In 1994, the World Health Organization’s World Health Day was dedicated to oral health for the first time, reflecting a recognition of the field’s importance in global health. In the 25 years since this milestone, dentistry has seen considerable progress, such as a greater understanding of its integration in wider health, novel approaches to treating dental disease, breakthroughs in diagnostics, policy change, and even the establishment of World Oral Health Day, marked every March 20. Our understanding of what’s required to improve the oral health and lives of people around the world has continued to evolve.
The FDI World Dental Federation revamped its definition of oral health in 2016 to include the ability to smile, recognizing the close relationship between oral health and mental health.1 Business, charities, and dental professionals have partnered more closely together than ever before to amplify their impact and create more smiles around the world.
A partnership between Save the Children and the Mars Wrigley Foundation, for example, has provided oral health education, access to care, and clean drinking water to more than 1 million adults and school children across the globe. Thanks to innovative partnerships like these, we have developed a more holistic approach to oral care that delivers for those who need it most.
But despite the strides we’ve taken in improving the oral health of millions around the world, now is not the time to become complacent. Reflecting on how these advances have already transformed the lives (and smiles) of so many people, what is most striking about all this progress is how much of it has laid the groundwork for even greater transformations to come.
These are exciting times for dentistry. But what’s next? In the spirit of World Oral Health Day, I’ve turned my gaze ahead to three of the top arenas in which I believe oral health will continue to progress and evolve significantly over the next 25 years: treatment technologies, approaches to caries, and understanding the microbiome and beyond.
Treatment Technologies
Toward the end of 2017, the American Academy of Pediatric Dentistry published its first guidelines on the use of silver diamine fluoride (SDF),2 further strengthening the case for SDF to become a widespread treatment for dental caries in children at the very start of decay. Cost effective and straightforward to apply compared to alternatives such as extractions or crowning, SDF has long been used in countries such as Japan.
Having only achieved approval from the US Food and Drug Administration in 2014,3 it now looks to be gaining real momentum as an oral care tool globally. In fact, the ADA recently recommended SDF for arresting advanced cavitated lesions in primary teeth.4
At the other end of the caries spectrum, self-assembling peptides are not a new discovery. But they are now reaching the wider dental profession and have the potential to help us address issues such as carious lesions in their early stages by promoting remineralization, forgoing the need for more invasive treatments.5
Approach to Caries
One of the big success stories of dentistry over recent decades has been the significant decline of caries in Western countries.6 Yet while treatments such as SDF have the potential to accelerate this decline further, there is a growing awareness that what we are seeing with dental caries is a segmentation of the problem. The oft-cited rule of thumb is that roughly 80% of caries is found within 20% of the population.
Though the applicability of this adage has been challenged, caries is certainly inequitable.7,8 Some groups of people, particularly in low-income countries, either lack access to emerging treatments or are unable to prevent caries in the first place due to factors such as a poor diet and hygiene. We will need to rethink our approach to helping these populations, perhaps in part by expanding our reach with telemedicine, to avoid this plateau.
The cost of caries can be huge. Almost $300 billion is spent worldwide on direct costs associated with the disease,9 and the economic, societal, and social impact of poor oral health is immense. We now have a much more holistic view of how oral health impacts your overall quality of life, raising the importance of individualized prevention, and greater education around the issue should be one of governments’ biggest health priorities.
It will be crucial to ensure that oral health guidelines are updated to reflect the changing eating behaviors of our society as well, including preventive measures to help spread the word more widely to medical practitioners around things like regular brushing, flossing, and the use of sugar-free gum after meals and snacks.
The tools we have to tackle caries already exist. We need a concerted effort to raise awareness of them around the world. We need policy makers to create the infrastructure for dental professionals and community practitioners to align on these proven strategies.
Understanding the Microbiome and Beyond
The role of the microbiome in health has gained ever-increasing attention in recent years, and the oral microbiome holds significant promise. While Philip Marsh’s ecological plaque hypothesis suggesting that oral diseases are the result of imbalances in the microflora in the mouth was published back in 1994,10 the next few years will see the industry continue to identify how oral health and systemic health are interconnected, breaking down siloed treatment and continuing the shift of dental professionals’ focus from treating individual teeth to the mouth to the body as a whole.
Eventually, we may see dental professionals being able to diagnose things happening in the mouth that may be impacting (or have the potential to impact) other parts of the body as well. It’s a new frontier and an expansion of our current roles and industry. But when taken in combination with the other changes we are witnessing, it presents an opportunity for us to be at the forefront of a transformative period in health.
References
1. Glick M, Williams DM, Kleinman DV, et al. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. J Am Dent Assoc. 2016;147:915-917.
2. American Dental Association. AAPD issues first evidence-based guideline on silver diamine fluoride use. https://www.ada.org/en/publications/ada-news/2017-archive/october/aapd-issues-first-evidencebased-guideline-on-silver-diamine-fluoride-use. Accessed March 14, 2019.
3. US Food & Drug Administration. 510(k) Premarket Notification for Diammine Silver Fluoride Dental Hypersensitivity Varnish. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K102973. Accessed March 14, 2019.
4. Slayton RL, Urquhart O, Araujo MWB, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions. J Am Dent Assoc. 2018;149:837-849.
5. Alkilzy M, Santamaria RM, Schmoeckel J, Splieth CH. Treatment of Carious Lesions Using Self-Assembling Peptides. Adv Dent Res. 2018;29:42-47.
6. Malmö University. Global burden of caries disease. https://www.mah.se/CAPP/Country-Oral-Health-Profiles/Global_burden_of_caries_disease/. Accessed March 14, 2019.
7. Fleming E, Afful J. Prevalence of total and untreated dental caries among youth: United States, 2015–2016. NCHS Data Brief. 2018;307:1-8.
8. Dugmore CR.The 80-20 phenomenon (80:20 distribution of caries) – Myth or Fact? Br Dent J. 2006;201:197-8.
9. World Health Organisation. Sugar and dental caries. https://apps.who.int/iris/bitstream/handle/10665/259413/WHO-NMH-NHD-17.12-eng.pdf;jsessionid=5399AEB0E6C9645B4DC326130B3E35E1?sequence=1. Accessed March 14, 2019.
10. Marsh PD. Microbial ecology of dental plaque and its significance in health and disease. Adv Dent Res. 1994;8:263-71.
Dr. Dodds is senior principal and lead oral health scientist at Mars Wrigley Confectionery in Chicago. He works with the Wrigley Oral Health Program (WOHP), which supports dental care professionals in educating individuals about maintaining a healthy lifestyle and reducing tooth decay. He joined Wrigley in 2002 after 15 years in academic dentistry and is adjunct faculty at the UIC College of Dentistry, Chicago. He holds a dental degree from the University of Edinburgh and a PhD in dental science from the University of Liverpool, and he has published more than 60 peer-reviewed papers, book chapters, and articles. He can be reached at michael.dodds@effem.com or at linkedin.com/in/michael-dodds-7655203/.
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