The World Health Organization (WHO) defines oral health as a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss and other diseases and disorders.
According to the FDI World Dental Federation, oral health is multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex.
Worldwide, the most common oral diseases are dental caries (cavities, decay), periodontal (gum) disease, oral cancer, oral infectious diseases, trauma from injuries and hereditary lesions.Around the globe, 60-90% of school-aged children and nearly 100% of adults have tooth decay. In fact, dental caries (which includes all stages of tooth decay) is the most common, yet preventable, chronic disease on the planet and constitutes a major global public health challenge.
In Canada, an estimated 2.26 million school-days are missed each year due to dental-related illness and tooth decay accounts for one-third of all day surgeries performed on children between the ages of 1 and 5.
In the United States, a child is five times more likely to seek emergency room treatment for dental problems than for asthma, often because they are unable to see a dentist, are uninsured or cannot afford routine dental care and half of all children enter kindergarten with tooth decay.
The accompanying chart (Table 1) shows the worldwide prevalence and ranking of various oral health and other conditions:
|Oral health condition||World prevalence||
World ranking of
disease in prevalence
|Source: Global Burden of Disease 2010|
|Untreated decay (caries) of permanent teeth||35% of population||1|
|Severe periodontal (gum) disease||11% of population||6|
|Severe tooth loss||2% of population||36|
|Oral cancer||1 to 10 cases per 100,000 people||-|
|Tension-type headache||21% of population||2|
|Migraine||15% of population||3|
|Low back pain||9% of population||9|
|Diabetes||8% of population|
|Asthma||5% of population|
Across OECD countries, on average, 5% of total health expenditures originate from treatment of oral diseases. Direct treatment costs due to dental diseases worldwide have been estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure. Indirect costs due to dental diseases worldwide amounted to US$144 billion yearly, corresponding to economic losses within the range of the 10 most frequent global causes of death. The global economic impact of dental diseases amounted to US$442 billion in 2010. Overall improvements in oral health may imply substantial economic benefits, not only in terms of reduced treatment costs, but also because of decreased productivity losses in the labour market. Recent findings suggest that oral diseases account for productivity losses of over $1 billion per year in Canada alone.
While oral health has been recognized as a basic human right by numerous dental and public health organizations internationally, more than 70% of the world's population (mostly in low- and middle-income countries) are in need of appropriate and affordable oral health care. Poor oral health results from a number of factors, including a lack of resources, oral hygiene habits, oral health education and accessible oral health care.
The WHO has identified priority areas for countries to consider when initiating or strengthening oral health programs.These include:
A recent study found that oral health is a major public health problem in Europe and that oral diseases have considerable negative impacts on the quality of life of populations. The study indicated that, 'vulnerable and low-income groups as a whole receive oral health care services less frequently than the general population and more so for emergency situations when in pain, rather than for preventive care'.
The conclusion of the review of dozens of public health programs across European countries was that in the case of oral health, investment in simple preventive programs is cost-effective and that 'solving the problem of poor oral health in Europe does not require an entirely new policy in every case or a reinvention of the wheel'.
There are many programs in place to address the oral health inequalities for vulnerable groups, with new models and approaches to care being introduced and explored on an ongoing basis.