INTRODUCTION

1 INTRODUCTION

Many people worldwide suffer from oral disease because of pain and discomfort, loss of function and reduced quality of life.1-4 Oral diseases afflict people of all ages. The World Health Organization (WHO) considers oral conditions, such as dental caries, periodontal disease, tooth loss, oral cancer, HIV/AIDS oral lesions and oro‐dental trauma being significant public health problems.1, 4, 5 As with other noncommunicable chronic diseases (NCDs), poor diet high in sugars, tobacco use and excessive use of alcohol are important risk factors.3, 6, 7 Social determinants are important with poor oral health extraordinary high among deprived population groups8; moreover, the disparities in oral health persist across the life course.

Healthcare systems are essential for improving and maintaining the health among population groups. They result from the combined efforts of government agencies, institutions and resources, with the aim of improving health of their people. Properly designed health systems should have a strong component of health promotion and disease prevention, provide for early disease detection and health communication and facilitate appropriate intervention.9 A health system requires staff, funds, information, supplies, transport, communication networks, and overall guidance and direction. It also needs to provide services that are responsive and financially fair. Meanwhile, the structure and efficacy of oral health systems vary. Low‐ and middle‐income countries have critical shortages of oral health professionals, and systems are largely symptoms‐oriented. In high‐income countries, oral health professionals are available and advanced systems provide curative and preventive services to people of all ages.9, 10 Nevertheless, globally, underprivileged people are served inadequately by primary oral health care, and treatment of disease is costly and unfair.11

The good news is that the major oral diseases are preventable. Since the 1980s or so, the significance of disease prevention has grown in a number of countries and substantial experience has been gained from implementation of community actions, introduction of preventive activities directed towards population groups and individual preventive care.12-14 In addition, countries have demonstrated the effect of oral disease prevention through healthy environments. Fluoridation programmes have proven to be effective in preventing dental caries.15, 16 Health‐promoting schools17, 18 are successful in encouraging healthy lifestyles and oral health among children and youth. Publicly funded care for older people is shown to improve oral health and quality of life,19 and tobacco and alcohol interventions through community actions or dental settings20, 21 are key actions for reducing oral cancer and periodontal disease. Moreover, healthy diet and reducing the intake of free sugars are important in prevention of dental caries.22

1.1 WHO policies

Public health intervention against oral diseases of all age groups has gained much concern over the past decades. WHO has given particular emphasis to incorporation of oral health into general health in national NCD prevention programmes and encourages the application of the Common Risk Factors approach.6 In 2007, the WHO World Health Assembly called upon countries to ensure that systematic policies for oral health and effective population‐directed oral health programmes are organized. The World Health Assembly established a Resolution (WHA60.17) on Oral Health: Action plan for promotion and integrated disease prevention, which stresses the responsibility of countries in developing appropriate public health actions for oral disease prevention and health promotion.23 Likewise, WHO pointed out the unique role of the research community24 and oral health professionals25 in building country capacity for oral health.

1.2 Objectives

Ten years after the confirmation of the WHA60.17 resolution on oral health, there is a need to ascertain the current application of policy recommendations on the strengthening of population‐oriented oral disease prevention and health promotion. Thus, the objective of this study was to determine the nature and the extent of appropriate oral health intervention activities for children, youth, adults and older people in low‐, middle‐ and high‐income countries.

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