UWC Professor Emeritus and dental health expert, Sudeshni Naidoo. Image: Shelley Christians/UWC

It's a disease that keeps children out of school, limits adults’ job prospects and increases the risk of chronic conditions like heart disease and diabetes. Yet, oral disease remains largely ignored in healthcare planning and global health priorities despite its far-reaching impact, warned University of the Western Cape (UWC) Professor Emeritus and dental health expert, Sudeshni Naidoo.

In a British Medical Journal editorial, Prof Naidoo and international oral-health experts reported that oral diseases affects one in two people worldwide and should therefore be considered a non-communicable disease (NCD), just like other chronic diseases such as diabetes and cardiovascular diseases.

After oral disease was initially omitted from the most influential policy proposal, the “zero draft” political declaration for the 2025 UN high-level meeting on non-communicable diseases (NCDs) in September, Prof Naidoo said oral disease had since been successfully included in the document - though yet to be approved - following a plea from oral health experts.

The declaration is a document for the UN high-level meeting that sets out proposed commitments, targets and actions on key global issues, including South Africa. This year’s meeting, held in New York on 25 September, set firm targets for 2030, including cutting tobacco use by 150-million people, bringing hypertension under control for another 150-million, and ensuring a further 150-million people have access to mental healthcare.

It also pledged to strengthen national health systems, improve governance, and advance equity and integrated healthcare delivery.

Although experts applauded the late inclusion of oral health, which now has a dedicated paragraph in the “zero draft” political declaration, the scholars argued that the exclusion of oral diseases from many public health narratives exposes a broader problem of the narrow, siloed and outdated way that NCDs are framed in international health agendas. They said so far the agenda had only concentrated on five chronic conditions - cardiovascular disease, cancer, diabetes, chronic respiratory disease and mental health.

Despite calls to adopt a “6×6 model” to include oral diseases and sugars as a distinct risk factor, progress on this proposed integration remained slow. Sugars were often subjoined under a broad category of “unhealthy diet”, despite its role in tooth decay, diabetes and obesity.

“Without explicit inclusion, oral diseases remain excluded from national planning, resource allocation, policy making and monitoring frameworks,” the experts noted. 

The authors included Prof Habib Benzian of New York University, now also Extraordinary Professor at the Faculty of Dentistry at UWC, Dr Dympna Kavanagh from Ireland’s Department of Health, and Prof Manu Raj Mathur of the Public Health Foundation of India. 

Prof Naidoo was also the director of the only World Health Organization Collaborating Centre on Oral Health in Africa.  They argue that despite oral health disorders such as gum disease, tooth decay and oral infections regarded as an early marker for chronic conditions such as heart disease and diabetes, medicine and dentistry continue to evolve as separate professions, creating educational and institutional silos that leave oral health neglected.

Not only does toothache and gum infections cause severe pain and make it hard for children to attend school and result in reduced performance at work, poor oral health is also closely linked to heart disease and diabetes.

Harmful bacteria from infected gums can enter the bloodstream and travel to the heart and arteries. This triggers inflammation that raises the risk of heart attacks and strokes.  Gum disease also makes diabetes harder to control, as chronic inflammation disrupts the body’s ability to regulate blood sugar. 

In order to integrate oral disease into health agendas, the authors proposed four key actions, that is: 

1. UN member states, such as SA, must explicitly request the inclusion of oral diseases in the zero draft of the UN political declaration, and not only as a single word recognition;
2. Oral health must be made an essential component of universal health coverage, delivering essential and preventive and curative services at clinic level supported by trained health workers, referral systems and adequate financing;
3. The commercial determinants of oral diseases must be treated as a public health priority, and there must be stronger regulation of harmful products, such as sugary foods, tobacco, and alcohol, with no interference from the industry to protect health policies; and,
4. Oral health is a shared public concern and all parties, including government, civil society and professional networks, should strengthen advocacy and produce solutions for improved oral health.