25 July 2019

It is high time for changes to take place in the Dutch dental and oral care, according to Stefan Listl, professor at the department of dentistry of Radboud university medical center. In the Netherlands, this aspect of healthcare is not included in the basic healthcare insurance package, as opposed to many other European countries. The social inequalities regarding access to oral care for people aged 50 and above also show much higher discrepancies than other European countries. The productivity loss due to dental ailments in the Netherlands is estimated at 3 billion euros per year. In a series of articles in the Lancet, Listl and international colleagues write why our current global system of oral care is getting stuck. But also, what we can do about it.

The Lancet is publishing a series of articles (Lancet Oral Health Series) that describe the vast global challenges in attaining improved oral health. One of the researchers and authors is Stefan Listl. Oral diseases primarily affect the poorer and marginalized groups in society. Oral diseases have a major impact on both individuals and society through ailments such as pain and sepsis, but also due to reduced quality of life, lost school days, reduced labor productivity, and the costs of dental treatments.
 
Productivity losses of three billion per year
Listl: “But there is still plenty of room for improvement in the Netherlands as well. Recent research revealed that social inequalities in the oral health of people over 50 in the Netherlands even surpass those in many other European countries. Productivity losses due to dental ailments in the Netherlands are estimated at more than three billion euros a year.” Oral diseases are also related to factors such as sugar consumption, tobacco consumption, and harmful alcohol consumption. Sugar consumption increases the risk of caries, being overweight, obesity, and related conditions such as diabetes. It is becoming increasingly clear that the influence, power, and impact of the global sugar industry is a threat to public health, which means that stricter regulations and legislation by governments are required.
 
Extensive reform necessary
Dental care is characterized primarily by high-tech and specialized care. The authors in the Lancet Oral Health Series write that this approach has failed to address the global issue of oral diseases. An extensive reform of dental care systems is therefore urgently needed. Universal Health Coverage is meant to improve the integration of oral care into the broader healthcare system, making it more accessible and able to respond to the oral health needs of the population.
 
Focus on prevention
Payment systems for oral care providers should focus more on encouraging prevention rather than rewarding restorative care. According to the authors, a preventive approach for the entire population is required in order to achieve sustained improvements in oral health and to address inequalities. An integral public health policy is necessary to address the joint risks (free sugars, tobacco, and alcohol consumption, as well as social and commercial determinants) of oral diseases and other non-communicable diseases.
 
Basic health insurance package
“The need for a different approach to oral care is also present in the Netherlands”, Listl says. “To me, the fact that adult oral care is left entirely out of the basic health insurance package doesn’t seem to be a suitable solution from a societal point of view. And the quality and effectiveness of oral care could also be enhanced significantly if we consider prevention-oriented reward systems, improved integrated cooperation between different care professionals, improved public health prevention, and improved capacity planning focused on the oral health needs of the population.”
 
Influence of sugar industry
According to the authors, the global sugar industry uses strategies to increase sales and profits and to undermine public health efforts to reduce the consumption of free sugars. In the Lancet Oral Health Series, the authors write that there is an urgent need to develop clearer and more transparent conflict-of-interest policies and procedures to limit and clarify the influence of the sugar industry on dental research and oral health policies.
 
Most prevalent disease worldwide
Oral health is an integral part of general health and well-being. Oral diseases affect the teeth and mouth and can cause ailments such as tooth decay (caries), gum disease and tumors in the mouth. Although mostly preventable, oral diseases are common conditions affecting more than 3.5 billion people worldwide. Tooth decay is the most prevalent disease worldwide. The number of people affected by this ailment is still increasing in many low- and middle-income countries.

Further information on The Lancet Oral Health Series: www.thelancet.com/series/oral-health

Stefan Listl is member of theme Healthcare improvement science.

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