The term oral health not only considers the “health of the mouth,” but is directly linked to the most prevalent conditions in the world, of which include dental caries, periodontal disease and tooth loss.1 Oral disease is a silent epidemic, which pervasively influences one’s “quality of life and social functioning” to a point where prolonged pain, speech and eating difficulties can manifest into the more socially debilitating consequences of poor self-esteem or deprived educational opportunities.1 With the treatment costs of these conditions averaging at 4.7% of the global health expenditure, it is expected that only certain strata of populations will be able to experience the luxuries of dental care.1 Regarding dental care, the end goal is to arrest the potentiation of oral disease, all the while promoting universal oral health. Therefore, it is integral to change the ways in which humanity etches its presence on the global theme of sustainability. Spearheaded by the United Nations in 2015, Transforming our world: the 2030 Agenda for Sustainable Development are guidelines which “seeks to realise the human rights of all” amidst a planet that can “support the needs of the present and future generations.” 2 If adopted internationally, the 17 SDGs within this agenda can transform universal oral health into a realistic ideology, by tackling inequalities, all the while promoting peace, a quality education and economic prosperity within sustainable communities.
Global public health research has concluded that oral health follows a social gradient- a phenomenon that establishes a link between one’s oral health and their social status.3 Socio-economic determinants include the varying environments within which we are born, prosper and age, however, it is also fuels dental health inequalities to a point where “poor people have more oral diseases and rich people have healthier teeth and gums.” 1,4 The oral health industry is privatised, thereby it is associated with high treatment costs and relies on out-of-pocket payments. This fiscal burden affects both developed and developing nations, with poverty-stricken and rural communities manifesting their limited dental care accessibility through a greater number of DMFT.5 In reference to these lower SES communities, “energy-dense and nutritionally compromised” foods, high in refined sugars, are readily consumed due to their affordability and convenience.6 Frequent sugar intake is associated with the prevalence of dental caries, and studies undertaken in poorer African and Asia-Pacific areas have indicated not only increased caries incidences but also malnutrition.1,7 Malnutrition is inevitable to those who live in poverty, where the adverse implications that a lack of protein and essential minerals can have on one’s dentition and tooth eruption are poorly understood and regarded as secondary to general health.8 The latter stems from a substandard education regarding oral hygiene and caries prevention resources. By following the Philippine’s example of “including evidence-based oral health interventions such as fluoride toothpaste for brushing to students,” we can promote “cost-effective and sustainable interventions to reduce oral diseases.” 1 Moreover, providing tertiary dental education in low SES communities would encourage a greater proportion of dental personnel, and consequently, greater dental care accessibility away from urbanised areas. Therefore, in addition to reducing inequalities, increasing job production, economic growth and dental infrastructure, by following the guidelines for SDGs 4, 8, 9, 10 and 11 we are developing sustainable communities, where profits can further other industry growth, minimise poverty and world hunger.9 A key benefit of economic growth is the sharing of resources between metropolitan and outskirt cities, thereby promoting “well-being for all.” 9
It is important to recognise that direct access of dental services isn’t enough to achieve sustainability, especially when it comes to achieving SDGs 5 and 10. Addressing the inequalities of society, particularly gender inequality, will aid in the even distribution of resources centred around encouraging better oral health. By empowering women of all strata worldwide, the oral hygiene instructions we provide them, will be passed onto the children they tirelessly mother- thereby effecting generational change.10 Additionally, these inequalities engender widespread domestic violence, where “the face is a common target in assault.” 11 As a result, oral health care professionals can not only identify abuse-related facial injuries, but also foster peace and justice by liaising with anti-violence organisations to refer their patients to “specialist agencies for intervention and support.” 11 Moreover, Australian studies have indicated that indigenous populations have worse oral health than those of non-indigenous, reiterating that ethnic inequalities regarding tooth decay are prevalent.12 Therefore, it is the responsibility of oral health professionals to practice cultural competence within their dental clinics. Through this manner, we are establishing a tolerant and healthcare-accessible environment to all.13
The responsibility of reaching the SDG targets mustn’t be limited to government policy-makers; it should extend to those within the oral health profession as well. Dental materials like mercury-containing amalgam, amongst other metal wastes are “leachable toxins which can contaminate soil and groundwater after disposal.” 14 This behaviour directly hinders the progress of SDGs 12, 14 and 15, whilst compromising the availability of clean water and sanitation for all (SDG 6). Clean and sustainable water management is “critical for socio-economic development and human survival itself.” 15 It mitigates “morbidity associated with faecal-oral infections” and encourages water fluoridation in communities- hence “benefiting from its preventative role in tooth decay, regardless of age, gender or socioeconomic status.” 17,18 Therefore, it is imperative to sensitise dentists to the ramifications associated with improper waste generation and disposal, as this administers a proactive and environmentally-friendly approach to their practice. Additionally, the utilisation of renewable energy technologies within clinics can not only reduce detrimental greenhouse gas-fuelled climate change, but also prevents downstream repercussions on agriculture and water quality; this links back to achieving SDGs 1,2,3 and 6.19
The 2030 Agenda for sustainable growth inspires partnerships that aim to “integrate human rights into global and national policies.” 20 Oral health professionals have the most sway in regard to promoting oral health education, of which include primary prevention methods and clinical techniques. However, establishing partnerships with policy-makers to bridge the discrepancies between oral healthcare within various communities is crucial, as poor oral health is fuelled by multiple determinants. These partnerships can be associated with FDI trade and agricultural bodies, to ensure that there is a reduction in sugar foods on the market and an increase in nutritious and anti-cariogenic foods.21 Moreover, these partnerships can focus on providing lower SES communities with tangible or educational resources to combat inequalities that revolve around gender, ethnicity and economics. Oral healthcare is unfortunately a luxury to much of the world, however, by aiming to hit the targets outlined in the 2030 Agenda for Sustainable development, there is the possibility of dental care becoming universal, like the human right it is meant to be.