDO�KHDOWK�DQG�0LOOHQQLXP�'HYHORSPHQW�*RDOV��0'*V��DUH�FORVHO\�OLQNHG��7KH�0'*V�SURYLGH�D�FRQFHSWXDO�IUDPHZRUN�IRU�DGYRFDF\��IXQGLQJ�RSSRUWXQLWLHV�and action which cut across sectors and professions. ,PSURYLQJ�RUDO�KHDOWK�FDQ�FRQWULEXWH�WR�DFKLHYLQJ�WKH�0'*V��ZKLFK�DLP�DW�DGGUHVVLQJ�JOREDO�VRFLDO�DQG�HFRQRPLF�FRQGLWLRQV�E\�WKH�\HDU������
“Political Declaration on Prevention and Control of Noncommunicable Diseases, UN High-level Meeting of the UN General Assembly, Paragraph 19:”
18
WHAT IS THE RELATIONSHIP BETWEEN ORAL HEALTH AND……extreme poverty and hunger (MDG1)?3DLQ�DQG�GLVFRPIRUW�IURP�FDYLWLHV��WRRWKOHVVQHVV�DQG�PDOIRUPDWLRQ�FDQ�DHFW�WKH�DELOLW\�RI�DQ�LQGLYLGXDO�to chew and to obtain adequate nutrition, which, in WXUQ��DHFWV�WKH�LPPXQH�UHVSRQVH�DQG�WKH�DELOLW\�WR�¿JKW�GLVHDVH��,QFRPH�ORVW�GXH�WR�DEVHQFH�IURP�ZRUN�DQG�UHGXFHG�HGXFDWLRQDO�DWWDLQPHQWV�EHFDXVH�RI�GHQWDO�SUREOHPV�DQG�RWKHU�GLVHDVHV�FDQ�EH�VLJQL¿FDQW��DQG�WKH�cost (real or perceived) of dental care is a barrier to access IRU�PDQ\��
…primary education (MDG2)?7RRWK�GHFD\�LV�WKH�PRVW�FRPPRQ�FKLOGKRRG�GLVHDVH�DQG�WKH�UHVXOWLQJ�WRRWKDFKH�FRQWULEXWHV�WR�KXJH�QXPEHUV�RI�GD\V�PLVVHG�IURP�VFKRRO��&KLOGUHQ�RIWHQ�EHDU�SDLQ�UHVXOWLQJ�LQ�ORVV�RI�FRQFHQWUDWLRQ��WLUHGQHVV�DQG�SRRU�SHUIRUPDQFH�DW�school.
…gender equality and the empowerment of women? (MDG3)?7KH�HGXFDWLRQ�RI�ZRPHQ�ZLOO�VXSSRUW�SURJUHVV�LQ�SUHYHQWLQJ�RUDO�GLVHDVHV�DQG�LOO�KHDOWK�LQ�FKLOGUHQ�DV�PRWKHUV�RUDO�KHDOWK�VWDWXV�LV�D�GHWHUPLQDQW�RI�FKLOG�RUDO�KHDOWK��$V�ZRPHQ�DUH�RIWHQ�SULPDU\�FDUHWDNHUV�PRWKHUV��FDQ�EH�PRUH�SURGXFWLYH�DQG�KDYH�PRUH�WLPH�IRU�RWKHU�DFWLYLWLHV�LI�FKLOGUHQ�DUH�KHDOWK\��$OVR��DV�ZRPHQ�KDYH�ORQJHU�OLIH�H[SHFWDQF\��JRRG�RUDO�KHDOWK�WKURXJKRXW�WKH�HQWLUH�OLIHVSDQ�EHFRPHV�PRUH�LPSRUWDQW����
…child mortality (MDG4)?'HQWDO�LQIHFWLRQ�DQG�KDUPIXO�WUDGLWLRQDO�SUDFWLFHV�DV�well as low-quality oral health care can lead to death. 7KH�JDQJUHQRXV�RURIDFLDO�GLVHDVH�QRPD�PDLQO\�DHFWV�FKLOGUHQ�DQG�LV�RIWHQ�IDWDO��7KH�NH\�ULVN�IDFWRU�IRU�QRPD�LV�SRYHUW\��WKH�GLVHDVH�GHYHORSV�LQ�FRQGLWLRQV�RI�PDOQXWULWLRQ�DQG�JURZWK�UHWDUGDWLRQ��XQVDIH�GULQNLQJ�water, poor sanitary practices and infectious diseases VXFK�DV�PHDVOHV��PDODULD��GLDUUKRHD��SQHXPRQLD��WXEHUFXORVLV�DQG�+,9�$,'6���
…maternal health (MDG5)?3RRU�PDWHUQDO�RUDO�KHDOWK�PD\�UHVXOW�LQ�ORZ�ELUWKZHLJKW�EDELHV�DQG�SRRU�RUDO�DQG�JHQHUDO�KHDOWK�LQ�FKLOGUHQ��,PSURYLQJ�WKH�RUDO�KHDOWK�RI�ZRPHQ�ZLOO�LPSDFW�XSRQ�WKHLU�JHQHUDO�KHDOWK�DQG�WKH�KHDOWK�RI�WKHLU�IDPLOLHV��
...HIV/AIDS, malaria and other diseases (MDG6)?
$ERXW���±����RI�SHRSOH�ZLWK�+,9�KDYH�RUDO�IXQJDO��bacterial or viral infections which often present early in the course of the disease and these can serve as early LQGLFDWRUV�RI�+,9�LQIHFWLRQ��'U\�PRXWK�GXH�WR�GHFUHDVHG�saliva production contributes to tooth decay. Cross-LQIHFWLRQ�FRQWURO�LV�YLWDO�WR�DYRLG�WUDQVPLVVLRQ�RI�GLVHDVHV�GXULQJ�GHQWDO�WUHDWPHQW���
2UDO�GLVHDVHV�VKDUH�WKH�VDPH�ULVN�IDFWRUV�DV�PDQ\�QRQFRPPXQLFDEOH�GLVHDVHV�DQG�SUHYHQWLRQ�ZLOO�VDYH�OLYHV���
…environmental sustainability (MDG7)?$SSURSULDWH�WHFKQRORJ\��HHFWLYH�LQIHFWLRQ�FRQWURO�DQG�VDIH�GLVSRVDO�RI�PHGLFDO�ZDVWH�DOO�FRQWULEXWH�WR�HQYLURQPHQWDO�VXVWDLQDELOLW\��3URSHU�VDQLWDWLRQ�IDFLOLWLHV�DQG�FOHDQ�ZDWHU�HQDEOHV�JHQHUDO�KHDOWK�DQG�RUDO�KHDOWK�PDLQWHQDQFH���
…a global partnership for development (MDG8)?3DUWQHUVKLSV�SURPRWLQJ�RUDO�KHDOWK�DPRQJ�NH\�VWDNHKROGHUV�DUH�SLYRWDO��$FFHVV�WR�HVVHQWLDO�PHGLFLQHV��EDVLF�RUDO�FDUH�DQG�SUHYHQWLRQ�WKURXJK�ÀXRULGH�ZLOO�LPSURYH�TXDOLW\�RI�OLIH�DQG�UHGXFH�WKH�EXUGHQ�RI�RUDO�GLVHDVH��HVSHFLDOO\�LQ�FKLOGUHQ�ZLWKLQ�GLVDGYDQWDJHG�populations [12].
HOW CAN ORAL HEALTH BE IMPROVED?2UDO�KHDOWK�FDQ�EH�LPSURYHG�ZLWK�D�QXPEHU�RI�VWUDWHJLHV�DQG�HRUWV�EDVHG�RQ�FROODERUDWLYH�DQG�LQWHUVHFWRUDO�DSSURDFKHV��0RVW�LPSRUWDQWO\��RUDO�KHDOWK�QHHGV�WR�EH�LQWHJUDWHG�LQWR�DSSURDFKHV�WR�LPSURYH�JHQHUDO�KHDOWK�DQG�to prevent and control NCDs.
19
STRATEGIES FOR IMPROVING ORAL HEALTH ALSO INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING [13].
Prevention of oral disease and promotion of oral health$V�FXUDWLYH�WUHDWPHQWV�DUH�QHLWKHU�D�UHDOLVWLF�QRU�D�sustainable approach to address the burden of oral diseases, SUHYHQWLRQ�RI�RUDO�GLVHDVHV�DQG�SURPRWLRQ�RI�RUDO�KHDOWK�PXVW�EH�DW�WKH�FRUH�RI�QDWLRQDO�SROLFLHV�DQG�SURJUDPPHV��7KLV�LQFOXGHV�UHGXFLQJ�ULVN�IDFWRUV�RI�RUDO�GLVHDVHV�DQG�WKHLU�DVVRFLDWHG�GHWHUPLQDQWV�DV�ZHOO�DV�VWUHQJWKHQLQJ�DZDUHQHVV�of healthy behaviours and health literacy.
8QLYHUVDO�DFFHVV�WR�DRUGDEOH�DQG�HHFWLYH�ÀXRULGH([SRVXUH�WR�ÀXRULGH�LV�WKH�VLQJOH�PRVW�FRVW�HHFWLYH�PHDVXUH�WR�SUHYHQW�WRRWK�GHFD\�DQG�LPSURYH�RUDO�KHDOWK��5HJXODU�XVH�RI�ÀXRULGH�WRRWKSDVWH�LV�WKH�PRVW�LPSRUWDQW�ZD\�WR�HQVXUH�D�JRRG�SUHYHQWLYH�HHFW�
Human resources for oral health and public oral health7KH�WUDLQLQJ�RI�WKH�RUDO�KHDOWK�ZRUNIRUFH�QHHGV�WR�EH�VWUHQJWKHQHG�DQG�H[SDQGHG�WR�LPSURYH�WKH�TXDOLW\�DQG�LQFUHDVH�WKH�QXPEHU�RI�RUDO�KHDOWK�SURIHVVLRQDOV��(PSKDVLV�QHHGV�WR�EH�SXW�RQ�WKH�HTXDO�JHRJUDSKLFDO�GLVWULEXWLRQ�RI�RUDO�health personnel within countries.
Integration of oral health care into Primary Health Care2UDO�KHDOWK�FDUH�WKDW�UHOLHV�RQ�D�WHFKQRORJ\�IRFXVHG�FXUDWLYH�DSSURDFK�LV�XQUHDOLVWLF�IRU�PDQ\�ORZ�DQG�PLGGOH�LQFRPH�FRXQWULHV��7R�DFKLHYH�HTXLW\�LQ�RUDO�KHDOWK�FDUH��HVVHQWLDO�RUDO�KHDOWK�FDUH�PHDVXUHV�QHHG�WR�EH�LQWHJUDWHG�LQ�3ULPDU\�+HDOWK�&DUH�LQFOXGLQJ�UHOLHI�RI�SDLQ��SURPRWLRQ�RI�RUDO�KHDOWK�DQG�PDQDJHPHQW�RI�RUDO�GLVHDVHV�DQG�conditions.
Oral health information-surveillance, monitoring and evaluation*OREDO�DQG�QDWLRQDO�VXUYHLOODQFH�VKRXOG�EH�VWUHQJWKHQHG�WR�LGHQWLI\�ULVN�IDFWRUV�DQG�RUDO�KHDOWK�QHHGV�DV�D�EDVLV�IRU�GHYHORSLQJ�DSSURSULDWH�DSSURDFKHV�DQG�PHDVXUHV��0RQLWRULQJ�DQG�HYDOXDWLRQ�DUH�FULWLFDO�IRU�HQVXULQJ�WKH�HHFWLYHQHVV�DQG�VXVWDLQDELOLW\�RI�LQWHUYHQWLRQV��([LVWLQJ�HRUWV�VKRXOG�EH�VWUHQJWKHQHG�DQG�H[WHQGHG�
INTEGRATING ORAL HEALTH IN SCHOOL HEALTH - THE FIT FOR SCHOOL APPROACH7KH�3KLOLSSLQH�'HSDUWPHQW�RI�(GXFDWLRQ��VXSSRUWHG�E\�WKH�*HUPDQ�'HYHORSPHQW�&RRSHUDWLRQ��*,=���WKH�3KLOLSSLQH�1*2�)LW�IRU�6FKRRO�,QF��DQG�RWKHU�partners initiated the Essential Health Care 3URJUDP��(+&3��LQ�SXEOLF�HOHPHQWDU\�VFKRROV��7KH�SURJUDP�LV�EDVHG�RQ�WKH�)LW�IRU�6FKRRO�$SSURDFK�DQG�LQWHJUDWHV�WKUHH�HYLGHQFH�EDVHG�SUHYHQWLRQ�PHDVXUHV�IRU�WKH�PRVW�SUHYDOHQW�FKLOGKRRG�GLVHDVHV��VRLO�WUDQVPLWWHG�LQWHVWLQDO�ZRUP�LQIHFWLRQV��K\JLHQH�related diseases such as diarrhea and respiratory LQIHFWLRQV��DQG�UDPSDQW�WRRWK�GHFD\�
7KH�SURJUDP�LPSOHPHQWV�WKUHH�VFKRRO�KHDOWK�DFWLYLWLHV�UXQ�E\�WHDFKHUV�
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7KH�(+&3�LV�FXUUHQWO\�UHDFKLQJ�DERXW���PLOOLRQ�FKLOGUHQ�LQ�WKH�3KLOLSSLQHV��&DPERGLD��,QGRQHVLD�DQG�/DR�3'5��0DWHULDO�FRVWV�DYHUDJH������86'�FKLOG�\HDU��$RUGDELOLW\�LQFUHDVHV�SUREDELOLW\�WKDW�WKLV�SURJUDP�FDQ�EH�LQWHJUDWHG�LQ�WKH�UHJXODU�JRYHUQPHQW�EXGJHWV�HYHQ�LQ�UHVRXUFH�SRRU�FRXQWULHV��WKXV�HQVXULQJ�VXVWDLQDELOLW\�EH\RQG�LQLWLDO�start-up costs.
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Funding and policies based on oral health prioritiesOral health policies and action plans need to be developed DQG�PDLQWDLQHG�QDWLRQDOO\�DQG�ORFDOO\�UHÀHFWLQJ�WKH�SDUWLFXODU�RUDO�KHDOWK�QHHGV��%DVHG�RQ�VROLG�GDWD�IURP�IXQFWLRQLQJ�VXUYHLOODQFH�DQG�PRQLWRULQJ�V\VWHPV�WKH\�QHHG�WR�EH�LQWHJUDWHG�LQ�JHQHUDO�KHDOWK�DSSURDFKHV�DQG�DLPHG�DW�UHGXFLQJ�LQHTXDOLWLHV�DQG�GLVSDULWLHV��%DVLF�DQG�HVVHQWLDO�HPHUJHQF\�FDUH�VKRXOG�EH�LQFOXGHG�LQ�EHQH¿W�SDFNDJHV�RI�VRFLDO�KHDOWK�LQVXUDQFHV�WR�JXDUDQWHH�XQLYHUVDO�DFFHVV�IRU�DOO�
20
IMPROVING AND PROTECTING ORAL HEALTH - KEY MESSAGES FOR PATIENTS. [3]
Adults, adolescents and children
�� ,PSURYH�H[SRVXUH�WR�ÀXRULGH��� � � �� EUXVK�WHHWK�WZLFH�GDLO\�XVLQJ�ÀXRULGH�� � � toothpaste and use other sources of � ÀXRULGH��L�H��IURP�ÀXRULGDWHG�VDOW�� � �� PRXWK�ULQVH�RU�ZDWHU��
• Children should brush their teeth � WZLFH�D�GD\�ZLWK�D�SHD�VL]HG�DPRXQW� � RI��ÀXRULGH�WRRWKSDVWH��
�� (QMR\�KHDOWK\�IRRG�DQG�EHYHUDJHV�� � �� DQG�OLPLW�FRQVXPSWLRQ�DQG�IUHTXHQF\�� � �� RI�VXJDU\�IRRG�DQG�GULQNV��HVSHFLDOO\�� � �� EHWZHHQ�PHDOV�
�� &KHZ�VXJDU�IUHH�JXP�DIWHU�PHDOV� � DQG�VQDFNV�
• Reduce or quit tobacco and alcohol use.
�� 3URWHFW�WHHWK�E\�ZHDULQJ�D�PRXWK�� � �� JXDUG�DQG�D�KHOPHW�GXULQJ�� � � � contact and accident-prone sports and transportation.
�� 6HH�D�GHQWLVW�RU�GRFWRU�IRU�UHJXODU�� � �� FKHFN�XSV�IRU�RUDO�GLVHDVHV�DQG�VLJQV� � RI�LPSDLUHG�JHQHUDO�KHDOWK�
�� %H�YLJLODQW�LI�\RX�KDYH�SDLQ��VRUHV�� � �SDWFKHV�RU�XQXVXDO�EOHHGLQJ�LQ�\RXU� � PRXWK�WKDW�ODVWV�IRU�WZR�ZHHNV�RU�PRUH�� �� ±�JHW�DGYLFH�IURP�D�GHQWLVW�
�� 8VH�VXJDU�IUHH�PHGLFLQHV� where possible.
�� 6XSSRUW�DQG�HQJDJH�LQ�FRPPXQLW\�� � �� DFWLYLWLHV�WR�SURPRWH�RUDO�KHDOWK�
School oral health
6FKRROV�DQG�SUH�VFKRROV�DUH�LGHDO�VHWWLQJV�WR�SURPRWH�RUDO�KHDOWK��WKH\�UHDFK�FKLOGUHQ�DQG�\RXQJ�SHRSOH�DW�D�UHFHSWLYH�DJH�DQG�FDQ�KHOS�LQ�GHYHORSLQJ�OLIHORQJ�KHDOWK\�EHKDYLRXUV��6XSSRUWLYH�VFKRRO�SROLFLHV��WKH�SK\VLFDO�HQYLURQPHQW�DQG�VNLOOV�EDVHG�KHDOWK�HGXFDWLRQ�DUH�HVVHQWLDO�LQ�PDLQWDLQLQJ�RUDO�KHDOWK�DQG�WKH�FRQWURO�RI�ULVN�EHKDYLRXUV��6FKRROV�FDQ�DOVR�SURYLGH�D�SODWIRUP�IRU�WKH�SURYLVLRQ�RI�RUDO�KHDOWK�FDUH�if resources allow.
Integration of oral health into public health programmesNational public health initiatives for the control and prevention of oral disease need to include oral health SURPRWLRQ�DQG�LQWHJUDWHG�GLVHDVH�SUHYHQWLRQ�VWUDWHJLHV�EDVHG�RQ�FRPPRQ�ULVN�IDFWRU�DSSURDFKHV�>��@��3XEOLF�KHDOWK�SROLFLHV�DQG�KHDOWK�SURPRWLRQ�SOD\�DQ�LPSRUWDQW�UROH�WR�KHOS�LQGLYLGXDOV�PDNH�KHDOWK\�LQIRUPHG�FKRLFHV�IRU�SUHYHQWLQJ�RUDO�GLVHDVH��0HDVXUHV�LQFOXGH�EXW�DUH�QRW�OLPLWHG�WR� WKH�IROORZLQJ�
21
Children should brush their teeth twice a dayZLWK�D�SHD�VL]HG�DPRXQWRI�ÀXRULGH�WRRWKSDVWH
22
CONCLUSION2UDO�KHDOWK�LV�LQWHJUDO�WR�JHQHUDO�KHDOWK�DQG�D�EDVLF�KXPDQ�ULJKW��&RQFHUWHG�DQG�FROODERUDWLYH�DFWLRQ�QHHGV�WR�EH�PRELOL]HG��PDLQWDLQHG�DQG�VWUHQJWKHQHG�>��@�WR�DGGUHVV�WKH�KLJK�EXUGHQ�RI�RUDO�GLVHDVH�DQG�WKH�YDVW�LQHTXLWLHV�LQ�DFFHVV�WR�RUDO�KHDOWK�FDUH�H[LVWLQJ�ZLWKLQ�DQG�EHWZHHQ�FRXQWULHV��7KH�LQWHJUDWLRQ�RI�RUDO�KHDOWK�LQWR�JHQHUDO�health approaches, especially the control and prevention RI�1&'V�LV�D�UHDOLVWLF�RSSRUWXQLW\�WR�UDLVH�WKH�SUR¿OH�RI�RUDO�KHDOWK�DQG�WR�HQG�WKH�LQWHUQDWLRQDO�QHJOHFW�RI� oral diseases.
23
10. Benzian H, Bergman M, Cohen L, Hobdell M, Mackay J. The UN High-level meeting on prevention and control RI�QRQ�FRPPXQLFDEOH�GLVHDVHV�DQG�LWV�VLJQL¿FDQFH�IRU�RUDO�health worldwide. J Pub Health Dent. 2012;72:91-93.
11. UN General Assembly. Political Declaration o of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases. 24 January 2012. Available at: www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf.
12. World Health Organization, FDI World Dental Federation and International Association for Dental Research. Global Consultation on Oral Health through Fluoride. 17–19 November 2006, Geneva, Switzerland/Ferney-Voltaire, France. Available at: www.who.int/oral_health/events/oral%20healthc.pdf.
13. FDI, WHO, ADEA, ADA, WHO PAHO, IFDEA, IADR, AADR, AAPD. Oral Health – Integration and Collaboration. Testimony for the 2005 Global Health Summit, Philadelphia, Pennsylvania, June 5, 2005.
14. Monse B, Benzian H, Araojo J, Holmgren C, van Palenstein Helderman W, Naliponguit EC, Heinrich-Weltzien R. A Silent Public Health Crisis: Untreated Caries and Dental Infections Among 6- and 12-Year-Old Children in the Philippine National Oral Health Survey 2006. Asia Pac J Public Health 2012 Dec 13 (Epub ahead of print).
15. Petersen PE, Ogawa H. The global burden of periodontal disease: towards integration with chronic disease prevention and control. Periodontol 2000 2012;60:15–39.
16. Glick M, Monteiro da Silva O, Seeberger GK et al. FDI Vision 2020: shaping the future of oral health. Int Dent J 2012 62: 278–91.
For more information contact:FDI World Dental Federation Avenue Louis Casai 51 Case Postale 3 1216 Cointrin – Genève Switzerland+41 22 560 [email protected]
FDI wishes to thank Habib Benzian for contributing to the development of this document.
REFERENCES1. World Health Organization. Oral Health. Fact sheet no 318. April 2012. Available at: www.who.int/mediacentre/factsheets/fs318/en/index.htm.
2. World Health Organization. The Liverpool Declaration: Promoting Oral Health in the 21st Century. A call for action. September 2005. Available at: www.who.int/oral_health/events/orh_liverpool_declaration_05.pdf.
3. Beaglehole R, Benzian H, Crail J, et al. The Oral Health Atlas. Mapping a neglected global health issue. FDI World Dental Federation, Geneva, 2009.
4. Tomar SL, Asma S. Smoking-attributable periodontitis LQ�WKH�8QLWHG�6WDWHV��¿QGLQJV�IURP�1+$1(6�,,,��1DWLRQDO�Health and Nutrition Examination Survey. J Periodontol 2000;71:743–751.
5. Petersen PE, Bourgeois D, Ogawa H, et al. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661–669.
6. Marcenes W, Kassebaum NJ, Bernabe E, Flaxman A, Naghavi M, Lopez A, Murray CJ. Global Burden of Oral Conditions in 1990-2010: A Systematic Analysis. J Dent Res 2013;92:592-597.
7. World Health Organization. Global Data on Incidence of Oral Cancer. Geneva, Switzerland 2005. Available at: http://www.who.int/oral_health/publications/oral_cancer_brochure.pdf.
8. World Health Organization. Human Genetics Programme. International Collaborative Research on Craniofacial Anomalies. Available at: http://www.who.int/genomics/anomalies/en/Chapter02.pdf.
9. Benzian H, Hobdell M, Holmgren C, Yee R, Monse B, Barnard JT, van Palenstein Helderman W. Political priority of global oral health: an analysis of reasons for international neglect. Int Dent J 2011;61:124-130.
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FDI World Dental Federation Avenue Louis Casai 51 Case Postale 3 1216 Cointrin – Genève Switzerland+41 22 560 8150
[email protected] www.fdiworldental.org