Maybe you would think of diabetes or, perhaps, asthma. After all, they are frequently in the spotlight.
The answer might surprise you: dental caries – or tooth decay – is, in fact, the world’s most common, possibly least-talked-about, non-communicable disease. It affects 60 to 90 percent of the world’s children, and it is 20 times more common than diabetes and five times more common than asthma.
We might think this lack of attention is because, although widespread, tooth decay really isn’t that important. After all, as the leaflets say, it’s largely preventable and easily treatable. All we have to do is take care of our teeth and go along to the dentist for our twice-yearly check-up and hygiene appointment. In the worst case, perhaps we’ll have to deal with a little toothache before we’re able to get help.
From the point of view of a child living comfortably in a country where dental care is both easily accessible and affordable to all, where there’s enough fluoride in the water to protect teeth, where sugar consumption is under control, and where parents have the time and knowledge to help them care for their teeth, perhaps that’s so.
But, unfortunately, there’s no such place. Not even in the developed world. A 2016 report from the U.K.’s Royal College of Surgeons shows that hospital admissions for tooth decay in 5- to 9-year-old children far exceed those for tonsillectomies. In California, perhaps 40 percent of children have caries by kindergarten age, according to Francisco Ramos-Gomez, professor of pediatric dentistry at UCLA. Children in Cambodia and Indonesia suffer even more, with reports of 90 percent of 3- to 5-year olds affected.
These statistics alone suggest that something is going seriously wrong. But closer inspection of a country’s data usually reveals the complexity of the issues behind tooth decay. As a recent Pew Trust report shows, low-income, minority and rural children in the U.S. suffer disproportionately from problems with dental health and access to care.
“Poor children suffer twice as much dental caries as their more affluent peers, and their disease is more likely to be left untreated,” concluded a ground-breaking Surgeon General’s report on oral health in America (2000).
The same is true in most countries. For instance, in the U.K., the Royal College of Surgeons reported that 64 percent more children in the less prosperous North West experienced tooth decay than their peers in the South East.
But while the statistics may cause dismay, none of them can convey the life-limiting effects that tooth decay can have on children. First, there’s the pain. According to Dave Perry, a pediatric dentist from Alameda, California: “Often they can’t even tell you they’re in pain – their teeth have hurt for so long, they think it’s normal.”
And then there’s the risk to their overall health. Untreated tooth decay can turn into painful abscesses and facial swellings, or even spread as infections to other parts of the body, which, in very rare cases, can be fatal. In 2007, the widely reported death of 12-year-old, Maryland school kid Deamonte Driver from untreated tooth decay and a resulting brain infection shocked many in the U.S. and around the world.
As in Deamonte’s case, treatment for tooth decay is increasingly being delayed too long, with families desperately seeking help in emergency rooms and young children, who can have trouble staying still, being subjected to the risk of general anesthetic as their teeth are extracted.
There’s also the effect on a child’s education. According to the World Dental Federation, 1.6 million school days are lost in the U.S. because of dental issues. Professor Ramos-Gomez, says: “In my experience, dental pain and suffering is the number one cause of school nurses removing children from the classroom and sending them home.”
And how does all this impact their futures? U.S. research shows that from a very early age, many Americans have strong biases against people with less than perfect teeth. “If you want to portray someone as being wicked, they have missing front teeth,” says Susan Hyde, Associate Professor at U.C.S.F. and author of research on untreated dental disease and limited job opportunities. According to Dr. Hyde, the negative impact of dental decay on employment more than justified a socially funded program to help restore teeth and provide hygiene education.
Some influential dental professors, scientists and writers are sounding the alarm about oral disease and the failure of dental systems worldwide to serve vulnerable populations, despite the availability of excellent preventive solutions. One group, who come from the U.S., Sweden, Denmark, Colombia, Australia and Kenya, went so far as to lay out their concerns in a thought-provoking document called the “La Cascada Declaration.”
Journalists and writers are also beginning to touch on the painful topic of dental inequities. For instance, Mary Otto, a leading U.S. health journalist, recently published the prize-winning book "Teeth," exposing America’s oral health challenges in deeply disturbing detail, and Sarah Smarsh wrote a memorable essay, Poor teeth.
But it’s not only about raising public awareness of the problems. There needs to be action. Many advocates of better access to preventive care for vulnerable children have successfully lobbied for large-scale dental health programs, involving education and preventive treatment, to help disadvantaged populations in their countries. And many are already making life better for children in communities all over the world. There’s a need to share this information, learn from their successes and spur a more coordinated global approach to achieve improvements everywhere.
Recently 3M Oral Care hosted a group of deeply committed experts from Latin America, China, Russia, the U.K and the U.S. to discuss the latest dental science and preventive approaches, as well as share best practices from their countries on how they too are passionately defending children’s teeth.
To learn more about the challenges they face and the scientific evidence that drives them, read their inspirational stories, and learn from their hard-earned advice, go to www.3m.com/whyteethmatter and download our e-book “Why Teeth Matter.”