Oral health care needs our attention

Oral health care needs our attention
Written by admin

Daily tooth-brushing in Philippine schools, like this elementary school in Guihulngan City, Negros Oriental, was pioneered by the foreign-funded Fit for School project.  PHOTO BY MARIT STINUS-CABUGON

Daily tooth-brushing in Philippine schools, like this elementary school in Guihulngan City, Negros Oriental, was pioneered by the foreign-funded Fit for School project. PHOTO BY MARIT STINUS-CABUGON

TODAY, Nov. 28, 2022, begins the first session of the Intergovernmental Negotiating Committee that is tasked with drafting a legally binding instrument on plastic pollution. While plastic pollution is a problem in itself, the production, use and disposal of fossil-fuel derived plastics are also tied to the wider issue of climate change. The meeting, dubbed the INC1, comes on the heels of COP27. Considering the link between plastics and climate change, it is paramount that INC1 delegates gathering in Punta del Este, Uruguay, lay the foundations for a strong Global Plastics Treaty.

Climate change, choking plastic pollution, a Covid-19 pandemic that continues to rear its ugly face, the murderous war on Ukraine and all its devastating effects — these overwhelming realities notwithstanding, the World Health Organization reminds us that oral health care needs our attention too , and now.

According to the “Global oral health status report — towards universal health coverage for oral health by 2030,” released Nov. 18, 2022, an estimated 3.5 billion people — 44 percent of the world’s population — suffer from oral disease. The most common oral disease is untreated caries of permanent teeth. Its afflicting an estimated 2 billion people makes it the most widespread non-communicable disease.

The report said 514 million children suffer untreated caries in their baby teeth (deciduous or first teeth) making such a condition the “single most common chronic childhood disease” worldwide.

WHO defines dental caries as “a gradual loss and breakdown (decay) of tooth hard tissues (enamel and dentine) that results when free sugars contained in food or drinks are converted by bacteria into acids that destroy the tooth over time.” And what are free sugars? They are “all sugars added to foods by the manufacturer, cook or consumer, plus sugars that are naturally present in honey, syrups and fruit juices. Caries can lead to cavities, which are permanently damaged areas in the hard surface of the teeth.. .”

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Consumption of free sugars, the WHO says, “is the most important risk factor for dental caries … High sugar consumption is directly related to higher caries activity, and restricting intake of sugar decreases incidence and severity of dental caries.” Yet, corporations that are manufacturing sugar-filled food and beverages, despite the obvious link between consumption of their products and poor oral health, seek to influence health and education sectors “to give themselves a socially responsible image, including for example, sponsorship of school activities and sporting events.” WHO warns that, “With sophisticated marketing, promotion and sales approaches, these industries seek to influence consumer behavior and create an environment where their products are universally available, affordable, accessible and appealing — a powerful and potent threat to population oral health.”

While food and beverages that destroy our teeth are universally available and affordable, even the most basic of oral health care isn’t. According to the oral health country profiles, even fluoride toothpaste is considered unaffordable in the Philippines with 1.2 labor days needed to buy an annual supply of fluoride toothpaste per person. By comparison, in Thailand and Singapore a person needs to work 0.6 and 0.1 days only, respectively, to earn enough to buy a year’s supply of toothpaste. A combination of high price of the toothpaste and low per capita income makes toothpaste of the recommended quality and quantity unaffordable to the average Filipino.

Thailand is identified as a role model in the Global South by having routine or preventive oral health care, as well as essential and advanced curative oral health care by covered government-funded health care insurance. WHO’s ambitious goal is — as the title of its report states — to have oral health included in universal health coverage in all member states by 2030. In the Philippines, I understand, oral health care is not yet covered by PhilHealth except for some surgical procedures . The Department of Education is promoting oral health through daily tooth brushing with fluoride toothpaste though this is done only in schools that are being supplied with toothpaste. Commercial fluoride toothpaste is expensive but much cheaper recommended fluoride-concentration-compliant, locally produced alternatives are actually available. WHO strongly recommends that, “Measures to promote the production, marketing and sustained use of fluoride toothpaste need to be taken to counter observed trends of increasing market share of non-fluoridated toothpaste in some countries. Product quality and the sale of counterfeit products should be controlled regularly.” A testing of different brands of toothpaste some years ago revealed that several brands being sold in the Philippines didn’t contain the minimum recommended concentration of fluoride.

Poor oral health may not be life-threatening. However, as pointed out by Habib Benzian and colleagues in their commentary to the WHO report (The Lancet, Nov. 18, 2022), “The cumulative negative impacts of oral disease on societies and economies are unacceptable and adversely affect human development.” It would be even more unacceptable to fail to take decisive steps towards addressing poor oral health considering the availability of affordable and cost-effective interventions.


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