Oral health has been isolated from traditional healthcare and health policy for too long, despite the major global public health burden of oral diseases, according to a Lancet Series on Oral Health, published today in The Lancet.

Professor Marco A. Peres

Professor Marco Peres, from Menzies Health Institute Queensland and Griffith University’s School of Dentistry and Oral Health, is the only Australian academic in the international team of authors of the Lancet series.

“In Australia, dental caries affects 34% of five-and-six year-old children and 46.2% of nine-and-10-year olds. In older children with permanent dentition the prevalence is 9.2% among six to eight-year-olds and nearly 40% in 12 to 14-year-olds,’’ says Professor Peres.

Failure of the global health community to prioritise the global 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. Oral diseases, including tooth decay, gum disease and oral cancers, affect almost half of the global population, with untreated dental decay the most common health condition worldwide. Lip and oral cavity cancers are among the top 15 most common cancers in the world.

In addition to lower quality of life, oral diseases have a major economic impact on both individuals and the wider health care system. In Australia, recurrent expenditure on dental services cost $9.904 billion in 2015-16.

“Australasia has the second-highest per capita expenditure on dental care and productivity losses due to dental problems in the world,’’ Professor Peres said.

A new Lancet Series led by University College London (UCL) brought together 13 academics experts from 10 countries to better understand why oral diseases have persisted globally over the past three decades, despite scientific advancements in the field, and why prevalence has increased among socially disadvantaged and vulnerable people.

A tipping point for global oral health

“Dentistry is in a state of crisis,” said Professor Richard Watt, Chair and Honorary Consultant in Dental Public Health at University College London (UCL) and lead author. “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.”

Sugar, alcohol and tobacco fuel burden

Professor Peres said there was debate in Australia regarding the effectiveness and appropriateness of having a ‘sugar tax’.

“Many public health, academic and consumer groups support a tax on sugar, but political support is limited and there is a strong lobby against the implementation of a sugar tax led by sugary drinks companies.”

Professor Watt added: “The use of clinical preventive interventions such as topical fluorides to control tooth decay is proven to be highly effective, yet because it is seen as a ‘panacea’, it can lead to many losing sight of the fact that sugar consumption remains the primary cause of disease development.

‘”We need tighter regulation and legislation to restrict marketing and influence of the sugar, tobacco and alcohol industries, if we are to tackle the root causes of oral conditions.”

Radical reform of dentistry needed

Lancet Series authors have called for wholesale reform of the dental care model in five key areas:

  1. Close the divide between dental and general healthcare
  2. Educate and train the future dental workforce with an emphasis on prevention
  3. Tackle oral health inequalities through a focus on inclusivity and accessibility
  4. Take a stronger policy approach to address the underlying causes of oral diseases
  5. Redefine the oral health research agenda to address gaps in LMIC knowledge

The Australian Government implemented the Child Dental Benefit Schedule (CDBS) in 2014 to provide financial support for basic dental care for nearly 3 milllion children aged 2 to 17 years. The CDBS has a cap of $1000 per child over two consecutive years.

“To the best of our knowledge, there is no study evaluating the cost-effectiveness of the CDBS,” Professor Peres said.

“The implementation of universal dental care coverage has been advocated to reduce socioeconomic inequalities in oral health and should be considered in Australia.”