Tooth decay is the most common health condition worldwide according to the Global Burden of Disease 2019 yet oral health is frequently overlooked as an indicator of overall wellbeing. Moreover, oral diseases, such as dental caries and periodontitis, share several risk factors with non-communicable diseases (NCDs), including sugar consumption, tobacco use, and alcohol use. In 2021 the World Health Assembly passed a resolution urging Member States to address the key risk factors oral diseases share with NCDs. The resolution mandates WHO to enhance the capacities of oral health professionals and recommends a shift away from traditional ‘curative’ approaches, towards prevention in family, school, and workplace settings, as well as primary health care.    

The WHO 2022 Global oral health status report, identifies the scale of the problem, and the need for urgent action and suggests innovative solutions and recommendations such as: 

• Integrating oral healthcare with primary care, including prevention and oral health promotion.

• Optimising an individual’s capability to perform effective self-care. 
• Embedding oral health in the NCD agenda and ensuring essential oral healthcare interventions are included in UHC benefit packages.

Key facts  

• Untreated oral diseases affect almost half of the world’s population. 
• The estimated number of cases of oral diseases globally is approximately 1 billion more than the combined cases of all five main NCDs (mental disorders, cardiovascular disease, diabetes mellitus, chronic respiratory diseases and cancers).  
• Most oral diseases are preventable but unhealthy diets, tobacco use, lack of self-care and lack of access to oral healthcare products and oral healthcare professionals – all greatly increase the risk of their development, particularly in lower-and upper-middle income countries.
• Oral health is a contributor to overall health, and there is strong evidence of a bi-directional relationship between oral health and diabetes. 
• Preventive oral health should start before conception and during pregnancy with childbearing women taking care of their own teeth. Many studies show that oral health status in childhood can determine the future state of adult health. 
• Oral health is also associated with mental health because activities in social settings that involve human interactions i.e., facial expressions, smiling, and speaking can all indicate the status of an individual’s oral health. 

Why does C3 care about oral health and how are we addressing it?  

The intersection of oral disease and NCDs make addressing oral health a priority for C3 to help people understand the importance of healthy teeth and gums – and live healthier, longer lives.    

Nurses and midwives are in a unique position to raise awareness about the importance of oral health and provide oral health education to individuals, families and communities. Implementing preventive measures early will alleviate individual pain, discomfort and disfigurement and reduce the economic burden of oral diseases on individuals and on global health systems. C3’s oral health programme features several projects – all involve engaging with the nursing and midwifery workforce on a national and/or global scale to reduce the burden of oral disease.   

Nurses Addressing Oral Health   

Currently, there are only 1.6 million dentists worldwide – with most of them heavily focused in Europe and North America. There is however, a much higher number of primary healthcare workers (including nurses and midwives) – around 27 million worldwide!   

Recognizing this unique opportunity, in 2021, C3 embarked upon a partnership with Colgate-Palmolive to increase oral health awareness within the global nursing workforce by convening a global group of nurse leaders and experts to discuss the issue of oral health, disease prevention, and the role of nurses. C3 is delighted to have worked with: Guyana-born Professor Cynthia Pine CBE, the first woman to be Dean of a British Dental School; Stephen Ogweno, a nurse and population health expert, living in Kenya, who has worked with WHO and the World Dental Federation; and Dr Habib Benzia, International Public Health expert with focus on oral health, NCDs, and health policy, and co-editor of WHO’s first ever Global Oral Health Status Report. The steering group remains active, and members have shared real-life examples of oral health disease prevention (or lack of it!) between countries and continents, ideas for policy and practice, and have identified opportunities for future growth in this area.  

As part of this work, in 2021, C3 was part of a symposium presentation on nurses addressing oral health at ICN Congress (the most prestigious global event in the nursing calendar). C3 is thrilled to be part of ICN 2023 in Montreal, Canada during which we will support a symposium presentation, engage and survey nurses’ knowledge on oral health, and facilitate a meeting of North American nurse leaders on the next steps to take in elevating the role of nurses globally in addressing oral health.      

Oral Health in Africa  

In 2022, Colgate partnered with C3 Collaborating for Health (C3), the Commonwealth Nurses and Midwives Federation (CNMF), and the World Continuing Education Alliance (WCEA) to raise awareness about the importance of oral health for nurses and midwives and elevate the need for oral health education in practice. The initiative is part of Colgate’s Bright Smiles, Bright Futures Programme. The transition to an increased focus on oral health promotion and disease prevention will have three major areas: enhancing oral health education in initial nursing and midwifery education; providing an online CPD module on oral health; and the inclusion of oral health into client or patient assessment forms and care plans. So far, a training programme has been created and delivered to nurses and midwives in Kenya, South Africa and Tanzania. Survey results pre-and post-participating in training have been overwhelmingly positive and reveal a real need to extend the reach of the work to nursing and midwifery workforces in Further work is now underway to train parents and target nurses and midwives in those countries, as well as to extend the programme to nurses in Botswana, Malawi, Rwanda, Ghana, Uganda, and Zambia. Click here to learn more.  

The partners, Colgate, C3, CNMF and WCEA are excited to have this opportunity and are confident the project will bring about lasting and sustainable change which can be replicated in other countries.    

Colgate-Palmolive is a caring, innovating growth company that is reimagining a healthier future for all. Since 1991, the Colgate Bright Smiles, Bright Futures® Program has reached more than 1.4 billion school children in over 80 countries to teach them about oral health care.    

Diabetes and Oral Health   

In response to the global oral health project outputs, C3 has partnered with Learn with Nurses (an award-winning community interest company that offers training to nurses) and the Commonwealth Nurses and Midwives Federation (CNMF), to reduce the burden of type 2 diabetes (T2DM) through engaging with UK-nurses to raise their knowledge and awareness of the issue of oral health, and specifically on the bi-directional relationship between oral health and diabetes. A training programme is currently under development to engage and train a cohort of UK-based nurses on the bi-directional relationship between T2DM and oral health; and explore the barriers and facilitators to nurses addressing T2DM and oral health. An output of this work will be a series of nurse-owned recommendations for T2DM prevention and improving oral health, which will be presented to key UK policy makers, nurse leaders and nurse training institutions, to create a high-level dialogue. This project has been funded by Burdett Trust for Nurses.   

Oral Health talks and webinars   

Raising awareness around the prevention of oral disease and NCDs is integral to addressing this growing epidemic. C3 has given various talks and seminars on oral health and our work with healthcare professionals globally.  

This year, C3’s director Christine Hancock spoke at the WHO and Health Education England seminar ‘Working for Health 2030’ drawing attention to the important work we are doing in oral disease and NCD prevention.   

 In 2022, as part of C3’s series of international seminars Stephen Ogweno – who is part of our Nurses Addressing Oral Health project – discussed the reality of oral health and opportunities for improvement. You can watch this seminar and others on demand!