Global oral health: A proposal for a change of picture

Gerhard K Seeberger

doi:10.4103/ijdr.IJDR_674_19

Users online:


GUEST EDITORIAL

Year : 2019 | Volume : 30 | Issue : 4 | Page : 483-485

Global oral health: A proposal for a change of picture

Gerhard K Seeberger
President of the Academy of Dentistry International, New York, USA

Click here for correspondence address and email

Date of Submission	29-Aug-2019
Date of Decision	30-Aug-2019
Date of Acceptance	06-Sep-2019
Date of Web Publication	18-Sep-2019

How to cite this article:
Seeberger GK. Global oral health: A proposal for a change of picture. Indian J Dent Res 2019;30:483-5

How to cite this URL:
Seeberger GK. Global oral health: A proposal for a change of picture. Indian J Dent Res [serial online] 2019 [cited 2023 Mar 30];30:483-5. Available from: https://www.ijdr.in/text.asp?2019/30/4/483/271140

For more than half a century, the picture of the global oral health has seen two unchallenged protagonists: the oral health profession with the dentist as the undisputed expert in making correct diagnoses and treatment proposals to maintain and reconstitute oral health, guided by the ethical principle primum nihil nocere;^[1] and the sugar, food and beverage industry, an uncontested business expert, guided by the ethical principle of 'making profit'.^[2]

While the purpose of the first ethical principle is to guarantee life, quality of life and wellbeing, the purpose of the second is to be a powerful driver of entrepreneurial energy important to business 'and' to society.

A big difference in searching for the good of mankind? No! Both engage in society's welfare.

A big difference in outcomes? Difficult to say! Sugar business is growing; non-communicable diseases (NCDs) are on the rise; and untreated caries of permanent teeth is still the most prevalent disease since a decade.^[3] A win-win situation if looking only at numbers.

A big difference for people? Yes!

The oral health profession has not been able to keep pace with the need for oral disease prevention, oral health promotion and quality care, and the sugar-producing and -using industry is marching towards vertiginous profits, especially in the new markets like China, India, other parts of Asia, and Africa.^[4],[5],[6]

The recent status of the global oral health is outlined in the recent Lancet Executive Summary, Series, Comments, Editorial, and Perspectives on oral diseases.^{[7],[8],[9],[10],[11],[12],[13],[14]} The development of the picture described is sufficiently and inertially looked at since almost 60 years. At this point, it is worth remembering the days when tackling the sugar argument was the dentists' domain. They informed their society about adequate oral-disease-prevention measures, the choice of a healthy diet, avoiding by the same token tooth and liver disease, while offering oral health. And if a restitutio ad integrum of oral tissues was not possible, they diligently looked after a quality restitutio ad functionem! Have dentists been kept out as potential opposers of the sugar business on purpose? Is this why oral health is not a priority on the political agenda of almost any state on the globe?

Private and public dentists from all over have shown to contribute substantially to health and wealth as long as they have been the real leadership of oral health.^[15] They are the pioneering profession of prevention in medicine, as has been pointed out by the former World Health Organisation's (WHO) DG Margaret Chan in 2012,^[16] and they are pioneers in developing good economies for people, the oral health profession, the medical profession and for any other profession. Supported by the dental industry, dentists smartly contributed, continue to contribute and foster WHO DG Tedros Adhanom Ghebreyesus' hope that'in years to come, the term quality care will fall into disuse as there is no other kind'.^[17]

For too long, the sugar industry has raised profits on a market without regulation and legislation. The increasing number of victims of free sugar consumption is the result of a global economic system that currently favours wealth creation over health creation. Considering that sugar is a gateway drug for other addicting substances and behaviours, such as alcohol, tobacco, other non-legalized drugs and technologies, this scenario has no other chance than ending up in a disaster. The supporting research for this has been delivered by two expert groups: economists and physicians. Both measure reactions, and one gives the explanation for the results of the other. Societies consuming free sugar over a liver's metabolic capacity are less efficient and more depressive and on their best way to extinction. Who says this? Bankers and endocrinologists.^[18],[19] Economy is the mathematics of bankers, and endocrinology is the mathematics of medicine! And there is nothing to discuss about it! Increasing poverty, the growing numbers of refugees, critical illiteracy and depression in younger generations are leading to an unstoppable decrease of the market for high-end products of any kind.

Our political leaders had ample time, as they were solicited by two fundamental articles from dentists, to deepen their knowledge about the reasons for the neglect of oral health as a priority on the political agenda 8 and 5 years ago.^[20],[21] After all, oral health is a core element of health and a fundamental human right. This right cannot be fought for by the oral health profession alone anymore.^[8] The support of the dental industry is no longer sufficient to tackle the constantly growing negative effects of sugar with new techniques and technology, and the support of the pharmaceutical industry of the medical profession in tackling other NCDs does not suffice to invert the stream of NCDs towards new frightening heights anymore.

The FDI World Dental Federation with its vision to 'lead the world to optimal oral health' shall do everything to be the undisputed leader in marching towards this goal. Optimal oral health is an intrinsic part of the United Nations (UN) 2030 Agenda and more specifically, the Sustainable Development Goal, SDG 3, good health and wellbeing. FDI must spearhead a new global oral health movement aiming at improving oral health, reducing pain and suffering especially for children and elderly, and strengthening efforts to address oral health as part of Universal Health Coverage to better contribute to the overall efforts of the NCD movement.^[11] This demands rather a change of the oral healthcare system and reconsidering the oral healthcare workforce than a change of players.^[22] It is illogical that a bank proposes sugar tax based on their research when we can learn from the effects of tobacco tax that approximately 20% of the world's population are smokers (35% males)^[23] and this number has not changed over the last three decades despite several tobacco tax increases.^[24],[25] Recent research has shown that decreasing tobacco sales are reciprocally linked to a black-market increase, mainly driven by the tobacco industry.^[26]

How unfair and cowardly do we want to look when proposing sugar tax to health-illiterate and sick people, who are not victims because of their own behaviour but victims of environmental exposure? How fair, instead, would it be to tax alcohol, sugar and tobacco before production and not before consumption? Any conflict of interest with the pharma industry?^[27] How about advocating for oral health as our colleagues successfully did 60 years ago, turning misled oral-health-illiterates into critical health-literates and thus benefitting a happier, healthier and more effective society? Why are we afraid to invert a system, the healthcare system included, that pays toll to a physical/material world governed by the law of entropy,^[28],[29] while a biological world that we are an intrinsic part of must tend to lower entropy and increase syntropy? The latter is the energy of life as Luigi Fantappiè, an Italian mathematician, pointed out in his work with Albert Einstein and Robert Oppenheimer.^[30] If oral disease and NCDs are the result of the prevalence of entropy then, for the sake of complementarity, oral health needs now, after 60 years of damage, a system where syntropy is the driver. Business does not need to panic, as business will not be left behind, since it depends on living people, who are potential customers.

The FDI World Dental Federation's recent activities have shown that it is the unchallenged global advocator for an applied oral health concept able to deliver patient-centered outcomes. To better tackle the global burden of oral disease including the related cost burden and to realize its vision of 'optimal oral health for all' leaving no one behind, it must strive towards a concept guaranteeing for people-centered outcomes. The latter demands for strong FDI governance and a membership vividly involved in building undisputed global oral health leadership. Why, just to start with, not appreciate a famous sentence of Anne Frank: 'How wonderful it is that nobody needs to wait a single moment before starting to improve the world.'

References

1.	Frankenberger R, Van Meerbeek B. Primum nihil nocere-A basic principle in adhesive dentistry. J Adhes Dent 2016;18:187.
2.	Moriarty J. Business Ethics. In The Stanford Encyclopedia of Philosophy. Edited by Edward N. Zalta. Stanford, CA: Stanford University, 2017.
3.	GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017 [published correction appears in Lancet. 2019 Jun 22;393(10190):e44]. Lancet. 2018;392(10159):1789–858.
4.	OECD/FAO. OECD-FAO Agricultural Outlook 2018-2027, OECD Publishing, Paris/Food and Agriculture Organization of the United Nations, Rome 2018.
5.	Imarc. Available from: https://www.imarcgroup.com/sugar-manufacturing-plant. [Last accessed on 2019 Aug 11].
6.	The Lancet. Available from: https://els-jbs-prod-cdn.literatumonline.com/pb/assets/raw/Lancet/infographics/oral-health/TheLancet_Oral_Health_Series_Big-sugar- 1563457104757.jpg. [Last accessed on 2019 Aug 11].
7.	The Lancet. Available from: https://www.thelancet.com/series/oral-health. [Last accessed on 2019 Aug 11].
8.	Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: A global public health challenge. Lancet 2019;394:249-60.
9.	Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, et al. Ending the neglect of global oral health: Time for radical action. Lancet 2019;394:261-72.
10.	Kearns CE, Berto LA. Conflicts of interest between the sugary food and beverage industry and dental research organizations: Time for reform. Lancet 2019;394:194-6.
11.	Beaglehole RH, Beaglehole R. Promoting radical action for global oral health: Integration or independence. Lancet 2019;394:196-8.
12.	The Lancet. Available from: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736 (19) 31639-3.pdf. [Last accessed on 2019 Aug 11].
13.	Davies R. Richard Watt: Time to tackle oral diseases. Lancet 2019;394:209.
14.	Barnett R. Polished smiles and porcelain teeth. Lancet 2019;394:210-1.
15.	Wolf TG, Seeberger GK, Callaway A, Briseño-Marroquín B, Rusca P, Frank M, et al. Is liberal independent dental practice in danger? Assessing forms of dental practice in the European Regional Organization (ERO) zone of the FDI World Dental Federation. Quintessence Int 2018;49:313-24.
16.	NCD Alliance. Available from: https://ncdalliance.org/news-events/blog/oral-health-–-why-it-can't-be-ignored-in-the-bigger-health-landscape. [Last accessed on 2019 Aug 11].
17.	Ghebreyesus TA. How could health care be anything other than high quality. Lancet Glob Health 2018;6:e1140-1.
18.	Lustig RH. The Hacking of The American Mind: The Science Behind the Corporate Takeover of Our Bodies and Brains Author: Robert Lustig Avery Press (Penguin Random House), New York (released Sept. 12, 2017). ISBN 978-1-10198-258-7.
19.	Morgan Stanley. Available from: https://www.morganstanley.com/ideas/sugar-economics-how-sweet-it-isnt/. [Last accessed on 2019 Aug 11].
20.	Benzian H, Hobdell M, Holmgren C, Yee R, Monse B, Barnard JT, et al. Political priority of global oral health: An analysis of reasons for international neglect. Int Dent J 2011;61:124-30.
21.	Benedetti G, Stauf N, Strohmenger L, Campus G, Benzian H, Political priority of oral health in Italy: An analysis of reasons for national neglect. Int Dent J 2015;65:89-95.
22.	Fejerskov O, Escobar G, Jøssing M, Baelum V. A functional natural dentition for all – and for life? The oral healthcare system needs revision. J Oral Rehabil 2013;40:707-22.
23.	The World Bank. Available from: https://data.worldbank.org/indicator/SH.PRV.SMOK. [Last accessed on 2019 Aug 11].
24.	Callison K, Kaestner R. Do higher tobacco taxes reduce adult smoking? New evidence of the effect of recent cigarette tax increases on adult smoking. Economic Inquiry :52. doi: 10.1111/ecin.12027.
25.	Coady MH, Chan CA, Sacks R, Mbamalu IG, Kansagra SM. The impact of cigarette excise tax increases on purchasing behaviors among New York city smokers. Am J Public Health 2013;103:e54-60.
26.	Gallagher AWA, Evans-Reeves KA, Hatchard JL, Gilmore AB. Tobacco industry data on illicit tobacco trade: A systematic review of existing assessments. Tob Control 2019;28:334-45.
27.	Kearns CE, Watt RG. Transnational corporations and oral health: Examples from the sugar industry. Community Dent Health 2019;36:157-62.
28.	Holden ACL. Consumer-driven and commercialised practice in dentistry: An ethical and professional problem? Med Health Care and Philos 2018;21:583-9.
29.	Balaji SM, Seeberger GK, Hennedige O. Burden of oral diseases and noncommunicable diseases: An asia-pacific perspective. Indian J Dent Res 2018;29:820-9. [PUBMED] [Full text]
30.	Sintropia – Syntropy Journal. Available from: http://www.sintropia.it. [Last accessed on 2019 Aug 11].