Global Oral Health
Global Oral Health at King’s Global Health Institute is led by the Population & Patient Health Division in the Dental Institute, drawing from the clinical and public health community as well as the wider disciplines of sociology and psychology. The Innovation & Translation Centre focuses on delivering impact through transforming evidence into policy and practice, and this has led to cross-institutional collaborations with the Centre for Global Health and Health Partnerships and the Policy Institute at King’s.
Work on Global Oral Health includes contributions to the Global Burden of Disease study, work on the global dental-workforce (human resources for oral health), focused research on the provision of dental care in Brazil and China, and needs-led research into the oral public health system in Sierra Leone aiming to build a sustainable future dental workforce.
This work has indicated the need for a primary focus on prevention of oral diseases, which should include population-level interventions to address the social determinants of oral health in childhood and across the life course. This, together with targeted treatments may be the best way to reduce the current high prevalence and burden of oral diseases in later life, avoiding the otherwise high costs of treating the large number of adults with unmet needs for dental care
Global Burden of Oral Disease
KCL researchers contributed to a report from the Global Burden of Disease Study 2015 identifying a high prevalence of oral disease worldwide, posing a significant public health challenge for policymakers. While death as a result of oral disease is unusual, nearly half of the world population suffers disability from oral conditions. Untreated caries in permanent teeth affected 2.5 billion people worldwide (34% of the population), 573 million children had untreated caries in deciduous teeth, and 538 million (mainly older) people had total tooth loss. Total tooth loss accounted for a loss of 7.6 million disability adjusted life years (DALYs), and severe chronic periodontitis and untreated caries 5.2 million DALYs. Given global patterns of population ageing, the number of people with untreated oral conditions rose from 2.5 billion in 1990 to 3.5 billion in 2015, with a 64% increase in DALYs. The societal cost of oral conditions may already exceed US$442 billion.
Global Dental Workforce
King’s research on the Global Dental Workforce has identified a striking maldistribution of human resources for oral health (HROH), leading to marked inequalities in access to dental care. Most of the world's 1.6 million dentists are based in Europe and the Americas, and 69% of the world's dentists serve 27% of the global population. Africa has only 1% of the global workforce. Dental-workforce ratios range from one dentist per 1,440 population in the Americas to 1/ 2,013 in Europe, 1/15,138 in SE Asia and 1/41,943 in Africa. Data sources on HROH were weak, and workforce expansion and migration may result in rapid changes in dentist numbers that may not have been captured.
Analyses of the third National Oral Health Survey of China, conducted in collaboration with Peking University, highlighted the gap between dental workforce needs and workforce capacity in China. The survey indicated that a minimum of 40,000 dental professionals would be required to deliver basic preventive care and treatment to 12-year olds alone. Extrapolating to the needs of the entire population would require a minimum of 3 million dental professionals. The current HROH (50,000 dentists) are only able to serve an estimated 5% of the population with minimum intervention. Most of the need for HROH (73%) was in the rural population.
Research into dental workforce development has also been conducted in collaboration with partners in Oman and Brunei Darrusalam
Policy research, implementation and capacity-building programs
The Global Collaboratory for Caries Management is a project between the Dental and Policy Institutes at King’s which launched in 2013 and will run for a minimum of five years. Led by Professor Nigel Pitts, it is a global oral health initiative intended to drive policy, health systems and dental practice towards a more modern, preventive approach to caries care and improved health outcomes. Its focus is on the implementation into both policy and clinical practice of two recent international systems: for caries detection and assessment – ICDAS (International Caries Detection and Assessment System) and for clinical management – ICCMS™ (International Caries Classification and Management System). Designed to be a ‘centre without walls’ the Global Collaboratory for Caries Management encourages its collaborators to interact regardless of physical location, using IT resources and communication technologies to support ICCMS™ implementation and channel research findings into policy, practice, and education
King’s Sierra Leone Partnership Dentistry Project is working with the government and health professionals, helping to overcome the challenges in oral public health that Sierra Leone faces. In 2014, Sierra Leone had nine dentists for the country’s population of 6 million people. Led by Profs Jenny Gallagher and Stephen Challacombe, with Dr Patric don Davis a leading dentist in Sierra Leone, the project aims to develop needs-led human resource planning for oral health in low income countries using Sierra Leone as a case study.
Qualitative interviews were conducted in Feb-March 2016 exploring the views of key players (dentists, other health workers and government officials) in Sierra Leone on the oral health needs of the population, how these could be met, and the implications for building a sustainable future dental workforce. The first step will be training for mid-level providers to build workforce capacity, moving towards national coverage of basic preventive and treatment services, including underserved areas. A need was also identified for an epidemiological survey of children and adults within all four regions of Sierra Leone to explore their oral health needs, using established global and UK national survey methodologies. As a first step, a preliminary survey has been conducted of school age children. A total of 1650 children were contacted from 22 randomly selected schools (both primary and secondary) spread across urban, semi-urban and rural settings in every region of Sierra Leone.
The Senior Dental Leadership Programmewas launched in 2007 by Prof Raman Bedi, to develop the strategic leadership skills of the world's senior dental professionals. The global dental community already has the clinical knowledge and skills to prevent dental disease, but lacks leaders who can implement the strategies that will put the resources, knowledge and skills to work. The SDL programme is supported by the Global Child Dental Fund, Harvard University, and King’s College London, with industry partners. It has held ten annual conferences in London and the USA designed to create these leaders, with attendees from countries including China, India, Malaysia, Solomon Islands, Malawi, Tanzania, Zambia, South Africa, Saudi Arabia, Mexico and Brazil. During five days of training, delegates develop their leadership skills and learn to use them effectively to advance oral health agendas and improve the dental health of children. To extend the reach of the initiative an online programme, in Advanced Dental Leadership has recently been launched.