Minding the tooth gap – Oral Health Series (2)

The Tanden Frisk team is back and we are delivering the second part of our oral health blog series. This month, we put the spotlight on the world’s most prevalent health condition usually hidden in the darkness of oral cavities without recieving the attention that it should: dental caries. So, keep reading as you will be uncovering all you need to know about this disease and good oral health for all people matters!

Why care about dental caries

Despite being preventable, in 2017, dental caries was the most widespread non-communicable disease (NCD) globally. In the 2015 Global Burden of Disease Study, dental caries  ranked first for caries of permanent teeth (affecting 2.3 billion people) and 12th for deciduous teeth (affecting 560 million children), making it a major public health problem. Therefore, to curb this menace, joint action between local, regional, national, and international levels, and among researchers, policymakers, public health practitioners, clinical teams, and the public is needed urgently.

Quality of life can deteriorate when dental caries are left untreated since they may lead to  sleeping and eating difficulties. Dental caries may result in severe pain, and and in advanced phases of this disease, chronic systemic infections can occur, and cause abscesses. Dental caries is also associated with negative growth patterns and it is a frequent cause of absence from school or work.

Moreover, the lack of proper health facilities and the uneven distribution of oral health professionals in most countries translates into low access to primary oral health services. For example, the overall coverage for oral health services in adults ranges from 35% in low-income countries, 60% in lower-middle-income countries, 75% in upper-middle-income countries, to 82% in high-income countries. This has resulted in a high proportion of oral diseases being untreated and has led to significant unmet patient needs. Moreover, even in high-income settings, dental treatment is costly, averaging 5% of total health expenditure and 20% of out-of-pocket health expenditure.

Prevention is better than any cure

Dental caries, also called tooth decay, are the result of an interaction between different risk indicators, mainly bacteria and carbohydrates, that leads to acid production which weakens the tooth surface (enamel) and causes a hole in the tooth. If not stopped early, it can damage the tooth structure, causing pain and sometimes, the sufferer has to endure invasive interventions.

According to the World Health Organization (WHO), through simple and cost-effective interventions at the population and individual levels, dental caries are preventable. More importantly, in the early stages of the disease, carious lesion progression can be halted before cavitation and even reversed.   Dental caries can be prevented through public health interventions by addressing common risk factors. Fluoride, for example, is a primary tool used to prevent dental caries, whether through water fluoridation, toothpaste and gel. This protects the tooth against demineralization and supports remineralization by acting as an antimicrobial agent against cariogenic bacteria. Another approach is behavioral and lifestyle changes, such as, changing one’s oral hygiene routine, and stopping smoking.

Minding the (tooth) gap: inequity in access to oral health remains in Sweden

In Sweden,  provision of dental health prevention and dental treatment for children has been the government’s priority for the longest time. Therefore, maintaining an accessible dental care system has been prioritized throughout the last 40 years. The measures are more than somewhat working: ahead of many other countries, prevalence of dental caries among children in Sweden is decreasing. The dental service is delivered regularly and individually targeted. In fact, it is estimated that in a range of two years, 95% of children and adolescents have had contact with the dental service. Also, the latest legislation reform offers dental care for children, adolescents, and young adults up to 23 years of age.

Dental care is provided either by a dentist from the public dental service or from private practice. But the majority of the dental care for children and adolescents is carried out by the public dental service. Traditionally, the Nordic countries’ welfare systems and dental services were based on population strategies. Thus, preventive programs have been developed and offered to the total population or to vulnerable subgroups especially prone to tooth decay. Nevertheless, in the last decade, individually oriented preventive dental care based on risk assessment has become part of almost every county’s oral health guidelines. This means that the length of recall intervals for children have been individualized, based on individual caries risk assessment. Different categories of personnel such as dental hygienists and dental nurses have been involved in delivering such prevention schemes. As a consequence, caries incidence has been reduced, as mentioned earlier. On the other hand, caries prevalence in Swedish children and adolescents show that populations have not benefited equally from these preventive schemes. Swedish data shows that children living in poorer areas have a higher rate of dental caries in comparison to those in rich areas.

This is where our project ´Tanden Frisk´ comes in. We aim to counteract the uneven access to oral health services, by reaching out to the vulnerable groups in different areas and neighborhoods in Sweden and by increasing oral health literacy and thus increasing access to oral health services among disadvantaged and marginalized population groups.

For those that got hooked on the topic: Check this out for some further interesting reading.

How is the government in your country addressing oral health? Are effective and reliable measures in place? How about the private sector? Do you think the situation can be improved? Share your thoughts and let us know in the comments below! Feel free to contact Aya and Carolina or the bloggers! 

And, don’t forget to check out our previous oral health posts – If you missed the first part of our oral health series, here it is: ‘Be Proud of your mouth with Tanden Frisk‘. Interested in eco-friendly ways to care for your teeth? Find all you need here: ‘Go Green With Your Teeth Clean‘!

See you next month, on the third part of our Oral Health Blog series!

Authors: Aya El Hajj and Carolina Garcia Sanchez