The Case for Oral Health Care

The Case for Oral Health Care

Since the 1990s, the “bottom billion”—the poorest citizens of the world—have experienced a surge of development unprecedented throughout history.

Over one billion people have been lifted out of extreme poverty; average incomes have more than doubled in developing countries; infant mortality rates have plummeted; fewer people go hungry every day; millions of girls have gained access to education; and death caused by HIV/AIDS, malaria and other diseases have declined dramatically.

These advancements are remarkable—but progress has been uneven. In concentrated areas of the world, most critically throughout sub-Saharan Africa and South Asia, development inequalities persist.

For marginalized communities, oral health is a looming crisis.

Amidst decades of tremendous progress, the global burden of oral diseases has increased 20% since 1990, largely due to population growth and aging. Although poor oral health is associated with diabetes, cardiovascular disease, strokes and other major chronic diseases, it is often a neglected area of public health policy.

According to the World Health Organization, nearly 100% of adults worldwide have tooth decay, 20% of middle-aged adults have severe gum disease and 30% of people over 65 have no natural teeth.

Over time, regions of the world where infectious diseases are prevalent have suffered greater increases of chronic diseases. Tooth decay, for example, is the most common chronic disease in childhood worldwide. In fact, oral diseases such as dental caries, periodontal diseases and oral cancers are among the most prevalent noncommunicable diseases worldwide.

To put these diseases into perspective, noncommunicable diseases were responsible for 68% of deaths worldwide in 2012.

Image by Nana B Agyel

Image by Nana B Agyel


Compared to global averages, the presence of oral diseases are more widespread in both children and adults in low-income and disadvantaged communities. Particularly in rural areas, public health clinics are scarce, knowledge of proper hygiene is limited and oral health resources (like fluoride) are limited.

Not including cavities and mild gum disease, roughly 4 billion people suffer from untreated oral health conditions.

The pain associated with serious oral health conditions can restrict the ability of people to speak, breathe, chew, swallow, sleep and even smile. Discomfort can cause children to miss school and adults to miss work, which can lead to social immobility and diminish quality of living. A national oral health survey found that nearly 3 in 10 Kenyans avoid smiling due to their teeth.

The situation is clear: Poor oral health is a neglected problem in global development.

Particularly in East Africa—where oral health outcomes are worsening due to extreme poverty, lack of medical access and poor oral hygiene—there exists a strong need for interventions that prevent tooth decay while providing immediate relief to people in pain. The intrinsic link between good oral health and quality of life is universal, yet international initiatives fall short of supplementing shortages in oral health care service delivery.

The problem of oral health may initially seem too prevalent to solve or too challenging to prioritize. When it comes to big picture numbers for oral health personnel, increasing health care services in developing countries is a tall task. Furthermore, treating dental diseases is expensive, constituting roughly 10% of health-care budgets in industrialized countries. In low-income countries, the same amount would exceed the entire financial resources available for child health care.

Dentists to Population Ratio

In Africa, there is one dentist for every 150,000 people. Rural communities typically have no access to oral health professionals and consequently millions of people have never visited a dentist. Even for a country like Kenya, which has relatively more dentists than other nations, the amount of oral health professionals is insufficient; over 1,000 dentists in Kenya serve a population of 17 million and too many people are left without care. WHO recommends one dentist for every 7,000 people, while countries like the United States have one for every 1,650.

Though the numbers may seem daunting, it’s not all bad news!

Complications caused by tooth decay and oral diseases are entirely preventable if treated in their early stages. Even in the developing countries least equipped to strengthen oral health care, the combination of a toothbrush, fluoride and a well-informed brusher can significantly reduce the risk of disease. While diets in East Africa and around the world are gradually changing (increased sugar intake, higher alcohol consumption, widespread tobacco use and an overall lack of fluoride), the effects are not too dire to mitigate.

Already, aid and health organizations have established strategic frameworks to build healthy communities and combat ill health:

  1. Reduce the burden of oral disease and disability, especially in poor and marginalized populations;
  2. Promote healthy lifestyles and reduce risk factors to oral health that arise from environmental, economic, social and behavioral causes;
  3. Develop oral health systems that equitably improve oral health outcomes, respond to people's legitimate demands, and are financially fair;
  4. Frame policies in oral health based on integration of oral health into national and community health.

In 2015, the United Nations adopted the Sustainable Development Goals, with the third goal to “Ensure healthy lives and promote well-being for all at all ages.” A healthy life is a life free from oral diseases and conditions. Dental cavities, periodontal disease, tooth loss, oral cancer, dental trauma and oral infections threaten the well-being of those communities left behind.

Our greatest challenges are reaching these communities and creating sustainable change.

By building on the progress of past decades, reflecting on lessons learned and contributing to a more equitable and healthy world, we can tackle the root causes of poor oral health. An investment in oral health will create lasting positive impact on the lives of the bottom billion—people who deserve to benefit from the greatest surge in development in history.