Rachael England explores why dental hygienists and therapists are vital in improving global oral health and advancing preventative care.
For many years, oral diseases have been neglected in the global public health agenda. Oral diseases can include dental caries, periodontitis, oral cancer, edentulism, tooth surface loss and noma. This has led to the prevalence of oral diseases continuing to increase from 3.5 billion in 2017 to 3.7 billion in 2021.
This burden continues to disproportionately affect people from marginalised and disadvantaged communities. Oral diseases are strongly associated with the social gradient and therefore reflect persistent and widening health inequalities. Not only are oral diseases physically debilitating, but they also have a profound effect on a person’s psychological and emotional wellbeing. This can lead to lower self-esteem, poorer oral-health-related quality of life, and challenges in obtaining employment and maintaining relationships.
Grim picture
Furthermore, there is increasingly robust evidence linking oral disease to systemic diseases. However, while this evidence is valuable, the legitimacy of oral health as a public health priority should not be dependent on these associations. Oral diseases constitute a significant burden independently and deserve inclusion in all health policy frameworks.
Globally, oral diseases are estimated to cost the economy $442 billion annually, including direct costs (eg fillings and extractions) and indirect costs (eg travel and lost income). In the UK, research estimates that 1.2 million work days are lost per year due to oral health issues, costing the economy an estimated £82.86 per person per day.
For the last century, oral diseases have been mostly addressed with the curative model of treating disease, rather than preventing it. As we can see from data, this approach is not working. What the curative model fails to address are the social and commercial determinants of health (SCDoH). The SCDoH are the circumstances in which people grow, live, work and age, which largely determine behaviours and the opportunities available to people. These are further impacted by the influence of powerful corporations and political actors.
Despite this rather grim picture, there has never been a more exciting time to work in oral health.
Oral health attention
In May 2021, the World Health Organization’s (WHO) World Health Assembly adopted a historic resolution that recognised oral health should be firmly embedded within the noncommunicable disease (NCD) agenda (WHA74.5). Additionally, it stated that oral healthcare interventions should be included in universal healthcare coverage (UHC) programmes, bringing oral health to the top of the global public health agenda. UHC refers to a package of essential health services provided to a population without imposing financial hardship on the user.
This momentum continued with the adoption of the global strategy on oral health (WHA75.10) in May 2022. The strategy informed the development of a WHO global strategy and action plan on oral health 2023-2030 (GOHAP), that includes a framework for tracking progress with 11 global targets and 100 actions to be achieved by 2030. Responsibility is spread across WHO member states, the WHO secretariat, international partners, civil society and private sectors.
Following the COVID-19 pandemic, renewed attention has been placed on access to oral healthcare in the UK. Recently, £11 million was allocated for improving access to oral healthcare, alongside the announcement of a nationwide daily school toothbrushing scheme in England to tackle the rising levels of oral disease. Additionally, the expansion of water fluoridation was confirmed for the north east of England, where dental caries in five-year-olds varies between 14% in fluoridated Hartlepool and 34% in neighbouring non-fluoridated Middlesbrough.
With both national and global attention on oral health, this is an opportune time for dental hygienists and therapists (DHTs) to showcase their contribution and advocate for the profession.
‘Progress in oral health won’t happen by accident. It must be planned, led, and delivered together.’
Rachael England
Global strategy and action plan on oral health
The vision of the GOHAP is that 80% of the global population will receive access to essential oral health care, and the prevalence of oral diseases will reduce by 10% across their life course by 2030. These ambitious goals are a mere six years away and the role of DHTs in the GOHAP is crucial.
Objective one – oral health governance
This objective aims to improve political commitment and leadership. It provides national organisations and professional bodies the opportunity to contribute to policy development and provide insights to the needs of both the workforce and the communities they serve. DHTs will be vital in joining and supporting leadership within their health authority to design and implement sustainable oral health improvement programs, and policies involving sugar, tobacco and alcohol consumption.
Objective two – oral health promotion and oral disease prevention
This objective aims to enable all people to achieve the best possible oral health. DHTs are the frontline of prevention and can be found leading community projects and advocating for their needs, ensuring appropriate resource allocation and efficiency while delivering cost-effective prevention strategies.
It is essential that education providers supply up-to-date training on the delivery of preventive and community programs, additionally harnessing the use of AI to optimise reach and effectiveness.
Objective three – health workforce
Objective three focuses on the development of innovative workforce models. DHTs in the UK have an expanded scope of practice and should be supported to utilise their full potential to improve access to care, provide care for hard-to-reach populations and support community programmes. Innovative models could include dental therapy led paediatric clinics in remote and high-needs areas, or mobile clinics staffed entirely by DHTs with remote access to a supporting dentist.
Objective four – oral healthcare
This objective aims to integrate essential oral healthcare into primary healthcare. DHTs have been shown to be highly effective deployed within primary healthcare centres. Meeting patients directly where they seek care for systemic health issues – imagine a patient attending for a hip replacement and being able to access the oral healthcare they need prior to surgery within the same hospital. Or counselling a person newly diagnosed with diabetes on their oral health needs.
Objective five – oral health information systems
Objective five aims to enhance surveillance and health information systems. DHTs are ideally placed to support population wide data collection and provide timely and relevant feedback to decision-makers for evidence-based policymaking. Within dental practices, data can be used to identify emerging trends in community dental public health and even predict the oral health needs of individuals and families. Furthermore, integrated health records can support both oral health and our medical colleagues to provide a joined-up, holistic care plan.
Objective six – oral health research agendas
This objective proposes the creation and continual updating of needs-specific research based on population oral health. DHTs are ideally placed to participate in practice-based research that may involve new preventive or therapeutic treatments. They can advocate for improved research funding and support the development of new clinical guidelines.
All members of the dental team should be represented within research to ensure that outcomes are appropriate, equitable and inform evidence-based policy that supports the entire oral health workforce.
Conclusion
Dental hygienists and therapists are vital in achieving both the Department of Health and Social Care (DHSC) and WHO’s oral health goals through preventive care and policy advocacy. However, further workforce development is essential. This includes significantly increasing the number of training places for DHTs, encouraging applications from individuals in underserved and rural communities, addressing retention issues and the challenges of an aging workforce, and extending ‘golden handshake’ incentives to the entire dental team.
Access to care does not guarantee utilisation. Therefore, with the support of our colleagues, we can increase the public awareness of their entitlement to directly access oral healthcare via DHTs. This entry point should be viewed as a strategic opportunity within health systems to broaden access, streamline pathways and reduce unnecessary barriers to care.
Over the next six years, DHTs should innovate and collaborate with a broad range of stakeholders, including health economists, policymakers, health systems managers and bioethicists to influence oral health policies through their professional organisations at both national and international levels, promoting implementation strategies that align with the DHSC and WHO’s goals. Interdisciplinary collaboration of this kind is essential to drive systems-level change, ensuring that oral health is embedded within broader health and social care agendas.
Progress in oral health won’t happen by accident. It must be planned, led, and delivered together.
NSK Ikigai is a vibrant community of dental hygienists and dental therapists, running courses, webinars and other events throughout the year. For more info visit mynsk.co.uk/ikigai/
The Regeneration Course 27 September 2025: Professor Luigi Nibali and Dr Varkha Rattu will present a lecture and workshop combo, featuring MINST (minimally invasive non-surgical therapy) techniques for hygienists and therapists. Click here to reserve your place!
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