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‘Dentistry is in a state of crisis’: Big Sugar, alcohol and smoking are fuelling tooth decay and mouth cancer, warns study

According to a Lancet study, over 3.5 billion people worldwide are now suffering from various oral diseases

Neglect by the global health community and heavy marketing by the major players in the sugar industry (known as the Big Sugar) are fuelling the oral health crisis, impacting over 3.5 billion people worldwide, scientists have warned.

Oral diseases include a range of chronic clinical conditions affecting the teeth and mouth. Tooth decay, gum disease, and oral cancers reportedly affect nearly half of the global population.

According to the study, untreated dental decay is the most common health condition worldwide. Lip and oral cavity cancers-- which reportedly caused 177,384 deaths in 2018--  are among the top 15 most common cancers globally, the study added.

“Oral diseases are a major global public health problem affecting over 3.5 billion people. However, they are a neglected issue, rarely seen as a priority in health policy. Dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed,”  researchers said in the study, which was published in The Lancet.

The burden is on course to rise as more people are exposed to the underlying risk factors of oral diseases, including sugar, tobacco, and alcohol, they warn.

Oral diseases have a significant economic impact on both individuals and the healthcare system. 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 Lancet Series on Oral Health, led by University College London (UCL) researchers, brought together 13 academic and clinical experts from 10 countries. The researchers wanted to understand why oral diseases, which are largely preventable, have persisted over the last three decades, despite scientific advancements in the field.

According to the researchers, it reflects the widespread social and economic inequalities and inadequate funding for prevention and treatment.

Children living in poverty, socially marginalized groups, and older people are the most affected by oral diseases and have poor access to dental care.

In many low-income and middle-income countries (LMICs), oral diseases remain largely untreated because the treatment costs exceed available resources. Coverage for oral healthcare in LMICs is vastly lower than in high-income countries (HICs). Even in the US, accessing dental care is the highest cost barrier compared to any other healthcare service, and the highest dental expenditures globally were found for the US  at $129.1 billion. 

“Dentistry is in a state of crisis. Current dental care and public health responses have been largely inadequate, inequitable, and costly, leaving billions without access to even basic oral health care,” says the study. 

The powerful sugar lobby

According to the researchers, 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.

The study says sugar consumption is the underlying cause of tooth decay and obesity. According to the researchers, soft drinks are a major source of sugar in the global diet. While sugary drinks consumption is highest in HICs, the growth in sales of sugary drinks in many LMIC is substantial.

Although free sugars are used in the production of many processed foods and drinks, soft drinks are a major source of sugar in the global diet. (Getty Images)

“The international soft drinks market is dominated by a small number of companies—in particular, Coca-Cola and PepsiCo. These two alone accounts for over a third of worldwide soft drinks sales, with accumulated revenues over $100 billion in 2014, a sum that exceeds the gross domestic product even of HICs among a total of 125 countries globally, according to World Bank data,” says the study.

The researchers say between 2009 and 2015, Coca-Cola, PepsiCo, and the American Beverage Association spent $114 million in lobbying at the US federal level, adding that such commercial economic power readily translates into political power and policy influence.

“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,” says the team. 

Focusing on their marketing, the research states that the soft drinks industry spends a great deal on advertising their products, with direct marketing strategies aimed at children and young people.

“In 2013, US drinks companies alone spent $866 million on advertising sugary drinks and energy drinks. By 2020, Coca-Cola intends to spend $12 billion on marketing their products across Africa in contrast to the World Health Organization or WHO’s total annual budget of $4.4 billion (2017),” the study says. 

The researchers believe commercial baby foods are also a culprit as they are generally highly processed products and often have high sugar content.

“A 2018 European Commission report of over 4,200 commercial baby foods and drinks sold across Europe revealed that 41% of the products analyzed contained free sugars. Free sugars were particularly abundant in baby biscuits and rusks, baby cereals, baby juices and drinks, baby fruit products, desserts and yogurts, and other baby snacks,” says the report.

According to the study, the global commercial baby food market was estimated to be worth over $37 billion in 2010, with Europe, the USA, and Asia holding a significant share. However, emerging economies are expected to see high growth in sales.

Radical reforms: The need of the hour

According to the researchers, a radically different approach is now needed to tackle this global health challenge. They add that oral healthcare systems need to be more inclusive, accessible, and accommodating for socially deprived and vulnerable groups.

The researchers recommend standardized oral disease surveillance systems to examine the full extent and severity of oral conditions globally. “Rather than being isolated and separated from the mainstream healthcare system, dentistry needs to be more integrated, in particular with primary care services,” they say. 

Researchers have called for a complete reform of the dental care model in five key areas. (The Lancet)

Further, researchers recommend “bold action” and stricter rules to address the negative influence of the global sugar industry, which they say uses multiple strategies to lessen the effect of any public health efforts attempting to reduce free sugar consumption. 

“A pressing need exists to develop a 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. Reduce industry influence in the development of clinical practice guidelines by requiring the majority of committee members and committee chair to be free of financial conflicts of interest. Based on experience gained from tobacco control, dental professional organizations, academic institutions, individual researchers, and policymakers should not accept any funding, sponsorship, or support from the sugar industry,” says the study. 

The studies are - Oral diseases: a global public health challenge and Ending the neglect of global oral health: time for radical action.