CDA Essentials 2019 • Volume 6 • Issue 7

24 | 2019 | Issue 7 N ews and E vents Q: What is the impact of globally pervasive oral health disease? PA: The burden of oral disease is considerable in terms of the prevalence of the conditions, but also in terms of the burden of pain, sepsis and infection, and costs. We presented a figure which used data from the EU where they compared the costs related to different disease groups across 28 countries in Europe in 2015. The costs for dental care was third in that list behind diabetes and cardiovascular disease, but ahead of cancer and mental illnesses. Clearly the cost is enormous. When you consider the indirect cost of things like days off work and school, the burden is extremely significant. In Western and developed countries like Canada, there are significant inequalities with the burden of disease being felt far more strongly in the poorer parts of society. Richer parts of society have a low level of decay or gum disease or other oral conditions. The message we wanted to get through to the readers of The Lancet was that the causes of these conditions are just the same as all the other conditions people are dealing with. In other words, it’s free sugars consumption, it’s smoking, it’s tobacco, it’s excess alcohol consumption. Q: Can you talk about how industry is having an impact on oral health around the world? PA: In this series, we wanted to highlight the commercial determinants of health and in particular with the tobacco and sugar industry, and how they have a very strong influence. The series data shows that Coca-Cola is going to invest almost $12 billion in Africa to market its products. For comparison, the entire budget of the World Health Organization for one year is $4.4 billion. These companies are extremely powerful and are involved with a range of organizations, including dental research organizations. This can result in far less research being done on the consumption of sugar and how we can reduce sugar consumption, which of course is something they don’t wish to investigate. Q: Is the dental health care system in Canada and globally prepared to manage the burden of oral health disease? PA: At the moment, with this mega-burden of disease and dental care as it is provided in the world and predominantly in developed countries, we are not going to be able to deal with dental disease. Current models have yet to reduce the burden of disease in developed countries and so, it certainly won’t be able to do so in developing ones. Even in the richer countries like Canada, we won’t be able to deal with the burden due to our larger problems of inequality. Q: What systematic and policy changes does this series recommend? PA: This is a very complex situation. It’s not easy, but I think we really have to start thinking about how we need to change things, working and looking at things like how the sugar industry influences the dental industry across the globe. I think we can also look at how we’re training our students in our dental schools. Globally speaking, the training of dental students has not changed fundamentally for decades. Most training still focuses on treating periodontal disease and dental caries once they’ve occurred. We need to be training students to focus more of their activities upstream to help prevent disease in individuals, families, communities and populations Q: In your opinion, how can changes be made in the Canadian dental health care systems? PA: I truly believe that we need to start looking at more upstream approaches, meaning population-based approaches and reducing sugar consumption. This goes beyond continuing to treat people. Many of your readers have heard me talk about the fact that we need to re-examine the essentially private dental care system in Canada. In this country, 95% of dental care is provided through the private sector. That sector is very good for Canadians who can access care at dental offices, but it’s not good for the approximately 25% people who cannot. We need to take a strong look at how we can begin to bring some dental care into Canada’s public health care system and make it cheaper for the people who are the patients after all, it is those with the highest levels of disease who have the greatest barriers to dental care. Q: Where can our readers find more information about The Lancet Oral Health Series? PA: The series is open access. Your readers can find all of the articles at thelancet.com/series/oral-health a Listen to the full interview with Dr. Allison on CDA Oasis wp.me/p2Lv6A-78i