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Sugar, tobacco and alcohol adding to global oral health crisis

3.5 billion people affected by oral diseases globally, says study

Adrian O'Dowd

Monday, 22 July 2019

Serious issues with oral disease around the world affecting billions of people are being made worse by failure to tackle consumption of sugar, tobacco and alcohol, concludes a new series* on oral health published in The Lancet.

The Lancet series on oral health, led by University College London (UCL) researchers brought together 13 academic and clinical experts from 10 countries, including the UK, to better understand why oral diseases have persisted globally over the last three decades, despite scientific advancements in the field.


Currently, oral diseases – including tooth decay, gum disease and oral cancers – are considered to be a significant global public health burden, affecting 3.5 billion people worldwide, with untreated dental decay the most common health condition worldwide.

The treatment of oral diseases cost €90bn per year across the EU, the third most expensive condition behind diabetes and cardiovascular diseases.

In England, nearly a quarter (23%) of five-year-old children have tooth decay but levels of decay vary widely across country. In the 6-10 year old children age group, tooth extractions are the most common reason for admission to hospital for a general anaesthetic.

Professor Richard Watt, chair and honorary consultant in dental public health at UCL and lead author of the series, 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.”

The researchers said the global health community had failed to prioritise the burden of oral health and called for radical reform of dental care, tightened regulation of the sugar industry, and greater transparency around conflict of interests in dental research.

The series identifies three main determinants of the current situation as sugar, tobacco and alcohol, with sugar being the single biggest contributor to worsening oral health globally.

The burden of oral diseases was set to rise, they argued, as more people were exposed to the main risk factors of oral diseases and sugar consumption was increasing rapidly across many low- to middle-income countries.

Although some countries had implemented taxes on sugar products, said the researchers, there was strong lobbying against such policies by sugary drinks companies.

In high-income countries, dentistry was increasingly technology-focused and caught in a “treatment-over-prevention” cycle, failing to tackle the underlying causes of oral diseases.

The researchers said oral health should be less removed from general health, with dentistry rarely being thought of as a mainstream part of healthcare policy, despite its close link to health and wellbeing.

Professor Watt added: “Sugar consumption is the primary cause of tooth decay. The UK population is consuming far too much sugar – considerably higher than the Department of Health and WHO recommends.

“We need tighter regulation and legislation to restrict the marketing and promotion of sugary foods and drinks, if we are to tackle the root causes of oral conditions.”

Dr Jocalyn Clark, an executive editor at The Lancet, said: “Dentistry is rarely thought of as a mainstream part of healthcare practice and policy, despite the centrality of the mouth and oral cavity to people’s 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.”


*R Watt, et al. Oral Health. A series from The Lancet journals. Published 18 July 2019.

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