WHO updates fact sheet on Oral Health (20 March 2020)

The World Health Organization (WHO) has updated its fact sheet on oral health.

Background Information:

Dental caries (tooth decay)

Dental caries result when plaque forms on the surface of a tooth and converts the free sugars (all sugars added to foods by the manufacturer, cook, or consumer, plus sugars naturally present in honey, syrups, and fruit juices) contained in foods and drinks into acids that destroy the tooth over time. A continued high intake of free sugars, inadequate exposure to fluoride and a lack of removal of plaque by toothbrushing can lead to caries, pain and sometimes tooth loss and infection.

Periodontal (gum) disease

Periodontal disease affects the tissues that both surround and support the tooth. The disease is characterized by bleeding or swollen gums (gingivitis), pain and sometimes bad breath. In its more severe form, the gum can come away from the tooth and supporting bone, causing teeth to become loose and sometimes fall out. The main causes of periodontal disease are poor oral hygiene and tobacco use.

Oral cancer

Oral cancer includes cancers of the lip, other parts of the mouth and the oropharynx. Oral cancer is more common in men and in older people, and varies strongly by socio-economic condition.

In some Asian-Pacific countries, tobacco, alcohol and areca nut (betel quid) use are among the leading causes of oral cancer. In North America and Europe, human papillomavirus infections are responsible for a growing percentage of oral cancers among young people.

Oral manifestations of HIV infection

Oral manifestations occur in 30-80% of people with HIV, with considerable variations depending on the affordability of standard antiretroviral therapy (ART).

Oral manifestations include fungal, bacterial or viral infections of which oral candidiasis is the most common and often the first symptom. Oral HIV lesions cause pain, discomfort, dry mouth, and difficulties swallowing.

Early detection of HIV-related oral lesions can be used to diagnose HIV infection and monitor the disease’s progression. Early detection is also important for timely treatment.

Oro-dental trauma

Oro-dental trauma results from injury to the teeth, mouth and oral cavity. Around 20% of people suffer from trauma to teeth at some point in their life.7 Oro-dental trauma can be caused by oral factors such as lack of alignment of teeth and environmental factors (such as unsafe playgrounds, risk-taking behaviour and violence). Treatment is costly and lengthy and sometimes can even lead to tooth loss, resulting in complications for facial and psychological development and quality of life.


Noma is a severe gangrenous disease of the mouth and the face. It mostly affects children between the ages of 2 and 6 years suffering from malnutrition, affected by infectious disease, living in extreme poverty with poor oral hygiene and/or with weakened immune systems.

Noma is mostly found in sub-Saharan Africa, although cases have also been reported in Latin America and Asia. Noma starts as a soft tissue lesion (a sore) of the gums, inside the mouth. The initial gum lesion then develops into an acute necrotizing gingivitis that progresses rapidly, destroying the soft tissues and further progressing to involve the hard tissues and skin of the face.

Without treatment, noma is fatal in 90% of cases. Survivors suffer from severe facial disfigurement, have difficulty speaking and eating, face social stigma, and require complex surgery and rehabilitation. Where noma is detected at an early stage, its progression can be rapidly halted, through basic hygiene, antibiotics and improved nutrition.

Cleft lip and palate

Clefts of the lip or palate affect more than 1 in 1000 newborns worldwide. Genetic predisposition is a major cause. However, poor maternal nutrition, tobacco consumption, alcohol and obesity during pregnancy also play a role. In low-income settings, there is a high mortality rate in the neonatal period. If lip and palate clefts are properly treated by surgery, complete rehabilitation is possible.

Key Messages:

Oral diseases pose a major health burden for many countries and affect people throughout their lifetime, causing pain, discomfort, disfigurement and even death.

Most oral diseases and conditions share modifiable risk factors (such as tobacco use, alcohol consumption and an unhealthy diet high in free sugars) common to the four leading noncommunicable diseases (cardiovascular disease, cancer, chronic respiratory disease and diabetes).

In addition, it is reported that diabetes is linked in a reciprocal way with the development and progression of periodontal disease. Moreover, there is a causal link between the high consumption of sugar and diabetes, obesity and dental caries.

It is estimated that oral diseases affect nearly 3.5 billion people.

Untreated dental caries (tooth decay) in permanent teeth is the most common health condition according to the Global Burden of Disease 2017. 

More than 530 million children suffer from dental caries of primary teeth (milk teeth).

Severe periodontal (gum) disease, which may result in tooth loss, is also very common, with almost 10% of the global population affected.

Oral cancer (cancer of the lip or mouth) is one of the three most common cancers in some countries of Asia and the Pacific.

Treatment for oral health conditions is expensive and usually not part of universal health coverage (UHC). In most high-income countries, dental treatment averages 5% of total health expenditure and 20% of out-of-pocket health expenditure.

Most low- and middle-income countries are unable to provide services to prevent and treat oral health conditions.

Factors contributing to oral diseases are

  • an unhealthy diet high in sugar,
  • use of tobacco and
  • harmful use of alcohol.

Most oral health conditions are largely preventable and can be treated in their early stages.


The burden of oral diseases and other noncommunicable diseases can be reduced through public health interventions by addressing common risk factors.

These include:

  • promoting a well-balanced diet low in free sugars and high in fruit and vegetables, and favoring water as the main drink;
  • stopping use of all forms of tobacco, including chewing of areca nuts;
  • reducing alcohol consumption; and
  • encouraging use of protective equipment when doing sports and travelling on bicycles and motorcycles (to reduce the risk of facial injuries).

Adequate exposure to fluoride is an essential factor in the prevention of dental caries.

An optimal level of fluoride can be obtained from different sources such as fluoridated drinking water, salt, milk and toothpaste. Twice-daily tooth brushing with fluoride-containing toothpaste (1000 to 1500 ppm) should be encouraged.

Useful Link:

Link to the WHO fact sheet:



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