Prevention Over Treatment in Dentistry

The State of Oral Health Worldwide

Dental disease is certainly a global problem. According to the most recent Global Burden of Disease study (2021), untreated tooth decay in permanent teeth is the most common health condition worldwide.¹ The World Health Organization (WHO) estimates that oral diseases affect nearly 3.7 billion people worldwide.²

The prevalence of oral disease is increasing worldwide and is exacerbated by insufficient resources and services for the prevention and treatment of oral disease in most low- and middle-income countries.²

Studies show that more than 1 in 5 adults in the U.S. have untreated caries.³ Perhaps most alarmingly, the WHO has announced that the European Region has the highest prevalence of major oral disease worldwide, with 50.1% of the adult population affected.⁴

The Cost of Poor Dental Health

The global economic burden of oral disease is enormous, amounting to about $710 billion USD in 2019, including $387 billion in direct treatment costs, and $323 billion in indirect costs (lost productivity in lost workdays or school days, and reduced productivity at work or school).⁵

The personal costs are significant. Worldwide, most dental care costs are out of pocket and not usually covered by national health care benefits.² Three dental diseases—cavities, severe gum disease, and severe tooth loss—are the oral health problems that most significantly impact overall health and quality of life.^2,6

The interaction between oral disease and systemic disease is becoming increasingly evident in the research literature.⁷ In particular, there are strong reciprocal associations between non-communicable diseases and oral conditions, and these conditions account for more than 85% of total global healthcare costs.⁷

^{Figure. Common oral conditions and closely associated chronic diseases.} 

^{Course: Fu et al., 2025.7} 

Prevention Strategies That Are Impactful

Changing the dental care paradigm from a focus on treating disease to prevention has been widely recommended by international sources, such as the WHO, and international forums.^8,9

Primary Prevention Measures

• Good oral hygiene
• Public education about oral health
• Exposure to fluoride (through fluoridated toothpaste, fluoride varnish and fluoridation of water)
• Reduction of dietary free sugars
• Alteration of the oral microflora
• Fissure sealants
• Addressing causes of xerostomia
• Chemical measures to disrupt and reduce the biofilm, principally through the use of additives to toothpastes and mouthrinses
• Tobacco use cessation
• Interdental cleaning aids (such as floss, interdental brushes, or rubber piks)

The European Federation of Periodontology (EFP) has published guidelines for the prevention of tooth decay and gum disease, which provide an excellent basis for public education and preventive oral health programs.¹²

Cost Savings From Prevention

Most oral disease is preventable, so prevention is widely considered to be the linchpin for reducing the global burden of oral disease and the associated costs.^2,8,9

For example, the CDC estimates the following cost savings of water fluoridation:¹³

• One year of water fluoridation in the U.S. saves $6.5 billion in direct and indirect dental treatment costs
• Communities that provide fluoridated water save an average of $32 per person per year in cavity treatment costs
• Communities of 1,000 or more people see an average return on investment of $20 for every $1 spent on water fluoridation

Barriers to Preventive Dental Care

• Scarce dental service resources
• Remuneration of dental professionals does not incentivize prevention
• Poor access to dental services in high-risk populations, including affordability

Dental Professionals’ Role in Prevention

Many of these interventions are issues of public health and individual self-care practices. Nevertheless, dental professionals can play a role in both. Dental professionals support the health of their communities by being advocates for oral health in their communities, including encouraging local stakeholders to address such issues as water fluoridation, public education about oral health, and provision of oral care supplies to socioeconomically disadvantaged persons.

While working on patients’ teeth, dental professionals have a captive audience, and it is a perfect opportunity for patient education.

Given the increasingly apparent relationship between oral health and systemic health, and vice versa, medical–dental integration for prevention programs benefits patients and saves money. Dental health professionals should be open to increased cooperative care with medical professionals.¹⁴

References

^{1. Global Burden of Disease 2021. Institute for Health Metrics and Evaluation. 2024. Link}

^{2. Oral health. World Health Organization website. Published March 17, 2025. Accessed August 27, 2025. Link}

^{3. Fellows JL, Atchison KA, Chaffin J, et al. Oral health in America: Implications for dental practice. J Am Dent Assoc. 2022;153(7):601-609. doi:10.1016/j.adaj.2022.04.002}

^{4. WHO/Europe calls for urgent action on oral disease as highest rates globally are recorded in European Region. Published April 20, 2023. Accessed August 27, 2025. Link}

^{5. Jain N, Dutt U, Radenkov I, et al. WHO's global oral health status report 2022: Actions, discussion and implementation. Oral Dis. 2023;30(2):73-79. doi.org/10.1111/odi.14516}

^{6. Oral health facts. Centers for Disease Control and Prevention (CDC) website. Published May 15, 2024. Accessed August 4, 2025. Link}

^{7. Fu D, Shu X, Zhou G, et al. Connection between oral health and chronic diseases. MedComm. 2025;6(1):e70052. doi:10.1002/mco2.70052}

^{8. Hayashi M, Haapasalo M, Imazato S, et al. Dentistry in the 21st century: Challenges of a globalising world. Int Dent J. 2014;64(6):333-342. doi:10.1111/idj.12132}

^{9. World Health Organization (WHO). Global oral health status report. 2022. Link}

^{10. Vernazza CR, Birch S, Pitts NB. Reorienting oral health services to prevention: Economic perspectives. J Dent Res. 2021;100(6):576-582. doi:10.1177/0022034520986794}

^{11. Mark AM. Preventing tooth loss. JADA. 2020;151(9):712. doi:10.1016/j.adaj.2020.06.021}

^{12. Recommendations for the public. European Federation of Periodontology website. N.D. Accessed August 27, 2025. Link}

^{13. Facts about return on investment of oral health interventions. Centers for Disease Control and Prevention (CDC) website. Published May 15, 2024. Accessed August 4, 2025. Link}

^{14. Vernazza CR, Birch S, Pitts NB. Reorienting oral health services to prevention: Economic perspectives. J Dent Res. 2021;100(6):576-582. doi:10.1177/0022034520986794}