Policy Statement on Oral Diseases as Non communicable Diseases within the NCD Agenda | IADR - International Association of Dental Research

Policy Statement on Oral Diseases as Non communicable Diseases within the NCD Agenda
H. Priya, F. Cieplik, K. Scholz, U. Singh, L. Tenuta, M. Charles-Ayinde, and C. Fox

The World Health Organization (WHO) defines oral health as the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions, such as eating, breathing and speaking, while also encompassing psychosocial dimensions, such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment.1 Oral diseases encompass a range of diseases and conditions that are chronic, slowly progressing and affect people over their entire life course.2 Oral diseases align with the WHO's definition of noncommunicable diseases (NCDs)*, as they are non-infectious diseases of long duration resulting from a combination of environmental, behavioral, physiological, and genetic factors.3 The WHO Global Strategy and Action Plan on Oral Health (2023–2030) emphasizes the critical role of integrating oral health into the broader NCD prevention framework, advocating for universal access to oral healthcare and the inclusion of oral health within primary healthcare systems.4

Epidemiology of NCDs and Oral Diseases

NCDs accounted for 43 million deaths globally in 2021, constituting 75% of all non-pandemic-related deaths.5 Of all deaths resulting from NCDs, 73% occur in low- and middle-income countries (LMICs).5

Oral diseases, including dental caries and periodontal diseases, rank among the most prevalent NCDs globally, affecting an estimated 3.69 billion people— almost half of the world's population.6 Over the past three decades, oral disease cases have surged by over 1 billion – a 50% increase – outpacing global population growth.7,8 This trend is particularly pronounced and concerning in low-income countries (114% increase), LMICs (70% increase), upper-middle-income countries (33% increase), and high-income countries (23% increase), highlighting the urgent need for targeted interventions.8

Commercial, Social, and Behavioral Determinants

NCDs are strongly linked to behavioral and lifestyle factors, which can be examined through the lens of demographic and epidemiological transitions. Like other NCDs, oral diseases are largely behavior-related.9 Current preventive strategies focus on individual level behaviors, however, commercial determinants of health including the marketing, availability, and promotion of products exert a profound influence on individual behaviors and health outcomes. Commercial actors often shape environments that drive the consumption of unhealthy products, thereby fueling the burden of oral diseases and other NCDs.10

Research shows that modifiable risk factors such as excessive sugar consumption, all forms of tobacco use, alcohol consumption, unhealthy diets, and poor oral hygiene and their underlying social and commercial determinants contribute significantly to the burden of oral diseases.11 These same factors are also implicated in the etiology of other systemic NCDs, suggesting shared molecular and immunological pathways.12 The commercial and social determinants of health further exacerbate the incidence and severity of these conditions.13 Addressing these shared modifiable risk factors through integrated health policies, education, and regulatory measures is essential to mitigating their impact.

Associations between Oral Diseases and Other NCDs

Emerging evidence suggests a bidirectional relationship between oral diseases and other prevalent NCDs.14,15 The presence of an oral disease correlates with systemic conditions such as cancers, cardiovascular diseases, chronic respiratory diseases, type II diabetes mellitus, and mental health disorders.15,16 Individuals suffering from major NCDs are at an increased risk of developing oral diseases due to compromised immune responses and medication-related side effects. This interconnection highlights the systemic nature of oral health and its integral role in overall well-being. Further, interventions targeting oral diseases contribute to reducing the overall burden of systemic NCDs by improving inflammatory responses and metabolic health, through health behaviors that promote good health.15 Addressing oral health as part of a broader NCD prevention and treatment strategy is essential for improving public health outcomes on a global scale. The Bangkok Declaration on Oral Health - No Health Without Oral Health reinforces this perspective, calling for global policy action to integrate essential oral healthcare services into universal health coverage and strengthen health systems through an evidence-based, interdisciplinary approach.17

Economic Burden of Oral Diseases

The economic burden of oral diseases is considerable, the global economic burden of oral diseases was estimated at $710 billion in 2019, encompassing $387 billion in direct treatment costs and $323 billion in productivity losses.18 The financial toll and productivity losses surpass that of several other major NCDs, including hypertensive heart disease, asthma, and certain cancers and fall within the range for diseases that account for the top 10 global causes of death.19 This places a disproportionate strain on low- and middle-income countries where healthcare resources are limited.

Policy Statement

Given the well-documented interconnections between oral health and systemic NCDs, the International Association for Dental, Oral and Craniofacial Research (IADR) strongly advocates for the central integration of oral health within the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013–2020) and its successor strategies. To achieve this, IADR recommends prioritization of the following strategies:

1. Strengthening Alliances:
Establishing collaborations with broader NCD advocacy groups to ensure oral health is recognized as a global health priority, aligning with the Bangkok Declaration on Oral Health and WHO Global Oral Health Action Plan.
2. Implementing Cost-Effective Strategies:
Scaling up population-wide, community-based, and person-centered disease management approaches within the healthcare system, focused on prevention and inclusive of oral health and including health coaching and behavioral interventions supported by scientific evidence.
3. Promoting Life-Course Approaches:
Developing oral health interventions that integrate lifestyle guidance, screening, and longitudinal monitoring as adjuncts to primary prevention efforts tailored to fit the different stages of the life course.
4. Enhancing Universal Health Coverage (UHC):
Ensuring UHC programs include a basic package of essential oral healthcare services that goes beyond emergency care at the primary care level, with timely and equitable access to specialized oral healthcare when needed.

By addressing the shared risk factors and biological pathways linking oral diseases with other NCDs, policymakers and health organizations can drive a comprehensive and unified approach to NCD disease prevention and health promotion. *While this policy statement centers on oral diseases as noncommunicable conditions, it is important to recognize that some oral diseases, including certain types of oral cancer linked to infections such as human papillomavirus, involve communicable etiological factors.

*While this policy statement centers on oral diseases as noncommunicable conditions, it is important to recognize that some oral diseases, including certain types of oral cancer linked to infections such as human papillomavirus, involve communicable etiological factors.

1. World Health Organization. (2022). Global Strategy and Action Plan on Oral Health. Retrieved from: https://iris.who.int/bitstream/handle/10665/376623/9789240090538-eng.pdf?sequence=1. Accessed on January 23, 2025.
2. Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, Weyant RJ, Mathur MR, Guarnizo-Herreno CC, Celeste RK, Peres MA, Kearns C, Benzian H.
(2019). Ending the neglect of global oral health: time for radical action. Lancet. 394: 261-272.
3. Parlatescu, I., Dugan, C., Popescu, B. O., Tovaru, S., Dobre, M., & Milanesi, E. (2023). Non-Communicable Diseases and Associated Risk Factors in Burning Mouth Syndrome Patients. Medicina, 59(12), 2085.
4. World Health Organization. (2023). Global Oral Health Action Plan. Retrieved from: https://www.who.int/publications/i/item/9789240090538. Accessed on January 23, 2025.
5. Institute for Health Metrics and Evaluation. (2024). Global Burden of Disease Study (GBD 2021) Cause Specific Mortality 1990-2021. Retrieved from: https://ghdx.healthdata.org/gbd-2021. Accessed on March 19, 2025.
6. Bernabe, Eduardo et al. (2025) Trends in the global, regional, and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 405 (10482): 897 – 910.
7. United Nations Department of Economic and Social Affairs Population Division. (2024). World Population Prospects 2024. Available at: https://population.un.org/wpp/. Accessed on March 20, 2025.
8. World Health Organization. (2022b). Global Oral Health Status Report: Towards universal health coverage for oral health by 2030. Retrieved from: https://www.who.int/publications/i/item/9789240061484. Accessed on March 8, 2025.
9. Murtomaa H, Varenne B, Phantumvanit P, Chikte U, Khoshnevisan MH, Fatemi NM, Hessari H, Khami MR. (2022). Neglected epidemics: The role of oral public health to advance global health. J Glob Health. 12:02001.
10. Neri, E., Thompson, C., Heyes, C., Bostock, N., & Wills, W. (2025). A Commercial Determinants of Health Perspective on the Food Environments of Public Hospitals for Children and Young People in High-Income Countries: We Need to Re-Prioritize Health. International Journal of Environmental Research and Public Health, 22(4), 601.
11. Benzian H, Garg R, Monse B, et al. (2017). Promoting Oral Health through Programs in Middle Childhood and Adolescence. Silva Nd, Horton S, et al., editors. Child and Adolescent Health and Development. 3rd edition. Washington (DC): Chapter 16. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525256/. Accessed on March 20, 2025.
12. Dörfer C, Benz C, Aida J, Campard G. (2017). The relationship of oral health with general health and NCDs: A brief review. Int Dent J. 67(Suppl. 2):14–8.
13. Non-Communicable Disease (NCD) Countdown 2030 Collaborators. (2018). NCD Countdown 2030: Worldwide trends in non-communicable disease mortality and progress towards sustainable development goal target 3.4. Lancet. 392:1072–88.
14. Benzian H, Daar A, Naidoo S. (2023). Redefining the non-communicable disease framework to a 6 × 6 approach: incorporating oral diseases and sugars. The Lancet Public Health. 8(11): e899 - e904.
15. Botelho J, Mascarenhas P, Viana J, Proença L, Orlandi M, Leira Y, Chambrone L, Mendes JJ, Machado V. (2022). An umbrella review of the evidence linking oral health and systemic noncommunicable diseases. Nat Commun. 13(1):7614.
16. Seitz MW, Listl S, Bartols A, Schubert I, Blaschke K, Haux C, Van Der Zande MM. (2019). Current Knowledge on Correlations Between Highly Prevalent Dental Conditions and Chronic Diseases: An Umbrella Review. Prev Chronic Dis. 16:E132.
17. World Health Organization. (2025). Bangkok Declaration – No Health Without Oral Health: Towards Universal Health Coverage for Oral Health by 2030. Retreived from: https://www.who.int/publications/m/item/bangkok-declaration---no-health-without-oral-health. Accessed on March 17, 2025.
18. Jevdjevic M, Listl S. (2025). Global, Regional, and Country-Level Economic Impacts of Oral Conditions in 2019. Journal of Dental Research. 104(1):17-21.
19. World Economic Forum. (2024). The Economic Rationale for a Global Commitment to Invest in Oral Health. Retrieved from: https://www3.weforum.org/docs/WEF_The_Economic_Rationale_for_a_Global_Commitment_to_Invest_in_Oral_Health_2024.pdf. Accessed on March 15, 2025.
Commented [MC1]: The primary paper for this is unpublished - Listl, S., Atun, R., Tsakos, G., and Vujicic, M. (2024). Economic losses from oral diseases and the top ten global causes of death: Authors’ analysis of WHO data on DALYs by health conditions and IMF data on GDP. Therefore, I’ve used this white paper as the reference here.

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