On May 27, 2021, the 74th World Health Assembly of the World Health Organisation (WHO) approved a resolution on oral health (https://apps.who.int/gb/ebwha/pdf_files/WHA74/B148_REC1_EXT-en.pdf). This resolution placed oral health on the global health agenda and comes 14 years after oral health was last addressed in a resolution by the WHO.
This resolution reviews the high prevalence of the most common oral diseases (caries, periodontal disease, with resulting tooth loss, and oral cancer), their impact across the life course, the preventable nature of the major oral diseases, and the enormous cost of treating existing disease. Further, the unequal distribution of oral disease is highlighted, with a heavier disease burden upon those populations with limited resources. This inequity is seen in low-, middle-, and high-income countries. The statement also notes that the most common oral diseases have identified risk factors, which are lifestyle choices that are common to other noncommunicable diseases. An emphasis is placed on good oral health being commensurate with good general health and better quality of life. Due to the cumulative nature of oral diseases, older adults are particularly vulnerable to their sequelae.
The resolution also notes the many challenges to meeting the oral health care needs in diverse populations across the globe. Contributing factors include a lack of resources, lack of political willingness to prioritise oral health, lack of infrastructure in resource-poor countries, an absence of a coherent preventive strategy utilising inexpensive approaches (ie, school-based oral hygiene programmes), limited public awareness, as well as the ancillary but important issues of environmental impact (ie, mercury hygiene). The disproportionate impact of the COVID-19 pandemic on the provision of routine dental services is another example of the challenges to provision of routine care.
The resolution urges countries to consider a variety of actions, with implementation dependent on each country's particular set of circumstances. Key points include the following:
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Integration of oral health into national health policy.
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A focus on preventive strategies as opposed to approaches that emphasize treatment of existing disease.
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Consideration of workforce models that maximise efficiency.
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Development of accurate surveillance systems to define the oral disease burden.
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The need to evaluate and monitor the concentration of fluoride in drinking water as an effective public health approach to reduce caries in children.
Member countries are urged to consider oral health as a part of general health and look for collaborations to enhance the oral health messaging as part of a healthy lifestyle. Here, as mentioned, school settings should be engaged. Further, oral health providers should be able to identify cases of abuse and neglect which often manisfest as injuries to the face and mouth.
Last, the director-general of the WHO was tasked with developing a global strategy to improve oral health by 2022 and present an action plan by 2023. Conservative approaches, and concern for environmental safety, are to be emphasised.
The FDI issued a statement that followed the release of the WHO resolution on oral health (https://www.fdiworlddental.org/wha74-fdi-and-iadr-statement-item-132-ncds-and-oral-health).
This statement was supported by several organisations, including the International Association for Dental Research, the World Heart Federation, World Stroke Organization, and the International Diabetes Federation. The message urged member states to embrace the resolution and effect implementation, emphasize prevention of oral diseases and the importance of integrating dentistry and medicine. Inclusion of oral health into national health policy was urged.
This resolution is an exciting development, yet dentistry must recognise that achieving the stated goals is in part dependent upon how the profession embraces collaboration with and integration into the greater health care system. This activity can take many forms, including embracing a “healthy lifestyle” message when discussing the importance of oral hygiene with patients, where oral hygiene is discussed along with other lifestyle choices including the importance of a healthy diet, smoking cessation, moderate alcohol intake, and exercise. This broadermessage focusses on the importance of self-care and can help patients improve both oral and general health. Another example is the inclusion of primary care activities in the dental office, as patients can be evaluated chairside for a variety of health conditions that can impact the prevalence and severity of oral disease (ie, evaluating glycated haemoglobin indicating dysglycaemia, either prediabetes or diabetes). This also means a closer relationship with other health care providers, including physicians, nurses, physicians’ assistants, and pharmacists. The dental profession must move away from the focus on the “surgical” approach to focus on the “preventive” approach. Further, the profession must actively foster alternate approaches to delivery of preventive care. This last statement is critically important in resource-poor countries without a well-developed dental care delivery system.
The question now: How will the dental profession embrace this WHO resolution? Those actions will ultimately help determine the success or failure of the global initiative to address the enormous burden of oral diseases. Efforts bynational governments, national dental associations, advocacy organisations, individual health care practitioners, and many others must be mobilised in response to the resolution. This is an opportunity that must not be missed.