Oral Health: Prevention Is Key

Main Category: Dentistry
Article Date: 02 Jan 2009 - 2:00 PDT

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At this time of year, when many people may have consumed much more food and sugary drink than usual, the lead Editorial in this week's Lancet is dedicated to oral health and its neglect.

Because oral health is rarely life threatening, it can be a low priority for national governments - and teeth can be seen as expendable. Dentists have taken little interest in advocacy to promote good oral health, preferring to treat rather than prevent oral diseases. Yet tooth decay (dental caries) is one of the most prevalent health problems worldwide, with some 90% of people having had dental problems or toothache caused by this condition. In low-to-middle income countries, much tooth decay goes untreated. Severe periodontitis* affects 5-15% of most populations, and oral cancer is the eighth most common cancer worldwide and the most common in men in southeast Asia.

The dental healthcare workforce is spread unevenly through the world. While countries such as the UK and Germany have a dentist for every 1000 people, low-income and middle-income countries can have as few as one for every 50,000 population and in sub-Saharan Africa this ratio is close to one for every million. Rural areas are often those most in need of dentists. Although these poorer countries need more dental health practitioners, this is not practical in poor settings. Thus prevention is the key strategy.

Daily use of fluoride is the most cost-effective, evidence-based approach to reduce dental decay. Fluoridating water is a possible population-wide approach but implementation depends on a country's infrastructure and political will. Use of fluoridated toothpastes is also effective, but cost can prohibit this. In some countries, taxes can represent 50% of the price of toothpaste - so governments could cut these taxes and also work with manufacturers to produce lower cost toothpaste. The Editorial says: "In the Philippines, for example-where 97% of schoolchildren aged 6 years have dental caries-a programme that combines the promotion of daily handwashing with soap, tooth brushing with subsidised fluoride toothpaste, and twice-yearly deworming, is proving effective, affordable, and sustainable at US$0•56 per child per year."

Promoting good oral health could also help countries to achieve child-related development goals. Tooth decay can negatively affect a child's ability to eat, sleep, and do school work. Preliminary studies have suggested that dental caries and related pain and sepsis might contribute to undernutrition and low weight and height in children in developing countries. In developed countries, studies show that when tooth decay is treated, children start to put on weight and thrive. Oral pain is also one of the most common reasons for school absenteeism.

The Editorial concludes: "Professionally, health workers, including physicians, nurses, paediatricians, and pharmacists can all deliver prevention messages about the use of fluoride and the risk factors for oral disease. Politically, commitment is needed to integrate oral disease prevention into programmes to prevent chronic diseases and into public-health systems. Good oral health should be everybody's business."

http://www.thelancet.com Vol 373 January 3, 2009

The Lancet