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Experts Call For Radical Reform in Oral Health Care

New York University (NYU) College of Dentistry’s World Health Organization (WHO) Collaborating Center for Quality-improvement and Evidence-based Dentistry, together with The Lancet, hosted a United Nations (UN) side event on September 22 to bring oral health into the conversation about universal health coverage.

New York University (NYU) College of Dentistry’s World Health Organization (WHO) Collaborating Center for Quality-improvement and Evidence-based Dentistry, together with The Lancet, hosted a United Nations (UN) side event on September 22 to bring oral health into the conversation about universal health coverage. The goal was to accelerate global advocacy for oral health, and promote knowledge sharing and translation of evidence into practice.

The discussion follows a two-part series on oral health published by The Lancet that points to the “urgent need for radical reform” of oral health care to prioritize prevention and integrate dentistry into primary care.

From left to right: Stefan Lisl, MD, PhD, Radboud University; Habib Benzian, DDS, MScDPH, PhD, NYU College of Dentistry; Cristin Kearns, DDS, MBA, University of California, San Francisco; Paul Allison, FCAHS, McGill University; Jocalyn Clark, executive editor for The Lancet; Robert Weyant, MS, DMD, DrPH,  University of Pittsburgh School of Dental Medicine. Photo credit: NYU Photo Bureau/Sorel

Coauthored by Habib Benzian, DDS, MScDPH, PhD, a research professor at NYU Colleges of Dentistry and Global Public Health and associate director of global health and policy for the NYU WHO Collaborating Center for Quality Improvement and Evidence-based Dentistry, the series is a collection of papers authored by 13 academics from 10 countries. The series examines why oral health has been neglected, and advocates for immediate action.

“The isolation of oral health care or failure to integrate oral care into primary health care systems has led to a health care crisis. More than half of the world’s population has never seen a dentist, and will never experience oral health care if we do not integrate it with universal health coverage and primary health care,” says Benzian.

Integrating dental care into primary care will help tackle inequalities through inclusive universal access to oral health care, the authors contend. Countries such as Thailand, France and Brazil have successfully integrated oral health into universal health care.

“Oral health care is isolated from mainstream health care. Thus, we need a fundamentally different approach that integrates the two. A reformed oral health care system needs to incentivize prevention, embrace a wider team of health professionals (including primary care and midlevel providers), use evidence-based treatments, and respond to the diverse needs of local populations,” notes Benzian.

Because delivery of oral care is still largely based on a “treat-over-prevent” model, and uses high-technology approaches, dental care is unaffordable for more than half of the world’s population. Patients lacking coverage for dental care will decline necessary treatment, as it creates a financial hardship. Foregoing necessary oral health care often results in patients being treated in emergency departments for a simple dental problem.

The Lancet series recommends reforming the system by providing people with accessible and affordable oral care; it prioritizes prevention and the advancement of interprofessional collaboration. Other suggestions include taxing beverages that are high in sugar, and implementing additional policy changes to help protect and improve health.

“Good oral health starts with prevention and protection of vulnerable groups by reducing risks to oral health—including high sugar consumption, tobacco use, and alcohol use,” says Benzian. “Many countries have shown that policies and taxation are effective measures to address these risks.”

The UN side conference, “Leaving No One Behind: Integrating Universal Health Coverage and Essential Oral Health Care for All,” brought together experts and speakers from 10 countries and three governments, plus international organizations. The purpose was to discuss ways of accelerating progress toward better coverage, including essential oral health care worldwide. Panelists discussed global oral health challenges, experiences and innovations in universal health care coverage and oral health, and partnerships and collaboration designed to accelerate progress.

“The required changes are part of a long-term, step-wise process that needs vision and political leadership,” says Benzian. “We hope that The Lancet Series on Oral Health and the UN side event have raised the profile of oral health, and that we will see more action in the future.”

The UN General Assembly’s High-Level Meeting, Universal Health Coverage: Moving Together to Build a Healthier World, was held September 23.

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