Oral health matters. The teeth and mouth are an integral part of the body, supporting and enabling essential human functions, and the mouth is a fundamental feature of personal identity. Building on existing definitions,1, 2 oral health can be defined as being multidimensional in nature, including physical, psychological, emotional, and social domains that are integral to overall health and wellbeing. Oral health is subjective and dynamic, enabling eating, speaking, smiling, and socialising, without discomfort, pain, or embarrassment. Good oral health reflects an individual's ability to adapt to physiological changes throughout life and to maintain their own teeth and mouth through independent self care. Despite being largely preventable, oral diseases are highly prevalent throughout the life course and have substantial negative effects on individuals, communities, and the wider society. Oral diseases are a global public health problem, with particular concern over their rising prevalence in many low-income and middle-income countries (LMICs), linked to wider social, economic, and commercial changes.3, 4
Oral diseases are chronic and progressive in nature. For example, dental caries (tooth decay) affects very young children, but is a lifelong condition that tracks across adolescence and adulthood, and into later life. Oral conditions disproportionally affect impoverished and socially disadvantaged members of society. A strong and consistent social gradient exists between socioeconomic status and the prevalence and severity of oral diseases. In this way, oral diseases can be considered as a sensitive clinical marker of social disadvantage, being an early indicator of population ill health linked to deprivation.5 Oral diseases and oral health inequalities are directly influenced by wider social and commercial determinants, which are the underlying drivers of poor population oral health.6
Key messages
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Oral health is an integral element of overall health and wellbeing, enabling essential daily functions
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Oral diseases include a range of chronic clinical conditions that affect the teeth and mouth, including dental caries (tooth decay), periodontal (gum) disease, and oral cancers
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Despite being largely preventable, oral diseases are highly prevalent conditions, affecting more than 3·5 billion people around the world; dental caries is the most common disease globally with increasing prevalence in many low-income and middle-income countries
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Oral diseases disproportionally affect poorer and marginalised groups in society, being closely linked to socioeconomic status and the broader social determinants of health
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Oral diseases have substantial effects, causing pain, sepsis, reduced quality of life, lost school days, family disruption, and decreased work productivity, and the costs of dental treatment can be considerable for both the individual and the wider health-care system
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Oral conditions share common risk factors with other non-communicable diseases, which include free sugar consumption, tobacco use, and harmful alcohol consumption, as well as the wider social and commercial determinants of health
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Of particular concern is the effect of free sugar consumption on the prevalence of caries and overweight or obesity, and associated conditions such as diabetes
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Recognition is increasing of the influence, power, and effect of the global sugar industry as a threat to public health, which requires tighter regulation and legislation by governments
However, oral diseases are a neglected issue, rarely seen as a priority in health policy.7 Oral health and the dental profession have become somewhat isolated and marginalised from mainstream developments in health policy and health-care systems. The current model of dental care delivery and clinical preventive policy does not tackle the global burden of oral diseases. The so-called westernised model of modern dentistry (high technology and treatment focused) is unaffordable and inappropriate in many LMICs.8 Even in settings with resources, dentistry is not meeting the needs of large segments of the national population and is increasingly focusing on the provision of aesthetic treatments, largely driven by profit motives and consumerism.9 A radically different approach is needed to tackle the global challenge of oral diseases.
In this first paper of a two-part Series on oral health,10 we highlight the evidence for the global clinical and public health importance of oral diseases in terms of their prevalence, patterns of oral health inequalities, and effects on individuals, families, and society. Our analysis also highlights the underlying social and commercial determinants—the broad range of interacting biological, behavioural, psychosocial, economic, corporate, and political drivers that create the “conditions in which people are born, grow, live, work and age”11 that cause poor population oral health.6, 11 Furthermore, we present a unifying framework that places oral diseases in a broader context and directly links them to other non-communicable diseases (NCDs).