In 2020, when my dental colleagues and I organized the first oral health advocacy walk in our rural community in Ekiti State, Nigeria, people asked us questions on the streets. The most common was around why we were focusing on this issue at all. In my nine years as a dentist, I have seen time and again how often oral health is not viewed as a priority and instead is secondary to the other concerns.
However, the recent launch of the first ever Global Oral Health Status Report (GOHSR) by the World Health Organization shows that oral health is more important now than ever. The world can no longer afford to neglect a disease that affects 3 out of every 4 people in low- and middle-income countries (LMICs). Untreated oral diseases have social repercussions and a large impact on quality of life. They affect general well-being, employment, work performance and even mental health. Most of the LMICs affected do not have enough facilities or resources to effectively treat oral health conditions. It’s too huge a burden to ignore.
The GOHSR has shown us that even though oral health diseases have existed as far back as we can remember, the burden of this disease went higher by 50% between 1990 and 2019, making tooth decay the most common disease in the world. Despite several improvements in different countries, this problem still persists more than 30 years later.
Most oral health diseases are preventable, yet the report from WHO shows that over 514 million children around the world are affected by tooth decay. About 244 million of these children live in LMICs. Tooth decay in children can lead to severe pain, problems with speech, difficulty in eating or sleeping. Much more it can lead to school absenteeism and negatively impact their parents’ work.
In Nigeria, over 80% of children suffer from untreated tooth decay. This number is quite similar across several African countries. Likewise in Nepal, the National pathfinder survey shows that 58% of five to six year old school children are affected by tooth decay, 3 out of every 5 children miss school. The social and economic cost of neglecting oral health is causing a great burden globally and our children are deeply affected.
The societal perception of oral health as unimportant won’t change if we don’t build a global and inclusive movement to change it. Here’s how we can achieve this:
Local communities should be actively involved in improving their own health. Friendship bench is an innovative community approach that has helped spark mental health conversations through lay health workers. Oral health will benefit from a similar approach, however using rural women farmers. 85% of rural women in the world work in agriculture. Pakistan, Tanzania and Gambia are examples of LMICs that have women as forerunners in agriculture. These rural women farmers play a key role in community mobilization.
Many rural communities have existing discussion groups led by respected women farmers, where they discuss the wellbeing of the community. These women should be trained and paid to facilitate meaningful conversations around oral health also. They can then work together with local oral healthcare providers to design and implement suitable intervention programs for their communities.
While countries are working on community mobilization, international stakeholders like the Wellcome Trust, UNESCO and the World Bank can also play a key role in widening and funding oral health research being undertaken in LMICs. Most rural communities have insufficient research evidence on oral health, which has led to lack of sustainable solutions. There’s no one-size-fits-all solution to oral health in rural communities, however investing in evidence based research can move the needle of change.
Training researchers who live and work in rural communities is key to acceptability. Besides encouraging rural women farmers to facilitate oral health conversations, we must also build research capacity in them. They understand their communities and are best suited to answer questions and give feedback.
Friendship Bench approach in Zimbabwe rose on the shoulders of grassroot research backed by funding from Grand Challenges Canada in early 2016. Now, over 32 international stakeholders are committed to its funding. In the space of three years, the Friendship Bench has improved the mental health of half a million people in 6 countries. I strongly believe we can replicate the same for oral health.
The FDI World Dental Federation and WHO are already doing a great job of highlighting the importance of oral health, however we need more international actors on board.
The economic cost of doing nothing to stop oral health disease is high. Therefore, we must concentrate our combined efforts to reduce the global burden and inequities of oral health. Action on oral health needs a global social movement.
About the author: Dr. Adekemi Adeniyan is a rural dentist breaking down barriers to oral health for underserved communities to ensure equitable health access for all in Nigeria. She is Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University. You can follow her on Twitter @PstDrKemi
Competing interest: None
Handling Editor: Neha Faruqui