Oral health: 2030 vision

We all share a vision for a future of better oral health where children are caries free, and adults are enjoying improved levels of oral health and lower levels of tooth loss and periodontal disease.

In order to look forwards, it is necessary to look back at the past. The Oral Health Foundation will celebrate its half centenary next year, in 2021, and in the 50 years since its formation there have been huge advances in the oral health of the nation. It seems incredible now to think that the first Adult Dental Health Survey showed 38% of the population over the age of 16 had full dentures.¹ This meant that by middle age, some 75% of people were sporting their nice new NHS prostheses.

We have travelled a long way, and the once fanciful expectation of ‘Teeth for Life’ has become a reality for the majority of the population.

Rapid improvements in oral health occurred through the 1970s and 1980s, substantially due to the addition of fluoride to toothpaste. Unfortunately, the rate of improvement has now levelled off and there are still disturbing levels of oral disease among the population. A real threat to this improvement is being seen with the rise in non-fluoride toothpastes, often promoted by social media influencers.

The highest levels of disease are seen among the socially disadvantaged, and fundamental change needs to occur in order remove these social gradients. To create lasting improvement, the UK needs a proactive, rather than a reactive, stance towards oral health. There is a danger that we are currently complacent about existing levels of disease.

It is sad situation when, in 2019, there were just under 31,000 hospital admissions for extractions in 0–10-year olds in England alone.² This works out to around 85 each day. Oral health problems also continue to affect vast numbers of the UK's adult population.

The number of people with oral diseases, such as mouth cancer, continues to rise: cases are up 171% compared with 20 years ago.³ 2020 will mark the 20^th anniversary of the Oral Health Foundation's Mouth Cancer Action Month campaign. I'd like to say we've made great progress in tackling rates of the disease and improving survival in that time; however, sadly, that is not the case. It is the sixth most common cancer in the world and affects over 8300 Brits a year.³ On average, 23 people are diagnosed with mouth cancer in the UK every day. One of the main battles when it comes to tackling mouth cancer in this country is awareness. Results from a survey we conducted last year as part of Mouth Cancer Action Month showed over two-thirds of Brits do not know the main signs and symptoms of mouth cancer.³ The survey also found low levels of awareness (21%) of the risk factors for mouth cancer.³ Improving awareness of this disease is vital if we're to make progress over the next 10 years, to arrest the growth in numbers, and to see earlier diagnosis. Survival rates have not improved in the last 30 years. Let's make this the decade where that finally happens. Dental professionals have a key role to play if we are to achieve this.

A fundamental shift in mindset and attitude, from both the public and the profession, is needed, with a greater focus on the prevention of oral diseases. With restrictions on access to dental services caused by COVID-19 set to continue for some time, individuals need to take more responsibility for their oral health and not simply rely on the repair service provided by the current dental system. They need to recognise the role of their dental team in helping them towards improved oral health.

Tackling the high tooth extraction rate among 0–10-year olds should be high on the agenda over the next decade. We believe that the single most effective public measure to tackle the issue would be a more widely adopted water fluoridation policy. Currently, 72% of the UK population receive water with a low concentration of fluoride (0.2 mg/l), so low that its oral health benefits are marginal.⁴ Only 10% receive a water supply with a fluoride concentration reaching at least 0.7 mg/l where the oral health benefits can be felt.⁴ Public Health England recently reported that if all the 5-year olds currently receiving water supplies at fluoride levels of 0.2 mg/l instead received water at 0.7 mg/l, then dental carries could be reduced by 17% in the least deprived areas, rising to 28% in the most deprived areas.⁴ We strongly believe that, if significant strides are to be made to improve children's oral health by 2030, then good take-up of a community water fluoridation scheme is a must.

It is a scandal that 25% of children first attend school with dental decay and yet there have been no new water fluoridation schemes since 1987. From personal experience of working on the border of the non-fluoridated Sandwell and fluoridated Birmingham, we could tell, infallibly, which side of the dividing road children lived based on their caries experience. Uniquely, we currently have a government where both the Secretary of State and the Public Health Minister are strong advocates of expanding water fluoridation and, if we are to achieve our vision of better oral health in the next decade, as a profession, we must support and lobby strongly for targeted water fluoridation.

One of the most active areas of research over the past decade has been into oral systemic links, and good periodontal health is now being recognised as playing a key part in maintaining general health. By focusing on a more preventive, rather than reactive, oral healthcare system, we can hope to see improvements in not just oral health, but also in areas such as diabetes,⁵ cardiovascular disease, mental health⁶ and dementia.⁷

The pandemic has provided a very difficult start to the new decade; however, it also presents a chance to change direction and make sure we end the decade with better oral health than when we started it.