Oral health – a hidden epidemic

Nearly half of the world’s population – 3.5 billion people – lives with one or more untreated oral disease. Despite being largely preventable, these conditions can result in pain, infection, impairment, and other negative health impacts. No other disease group affects the population across all countries and stages of life in the way that oral diseases do.[1]

The global increase in oral diseases can be linked to several drivers, including excessive sugar consumption, tobacco, or alcohol use; and the wider social, commercial, and political determinants that impact health. The evidence shows that oral diseases disproportionally affect the most vulnerable and disadvantaged groups within and across societies. There are large gaps in population coverage for preventive and clinical services, especially for rural, low-resource, and marginalized communities.

Moreover, oral health systems often prioritise costly interventions that require expensive technologies and focus on dentist-centred approaches, rather than prioritising cost-effective measures that focus on prevention.

Thailand puts oral health at the heart of Universal Health Coverage

In 2002, Thailand implemented a Universal Health Coverage (UHC) system that offers comprehensive healthcare through three public health insurance schemes, which collectively cover the entire population. Notably, Thailand's UHC approach includes oral health services, making them accessible to everyone. A broad range of oral health services are provided, including prevention, treatment, and rehabilitation services, setting Thailand's UHC system apart from many others.

A multisectoral approach to UHC has evolved over the years in Thailand, which also prioritises oral health. The Ministry of Public Health has been implementing oral health education programmes for school-aged children for many years, aimed at encouraging good oral habits early on. A joint effort by teachers, parents, communities, and local health workers is undertaken to ensure that children's teeth are healthy both at home and school. This collaboration between the health and education sectors has strengthened over time and has proven critical in developing and maintaining school-based oral health programmes, demonstrating the value of multisectoral cooperation in promoting oral health as a part of UHC.

“The critical success factor of the school oral health programme is the participation of all sectors, including oral health self-care by students themselves, children’s oral health care at home by parents, oral health education by schoolteachers, the healthy school lunch programme by the school chef, health care services by health and oral health personnel, a budget for health promoting activities by local government, and a healthy environment surrounding the school (not selling candies and soft drinks) created by the whole community.” - Director of a primary school in Angthong province, Thailand.

The Dental Association of Thailand (DAT) – the country’s professional association of dentists – has also contributed to the school oral health programme through guidance that aims to prevent early tooth decay, including use of fluoride-based products and caries risk assessment guidelines.

Moreover, DAT provides an additional layer of prevention and promotion services by tackling common risk factors for NCDs, like sugar and tobacco use. DAT has supported, for instance, advocacy for the removal of sugar added to baby formula, and also recognises the importance of policies which tackle the upstream determinants of health.

For tobacco control, smoking cessation practices have been incorporated into the core curriculum of all dental students in Thailand since 2019. The Thai Dentist Alliance against Tobacco collaborated with DAT and the Ministry of Public Health on a programme to provide oral cancer screening to those at risk as part of the tobacco programme. Since 2021, the programme was integrated into the national benefits package, which allows everyone above 40 years of age to be screened once a year. In 2022, over 3,000,000 eligible individuals underwent oral cancer screening (Data from Health Data Center, MoPH).

Recommendations – replicating Thailand’s success

A multisectoral approach to tackling oral health that involves all relevant stakeholders has been important in Thailand and can be replicated in other countries. Thailand adopted a “health-in-all policies” approach for oral health, based on health sector collaboration with non-health sectors to create health-promoting environments in schools and communities. The school-based oral health programme complements the oral health benefits included in UHC packages. Altogether, these efforts offer a sustained approach to ensuring oral health for all.

Find out more about NCD Alliance’s policy asks for the 2023 UN High Level Meeting on UHC in our policy brief.