The global burden of disease.

Oral diseases: a global public health challenge

The Global Burden of Disease (GBD) 2010 Study produced comparable estimates of the burden of 291 diseases and injuries in 1990, 2005, and 2010. This article reports on the global burden of untreated caries, severe periodontitis, and severe tooth loss in 2010 and compares those figures with new estimates for 1990. We used disability-adjusted life-years (DALYs) and years lived with disability (YLDs) metrics to quantify burden. Oral conditions affected 3.9 billion people, and untreated caries in permanent teeth was the most prevalent condition evaluated for the entire GBD 2010 Study (global prevalence of 35% for all ages combined). Oral conditions combined accounted for 15 million DALYs globally (1.9% of all YLDs; 0.6% of all DALYs), implying an average health loss of 224 years per 100,000 population. DALYs due to oral conditions increased 20.8% between 1990 and 2010, mainly due to population growth and aging. While DALYs due to severe periodontitis and untreated caries increased, those due to severe tooth loss decreased. DALYs differed by age groups and regions, but not by genders. The findings highlight the challenge in responding to the diversity of urgent oral health needs worldwide, particularly in developing communities.

https://journals.sagepub.com/doi/pdf/10.1177/0022034513490168

Global burden of oral conditions in 1990-2010: a systematic analysis

Despite its relatively recent emergence over the past few decades, oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research. OHRQoL is a multidimensional construct that includes a subjective evaluation of the individual's oral health, functional well-being, emotional well-being, expectations and satisfaction with care, and sense of self. It has wide-reaching applications in survey and clinical research. OHRQoL is an integral part of general health and well-being. In fact, it is recognized by the World Health Organization (WHO) as an important segment of the Global Oral Health Program (2003). This paper identifies the what, why, and how of OHRQoL and presents an oral health theoretical model. The relevance of OHRQoL for dental practitioners and patients in community-based dental practices is presented. Implications for health policy and related oral health disparities are also discussed. A supplemental Appendix contains a Medline and ProQuest literature search regarding OHRQoL research from 1990-2010 by discipline and research design (e.g., descriptive, longitudinal, clinical trial, etc.). The search identified 300 articles with a notable surge in OHRQoL research in pediatrics and orthodontics in recent years.

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Oral Health-related Quality of Life: What, Why, How, and Future Implications

We aimed to consolidate all epidemiologic data about untreated caries and subsequently generate internally consistent prevalence and incidence estimates for all countries, 20 age groups, and both sexes for 1990 and 2010. The systematic search of the literature yielded 18,311 unique citations. After screening titles and abstracts, we excluded 10,461 citations as clearly irrelevant to this systematic review, leaving 1,682 for full-text review. Furthermore, 1,373 publications were excluded following the validity assessment. Overall, 192 studies of 1,502,260 children aged 1 to 14 y in 74 countries and 186 studies of 3,265,546 individuals aged 5 y or older in 67 countries were included in separate metaregressions for untreated caries in deciduous and permanent teeth, respectively, using modeling resources from the Global Burden of Disease 2010 study. In 2010, untreated caries in permanent teeth was the most prevalent condition worldwide, affecting 2.4 billion people, and untreated caries in deciduous teeth was the 10th-most prevalent condition, affecting 621 million children worldwide. The global age-standardized prevalence and incidence of untreated caries remained static between 1990 and 2010. There is evidence that the burden of untreated caries is shifting from children to adults, with 3 peaks in prevalence at ages 6, 25, and 70 y. Also, there were considerable variations in prevalence and incidence between regions and countries. Policy makers need to be aware of a predictable increasing burden of untreated caries due to population growth and longevity and a significant decrease in the prevalence of total tooth loss throughout the world from 1990 to 2010.

Global Burden of Untreated Caries A Systematic Review and Metaregression

This paper outlines the burden of oral diseases worldwide and describes the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related oral disease and orodental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease patterns and development trends across countries and regions reflects distinct risk profiles and the establishment of preventive oral health care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been shown in a large number of socioepidemiological surveys. In addition to poor living conditions, the major risk factors relate to unhealthy lifestyles (i.e. poor diet, nutrition and oral hygiene and use of tobacco and alcohol), and limited availability and accessibility of oral health services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health is urgently needed. The challenges of improving oral health are particularly great in developing countries.

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The global burden of oral diseases and risks to oral health

The worldwide rapidly growing burden of chronic diseases is closely linked to unhealthy environments and to lifestyles that include diets rich in sugars, widespread use of tobacco and excessive consumption of alcohol (1). Most oral diseases are closely related to these factors and are also dependent on clean water, adequate sanitation, proper oral hygiene and appropriate exposure to fluorides (2). Oral disease control and public health need to take integrated approaches to health promotion and disease prevention based on common risk factors. Mandates which are particularly important for WHO and the work of the Oral Health Programme are: Global Strategy on Prevention and Control of Noncommunicable Diseases (WHA 53); Global Strategy on Diet, Physical Activity and Health (WHA 57); Health Promotion and Healthy Lifestyles (WHA 57); Cancer Prevention and Control (WHA 58); International Plan of Action on Ageing (WHA 58), and Promotion of healthy lifestyles (WHA 58). These World Health Assembly Resolutions provide a supporting framework for Resolutions specific to Oral Health (WHA 42.39). National programmes which include measures at individual, professional and community levels are effective in preventing most oral diseases (3). Worldwide emphasis on health promotion and primary prevention of oral diseases is insufficient and developing countries and those with economies and health systems in transition face considerable challenges to provide universally accessible or affordable intervention and care. WHO has identified priority action areas for countries to consider when initiating or strengthening national oral health programmes: --effective use of fluorides for prevention of dental caries: the goal is to implement appropriate means of maintaining a constant low level of fluoride in as many mouths as possible through fluoridated drinking-water, salt, milk or affordable toothpaste (4); --oral health and prevention of oral disease through a healthy diet, i.e. advocacy for reduced consumption of sugars and increased intake of fruits and vegetables (5); --control of tobacco-related oral disease by involving oral health professionals in tobacco cessation and preventing children and youth from adopting the tobacco habit (6); --oral health through health-promoting schools (7), based on the WHO School Health Initiative;--oral health improvement among elderly people (8) through health promotion and age-friendly primary health care; --integration of oral health into national and community health programmes based on oral health-general health-quality of life interrelationships; --development of oral health systems and orientation of services towards prevention and health promotion; strengthening the prevention of HIV/AIDS-related oral disease, particularly in developing countries (9); --development of oral health information systems: evidence for oral health policy, formulation of goals and targets (10, 11) and measuring progress (12, 13); --research for oral health, oriented towards bridging the gaps in research between developed and developing countries (14). …

https://www.scielosp.org/article/ssm/content/raw/?resource_ssm_path=/media/assets/bwho/v83n9/v83n9a02.pdf

Saskia Estupinan-Day

Papers

The global burden of oral diseases and risks to oral health

WHO's action for continuous improvement in oral health.

Oral health of Haiti (OHOH): a year later.