Scientific Article
Big Sugar and Neglect by Global Health Community Fuel Oral Health Crisis

Richard G Watt (E-mail:, Marco A Peres, Lorna M D Macpherson, Robert J Weyant, Blánaid Daly, Renato Venturelli, Manu R Mathur, Stefan Listl, Roger Keller Celeste, Carol C Guarnizo-Herreño, Cristin Kearns, Habib Benzian, Paul Allison
Marco A Peres, Lorna M D Macpherson, Robert J Weyant, Blánaid Daly, Renato Venturelli, Manu R Mathur, Stefan Listl, Roger Keller Celeste, Carol C Guarnizo-Herreño, Cristin Kearns, Habib Benzian, Paul Allison, Richard G Watt, Oral diseases: a global public health challenge, The Lancet, Volume 394, Issue 10194, 2019, Pages 249-260, ISSN 0140-6736,
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    The Lancet
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The Lancet: Big Sugar and Neglect by Global Health Community Fuel Oral Health Crisis

Lancet series

Oral health at a tipping point

A new Lancet Series lays out why oral health has been neglected and argues that radical public health action is needed. The Series presents a considerable critique of current oral health-care systems and comes at a time when shifts within the global health agenda present an opportunity to bring much needed visibility to oral health.

Oral diseases: a global public health challenge

Research paper 1: Summary

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. In this first of two papers in a Series on oral health, the researchers describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact.

Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care.

The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes.

Key messages

  1. Oral health is an integral element of overall health and wellbeing, enabling essential daily functions
  2. Despite being largely preventable, oral diseases are highly prevalent conditions, affecting more than 3·5 billion people around the world; dental caries is the most common disease globally with increasing prevalence in many low-income and middle-income countries
  3. Oral diseases disproportionally affect poorer and marginalised groups in society, being closely linked to socioeconomic status and the broader social determinants of health
  4. Oral conditions share common risk factors with other non-communicable diseases, which include free sugar consumption, tobacco use, and harmful alcohol consumption, as well as the wider social and commercial determinants of health
  5. Recognition is increasing of the influence, power, and effect of the global sugar industry as a threat to public health, which requires tighter regulation and legislation by governments

Oral cancers

The major risk factors for oral cancers are tobacco use, alcohol consumption, and areca nut (betel quid) chewing

Social and commercial determinants of oral diseases

Additionally, recognition is growing for the need to move from current clinical approaches to policy initiatives that tackle oral health inequalities at the structural level, focusing on the social determinants of health and the risk factors shared between oral diseases and other NCDs, such as free sugar consumption, tobacco use, alcohol consumption, and their wider driving determinants.

  • Oral diseases present a major global public health burden, affecting 3.5 billion people worldwide, yet oral health has been largely ignored by the global health community, according to a new Lancet Series on Oral Health.
  • With a treat-over-prevent model, modern dentistry has failed to combat the global challenge of oral diseases, giving rise to calls for the radical reform of dental care
  • The burden of oral diseases is on course to rise as more people are exposed to the underlying risk factors of oral diseases, including sugar, tobacco and alcohol
  • Emerging evidence of the food, beverage, and sugar industry’s influence on dental research and professional bodies raises fresh concern

Ending the neglect of global oral health: time for radical action

Research paper 2: Summary

Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed.

In this second of two papers in a Series on oral health, the researchers present a critique of dentistry, highlighting its key limitations and the urgent need for system reform.

Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors.

Key messages

  1. Dentistry continues to adopt a treatment-dominated, interventionist, technical, and increasingly high-technology and specialised approach to care
  2. A different preventive approach, focusing on population-wide effects, is also needed, as the current individualistic clinical paradigm has not achieved sustained improvements in population oral health or addressed the persistent inequalities
  3. Integrated public health policies are needed to tackle the shared common risk factors (ie, free sugar consumption, tobacco use, alcohol consumption, and their driving social and commercial determinants) of oral diseases and other non-communicable diseases
  4. A range of highly developed corporate strategies are used by the global sugar industry to increase their sales and profits, and to undermine public health efforts to reduce free sugar consumption
  5. A pressing need exists to develop clearer and more transparent conflict of interest policies and procedures, to restrict and clarify the influence of the sugar industry on dental research and oral health policy

Moving upstream to maximise oral health improvement

Individualistic, clinical, and educational preventive approaches might achieve short-term benefits, but these benefits soon diminish unless the underlying causes of disease are tackled.

Priority should be given to investment in upstream, coherent, and integrated population-wide policies, such as taxes on sugary drinks, stronger regulation on the advertising and promotion of sugary foods and drinks targeting children, and the promotion of appropriate exposure to fluoride with toothpaste and water; as well as embracing a common risk factor approach to reduce tobacco use and harmful consumption of alcohol.

Addressing commercial determinants of oral diseases

Stricter regulation and legislation are needed to overcome corporate strategies that threaten and undermine oral health and related NCDs. Based on experience gained from tobacco control, dental professional organisations, academic institutions, individual researchers, and policy makers should not accept any funding, sponsorship, or support from the sugar industry.

Clear and transparent procedures and policies need to be adopted to identify and mitigate any possible objective or perceived conflicts of interest.

Source Website: The Lancet