EDITORIAL
Dr Cristiane da Mata Honorary Editor
A new era for dentistry? The WHO resolution on oral health is a landmark moment for dentistry and oral health – is change finally on the way? GV Black, the father of operative dentistry, once said in a lecture: “The day is surely coming and perhaps within the lifetime of you young men before me, when we will be engaged in practising preventive, rather than reparative, dentistry”. Black already knew back then the importance of prevention, suggesting ways to avoid the trapping of food in pits and fissures through “extension for prevention”.1 Whereas dentistry has evolved a lot since then, and extension for prevention is a concept no longer used, oral health worldwide does not seem to have followed at the same speed. From the introduction of local anaesthesia, the use of fluoride to prevent caries and smart toothbrushes, to 3D printing and digital radiography, dental materials and technology have come a long way, but the oral health of a great portion of the population is still in a poor state. Almost 150 years since Black’s lecture, dental caries, a largely preventable disease, is still a major public health problem worldwide. The treatment of choice is still drilling and filling, and this is not accessible to all. The result at an individual level is pain, tooth loss, and poor quality of life. At a population level, the economic burden is substantial, including lost days at work, hospital admissions for treatment under general anaesthesia (GA), and high expenditures on dental treatment. A recent study compared the global burden of 291 diseases and injuries, and found that untreated dental caries in permanent teeth was the most prevalent of all conditions in 2010, affecting 35% of the population worldwide.2 More than 3.9 billion people suffer from oral diseases, including caries, periodontal diseases, and cancers. Not surprisingly, oral diseases disproportionally affect poor and socially disadvantaged populations.
Landmark For this reason, the approval by the WHO of a resolution on oral health, which took place last year, is a landmark to be celebrated. It recognises the burden of oral disease at a global level, and urges WHO member states to have a plan in place to, among other things:
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integrate oral health into national health policies; enhance the professional workforce capacity to deliver quality care; move to minimum intervention approaches; and, raise awareness of the importance of good oral health and a functional dentition.
Bringing oral health into the spotlight was a first step. Now, the WHO will have to draft a global strategy to inform the development of an action plan by 2023. This action plan has to include clear, measurable targets, to be achieved by 2030. The idea is to ‘leave no one behind’, by improving access to care and prevention, reducing disease burden, and addressing risk exposure factors such as sugar, while encouraging community participation.
Challenges It all sounds very positive, but we cannot deny it is a considerable challenge. Major reforms in service delivery will be needed, and the importance of community engagement cannot be underestimated. Those living with oral diseases, who would benefit the most from these reforms, are the ones whose voices are not heard when planning for change. Another major challenge that needs to be taken seriously is fighting sugar industry lobbying. The link between sugar and dental caries has been long established and public health policies to tackle sugar consumption have to play a central role in this oral health strategy. There is still a long way to go, but if efforts and resources are put into place globally, dentistry could be heading towards a new era, and the way dental services are delivered could change dramatically. And maybe, somewhere down the road, hopefully not 150 years from now, GV Black’s prophecy might be fulfilled.
References 1. Joseph, R. The father of modern dentistry – Dr Greene Vardiman Black (1836-1915). The Journal of Conservative Dentistry 2005; 8 (2): 5-6. 2. Marcenes, W., Kassebaum, N.J., Bernabé, E., Flaxman, A., Naghavi, M., Lopez, A.,
n address key risk factors for oral disease shared with non-communicable diseases such as cardiovascular disease and cancers;
Murray, C.J. Global burden of oral conditions in 1990-2010: a systematic analysis. J Dent Res 2013; 92 (7): 592-597.
Journal of the Irish Dental Association | June/July 2022: Vol 68 (3) 109
