The WHO estimates that 5 billion of the world’s 6 ½ billion population suffer from dental decay, making dental caries the most common non-communicable disease in the world. Dental decay, particularly among children, has recently been described by a leading expert as having reached “pandemic” proportions.

While most in high-income countries have access to oral health professionals, the vast majority of people living in poorer countries either have to live with the resultant pain of tooth decay or seek relief through DIY or “street” dentistry performed by untrained practitioners without anaesthetic. Both options can be life threatening as severe decay can lead to serious infections, which without antibiotics can result in death, while “street” dentistry is rarely if ever administered with suitable cross-infection control, risking contraction of serious diseases like HIV and Hepatitis.

 

 

However, while deaths from infections, oral diseases (oral cancer, NOMA ) and cultural practises such as IOM run to hundreds of thousands, if not millions per year, by far the biggest impact of dental caries and other dental diseases are their detrimental effect upon quality of life. Living with the persistent pain of toothache day in, day out, is the common experience of hundreds of millions, if not billions, of the world’s population. Persistent pain, difficulty eating and an inability to sleep are common effects of dental caries and new studies around the world are consistently showing the wider socially adverse effects of dental decay. For example, a recent study in the Philippines showed that oral pain is the biggest cause of school absenteeism, while “needs assessments” of health and social needs carried out in middle and low-income countries consistently show relief from oral pain as a top ten “need” expressed by individuals and communities. A recent worldwide study has also shown that untreated dental caries impacts significantly on the physical and cognitive development of young children. Finally, still further studies have shown a major impact on people’s self-confidence and social interaction due to the manifestations of dental caries causing physical disfigurement and bad breath.

 

Despite all this suffering, oral health remains a largely ignored and vastly under-resourced health issue in middle and low-income countries.

 

High-income countries on the other hand have experienced a dramatic improvement in oral health over the last thirty years. This is mainly down to successful public health measures, particularly utilising fluoride, which have led to a vast reduction in caries. In some countries, dental caries rates have fallen by up to eight times, while those who do still suffer dental caries or other oral health conditions generally have access to clinic-based oral health professionals, who provide a wide range of services.

 

However, middle and low-income countries have largely not benefited from these advances, and in many countries (due to changing diet and the influx of “Western” refined sugar products) the caries burden is increasing sharply. Despite fluoride having been proven and used in the West for over fifty years and being a cheap commodity, the WHO estimates that still only 20% of the world’s population (essentially the developed world) have access to appropriate levels of fluoride. Therefore, over 5 billion people worldwide do not benefit from the most effective preventive measure against dental caries.

 

Less still have access to the most effective fluoride prevention tool of all – fluoride toothpaste. The WHO estimates that as little as 8% of the world’s population may brush their teeth with fluoride toothpaste, for reasons of access, lack of awareness and affordability. These reasons are accentuated by global factors including:- worldwide classification of fluoride toothpaste as a cosmetic product, subjecting it to cosmetic taxes (over 50% in some countries); the pricing behaviour of global toothpaste manufacturers; the lack of investment by governments and development NGOs in encouraging local manufacture of quality affordable toothpaste and promoting daily tooth brushing in middle and low-income countries.