The global call for oral health and general health

INTRODUCTION

The FDI World Dental Federation is the largest non-governmental organisation for oral health-care professionals worldwide with its vision of ‘Leading the world to optimal oral health’. FDI Policy Statements introduce scientific advances, reflect current thinking on evidence-based dentistry and address various critical issues related to oral health and oral health-care professionals. These Statements disseminate important policies, scientific standards and professional guidelines for promoting and advocating the FDI’s mission and vision. It is a fact that FDI policy statements are a core deliverable of the Federation and enable the FDI and its member National Dental Associations (NDAs) to carry out advocacy on key issues with decision makers at both national and international levels¹.

The FDI Science Committee is highly committed to critically analysing and transferring, in a timely fashion, scientific information to oral health-care professionals and other professions. Over the years, it has contributed considerably to the production of a series of FDI Policy Statements on various aspects of dentistry and related oral health care. Currently, the Committee consists of ten members, including Lijian Jin (Chair, Hong Kong SAR, China), Harry-Sam Selikowitz (Vice-Chair, Norway), Prasad Amaratunga (Sri Lanka), Maida-Medi Ganibegovic (Bosnia & Herzegovina), Takashi Inoue (Japan), Ira Lamster (USA) and Georg Meyer (Germany), as well as the official representatives from World Health Organisation (Poul-Erik Petersen), International Organisation for Standardisation (Derek Jones) and International Association for Dental Research (John Clarkson). Gerhard Seeberger serves as the FDI Liaison council member for the Committee. A panel of leading scientists and experts well serves as the consultants to the Committee, and gives valuable advice and inputs to prepare some important documents and policy statements.

At the 101st FDI Annual World Dental Congress (AWDC) in Istanbul, Turkey, 28–31 August 2013, five new or updated policy statements were presented by the Science Committee with incorporation of comments from member NDAs and were approved by the FDI General Assembly with over 97% supporting votes. They reflect the significant achievements of global dental professionals’ teamwork. These Statements are now published in this issue of IDJ¹.

Non-communicable diseases (NCDs) such as cardiovascular disease, cancer and diabetes are the leading causes of human deaths worldwide. The United Nations (UN) has recently acknowledged that oral disease, as one of the common NCDs, is among the major global health burdens and that it shares a number of common risk factors with other major NCDs and can benefit from responses to NCDs². The FDI Statement on ‘Non-communicable Diseases’³ is an abbreviated version of the FDI document on NCDs approved by the General Assembly during the 100th AWDC in Hong Kong in 2012. It highlights the significant link of oral disease to other NCDs and the great impact of oral health on general wellbeing. This Statement emphasises the incorporation of oral health-care strategies into the overall NCD agenda and global campaigns within the framework of the UN agencies.

Currently, tackling health inequalities within and between countries as well as the social determinants of health (SDH) is the common goal of public health policies nationally and internationally. The Statement on ‘Oral Health and the Social Determinants of Health’⁴ recognises that an unhealthy diet such as excessive intake of sugars, tobacco use and excessive alcohol consumption are common determinants of oral disease and other NCDs. A new model should be developed for oral health promotion to specifically address these common determinants of health, via the well-defined common risk factor approach (CRFA).

Both Statements strongly advocate that the FDI should establish global alliances with all key partners, in particular the World Health Organisation (WHO) and the International Association for Dental Research (IADR), and other major stakeholders, to address oral health and NCDs, to eventually reduce oral health inequalities globally. The NDAs and oral health-care professionals should strive to make governments and decision-makers aware of the great importance of common risk factors that affect both oral health and other NCDs, and essentially take more proactive measures to prevent and control the various determinants of all NCDs for optimal oral and general health.

The Statement on ‘Oral Infection/Inflammation as a Risk Factor for Systemic Diseases’⁵ reinforces the established relationship of oral infection and inflammation, in particular periodontal disease, to other major NCDs (e.g. diabetes and cardiovascular disease) as well as the promising effects of periodontal treatment on reduction of blood glucose level and improvement of endothelial function. It further stresses that all health-care professionals should understand the clinical implications of oral disease in general health and play a central advisory role in translating science into public awareness of oral health and health-policy making.

Notably, the essence of the three Statements above has been highly reflected in the FDI’s ‘Istanbul Declaration’ ‘Oral Health and General Health: a Call for Collaborative Approach’, which was officially issued during the 2013 AWDC⁶. It calls upon the FDI and all NDAs to support a broadened role and responsibility of oral health-care professionals for improving the general health and wellbeing of the community they serve, and all health-care leaders to appreciate oral health as an essential component of general health and strongly promote an interprofessional collaborative approach in the development of health policies.

In recent years, salivary tests and diagnostics have increasingly attracted great attention and interest from both dental and medical professional communities. The Statement on ‘Salivary Diagnostics’⁷ highlights the potential use of salivary tests to assess risk and make a diagnosis of some oral and systemic diseases. It further urges oral health-care professionals take note of the potential value and important implications of salivary testing in clinical practice. The FDI encourages further research in this exciting field.

The FDI is issuing the Statement on ‘Bisphenol-A in Dental Restorative and Preventive Materials’⁸ for the first time. Although no dental materials are primarily made from Bisphenol-A (BPA), final dental products may contain a minimum residue of BPA from the manufacturing process. Patients may therefore be exposed to minute amounts of BPA during and shortly after dental treatment. Currently, scientific research on BPA in clinical dentistry remains limited. Oral health-care professionals are encouraged to be aware of this crucial issue and stay updated on the scientific progress in this field. The FDI strongly discourages the use of BPA in the manufacture of any dental materials. Meanwhile, the FDI reaffirms the importance of greater awareness of oral health and prevention of dental caries, thereby ultimately reducing the need for dental restorative materials.

Acknowledgements

The FDI acknowledges with gratitude the great contributions from members of the Science Committee and experts in putting together these five FDI policy statements. Special thanks go to Harry-Sam Selikowitz for the statements on NCDs and the social determinants of health; Ira Lamster for the statement on oral infection/inflammation; David Wong (University of California, Los Angeles, USA) and Lijian Jin for the statement on salivary diagnostics; and Gottfried Schmalz (University of Regensburg, Germany) and Georg Meyer for the statement on Bisphenol-A. The valuable suggestions from Jean-Luc Eiselé and the FDI Council as well as the excellent administrative support from Isabelle Bourzeix are highly appreciated.