Why AHI Has Developed a School Intervention Specifically to Address the Burden of Dental Caries

Dental caries (tooth decay) is the world’s most neglected disease, causing suffering in more than 2.5 billion people globally. The Global Burden of Disease (GBD) Oral Health Group, led by Professor Wagner Marcenes, provided the scientific foundation for the historic 74th World Health Assembly (WHA) Resolution on Oral Health. This resolution recognised that “oral diseases are highly prevalent, with more than 3.5 billion people suffering from them, and that oral diseases are closely linked to noncommunicable diseases (NCDs), leading to a considerable health, social, and economic burden.”

The resolution urges Member States to address the shared risk factors of oral diseases and other NCDs, including excessive intake of free sugars, tobacco use, and harmful alcohol consumption. It calls for strengthening the capacity of oral health professionals and recommends a shift from the traditional curative approach to a preventive, integrated model. This includes promoting oral health across families, schools, and workplaces while embedding timely and inclusive care within primary health care systems. A broad consensus has since emerged that oral health should be firmly integrated into the global NCD agenda and incorporated into Universal Health Coverage (UHC) schemes [1,2].

The importance of addressing the global burden of oral diseases is further reinforced by the Sustainable Development Goals (SDGs), particularly Goal 3 (Good Health and Well-Being) and Goal 10 (Reduced Inequalities). Untreated dental caries is the most prevalent human disease worldwide, affecting an estimated 2.5 billion people in permanent teeth and 600 million in deciduous teeth [1,2]. Oral conditions account for a similar burden of Years Lived with Disability (YLDs) as maternal conditions, hypertensive heart disease, anxiety disorders, and schizophrenia—and exceed the YLDs attributable to most cancers (except stomach, liver, and lung cancers), cardiovascular disease, and most mental disorders [2].

Among children and adolescents, this burden is overwhelmingly due to untreated caries in deciduous and permanent dentitions, while periodontal disease and tooth loss are negligible in these age groups [2]. Dental caries therefore remains both a neglected disease and a driver of oral health inequities [2,3], with untreated disease in childhood primarily manifesting as oral pain [4,5].

The prevalence of oral pain among children and adolescents worldwide is high. Systematic reviews estimate that approximately one in three experiences toothache, with pooled prevalence rates of 32.7% [6] and 36.2% [7]—findings consistent with more recent multicentre and meta-analytic evidence [8–10]. Oral pain disrupts daily functioning—interfering with eating, sleeping, play, classroom concentration, and academic performance. It also places a significant strain on families: parents of children with toothache report higher household expenditure, feelings of guilt, and increased rates of workplace absenteeism [11–17].

Beyond the household, recent reviews confirm that untreated dental pain is a major determinant of school absenteeism and academic underperformance [18,19], with strong associations demonstrated across diverse socioeconomic contexts [8,9]. Moreover, dental pain and pulp involvement resulting from untreated caries significantly reduce oral health-related quality of life and daily performance among children and adolescents [20–22].

In light of this, health systems, universities, and the dental profession face an urgent challenge: to bring oral health to the centre of global health priorities and to respond to WHA74.5 with structural change. The main barrier remains the high cost of conventional dental care, which makes it impossible to meet the vast unmet treatment need. The population-level solution is to reorient services from restorative dentistry towards minimally invasive, preventive care [2].

This reorientation requires modernising both dental services and university curricula to train current and future professionals in evidence-based, minimally invasive caries management—shifting away from invasive restorative techniques toward preventive, community-oriented approaches [23].

References

  1. Marcenes W, Kassebaum NJ, Bernabé E, Flaxman A, Naghavi M, Lopez A, Murray CJL. Global burden of oral conditions in 1990–2010: a systematic analysis. J Dent Res. 2013;92(7):592–597.

  2. Bernabé E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, Alipour V, et al. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the Global Burden of Disease 2017 Study. Lancet. 2020;395(10219):1853–1867. doi:10.1016/S0140-6736(20)30064-X

  3. Schwendicke F, Dörfer CE, Schlattmann P, et al. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res. 2015;94(1):10–18. doi:10.1177/0022034514557546

  4. Boeira GF, Corrêa MB, Peres KG, et al. Caries is the main cause for dental pain in childhood: findings from a birth cohort. Caries Res. 2012;46(5):488–495. doi:10.1159/000339491

  5. Ferraz NKL, Nogueira LC, Pinheiro MLP, et al. Clinical consequences of untreated dental caries and toothache in preschool children. Pediatr Dent. 2014;36(5):389–392.

  6. Pentapati KC, Yeturu SK, Siddiq H. Global and regional estimates of dental pain among children and adolescents: systematic review and meta-analysis. Eur Arch Paediatr Dent. 2021;22(1):1–12. doi:10.1007/s40368-020-00545-7

  7. Santos PS, Barasuol JC, Moccelini BS, et al. Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis. Clin Oral Investig. 2022;26(2):1105–1119. doi:10.1007/s00784-021-04255-2

  8. Krisdapong S, Prasertsom P, Rattanarangsima K, Sheiham A. School absenteeism and toothache in Thai schoolchildren. J Dent Res. 2013;92(12):1095–1100.

  9. Jackson SL, Vann WF Jr, Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children’s school attendance and performance. Am J Public Health. 2011;101(10):1900–1906.

  10. Alves LS, Susin C, Damé-Teixeira N, Maltz M. Caries incidence and incremental patterns in children and adolescents: a systematic review. Rev Saude Publica. 2014;48(5):830–839.

  11. Abanto J, Paiva SM, Raggio DP, Celiberti P, Aldrigui JM, Bönecker M. The impact of dental caries and trauma in children on family quality of life. Community Dent Oral Epidemiol. 2012;40(4):323–331.

  12. Filstrup SL, Briskie D, da Fonseca M, Lawrence L, Wandera A, Inglehart MR. Early childhood caries and quality of life: child and parent perspectives. Pediatr Dent. 2003;25(5):431–440.

  13. Cunnion DT, Spiro A 3rd, Jones JA, et al. Pediatric oral health-related quality of life improvement after dental treatment. Clin Oral Investig. 2010;14(3):439–445.

  14. Martins MT, Sardenberg F, Abreu MHNG, Vale MP, Paiva SM, Pordeus IA. Impact of early childhood caries on the oral health-related quality of life of preschool children and their parents. Caries Res. 2013;47(3):211–218.

  15. de Paula JS, Sarracini KL, Meneghim MC, Pereira AC, Ortega EM, Martins NS. How does the perception of oral health influence school performance in children? Community Dent Health. 2015;32(1):22–27.

  16. Frencken JE, Peters MC, Manton DJ, et al. Minimal intervention dentistry for managing dental caries – a review: report of a FDI task group. Int Dent J. 2012;62(5):223–243.

  17. Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000;28(6):399–406.

  18. Guarnizo-Herreño CC, Watt RG, Pikhart H, et al. Poor oral health and school performance in children: a systematic review. Am J Public Health. 2014;104(7):e13–e21.

  19. Rebelo MAB, Rebelo Vieira JM, Correa MB, et al. Oral health and academic performance: a systematic review. Community Dent Oral Epidemiol. 2019;47(6):507–515.

  20. Gilchrist F, Marshman Z, Deery C, Rodd HD. The impact of dental caries on children and young people: what they have to say? Int J Paediatr Dent. 2015;25(5):327–338.

  21. Barbosa TS, Gaviao MB. Oral health-related quality of life in children: part II. Effects of clinical oral health status. A systematic review. Int J Dent Hyg. 2008;6(2):100–107.

  22. Martins-Júnior PA, Vieira-Andrade RG, Corrêa-Faria P, Oliveira-Ferreira F, Marques LS, Ramos-Jorge ML. Impact of early childhood caries on quality of life: a systematic review and meta-analysis. Caries Res. 2013;47(5):401–408.

  23. Frencken JE, Peters MC, Manton DJ, et al. Minimal intervention dentistry for managing dental caries – a review: report of a FDI task group. Int Dent J. 2012;62(5):223–243.