A new report shows that over half of all adults in the World Health Organisation (WHO) European Region had a major oral disease in 2019, the highest prevalence worldwide. It is urging member states to increase access to safe, effective and affordable essential oral health care as part of universal health coverage.
Universal health coverage cannot be achieved without oral health care. National health coverage packages must include access to oral health care services, either free of charge or at a price that people can afford. This is the main message of the new status report on oral health in the WHO European Region launched on April 20, 2023. The call comes in response to alarming figures contained in the report that the region (covering 53 countries across Europe and Central Asia) has the highest prevalence of major oral disease cases and the highest prevalence of caries – cavities and tooth decay – of permanent teeth, globally.
Key findings
The most recent data show:
- The European Region had the highest prevalence of major oral disease cases (50.1 per cent of the adult population) across all six WHO regions worldwide. This includes the highest prevalence of caries of permanent teeth across all WHO regions, which at 33.6 per cent of the European Region’s population represents almost 335 million cases in 2019.
- The region had the second greatest proportion of cases of tooth loss (25.2 per cent), about 88 million people aged 20 years or over. This translates to a prevalence of 12.4 per cent, the highest among the WHO regions and almost double the global prevalence of 6.8 per cent.
- The region also had the second highest estimated number, among the WHO regions, of new cases of oral cancers, at almost 70 000 – accounting for 18.5 per cent of the total estimated number of cases globally. More than 26 500 deaths in the Region were attributable to oral cancers in 2020.
- Of the European Region’s 53 countries, 34 (66.7 per cent) did not have a national oral health policy.
- Eleven countries (23.4 per cent) did not have dedicated staff for oral diseases in the noncommunicable diseases department of the ministry of health.
The report outlines progress in some areas, including a significant decline (7.2 per cent) between 1990 and 2019 in the prevalence of caries of deciduous teeth – commonly known as baby teeth or milk teeth – in children aged one to nine years, as well as a decline (3.9 per cent) in the prevalence of caries of permanent teeth in this age group. The overall picture, however, is deeply concerning.
Greatest need, least access to services
Oral health care services are largely provided by private fee-for-service practitioners, and, as a consequence, most patients bear high out-of-pocket costs.
Government programmes and insurance schemes provide only partial coverage for oral health care or none at all.
Within the region, 10 countries spent less than US$ 10 per person per year on oral health care, while 14 countries spent between US$ 11 and US$ 50. This is hugely problematic as research shows that people with the greatest need for oral health care have the least access to services.
Health begins in the mouth
Dr Hans Henri P. Kluge, WHO regional director for Europe, said, “Oral health is an essential part of health care. Many of our most basic human functions – speaking and communicating, eating, breathing, and, not least, smiling depend on good oral health. Untreated dental cavities can affect people’s quality of life at all ages but are particularly detrimental in childhood as they create problems that can last a lifetime. In children, dental caries affect school attendance and academic performance. Severe untreated caries can interfere with nutrition and growth. In many high-income countries, the extraction of carious teeth under general anaesthesia is the main reason for hospitalisation of young children. Among adults, untreated caries can be a major cause of absenteeism and can affect quality of life and work. Oral health truly impacts so many areas of our lives, but seldom gets the attention it deserves when it comes to health policies and coverage schemes.”
Dr Carina Ferreira-Borges, WHO/Europe regional advisor for alcohol, illicit drugs and prison health, added, “There is strong evidence that oral diseases disproportionally affect disadvantaged and marginalized groups – people on low incomes, people living with disability, older people living alone or in care homes, people who are refugees, or who are in prison or living in rural communities. The recommendations in this report address those inequalities as well, directing resources where they are most needed”.
Drivers of harm
Oral diseases are mainly caused by sugar consumption, tobacco use, alcohol use, trauma and a lack of oral hygiene. At a policy level, the key drivers include:
- Saturation (availability) of substances with high sugar content, especially sugar sweetened beverages;
- Aggressive marketing of substances with high sugar content, especially targeting children, as well as tobacco and alcohol;
- Poor access to primary/community oral health care services;
- Inadequate exposure to fluoride in the water supply and in oral hygiene products such as toothpaste.
Recommendations
Dr Hans Henri P. Kluge continued, “Dental caries is the most common noncommunicable disease worldwide – but it doesn’t have to be. We know what needs to be done. The aim of this report is to encourage governments and health authorities to increase access to safe, effective and affordable essential oral health care as part of national universal health coverage packages. This is the best way to address oral health inequities while simultaneously addressing multiple noncommunicable diseases and improving overall population health.”
The recommendations contained in the new WHO/Europe report complement those in the Global Oral Health Action Plan, which outlines 100 proposed actions for member states, the WHO secretariat, international partners, civil society organisations and the private sector, and is accompanied by a global monitoring framework to track progress on implementation.
Among its key recommendations, the new report for the European region specifically advises that governments:
- Develop new national oral health policies that align with the WHO Global Strategy on Oral Health and national noncommunicable disease (NCD) and universal health coverage (UHC) policies;
- Allocate dedicated staff and funds for oral health at the ministry of health or other national governmental health agency, ensuring integration with the NCD and UHC agendas.
- Implement policy measures aimed at reducing the intake of free sugars, such as mandatory nutrition labelling on pre-packaged food; reformulation targets to reduce sugar content in foods and beverages; public food procurement policies to reduce food offerings high in sugars; policies to protect children from the harmful impact of food marketing; and taxes on sugar sweetened beverages and foods high in sugars.
- Integrate oral health care into primary health care at all service levels, with the required staffing levels, skill mixes and competencies.
- Develop an innovative workforce model for oral health, including oral health professionals and other primary health care workers, to respond to the population’s oral health needs.
Speaking at the launch of the new report at the WHO regional office for Europe in Copenhagen, Dr Gauden Galea, strategic advisor to the regional director’s special initiative on non-communicable diseases and innovation, WHO/Europe, said, “The case for expanding universal health coverage and strengthening policy in the areas of nutrition, tobacco and alcohol is powerful, from a health, human rights and economic perspective. By doing so, we radically improve oral health and a range of other critical areas of health, including diabetes, cancer and cardiovascular disease. Responsibility for all key action areas lies with government and health policy-makers. We at WHO/Europe are there to support our member states in this. Let’s work together to make oral health under universal health coverage a reality”.