The case for universal oral health coverage according to the World Health Organization

heyN Friday, oral health advocates around the world received an early holiday gift from their long-standing wish list. They’ve been waiting their entire careers—with some STATs, nearly half a century—to turn oral health into conversations calling for health care access for all. The World Health Organization’s new Global Oral Health Status Report took the first step.

“This integration […] That’s really something that’s never been done before,” said Lisa Simon, a dental-licensed therapist at Brigham and Women’s Hospital and one of STAT’s 2022 Wunderkinds.

The World Health Organization report provides data on oral disease caseload and mortality rates for 194 countries, highlighting differences in the prevalence of oral health problems in different regions. It also emphasizes on the most common oral health problems like tooth decay, tooth loss, severe gum disease and oral cancer. The report highlights barriers to access, including cost and the need for specialized providers, and opportunities to tackle inequalities in service of the goal set by the World Health Assembly earlier this year: universal oral health coverage by 2030.

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Universal oral health coverage does not mean free services or advanced dental care — such as implants or prosthetics — for everyone, said Habib Benzian, who worked on the WHO report and is a research professor and co-director of the WHO Collaborating Center on Oral Health. York University College of Dentistry. Rather, universal coverage aims to ensure that all people have access to quality essential oral health services, regardless of where they live or how poor they are. Essential services include oral disease prevention, pain relief, fillings, and some dental restorations.

The report shows that nearly half of the world suffers from some form of oral disease, with three out of every four affected people living in low- and middle-income countries. But one of its most striking findings may be that a country’s income level doesn’t determine the overall picture of oral health, said Benjamin Chaffee, MD, associate professor of preventive and restorative dentistry at the University of California San Francisco School of Dentistry. .

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Based on the 2019 Global Burden of Disease data, there was not much difference in the prevalence of major oral diseases, except oral cancer, among high-, middle- and low-income countries. Chafee said these numbers show how global the issues are.

The data also points to the importance of preventive care, no matter how wealthy a country. “When a person goes to the dentist, it is often too late and the oral problem is already there,” Benoit Warren, WHO’s global oral health chief, told STAT via email.

For Warren, the spark that became the 99-page multi-year effort came through Burkina Faso more than 20 years ago. He was then a young WHO consultant working in remote areas of the West African country, where the nearest dentist was some 500 kilometers away. There were no dental schools to train the new workforce, so Burkinabes had to go to Senegal for oral health care training.

Faced with these access issues, public health schools in Burkina Faso began training nurses to double as dental nurses. In the field, it didn’t matter whether they went through any fancy schooling or not. What mattered to the patients was that the nurses had proper education on how to provide pain relief for tooth extractions or infections.

Watching this workforce training program in rural areas gave Wren an important perspective on how to bridge the access gap. She added that disparities faced by rural and poor communities exist around the world, so solutions when it comes to oral health care must work regardless of a given community’s access to technology. The report’s authors emphasize less invasive approaches to dentistry as an important step toward universal coverage: think less extraction or gum surgery, more fluoride products and education about flossing.

But items like fluoride toothpaste remain out of reach for many low-income people. WHO’s action plan can help guide governments to initiate oral health reforms. Announced on Friday, the WHO Executive Committee is set to implement the action plan in January 2023 and the World Health Assembly in May 2023.

Relying on a less specialized workforce could also help improve access – perhaps by training medical providers in oral health care, Burkina Faso-style. It is cheaper and takes less time to train people already working in health care in dentistry than to train novices.

“I think the entire health and public health community needs to increase their level of technical expertise when it comes to oral health,” Benzian told STAT via email. “Even our medical or nursing colleagues often know very little about oral health and how to address common conditions.”

This approach makes it easier to guarantee an oral health care workforce in remote areas where dental professionals are less likely to work.

“It’s a big, slow challenge, because most models are built on the basis of specialized providers with high technology equipment,” Wren said. “And all these things are, of course, very expensive.” Making oral health coverage less expensive could ease governments’ concerns about putting oral health under the same umbrella as universal medical access negotiations, laws and initiatives, Wren said.

Collaborations outside the medical-dentistry divide can also better meet the needs of patients. Simon was encouraged by the report authors’ call for wider collaboration between dentist-practitioners, health economics, policy and medical researchers. But it would be “nice” to see a similar appeal on the WHO report to collaborate with community members on research, she said. The case studies – from people in India who chew betel nut, a known carcinogen, to Nigerian survivors of noma, a type of gangrene – include diverse voices, but fall short of promoting that the subjects are focused in participatory research. Go

Even experts collaborating with WHO agree with this. Involving people in the informal sector is key, said Brittany Seymour, global health discipline director at the Harvard School of Dental Medicine, which has a contract with the WHO African regional offices. She said patients and advocates are often left out of research on the issues that affect them most.

He and the other researchers were struck less by the gloomy snapshot of global oral health care — and more by the fact that the report finally launched. Seymour cited a side session focused on oral health at the 2011 United Nations summit on non-communicable diseases as an early advocacy milestone.

info here [in the 2022 report] — it’s been building towards this for many years,” Seymour said. The WHO report is noteworthy because it “reflects the growing priority of oral health globally and the increasing political visibility that accompanies each of these events.”

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