Tooth with world map inside
March 16, 2018 — By IHPL

Despite some success with some innovative solutions in our backyards, such as Virtual Dental Homes and School-Based Health Centers, the oral health system in the United States (US) has room for improvement. Countries around the globe have taken to creating and implementing exemplary creative and individualized programs to address oral health issues that they face.

Programs that Take the Crown: Canada

Let us first take a look at our North American neighbor: Canada. Canadians are proud of their oral health outcomes and the fact that three-quarters of the population visits the dentist annually.1 Despite having a universal health care system, dental services are provided mostly through the private sector. Recently, many of the efforts have been focused on providing access to low-income communities and seniors through the use of mobile dental clinics and long-term care facility pilot projects, respectively. The Alex Dental Health Bus rolls through the streets of the western province of Alberta where it provides free dental care and education on preventive measures for low-income families. With the help of private sponsorship, more than 350 children are seen every month. There are also many initiatives for providing low-cost care to seniors. In some pilot programs, dentists coordinate care with long-term care facilities by providing seniors with affordable annual screenings and dental services in-residence.2   

Programs that Take the Crown: Denmark

Countries on the European continent have also been implementing various policies and programs in efforts to build up a preventive system against oral diseases. Such efforts are evident with the European Public Health Alliance 2012 ban on the addition of sugars to fruit juices.3,4 Similarly, countries such as Switzerland, Germany, and Finland have been promoting sugar-free products with the “Toothfriendly” seal of quality after multiple studies showed that reduction of sugar in specific food items directly decreased tooth decay.5 Denmark integrated the preventive oral health model into the community and now, systematically provides comprehensive dental services to children (0-18 years old) for free. Each municipality registers usage of services by children residing there. By 1997, 99 percent of children were receiving dental care annually.6

Programs that Take the Crown: Sweden

Just over the Oresund Bridge (connecting Denmark to Sweden) in Sweden’s third largest city, Malmo, a 2002 oral health survey determined that 85 percent of 3-year-olds suffered from dental caries. Given that more than three-quarters of the population consisted of immigrants, the department tailored their public health campaign to address the needs of such a diverse community through picture advertisements. The program enrolled a cohort of nearly 800 children born between 1998 and 2000 and provided scheduled dental visits for the children, oral health education sessions for the parents, and free oral health supplies such as toothbrushes, fluoridated toothpaste, and fluoride tablets. The program saw success with the reduction in caries prevalence and above-expectation adherence to the program schedule.7

Oral Health in Developing Nations

In contrast, developing nations face entirely different kinds of oral health diseases. For instance, while tooth decay affects industrialized countries, the burden is quite low in African countries. The World Health Organization (WHO) explains that this is predominantly due to lack of sugar in the diets.8 Instead of caries, noma—a bacterial infection that affects malnourished children and destroys the soft and hard tissues of the oral cavities—is rampant throughout the sub-Saharan region. Studies show that it may pass up mortality due to HIV/AIDS and malaria in the coming years.9 Thus, a group of 30 foundations and non-governmental organizations formed the International No-Noma Federation. The concerted effort to fight the disease in African countries involves awareness campaigns tailored to individual villages, strategies to combat malnutrition, and stronger surveillance.10 While prevention is crucial, a treatment-based approach that provides dental surgery is often necessary but expensive. Such programs rely on private funding as well as dental workforce supply.

Bridging the Gap in Oral Care Access

I firmly believe that improving oral health in the United States is going to require integration of oral health into the health care system, increase in the supply of dental health workforce, increase in funding, robust epidemiological surveillance capabilities, and an education campaign targeted towards low-income and racially diverse neighborhoods. That being said, such efforts place the onus predominantly on the government. Every year, we are teased with state and federal policies that consider universal oral health care access policies only to end up settling for far less. Learning about the various strategies implemented across the globe, I see strong potential in community-based approaches, many of which have already begun. These programs will require time to get started as well as research that demonstrates program impact in order to gain funding through the public and private sectors.

Author Bio:

Priya Vedula is a health policy analyst at the Institute for Health Policy and Leadership. Her work involves examining health policies and regulations with a focus on oral health, mental/behavioral health, and hunger. She received her Master of Public Health degree from Columbia University. 

References:

  1. National Health Expenditure Trends, 1975 to 2017. Canadian Institute for Health Information. Retrieved March 2018 from https://www.cihi.ca/sites/default/files/document/nhex2017-trends-report-en.pdf.
  2. The State of Oral Health in Canada. 2017. Canadian Dental Association. Retrieved March 2018 from https://www.cda-adc.ca/stateoforalhealth/_files/TheStateofOralHealthinCanada.pdf.
  3. Council Directive 2001/112/EC. 2012. Office Journal of the European Communities. Retrieved March 2018 from http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2002:010:0058:0066:EN:PDF
  4. The State of Oral Health in Europe. 2012. Better Oral Health Platform. Retrieved March 2018 from https://Report-the-State-of-Oral-Health-in-Europe%20(2).pdf.
  5. Toothfriendly Certification. Retrieved March 2018 from https://www.toothfriendly.org/en/certification.
  6. Christensen, L.B., Petersen, P.E., Hede, B. Community of Dental Health. (2010). Retrieved March 2018 from https://pdfs.semanticscholar.org/8aaa/205fe5181f4d25ffe2a9290063b7cd034e8e.pdf.
  7. Wennhall, I., Maretensson, E., et al. Caries-preventive effect of an oral health program for preschool children in a low socio-economic, multicultural area in Sweden: Results after one year. Acta Odontologica Scandinavica. (2005). Retrieved March 2018 from https://www.tandfonline.com/doi/full/10.1080/00016350510019900?scroll=top&needAccess=true.
  8. What is the burden of oral disease?. World Health Organization. Retrieved March 2018 from http://www.who.int/oral_health/disease_burden/global/en/.
  9. Abid, A., Maatouk, F., et al. Prevalence and Severity of Oral Diseases in the Africa and Middle East Region. SAGE Journals. (2015). Retrieved March 2018 from http://journals.sagepub.com/doi/abs/10.1177/0022034515582062.
  10. International Noma Federation. Retrieved March 2018 from http://www.nonoma.org/en/nos-activites/prevenir/.

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