The Burden of Dental Disease - Malmö Högskola · Table 1 Prevalence of edentulousness (%) of elderly reported for selected countries throughout the world WHO region/country Percent

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Author's personal copy

Oral HealthP E Petersen, World Health Organization, Geneva, Switzerland

ã 2008 WHO. Published by Elsevier Inc. All rights reserved.

Introduction

Despite great improvements in the oral health of popula-tions in several countries, global problems still persist.This is particularly so among the underprivileged groupsin both developing and developed countries. Oral disease

International Encyclopedia of Public Hea

conditions such as dental caries, periodontal disease, toothloss, oral cavity cancers, HIV/AIDS-related oral disease,and oro-dental trauma are major public health problemsworldwide. Poor oral health may have a profound effect ongeneral health. The experience of pain, and problemswith eating, chewing, smiling, and communication due to

lth, First Edition (2008), vol. 4, pp. 677-685

678 Oral Health


missing, discolored, or damaged teeth have a major impacton people’s daily lives and well-being. Furthermore, oraldiseases restrict activities in school, at work, and at homecausing millions of school and work hours to be lost eachyear the world over.

The objectives of the present article are to outline theoral disease burden globally and to highlight the influenceof major sociobehavioral risk factors related to oral health.Sources of information are the World Health Organiza-tion (WHO) Global Oral Health Data Bank (Petersen,2003; WHO, 2004), including scientific reports from pop-ulation studies carried out in various countries. For themajority of countries, WHO standardized criteria forclinical registration of oral disease conditions are thatapplied and calibration trials be conducted accordinglyfor the control of quality of data and assessment of inter-examiner variability (WHO, 1997). The data stored in thedata bank are updated regularly.

The Burden of Dental Disease

Dental caries (tooth decay) and periodontal disease (gumdisease) have historically been considered themost impor-tant global oral health burdens. Dental caries is still a majorhealth problem in most industrialized countries as thedisease affects 60% to 90% of school-aged children and

The designations employed and the presentation of material on this map doworld health organization concerning the legal status of any country, territory, c

or boundaries. Dashed lines represent approximate borde

Figure 1 Dental caries levels (DMFT) of 12-year-olds worldwide. Pe

improvement of oral health in the 21st century – the approach of theWEpidemiology 31(Suppl 1): 3–24; WHO (2004) Global Oral Health Data

International Encyclopedia of Public Healt

the vast majority of adults (Petersen, 2003; WHO, 2004).At present, the distribution and severity of dental cariesvary in different parts of the world and within the sameregion or country. Figure 1 illustrates the dental cariesexperience levels (severity) in permanent teeth asmeasured in 12-year-olds by the Decayed, Missing andFilled Teeth index (DMFT). The disease level in childrenis relatively high in the Americas (DMFT¼ 3.0) and in theEuropean Region (DMFT¼ 2.6), whereas it is less com-mon or less severe in the African region (DMFT¼ 1.7)(Petersen, 2003;WHO, 2004). Figure 2 illustrates the timetrends in dental caries experience of 12-year-old childrenin developing and developed countries. In most develop-ing countries, dental caries levels were low until recentyears. Now, however, dental caries prevalence rates anddental caries experience tend to increase. This is dueparticularly to the growing consumption of sugars and toinadequate exposures to fluorides. In contrast, a cariesdecline has been observed in most industrialized countriesover the past 20 years or so. This pattern was the result of anumber of public health measures, including effective useof fluorides, coupled with changing living conditions,healthier lifestyles, and improved self-care practices.

Worldwide, dental caries prevalence is high amongadultsas the disease affects nearly 100% of the population in themajority of countries. Figure 3 outlines the dental carieslevels among 35- to 44-year-olds, as measured by the mean

Decayed, missing andfilled permanent teeth

Very low: <1.2Low: 1.2–2.6Moderate: 2.7–4.4High: >4.4No data available

not imply the expression of any opinion whatsoever on the part of theity or area or of its authorities, or concerning the delimitation of its frontiersr lines for which there may not yet be full agreement

tersen PE (2003) The World Oral Health Report 2003: Continuous

HOGlobal Oral Health Programme.Community Dentistry and OralBank. Geneva, Switzerland: WHO.

h, First Edition (2008), vol. 4, pp. 677-685

0

1

2

3

4

5

1980 1981 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Developed countries All countries Developing countries

DMFT

Figure 2 Changing levels of dental caries experience (DMFT) among 12-year-olds in developed and developing countries. Petersen

PE (2003) The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century – the approach of the WHO

Global Oral Health Programme. Community Dentistry and Oral Epidemiology 31(Suppl 1): 3–24; WHO (2004) Global Oral Health DataBank. Geneva, Switzerland: WHO.

Decayed, missing andfilled permanent teeth

Very low: <5.0Low: 5.0–8.9Moderate: 9.0–13.9High: >13.9No data available

The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of thewhorld health organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers

or boundaries. Dashed lines represent approximate border lines for which there may not yet be full agreement

Figure 3 Dental caries levels (DMFT) of 35- to 44-year-olds worldwide. Petersen PE (2003) The World Oral Health Report 2003:Continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Community

Dentistry and Oral Epidemiology 31(Suppl 1): 3–24; WHO (2004) Global Oral Health Data Bank. Geneva, Switzerland: WHO.

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DMFT index (Petersen, 2003; WHO, 2004). Most indus-trialized countries and some countries of Latin Americashow high DMFT values (i.e., 14 teeth or more), while den-tal caries experience levels aremuch lower in the developing


countries of Africa and Asia. In several industrializedcountries older people often have had their teeth extractedearly in life because of pain or discomfort, leading toreduced quality of life. The proportion of adults with no


680 Oral Health


natural teeth (edentulous) aged 65 years or more is still highin some countries (Table 1); meanwhile, in many industria-lized countries there has been a positive trend of reductionin tooth loss among older adults in recent years (Chen et al.,1997) (Figure 4), in parallel with increased seeking of pre-ventive oral care services (Petersen et al., 2004).

In developing countries, oral health services are mostlyoffered from regional or central hospitals in urban centers,and little if any importance is given to preventive orrestorative dental care. Many countries of Africa, Asia,and Latin America have a shortage of oral health person-nel and generally the capacity of the systems is limited topain relief or emergency care. In Africa, the dentist to

Table 1 Prevalence of edentulousness (%) of elderly

reported for selected countries throughout the world

WHO region/countryPercentedentulous

Age group(years)

AfricaMadagascar 25 65–74

The Americas

Canada 58 65þUSA 26 65–69

Eastern Mediterranean

Egypt 7 65þLebanon 35 65–75Saudi Arabia 31–46 65þEurope

Albania 69 65þAustria 15 65–74Bosnia and

Herzegovina

78 65þ

Bulgaria 53 65þDenmark 27 65–74

Finland 41 65þHungary 27 65–74

Iceland 72 65þItaly 13 65–74

Lithuania 14 65–74

Poland 25 65–74

Romania 26 65–74Slovakia 44 65–74

Slovenia 16 65þUnited Kingdom 46 65þSouth-East Asia

India 19 65–74

Indonesia 24 65þSri Lanka 37 65–74Thailand 16 65þWestern Pacific

Cambodia 13 65–74

China 11 65–74Malaysia 57 65þSingapore 21 65þ

Reproduced from Petersen PE (2003) The World Oral Health

Report 2003: Continuous improvement of oral health in the 21stcentury – the approach of the WHO Global Oral Health

Programme. Community Dentistry and Oral Epidemiology 31

(Supplement 1): 3–24; and WHO (2004) Global Oral Health Data

Bank. Geneva: WHO.


population ratio is approximately 1:150 000, against about1:2000 in most industrialized countries. In children andadults suffering from severe tooth decay, teeth are oftenleft untreated or are extracted to relieve pain or discom-fort. In the future, tooth loss and impaired oral functionare therefore expected to increase as a public healthproblem in many developing countries.

Tooth loss in adult life may also be attributable to poorperiodontal health. Severe periodontitis, which may resultin tooth loss, is found in 5% to 20% of most adult popula-tions worldwide. Figure 5 illustrates the prevalence ofsymptoms of disease among 35- to 44-year-olds byWHO region (Petersen, 2003; WHO, 2004; Petersen andOgawa, 2005), using the so-called Community PeriodontalIndex (Score 0¼ individuals with healthy periodontal con-ditions; Score 1¼ individuals with bleeding from gums;Score 2¼ individuals with bleeding gums and calculus;Score 3¼ individuals with shallow periodontal pockets(4–5mm); Score 4¼ individuals with deep periodontalpockets (6mm or more)). Symptoms of periodontal diseaseare highly prevalent among adults within all regions; fur-thermore, from a global perspective, most children andadolescents have signs of gingivitis (gum disease) (WHO,2004). Aggressive periodontitis, a severe periodontal con-dition affecting individuals during puberty and that maylead to premature tooth loss, affects about 2% of youth(Albander, 1997).

Oral Cancer

Oral cavity cancer is more common in developing thandeveloped countrie s ( Figure 6 an d Figu re 7 ) (Stewar tand Kleihues, 2003; WHO, 2004).The prevalence of oralcavity cancer is particularly high among men, the eighthmost common cancer worldwide. In South-Central Asia,cancer of the oral cavity ranks among the three mostcommon types of cancer. In India, the age-standardizedincidence rate of oral cancer is 12.6 per 100 000 popula-tion. It is noteworthy that sharp increases in the incidencerates of oral cancers have been reported for severalcountries and regions such as Denmark, France, Germany,Scotland, and Central and Eastern Europe, and, to a lesserextent, Australia, Japan, New Zealand, and the UnitedStates (Stewart and Kleihues, 2003; WHO, 2004), due tohigh consumption of tobacco and alcohol.

Oral Health in HIV/AIDS

A number of studies have demonstrated the negativeimpact on oral health of HIV infection (Coogan et al.,2005). Approximately 40% to 50%ofHIV-positive personshave oral fungal, bacterial, or viral infections often occur-ring early in the course of the disease. Oral lesions strongly


0

20

40

60

80

1987 1994 2000 1987 1994 2000 1987 1994 2000

Regular dental attendance

20 teethor more

Edentulous

Figure 4 Percentages of 65- to 74-year-olds in Denmark who have regular (annual) dental attending habits, functional dentition(20 teeth or more), and without natural teeth (edentulous), by year of observation. Petersen PE, Kjoller M, Christensen LB, and

Krustrup U (2004) Changing dentate status of adults, use of dental health services, and achievement of national dental health

goals in Denmark by the year 2000. Journal of Public Health Dentistry 64: 127–135.

0%

25%

50%

75%

100%

AFRO AMRO EMRO EURO SEARO WPRO

CPI 4 CPI 3 CPI 2 CPI 1 CPI 0

Figure 5 Mean percentages of maximum Community

Periodontal Index (CPI) scores in 35- to 44-year-olds by WHO

Regional Offices. Petersen PE (2003) The World Oral HealthReport 2003: Continuous improvement of oral health in the

21st century – the approach of the WHO Global Oral Health

Programme. Community Dentistry and Oral Epidemiology

31(Suppl 1): 3–24; WHO (2004) Global Oral Health Data Bank.Geneva, Switzerland: WHO; Petersen PE and Ogawa H (2005)

Strengthening the prevention of periodontal disease: The WHO

approach. Journal of Periodontology 76: 2187–2193.

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associated with HIV infection are pseudo-membranousoral candidiasis, oral hairy leukoplakia, HIV gingivitis andperiodontitis, Kaposi sarcoma, and non-Hodgkin’s lym-phoma. Dry mouth as a result of decreased salivary flowrate may not only increase the risk of dental caries butnegatively impact quality of life because of difficulty inchewing, swallowing, and tasting food. The need for oralhealth care in terms of immediate care and referral, treat-ment of manifest oral disease, prevention, and health pro-motion is particularly high among the under-served,


disadvantaged population groups of developing countries,including HIV-infected people (Coogan et al., 2005).

Noma – Cancrum Oris

Noma, a debilitating oro-facial gangrene, is an importantdisease burden in many developing countries, particularlyin Africa and Asia (Figure 8) (Petersen, 2003). Nomaprimarily begins as a localized gingival ulceration andspreads rapidly through the oro-facial tissues, establishingitself with a blackened necrotic center (Enwonwu, 1995).About 70% to 90% of cases are fatal in the absence of care.Fresh noma is seen predominantly in the age group1–4 years, although late stages of the disease occur inadolescents and adults. Poverty is the key risk conditionfor development of noma; the environment inducing nomais characterized by severe malnutrition and growth retar-dation, unsafe drinking water, deplorable sanitary prac-tices, residential proximity to unkempt animals, and a highprevalence of infectious diseases such as measles, malaria,diarrhea, pneumonia, tuberculosis, and HIV/AIDS.

Oro-Dental Trauma

In contrast to dental caries and periodontal disease, reli-able data on the frequency and severity of oro-dentaltrauma are still lacking in most countries, particularly indeveloping countries (Andreasen and Andreasen, 2002).Some countries in Latin America report dental trauma inabout 15% of schoolchildren, while prevalence rates of5% to 12% are found in children aged 6 to 12 years in theMiddle East. Furthermore, studies from certain industria-lized countries have revealed that the prevalence of dental


≥ 6.93.3–6.8≤ 3.2

No data available

The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of theworld health organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers


Figure 6 Incidence of oral cavity cancer amongmales (age-standardized rate (ASR) per100000 world population). Petersen PE (2003)

The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century – the approach of the WHO Global

Oral Health Programme. Community Dentistry and Oral Epidemiology 31(Suppl 1): 3–24; WHO (2004) Global Oral Health Data Bank.

Geneva, Switzerland: WHO.

682 Oral Health


traumatic injuries is on the increase, ranging from 16% to40% among 6-year-old children and from 4% to 33%among 12- to 14-year-old children (Andreasen andAndreasen, 2002). A significant proportion of dentaltrauma relates to sports, unsafe playgrounds or schools,road accidents, and violence.

Dental Erosion

Dental erosion is the progressive, irreversible loss ofdental hard tissue which is chemically etched away fromthe tooth surface by extrinsic and/or intrinsic acids. Den-tal erosion appears to be a growing problem in severalcountries, affecting 8% to 13% of adults (ten Cate andImfeld, 1996), and increasing levels are thought to be dueto higher consumption of acidic beverages (i.e., soft drinks,fruit juices). Worldwide, there is a need for more system-atic population-based studies on the prevalence of dentalerosion using a standard index of measurement.

Developmental Disorders

Congenital diseases of the enamel or dentine of teeth,problems related to the number, size, and shape of


teeth, and craniofacial birth defects such as cleft lipand/or palate (CL/P) are most important. The incidenceof CL/P varies tremendously worldwide. Native Ameri-cans in North America show the highest incidence rates at3.74 per 1000 live births, whereas a fairly uniform inci-dence of 1:600 to 1:700 live births are reported amongEuropeans (WHO, 2002). The incidence rates appearhigh among Asians (0.82–4.04 per 1000 live births), inter-mediate in Caucasians (0.9–2.69 per 1000 live births), andlow in Africans (0.18–1.67 per 1000 live births). The causesof CL/P are complex, involving multiple genetic andenvironmental risk factors. Risk factors such as folic aciddeficiency, maternal smoking, and maternal age have par-ticularly been implicated in the formation of clefts (WHO,2002).

Malocclusion is not a disease but rather a set of dentaldeviations that in some cases can influence quality of life.Estimates of different traits of malocclusion are availablefrom a number of countries, primarily in Northern Europeand North America. For example, prevalence rates ofdento-facial anomalies in Northern Europe and NorthAmerica are reported at about 10%, according to theDental Aesthetic Index (Chen et al., 1997). Other con-ditions that may lead to special health-care needsinclude Down syndrome, cerebral palsy, learning and


>_ 6.93.3–6.8<_ 3.2

No data available

The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of theWorld health organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its forntiers


Figure 7 Incidence of oral cavity cancer among females (age-standardized rate (ASR) per 100000 world population). Petersen PE

(2003) TheWorld Oral Health Report 2003: Continuous improvement of oral health in the 21st century – the approach of theWHOGlobal

Oral Health Programme. Community Dentistry and Oral Epidemiology 31(Suppl 1): 3–24; WHO (2004) Global Oral Health Data Bank.

Geneva, Switzerland: WHO.

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developmental disabilities, and genetic and hereditarydisorders with oro-facial defects.

There is no consistent evidence of time trends indevelopment disorders, nor is there consistent variationby socioeconomic status, but these aspects have not beenadequately studied (WHO, 2002). In addition, there aremany parts of the world in which there is little or noinformation available on the frequency of developmentaldisorders, in particular, parts of Africa, Central Asia, LatinAmerica, the Middle East, and Eastern Europe.

Fluorosis of Teeth

Dental fluorosis develops during formation of teeth whenchildren are young. Drinking water with more than1.5 ppm (parts per million) of fluoride can give rise toenamel defects and discoloration of teeth leading toendemic fluorosis in the population. These may differ inintensity from mild to severe. For example, in East Africa,in the Great Rift Valley area, and in some parts of Indiaand north Thailand, the groundwater has very high levelsof fluoride. In such areas, dental fluorosis may be found inthe majority of people (WHO, 1994). Fluorosis of teethcan also occur in individuals in developed countries due


to widespread use of certain forms of fluorides for pre-vention of dental caries, although the degree of fluorosis ismostly very mild when compared with endemic fluorosis.

The Economic Impact of Oral Disease

Traditional treatment of oral disease is extremely costly,the fourth most expensive disease to treat in most indus-trialized countries. In industrialized countries, the burdenof oral disease has been tackled through establishment ofadvanced oral health systems which primarily offer cura-tive services to patients. Most systems are based ondemand for care and oral health care is provided byprivate dental practitioners to patients, with or withoutthird-party payment schemes. Some countries, includingthose of Scandinavia and the United Kingdom, haveorganized public health services, particularly providingoral health care to children and disadvantaged populationgroups. Traditional curative dental care is a significanteconomic burden on many industrialized countries where5% to 10% of public health expenditure relates to oralhealth (U.S. Department of Health, 1998; Widstrom andEaton, 2004). Over the past years, savings in dental expen-ditures have been noted for industrialized countries which


Cases reported before 1980

Cases reported 1981–1993

Cases reported 1994–2000

Sporadic cases recently reported

The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the world health organization concerning the legel status of any country, territory, city or area or of its authorities, or concerning the delmitation of its

frontiers or boundaries. Dotted lines represent approximate border lines for which there may not yet be full agreement

Figure 8 Cases of noma (cancrum oris) reported around the world. Petersen PE (2003) The World Oral Health Report 2003:

Continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Community

Dentistry and Oral Epidemiology 31(Suppl 1): 3–24.

684 Oral Health


have invested in preventive oral care and where positivetrends are observed in terms of reduction in the preva-lence of oral disease.

In most developing countries, investment in oral healthcare is low. In these countries, resources are primarilyallocated to emergency oral care and pain relief; if treat-ment were available, the costs of dental caries in childrenalone would exceed the total health-care budget for chil-dren (Petersen, 2003).

Oral Disease Burdens and Risk Factors

The current global and regional patterns of oral diseaselargely reflect distinct risk profiles across countries, relatedto living conditions, lifestyles, and the implementation ofpreventive oral health systems.The significant role of socio-behavioral and environmental factors in oral disease andhealth is shown in a large number of epidemiologicalsurveys (Chen et al., 1997). Socioepidemiological studies


have been carried out particularly in relation to dentaldiseases; for developed and increasingly for developingcountries these studies observe that the burden of disease,poor quality of life, and the need for care are highestamongst the poor or disadvantaged population groups.The sociobehavioral risk factors in dental caries are foundto play significant roles worldwide for both children andadults (Petersen, 2005). Some countries report tooth loss tobe higher in women than in men as women more often seekdental care (Chen et al., 1997).

A core group of modifiable risk factors is common tomany chronic diseases and injuries. The four most pro-minent noncommunicable diseases – cardiovascular dis-eases, diabetes, cancer, and chronic obstructive pulmonarydiseases – share common risk factors with oral diseases,preventable risk factors that are related to lifestyles. Forexample, dietary habits are significant to the developmentof chronic diseases and influence the development of dentalcaries. Oral cavity bacteria are involved in progression ofdental diseases such as dental caries and periodontal disease.


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Most important, excessive amounts and frequent consump-tion of sugars aremajor causes of dental caries and the risk ofcaries is high if population exposure to fluorides is inappro-priate. In addition, tobacco use has been estimated toaccount for over 90% of cancers in the oral cavity, and isassociated with aggravated periodontal breakdown, poorerstandards of oral hygiene, and thus premature tooth loss(Petersen, 2003). The oral cancer risk increases whentobacco is used in combination with alcohol or areca nut.In Asia, incidence rates of oral cancer are high and relatedirectly to smoking, use of smokeless tobacco, and alcoholconsumption.

The strong correlation between several oral diseases andnoncommunicable chronic diseases is primarily a result ofthe common risk factors. Many general disease conditionsalso have oral manifestations that increase the risk of oraldisease, which, in turn, is a risk factor for a number ofgeneral health conditions. Severe periodontal disease, forexample, is associated with diabetes mellitus and has beenconsidered the sixth complication of diabetes (Petersen andOgawa, 2005).

Conclusion

Given the extent of the problem, oral diseases are majorpublic health problems in all regions of the world. Theirimpact on individuals and communities as a result of painand suffering, impairment of function, and reduced qual-ity of life, is considerable. Globally, the greatest burden oforal diseases is on the disadvantaged and poor populationgroups. The current pattern of oral disease reflects dis-tinct risk profiles across countries related to living condi-tions, lifestyles, and environmental factors, and theimplementation of preventive oral health systems. Globalstrengthening of public health programs through imple-mentation of integrated oral disease prevention measuresand health promotion is urgently needed, and use ofcommon risk factors approaches should incorporate oralhealth within national health programs.

See also: Dental Epidemiology; Dentists; HIV/AIDS; Oral

Cancer.

Citations

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Andreasen JO and Andreasen FM (2002) Dental trauma. In: Pine C (ed.)Community Oral Health, pp. 94–99. London: Elsevier Science.

Chen M, Andersen RM, Barmes DE, Leclerq M-H, and Lyttle SC(1997) Comparing Oral Health Systems:A Second International Collaborative Study. Geneva, Switzerland:WHO.


Coogan M, Greenspan J, and Challacombe SJ (2005) Oral lesions ininfection with human immunodeficiency virus. Bulletin of the WorldHealth Organization 83: 700–706.

Enwonwu CO (1995) Noma: A neglected scourge of children in sub-Saharan Africa. Bulletin of the World Health Organization 73:541–545.

Petersen PE (2003) The World Oral Health Report 2003: Continuousimprovement of oral health in the 21st century – the approach of theWHO Global Oral Health Programme. Community Dentistry and OralEpidemiology 31(Suppl 1): 3–24.

Petersen PE (2005) Sociobehavioural risk factors in dental caries:International perspectives. Community Dentistry and OralEpidemiology 33: 274–279.

Petersen PE, Kjoller M, Christensen LB, and Krustrup U (2004)Changing dentate status of adults, use of dental healthservices, and achievement of national dental health goals inDenmark by the year 2000. Journal of Public Health Dentistry 64:127–135.

Petersen PE and Ogawa H (2005) Strengthening the prevention ofperiodontal disease: The WHO approach. Journal of Periodontology76: 2187–2193.

Stewart BW and Kleihues P (2003) World Cancer Report. Lyon, France:WHO International Agency for Research on Cancer.

ten Cate JM and Imfeld T (1996) Dental erosion, summary. EuropeanJournal of Oral Sciences 104: 241–244.

U.S. Department of Health (1998) National Health Expenditures, 1998.Washington, DC: Health Care Financing Administration.

WHO (1994) Fluorides and oral health. Technical Report Series No. 846.Geneva, Switzerland: WHO.

WHO (1997) Oral Health Surveys: Basic Methods, 4th edn. Geneva,Switzerland: WHO.

WHO (2002) Global Strategies to Reduce the Health Care Burden ofCraniofacial Anomalies. Geneva, Switzerland: WHO.

WHO (2004) Global Oral Health Data Bank. Geneva, Switzerland: WHO.Widstrom E and Eaton KA (2004) Oral health care systems in the

extended European Union. Oral Health and Preventive Dentistry 2:155–194.

Further Reading

Bratthall D, Petersen PE, Stjernsward JR, and Brown J (2006) Oral andcraniofacial diseases and disorders. In: Jamison DT, Breman JG,Measham AR, et al. (eds.) Disease Control Priorities in DevelopingCountries, pp. 723–726. New York: World Bank Health and OxfordUniversity Press.

Cohen L and Gift H (eds.) (1995) Disease Prevention and Oral HealthPromotion: Socio-dental Sciences in Action. Copenhagen,Denmark: Munksgaard.

Harris R and Pine C (eds.) (2007) Community Oral Health, 2nd edn.Berlin, Germany: Quintessence.

Petersen PE and Ueda H (2005) Oral health in ageing societies:Integration of oral health and general health. Report of a MeetingConvened at the WHO Centre for Health Development in Kobe,Japan, 1–3 June. Geneva, Switzerland: WHO.

WHO (2003) Diet, nutrition and the prevention of chronic diseases.Technical Report Series No. 916. Geneva, Switzerland: WHO.

Relevant Websites

http://www.nidr.nih.gov/sgr/sgrohweb/toc.htm – Oral Health inAmerica. A Report of the Surgeon General.

http://www.who.int/oral_health – Oral Health. World HealthOrganization.

http://www.whocollab.od.mah.se – World Health Organization (WHO).


http://www.nidr.nih.gov/sgr/sgrohweb/toc.htm

http://www.who.int/oral_health

http://www.whocollab.od.mah.se

Documents

The Burden of Dental Disease - Malmö Högskola · Table 1 Prevalence of edentulousness (%) of elderly reported for selected countries throughout the world WHO region/country Percent