Oral health

• dental caries (tooth decay)
• severe gum disease
• tooth loss and 
• oral cancers.  

Untreated dental caries is the single most common condition globally, affecting an estimated 2.5 billion people. Severe gum disease – a major cause of total tooth loss – is estimated to affect 1 billion people worldwide. About 380 000 new cases of oral cancers are diagnosed every year.

The report shows that almost half of the world’s population (45% or 3.5 billion people) suffer from oral diseases and that global cases of oral diseases have increased by 1 billion over the last 30 years – a clear indication that many people do not have access to prevention and treatment of oral diseases. 

The report underscores the glaring inequalities in access to oral health services, with a huge burden of oral diseases and conditions affecting the most vulnerable and disadvantaged populations. People on low incomes, people living with disabilities, older people living alone or in care homes, those living in remote and rural communities and people from minority groups carry a higher burden of oral diseases.

This pattern of inequalities is similar to other noncommunicable diseases such as cancers, cardiovascular diseases, diabetes and mental disorders. Risk factors common to noncommunicable diseases such as high sugar intake, all forms of tobacco use, and harmful use of alcohol all contribute to the global oral health crisis.

Only a small percentage of the global population is covered by essential oral health care services, and those with the greatest need often have the least access to services. The key barriers to delivering access to oral health services for all include the following.

• High out-of-pocket expenditures for oral health care often lead to catastrophic costs and significant financial burden for families and communities.
  
  
• The provision of oral health services largely relies on highly specialized providers using expensive high-tech equipment and materials, and these services are not well integrated with primary health care models.
  
  
• Poor information and surveillance systems, combined with low priority for public oral health research are major bottlenecks to developing more effective oral health interventions and policies.

Placing people at the heart of oral health services is critical if we are to achieve the vision of universal health coverage for all individuals and communities by 2030. The Global oral health status report acts as a starting point by providing baseline information to help countries monitor progress of implementation, while also providing timely and relevant feedback to decision-makers at the national level. There are many promising opportunities to improve the state of global oral health including:

• adopting a public health approach by addressing common risk factors through promoting a well-balanced diet low in sugars, stopping use of all forms of tobacco, reducing alcohol consumption and improving access to effective and affordable fluoride toothpaste;
  
• planning oral health services as part of national health agenda and improving integration of oral health services in primary health care as part of universal health coverage;
  
• redefining oral health workforce models to respond to population needs and expanding competencies of non-oral-health health care workers to expand oral health service coverage; and
  
• strengthening information systems by collecting and integrating oral health data into national health monitoring systems.

Oral health has long been neglected in global health, but many oral diseases can be prevented and treated with the cost-effective measures. WHO is committed to providing guidance and support to countries so that all people, wherever they live and whatever their income, have the knowledge and tools needed to look after their teeth and mouths, and to access services for prevention and care when they need them.

WHO is planning the first ever global oral health meeting for December 2024, which is one of the key milestones as part WHO preparations for the Fourth High-level Meeting of the UN General Assembly on the prevention and control of NCDs. The meeting will be an opportunity to formally unite national oral health focal points with national UHC focal points and work together, with the support of WHO, to define the path forward for integration of essential oral health care services as part of UHC.

The World Health Assembly adopted the resolution on oral health (WHA74.5) in 2021 at the Seventy-fourth World Health Assembly. The resolution recommends a shift from the traditional curative approach towards a preventive approach that includes promotion of oral health within families, schools and workplaces, and includes timely, comprehensive and inclusive care within the primary health care system. The resolution affirms that oral health should be firmly embedded within the NCD agenda and that oral health care interventions should be included in universal health coverage programmes.  

In response to the resolution on oral health, the Secretariat developed the Global strategy on oral health, adopted in May 2022 (decision WHA75(11)) with a vision of universal health coverage for oral health for all individuals and communities by 2030. The Global oral health action plan 2023‒2030 was subsequently developed and included in the report on NCDs noted by the Seventy-sixth World Health Assembly (decision WHA76(9)). This includes a monitoring framework for tracking progress, with measurable targets to be achieved by 2030.

In addition, WHO released the Global oral health status report in November 2022, which provides the first ever comprehensive picture of oral disease burden with data profiles for 194 countries, giving unique insights into key areas and markers of oral health that are relevant for decision-makers.

WHO is collaborating with the United Nations Environment Programme (UNEP) on a 3-year project on phasing down the use of dental amalgam under the Minamata Convention on Mercury. The project will be piloted in 3 countries – Senegal, Thailand and Uruguay – working jointly with the relevant WHO regional and country offices during implementation. The project seeks to strengthen national capacity to phase down the use of and demand for dental amalgam and manage mercury/hazardous wastes from dental use in a measurable, equitable and environmentally sustainable manner. 

WHO strongly advocates for close collaboration between ministries of health and ministries of environment to effectively phase down the use of dental amalgam and, in some cases when appropriate, even a phase out. This can be achieved by creating a national roadmap with a time-bound agenda including clear roles, deadlines, key stakeholders and sufficient resources that should be aligned to the WHO Global oral health action plan (2023–2030). 

Globally, there are a range of health care professionals specifically trained to respond to oral health diseases and conditions. There is wide variation in the naming conventions of oral health care professionals and relevant competencies that define their scope. The oral health workforce includes dentists, oral health therapists, dental hygienists, dental nurses, dental assistant and dental technicians. However, essential dental medicines and preparations could be delivered by other health care professionals in primary health care such as nurses, midwives and community health workers. These are preventive and minimal intervention procedures that can easily be applied in general primary health care settings. The development of innovative workforce model that promote task-sharing and interprofessional collaboration is one of the strategic objectives of the WHO Global oral health action plan (2023–2030).

No. Bad breath can be caused by a range of reasons and this symptom alone does not indicate an oral health issue of public health concern, although in individual cases it could be associated with an oral disease. Oral health is defined as the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions, such as eating, breathing and speaking, and encompasses psychosocial dimensions, such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment. Crooked teeth may indicate a need for more rigorous daily oral hygiene practices but in itself is not a public health issue.

There is no strong evidence to suggest a best practice for regular check-ups despite being a commonly cited approach to maintaining oral health. Dental check-ups are especially important during pregnancy.