Oral health: often overlooked – The Lancet Child & Adolescent Health

Tooth decay in children is both a visible and invisible problem. Children with tooth decay may have noticeable difficulty eating, speaking and sleeping, experience distress and pain, and smile less, which in turn affects their development, well-being, family life and social and school performance. Yet, as oral diseases disproportionately affect the most marginalized and poorest members of society, such as children living in poverty, refugees, people with disabilities and indigenous populations, their health burden is underestimated and the global epidemic of oral disease is not receiving the attention it deserves.

In 2015, 7.8% of the world’s child population, or 573 million children in total, had untreated dental caries. The prevalence of untreated caries on deciduous teeth and permanent teeth peaks between 1 and 4 years and between 15 and 19 years, respectively. Inadequate access and the prohibitive cost of treatment means that many children and adolescents, especially those living in low-resource settings, will face serious, lifelong consequences of chronic untreated dental caries, such as pain and incessant infections, as well as a reduced quality of life. and loss of school and work productivity. Even in high-income countries, oral diseases represent a heavy health and economic burden. A position paper from the Royal College of Surgeons of England, published on August 15, 2019, found that tooth decay is the leading cause of hospitalization in England – accounting for nearly 78,000 admissions – in children aged 5 to 9. in 2015-18.
The fact that preventable dental caries is widespread and causes such a disproportionate burden of disease challenges current dental health systems and public health policies. In the United States, not all private insurance companies offer dental insurance and not all dentists accept Medicaid; therefore, less than 60% of children under 5 visit a dentist regularly. In England, 41% of under-18s and 77% of children aged 1-2 did not see a dentist in 2018, even though dental care is free for this age group under National Health Service. This shows that cost is only one aspect of the barriers to adequate dental care. The demand-driven nature of dentistry means that clinics tend to be in affluent neighborhoods, creating a significant mismatch between supply and demand. Published in July 2019, The Lancet oral health Series advocates for a radical reform of dental services to further integrate them into the broader health system, especially in primary care, as part of universal health coverage and to ensure continuity of care. Since oral diseases are chronic and progressive, the series also calls for a shift from an interventionist approach to promoting and maintaining good oral health.

These necessary large-scale changes require commitment and action from all key stakeholders, including academics, health practitioners, dental associations and governments, as well as the World Dental Federation FDI and the WHO, to place oral health at the forefront of global and public health. agendas. In this regard, the UK Government’s commitment to expand supervised toothbrushing programs in nursery and primary schools is a welcome step towards change.

Like obesity and other non-communicable diseases, advocacy and policy changes to address broader socio-economic and market determinants must be part of the solution. Evidence-based policies – including taxes or levies on sugary products, stricter restrictions on advertising and promoting sugary foods and drinks to children and adolescents, and water fluoridation – should be implemented as a priority. Regulators should also require manufacturers to reformulate products to reduce sugar content, especially in baby foods. Above all, key stakeholders should avoid sugar industry funding and sponsorship.

At the individual level, child health practitioners need to better recognize that oral health is a vital part of child well-being and receive appropriate training. For example, they can initiate conversations with parents and young people about oral health during routine appointments, and provide simple education on oral hygiene techniques and healthy eating habits, especially during times when parents are most responsive (for example, when infants transition to solid foods) .

Oral health is an integral part of child health. It should not be a luxury for the rich, nor sacrificed for commercial gain. Interventions to prevent tooth decay – proper tooth brushing, reduced sugar intake, regular dental appointments – are simple and cost effective. But these interventions need to be implemented equitably and accompanied by strong advocacy and policy actions to challenge the sugar environment we live in.

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