The economic consequences of oral disorders at global, regional, and national levels

Abstract

Background

A comprehensive evaluation of the macroeconomic burden of common oral conditions is critical to inform clinical and research resource allocation. This study assessed the global macroeconomic impact of oral diseases - including untreated dental caries, periodontal diseases, edentulism, and other oral disorders - across 192 countries in 2021.

Methods

Disability-adjusted life years (DALYs) for oral disorders overall and by subtype were obtained from the Global Burden of Disease (GBD) 2021 database. Economic indicators were obtained from World Bank’s World Development Indicators. The macroeconomic impact was estimated using the Value of Lost Welfare (VLW) model. This framework, which is distinct from approaches focused on direct costs or health expenditures, integrates disability-adjusted life years (DALYs) with the value of a statistical life (VSL) to assess broader welfare loss. All results are reported in 2021 international dollars (PPP-adjusted).

Result

In 2021, the global VLW attributed to oral disorders reached $234.307 billion, equivalent to 0.24% of the global GDP. Edentulism was the largest contributor (0.16% of GDP), followed by periodontal disease (0.05% of GDP). Among the GBD super-regions, The Central European, Eastern European, and Central Asian super-region bore the highest relative burden for oral disorders (0.37% of GDP), driven primarily by edentulism (0.26% of GDP). Meanwhile, the highest burden for periodontal disease was in the South Asia super-region (0.058% of GDP), while sub-Saharan Africa super-region had the highest burden for deciduous caries (0.001% of GDP).

Conclusion

The macroeconomic burden imposed by oral diseases represents a significant global public health challenge. These findings underscore the urgent need to integrate oral healthcare into universal health coverage and non-communicable disease agendas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-025-07205-6.

Introduction

The World Health Organization (WHO) has estimated that approximately half of the global population is affected by some form of oral disease [1]. More critically, with prevalence increasing faster than global population growth between 1990 and 2019 [2]. Oral diseases compromise not only craniofacial health but also systemic well-being, including diabetes and cardiovascular disease, and incur direct healthcare costs estimated at US$387 billion annually [3–5]. Consequently, the integration of oral health into noncommunicable disease (NCD) prevention and universal health coverage has been increasingly formally proposed in 2019 [6]. – [7].

The Global Burden of Disease (GBD) study systematically evaluates epidemiological patterns by offering accessible data on the incidence, mortality, and DALYs-based disease burden of oral conditions across regions and countries [8]. While extant literature has explored clinical and epidemiological dimensions of oral diseases, yet a systematic and standardized quantification of their global macroeconomic burden remains lacking [3–5, 9, 10]. Filling this gap is critical for evidence-based policy prioritization and optimal resource allocation to improve global oral healthcare access and quality.

The Value of Lost Welfare (VLW) model provides standardized estimation of disease-induced socioeconomic losses by integrating DALYs with the value of statistical life (VSL) [11–14]. The latter, which reflects individuals’ willingness to pay for mortality risk reduction, enables valuation of non-market aspects and the intrinsic worth of health. Unlike conventional cost-of-illness studies, which focus solely on direct medical expenditures and productivity losses, [15] the VLW approach assesses both these financial impacts and intangible losses, such as pain, suffering, and reduced quality of life, thereby providing a more comprehensive assessment of economic and welfare impacts [16]. From a societal perspective, we apply this framework to estimate the macroeconomic burden of oral diseases overall and individually for untreated dental caries, periodontal diseases, edentulism, and other oral disorders across 192 income-stratified nations using GBD 2021 DALY data.

Methods

The study used 2021 oral disease DALYs from the GBD database (most recent available data) [8]. This metric was selected to ensure methodological consistency with this primary data source. All data were anonymized and untraceable to individuals. As the study estimates a single-year economic burden and does not involve future costs or outcomes, discounting was not applicable. Oral diseases were defined by ICD-10 codes: K02.0-K02.9 (K02 = Dental caries), K05.0-K05.6 (K05 = Gingivitis and periodontal diseases), K08.1-K08.9 (K8.1 = Loss of teeth due to accident, extraction, or local periodontal disease), and other oral diseases including K12 = Stomatitis and related lesions, K13 = Other diseases of lip and oral mucosa, and K14 = Diseases of tongue (Supplemental Table 1). Age-specific DALY rates (per 100,000 people per year) were extracted across 192 countries, stratified by 5-year age groups (0–4 to 95+). For each country, data on gross domestic product (GDP) and GDP per capita, adjusted according to the 2021 US dollar Purchasing Power Parity (PPP), were obtained from the World Bank’s World Development Indicators database [17]. All results are presented in 2021 international dollars, with adjustments for PPP. Countries were grouped into seven GBD super-regions following established approach:

(1) Central/Eastern Europe and Central Asia, (2) High-Income nations, (3) Latin America & Caribbean, (4) North Africa/Middle East, (5) South Asia, (6) Southeast/East Asia and Oceania, and (7) sub-Saharan Africa [18].

VSL represents the maximum monetary value an individual is willing for reducing a statistical mortality risk [16]. By integrating VSL with the DALYs associated with specific diseases, it becomes possible to assess the overall macroeconomic impact of a given disease [16, 19]. VSL is determined through empirical approaches and its definition is applicable to a subset of high-income countries. To standardize VSL estimation across all countries, we adopted the following formula based on established VSL estimates provided by the United States Department of Transportation [19, 20]

where the per capita GDP of each country is adjusted for purchasing power parity (PPP) and converted to US dollar equivalents. Subsequently, the income elasticity (IE) parameter of the VSL can be utilized for additional calibration to reflect willingness-to-pay [20]. When comparing high-income regions, the IE is 0.55, whereas conversions to low-income settings often apply more conservative values of 1.0 or 1.5. This study sets an IE parameter to 1.0 to eliminate willingness-to-pay assumptions [13, 16, 19]. Supplemental analyses using IEs of 0.55 and 1.5 were, however, conducted to allow readers to use local willingness to pay assumptions after income adjustment. Study has shown that the VSL varies with age, peaking in middle age and then declining as age increases - a pattern explained by the Life-Cycle Hypothesis where younger individuals with longer life expectancy exhibit greater willingness to pay for risk reduction, while declining lifespan reduces VSL in older ages [16]. To estimate VSL for any individual year (VSLY), a quadratic function known as f(a), which takes into account life-cycle variations in willingness-to-pay, was used to adjust VSL _peak, where a denotes age [16]. This function adjusts VSL_peak to VSL_a based on the extent of life lived. Considering imperfect financial markets, credit constraints prevent young low-income workers from borrowing to smooth consumption or invest in future earnings, depressing early-life VSL. As age and income rise, VSL increases until reaching its peak. The subsequent decline reflects diminishing returns to risk reduction for older individuals, forming the characteristic inverse-U shaped age-VSL profile [16]. The total value of life years (VLW) was calculated by aggregating the product of age-specific VSLY and DALY, expressed in 2021 PPP-adjusted USD [16].

The study was designed following Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines to ensure comprehensive reporting of health economic parameters (Supplemental Material) [21]. All calculations were executed via RStudio IDE (RStudio, PBC, Boston, MA, USA).

Results

Oral disorders pose a significant global economic burden, with the value of lost welfare (VLW) reaching $234.307 billion in 2021, accounting for 0.24% of the global GDP. The proportion of VLW due to oral disorders in GDP was highest in the Central Europe, Eastern Europe, and Central Asia super-region (0.37%; VLW = $16.99 billion), followed by the Latin America and the Caribbean super-region (0.27%; $11.8 billion) and the High-income super-region (0.26%; VLW =$147.7 billion). The lowest ratio was observed in the Sub-Saharan Africa super-region (0.10%; VLW =$1.84 billion), where the figure was less than one-third of the highest; full details are given in Figs. 1 and 2 and Supplemental Table 2.

Fig. 1.

VLW/GDP (2021) by GBD super-region for oral disorders overall, permanent and deciduous caries, periodontal diseases, edentulism, and other oral disorders

Fig. 2.

Pie charts showing the proportional distribution of oral disorder subtypes (permanent and deciduous caries, periodontal diseases, edentulism, and other oral disorders) within total oral disorder VLW across GBD super-regions (2021 USD, PPP)

Edentulism dominated the global oral disease burden, with a VLW of $149.041 billion in 2021, accounting for 0.16% of the global GDP. The proportion of VLW due to edentulism in GDP was highest in the Central Europe, Eastern Europe, and Central Asia super-region (0.26%; VLW = $12.09 billion). This was more than five times the proportion observed in the Sub-Saharan Africa super-region. Notably high ratios were also seen in the Latin America and Caribbean super-region (0.18%; VLW = $7.94 billion) and the High-income super-region (0.17%; VLW = $98.02 billion) (Figs. 1 and 2 and Supplemental Table 2).

Periodontal disease was the second-largest contributor to the global economic burden of oral disorders, with a total VLW of $48.5 billion in 2021, accounting for 0.05% of global GDP. The burden varied by region, being highest in the South Asia super-region (0.058%; VLW = $2.32 billion), followed by the Central/Eastern Europe and Central Asia super-region (0.057%; VLW = $2.67 billion) and the Southeast/East Asia and Oceania super-region (0.052%; VLW = $10.91 billion). The lowest ratio was observed in the Sub-Saharan Africa super-region (0.025%; VLW = $0.48 billion), only half the ratio of the South Asia super-region (Figs. 1 and 2 and Supplemental Table 2).

Other oral disorders constituted the third-largest component of the global economic burden attributable to oral conditions, with a total VLW of $25 billion in 2021 (0.026% of global GDP). Its VLW/GDP ratio showed limited variation across super-regions, ranging from 0.02% to 0.03%. The highest was observed in the Central Europe, Eastern Europe, and Central Asia super-region (0.03%; VLW = $1.38 billion), followed by the High-income super-region (0.026%; VLW = $14.75 billion) and the Southeast Asia, East Asia, and Oceania super-region (0.026%; VLW = $5.48 billion). The lowest was recorded in the Sub-Saharan Africa super-region (0.02%; VLW = $0.38 billion) (Figs. 1 and 2 and Supplemental Table 2).

Caries of permanent teeth resulted in a global VLW of $11.24 billion in 2021, Caries of deciduous teeth generated a global VLW of $0.46 billion in 2021, accounting for 0.011% of global GDP. The VLW/GDP ratio was highest in the Central Europe, Eastern Europe, and Central Asia super-region (0.017%; VLW = $0.8 billion), followed by the North Africa and Middle East super-region (VLW/GDP = 0.015%; VLW = $0.63 billion) and the South Asia super-region (VLW/GDP = 0.014%; VLW = $0.56 billion). In contrast, the ratios were lower in the Southeast Asia, East Asia, and Oceania super-region (0.0096%; VLW = $2.02 billion) and the Sub-Saharan Africa super-region (0.0096%; VLW = $0.18 billion) (Figs. 1 and 2 and supplementary Table 2).

Caries of deciduous teeth generated a global VLW of $0.46 billion in 2021, accounting for 0.00048% of global GDP. The VLW/GDP ratio was highest in sub-Saharan Africa (0.001%; VLW = $0.019 billion) - nearly three times that observed in the High-income super-region (0.00034%; VLW = $0.19 billion). The second highest ratio was in the South Asia super-region (0.00078%; VLW = $0.031 billion), followed by the North Africa and the Middle East super-region (0.00071%; VLW = $0.029 billion) (Figs. 1 and 2 and Supplemental Table 2).

The economic burden of oral diseases exhibits significant regional disparities. The high-income super-region bears the highest total VLW ($147.715 billion), yet its population size (1.089 billion) ranks only fourth globally. Although Southeast Asia, East Asia, and Oceania have the largest population (2.123 billion), their VLW ($42.492 billion) represents only 28.8% of that in high-income regions. Meanwhile, Sub-Saharan Africa, with a population of 1.135 billion, has the lowest total VLW ($1.838 billion). In terms of disease composition, edentulism contributes most significantly to the economic burden in high-income regions ($98.023 billion), while South Asia, despite having the highest DALYs from periodontal diseases, exhibits a considerably lower VLW ($2.325 billion) compared to high-income regions. Notably, the economic impact of dental caries (including both permanent and deciduous teeth) is relatively limited but unevenly distributed. Caries of permanent teeth generates substantial VLW in high-income regions ($6.415 billion), whereas the burden of deciduous caries is predominantly concentrated in Sub-Saharan Africa (VLW = US$0.0199 billion) and South Asia (VLW = $0.0311 billion). (Supplemental Table 7).

Figure 3 presents the 2021 national distribution of oral diseases overall and by subtype (including untreated dental caries, periodontal disease, edentulism, and other oral disorders). Detailed values are provided in Supplementary Fig. 1 and Table 3.

Fig. 3.

Global VLW/GDP heat maps (2021) by country for oral disorders overall, permanent and deciduous caries, periodontal diseases, edentulism, and other oral disorders

To test the sensitivity of our results to this assumption, we conducted analyses using IEs of 0.55 and 1.50. The global VLW estimate for oral diseases was highly sensitive to this parameter: it decreased by 29.4% to $165.314 billion under the more conservative IE of 1.5 and increased by 67.0% to $391.351 billion under an IE of 0.55, compared to the baseline estimate of $234.307 billion. Despite this wide variation in absolute economic impact, the relative ranking of oral disease subtypes and the distribution of burden across super-regions remained consistent across all sensitivity analyses (Supplemental Tables 4 and 5).

Discussion

Previous studies have highlighted the significant impact of oral diseases on public health and economic burdens, emphasizing the need for comprehensive intervention strategies [1–7, 9, 10]. Building on this foundation, our study introduces a welfare-economic assessment—distinct from direct costs or health expenditure—using the Value of Lost Welfare (VLW) model, which integrates DALYs with the value of a statistical life (VSL), to provide new insights into the macroeconomic impact of oral diseases (Supplementary Table 6). We estimated that oral diseases caused a global macroeconomic loss of USD 234.307 billion in 2021. The detailed estimates at global, regional, and national levels provide critical evidence for location-specific resource allocation, primary prevention, and priority setting.

The variation in VLW/GDP ratios for overall oral disorders across regions reflects distinct public health and economic contexts. The super-regions with the highest oral disorders VLW/GDP were (1) Central Europe, Eastern Europe, and Central Asia, (2) Latin America and the Caribbean, and (3) The High-Income super-region. The Sub-Saharan Africa super-region had the lowest VLW/GDP. Among low- and middle-income countries (LMICs), high prevalence rates of oral diseases (particularly caries, periodontitis, and edentulism), combined with unequal distribution of oral healthcare resources, often result in delayed treatment, thereby exacerbating the economic burden associated with oral diseases [22, 23]. Meanwhile, high-income regions still experience a considerable economic burden despite their abundant medical infrastructure; this may stem from the high incidence of chronic oral diseases like periodontitis, aggravated by the higher costs associated with maintaining oral health in an aging population, and can also be attributed to diet and high sugar consumption [24, 25]. Conversely, the low VLW/GDP ratio for oral diseases in Sub-Saharan Africa should not be misinterpreted as indicating a low disease burden or satisfactory oral health status. It may primarily reflect the region’s low GDP valuation per DALY, coupled with the health system’s prioritization of pressing issues like infectious diseases and malnutrition [26] Additionally, limited resources and low policy priority for oral health care, along with the young population structure and traditional low-sugar diets may reduce the direct economic impact and prevalence of oral diseases [27].

Consistent with previous GBD studies, edentulism contributed the highest proportion of economic burden among oral diseases, followed by periodontal disease, other oral disorders, and untreated dental caries. However, the economic impact of different oral disorders subtypes varies across regions. For example, the VLW/GDP due to edentulism was relatively high in the Central Europe, Eastern Europe, and Central Asia super-region, the Latin America and Caribbean super-region, and the High-income super-region, while Sub-Saharan Africa exhibited the lowest for these conditions. It reflects that LMICs face a more severe economic burden caused by edentulism, which may be attributable to multilayered structural determinants: deficiencies in oral healthcare infrastructure, limited access to restorative treatments, inequitable coverage of oral health benefits, and inadequate primary oral disease prevention [28]. These issues necessitate targeted policy interventions. By comparison, in high-income super-regions, the burden may stem from high-cost dental treatments and demand for complex oral restorations due to an aging population [29]. Despite the low VLW/GDP ratio in Sub-Saharan Africa, it should not be misread as a low disease burden, as the economic burden due to edentulism is disproportionately severe under resource-constrained, low-GDP conditions [30]. Regarding caries of deciduous teeth, an inverse pattern was observed: The High-income super-region’s VLW/GDP (0.00034%) was threefold lower than that of Sub-Saharan Africa super-region (0.001%). This suggests that high-income super-regions effectively control caries of deciduous teeth through systemic interventions (e.g., water fluoridation and pit-and-fissure sealants) [7]. In contrast, Sub-Saharan Africa super-region may experience a contradiction between surging consumption of refined sugars and lagging development of basic dental services, requiring the accelerated integration of essential oral healthcare into primary care systems [25, 27].

VLW/GDP attributable to permanent tooth caries and periodontal disease exhibit minimal variation across the seven GBD super-regions. As the two most prevalent oral diseases globally, they share universal risk factors, including high-sugar diets, tobacco use, and inadequate oral hygiene, across all socioeconomic gradients, which results in a globalized pattern of disease burden [24, 31]. Nevertheless, this pattern coexists with disparities in healthcare delivery systems. Specifically, while high-income super-region have advanced dental care systems, these advantages can be offset by fast-paced lifestyles, characterized by excessive sugar consumption, smoking habits, and less time for oral healthcare; in contrast, LMICs may benefit from traditional dietary patterns, which partially compensate for their limited access to healthcare services [32]. – [33] Furthermore, high-income super-region face elevated dental treatment costs due to higher labor expenses and advanced technologies, yet their widespread preventive care systems effectively reduce the incidence of advanced-stage cases; while LMICs benefit from lower per-treatment costs, delayed treatment often leads to more complex conditions that ultimately increase long-term healthcare expenditures [5, 34]. Therefore, effective oral health improvement will require both standardized prevention and region-specific approaches tailored to local socioeconomic contexts.

Other oral disorders encompass a range of conditions, including stomatitis, oral mucosa diseases, and tongue diseases [5]. Compared to dental caries and periodontal disease, these diseases are less associated with primary healthcare accessibility and behavioral risk factors (e.g., smoking, high-sugar diets), and are more influenced by genetic susceptibility, immune factors, and environmental determinants [35]. Moreover, treatment cost variation is relatively small, as some conditions only require low-intensity intervention (e.g., topical management of ulcers) [35]. Furthermore, the true disease burden may be obscured, as underdiagnosis in LMICs, where prevalence is higher, contrasts with potential non-essential interventions in high-income regions [36, 37]. These may explain the minimal variation in VLW/GDP due to other oral diseases across the seven GBD super-regions. Other oral disorders impose a substantial burden on both individuals and healthcare systems. Such disorders frequently cause chronic pain and diminished quality of life, especially among populations with limited access to specialized oral healthcare services [35, 38]. Therefore, it is imperative to enhance research into disease etiology and strengthen prevention and management strategies, with a particular focus on improving access to care for underserved communities.

The significant macroeconomic losses quantified by our VLW analysis provide a robust economic justification for elevating oral health on the global public health agenda. To translate these findings into actionable policy, we recommend approaches that focus on integration and cost-effectiveness: First, oral health should be integrated into broader health systems. Specifically, essential oral healthcare services ought to be incorporated into Universal Health Coverage (UHC), particularly in LMICs where the disparity between disease burden (DALYs) and economic valuation (VLW) is most pronounced. This integration ensures that oral health is not an isolated initiative but a core component of primary care, enhancing both its accessibility and efficiency. Furthermore, the strong epidemiological and economic links between oral diseases and other noncommunicable diseases (NCDs) support their combined management [39]. – [40] This approach makes use of existing NCD platforms and resources, combining efforts to enable more comprehensive care. Second, policymakers should prioritize cost-effective measures. For example, implementing a sugar-sweetened beverage (SSB) tax can reduce consumption and generate revenue to fund oral health programs [41]. – [42] Similarly, the coverage of preventive measures such as water fluoridation and school-based sealant programs should be expanded [43]. To alleviate workforce shortages, particularly in underserved areas, task-shifting models should be adopted to train primary care workers and community volunteers in basic oral health prevention and education [44]. – [45] These strategies can reduce long-term treatment dependency and advance the goals of the WHO Global Strategy on Oral Health.

Although this study contributes valuable insights, it is important to acknowledge its limitations. First, the VSL estimates for individual countries could be underestimated due to reliance on US empirical data rather than country-specific evidence. Second, VSL is age-adjusted through the f (a) function based on Aldy and Viscusi’s estimates [16]; however, this approach may not adequately account for regional differences, potentially affecting the analysis’s precision. Third, the GBD study’s DALY data for oral disorders rely heavily on modeled estimates, especially in LMICs with limited surveillance systems. This data sparsity introduces significant uncertainty into our national-level VLW results. which should be interpreted as informed approximations rather than precise values. When comparing results across countries, researchers and policymakers should prioritize broad patterns over specific rankings between similar countries. Finally, following GBD classification constraints, diverse conditions like stomatitis, mucosal diseases, and tongue disorders are grouped together. Given their varying etiologies and severity, economic welfare loss for this category represents a composite value and should not be attributed to any single condition. Therefore, future research should (a) incorporate country-specific VSL studies, (b) develop region-specific age-adjustment calibrations, (c) prioritize the collection of standardized primary oral health data to reduce modeling dependency and improve the precision of global burden assessments, and (d) apply more detailed disease categories to disaggregate the economic burden of broad categories like ‘other oral disorders’.

In conclusion, this study presents the first comprehensive assessment of the macroeconomic burden of oral diseases, revealing a global loss of $234.3 billion (0.24% of global GDP) in 2021. Our findings provide a robust evidence base for policymakers to prioritize oral health within UHC and NCD agendas, justifying increased investment and guiding resource allocation in healthcare systems worldwide. 

Abbreviations

WHO

World Health Organization

DALYs

Disability-adjusted life years

GBD

Global Burden of Disease

NCD

Noncommunicable disease

LMICs

Low- and middle-income countries

VLW

Value of lost welfare

VSL

Value of statistical life

GDP

Gross domestic product

PPP

Purchasing Power Parity

USD

United States Dollar

IE

 Income Elasticity

CHEERS

Consolidated Health Economic Evaluation Reporting Standards

Authors’ contributions

Jing Yang contributed to methodology, software, validation, formal analysis, original draft manuscript, and visualization. Qianqian Zhang and Dehua Zheng were involved in data interpretation, literature research and contributed signifcantly to preparation of the manuscript. Fengchun Hou designed and coordinated the study and had signifcant impact in drafting the manuscript. All authors have read and agreed to the published version of the manuscript. All authors read and approved the final manuscript.

Funding

Supported by Qingdao Key Medical and Health Discipline Project (2025–2027); Shandong Provincial Key Medical and Health Discipline of Oral Medicine (Qingdao University Affiliated Qingdao Stomatological Hospital); Science and Technology Project of Shinan District of Qingdao (2023-2-007-YY).

Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

All data were anonymized and untraceable to individuals.

Competing interests

The authors declare no competing interests.