HIV/AIDS and oral health
The HIV/AIDS epidemic is the fastest-growing threat to development today and the epidemic is particularly severe in sub-Saharan Africa. The greatest challenge in responding to HIV/AIDS at present is to ensure that proven, gender sensitive strategies for prevention and care are widely implemented to a level where there will be significant impact on the epidemic. An oral health component of public health programmes can make important contributions to the early diagnosis, prevention and treatment of this disease. A number of studies have demonstrated that about 40-50% of HIV-positive persons have oral fungal, bacterial or viral infections, often occurring early in the course of the disease3. Oral lesions strongly associated with HIV infection are pseudo-membranous oral candidiasis, oral hairy leukoplakia, HIV gingivitis and periodontitis, Kaposi?s sarcoma, non-Hodgkin lymphoma, and dry mouth owing to a decreased salivary flow.
The WHO Oral Health Programme has prepared a guide23 to provide a systematic approach to the implementation of epidemiological studies of oral conditions associated with HIV infection; to provide guidelines for the collection, analysis, reporting and dissemination of data from such studies; and to facilitate comparison of findings from different studies. It also aims to encourage oral health providers, primary health care workers and public health practitioners to make oral health status an integral part of optimum case management and of surveillance activities of the diseases associated with HIV infection.
Oral health information systems, evidence for oral health policy and formulation of goals
In 1981, WHO and the FDI World Dental Federation jointly formulated goals for oral health to be achieved by the year 200012,24, as follows:
- 50% of 5-6 year-olds to be free of dental caries.
- The global average to be no more than 3 DMFT at 12 years of age.
- 85% of the population should have all their teeth at the age of 18 years.
- A 50% reduction in edentulousness among 35-44-year-olds, compared with the 1982 level.
- A 25% reduction in edentulousness at age 65 years and over, compared with the 1982 level.
- A database system for monitoring changes in oral health to be established.
The establishment of oral health information systems remains a challenge for most countries of the world. The WHO Global Oral Health Programme is prepared to assist countries in their efforts to develop such systems which include health systems data additional to epidemiological indicators. At WHO, information systems are being established for the surveillance of global trends in oral disease and risk factors. The WHO Global Oral Health Data Bank compiles valuable information for monitoring the global epidemiological picture and trends over time in oral health. The WHO Global Oral Health Programme has initiated integration of the existing database with other WHO health databases and surveillance systems on risk factors9.
The formulation of new WHO goals has been initiated. WHO, FDI and IADR have jointly prepared new goals for the period up to the year 202025. The objectives and targets have been broadened in order to cover significant indicators related to oral health and care of population groups. The global goals are primarily designed to encourage health policy-makers at regional, national and local levels to set standards for oral health in relation to pain, functional disorders, infectious diseases, oro-pharyngeal cancer, oral manifestations of HIV infection, noma, trauma, craniofacial anomalies, dental caries, developmental anomalies of teeth, periodontal disease, oral mucosal diseases, salivary gland disorders, tooth loss, health care services and health information systems. The WHO Global Oral Health Programme will support countries directly as well as through regional and country offices in their formulation of goals, targets and standards of oral health.
Research for oral health
Research is the systematic process for generating new knowledge. Advances in knowledge, however, have not yet benefited developing countries to the fullest extent possible. It has been estimated, for example, that only 10% of funding for global health research is allocated to health problems that affect 90% of the world's population26. Clear disparities in economic strength, political will, scientific resources and capabilities, and access global information networks have, in fact, widened the knowledge gap between rich and poor countries. The WHO Global Oral Health Programme contributes to the process of redressing the imbalance in the distribution of knowledge about oral health, so that the results of research will benefit everyone in a sustainable and equitable manner. As knowledge is a major vehicle for improving the health of poor people in particular, the WHO Oral Health Programme will focus on stimulating oral health research in the developed and the developing world to reduce risk factors and the burden of oral disease, and to improve oral health systems and the effectiveness of community oral health programmes. In particular, more research should be devoted to: inequity in oral health; the psychosocial implications of oral health/illness; diet, nutrition and oral health; tobacco cessation programmes; oral health - general health - quality of life interrelation-ships; and HIV/AIDS.
The WHO Oral Health Programme intends to stimulate oral health research for, with and by developing countries in several ways, such as:
- Supporting initiatives that will strengthen research capability in developing countries so that research is recognized as the foundation of oral health policy.
- Encouraging oral health research training programmes at local level or based on interuniversity collaborative "sandwich" programmes.
- Providing universities in developing countries with easy access to the scientific literature within oral health and online access to scientific articles.
- Reducing the 10/90 gap in oral health research through work within the framework of the Global Forum for Health Research26.
CONCLUSION
Oral diseases are major public health problems. In addition to socio-environmental conditions, oral diseases are related to modifiable lifestyles. Unhealthy dietary habits, smoking and other tobacco use, alcohol consumption and poor hygiene are some of the common risk factors for many NCDs, including oral disease. The WHO Global Oral Health Programme enables effective execution of the common risk factor approach in disease prevention and health promotion. While there has been encouraging improvement in oral health in many countries over the past few decades, much work remains to be done. With many challenges ahead for Africa, it is important to build on our achievements, and on strategies that work.
This report highlights the priority areas for the WHO Global Oral Health Programme and provides a framework for implementation. WHO's work for oral health will focus on devising tools for intersectoral collaboration, community participation, supportive policy decisions, oral health systems development, and particularly development of community-based strategies for oral disease control and promotion of oral health.
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