Children’s right to oral health
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj-2024-082022 (Published 24 September 2024) Cite this as: BMJ 2024;386:e082022
- Dominique Mollet, PhD candidate1 2,
- Greig Taylor, NIHR clinical lecturer in paediatric dentistry3,
- Brigit Toebes, professor of health law in a global context2
- 1European Commission Joint Research Centre, Ispra, Italy
- 2Faculty of Law, University of Groningen, Netherlands
- 3School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Correspondence to: D Mollet s.d.mollet{at}rug.nl
Oral diseases are a leading contributor to the overall burden of non-communicable diseases, reflecting a global crisis in oral health. Around two billion adults and children have untreated carious lesions in their permanent teeth, while 514 million children have untreated carious lesions in their primary teeth.1 Dental caries is largely preventable,2 and although population level (upstream) policies can help reduce prevalence, an inappropriate focus on individual oral care remains.34 This individualised approach overburdens health systems, as exemplified by the oral health crisis in the UK.5
Dental professionals have called for reform of the oral health system with a clear emphasis on preventive, population level policies.3567 The right to oral health, particularly every child’s right to oral health, creates an imperative for policy makers to design and implement such policies.
The World Health Organization’s (WHO) global strategy and action plan on oral health 2023-2030 recognises that “[a]chieving the highest attainable standard of oral health is a fundamental right of every human being.”8 The vision of this strategy centres on universal coverage for oral health for all by 2030—meaning “that all individuals and communities have access to essential, quality health services that respond to their needs and that they can use without suffering financial hardship.”8 Additionally, the WHO strategy recognises the need for “upstream interventions… to strengthen the prevention of oral diseases and reduce oral health inequalities.”8
Upstream policies are particularly important in preventing the most common oral disease, dental caries, as it is driven primarily by sugar consumption and the associated commercial and social determinants.2 A clear focus on children is also critical,9 as childhood caries has serious consequences for oral health in later life, largely because of the persistence of childhood sociobehavioural factors such as dietary patterns.1011 This requires a broader approach to children’s oral health based on children’s rights stipulated in the UN Convention on the Rights of the Child, which is legally binding on virtually all states.912
Rights based approach
The right to health1213—which includes oral health—is defined broadly by the UN and others, and requires comprehensive population level measures.141516 It goes beyond universal health coverage and includes “facilities, goods, services and conditions necessary for the realization of the highest attainable standard of health.”16 It additionally covers “a right [for children] to grow and develop to their full potential and live in conditions that enable them to attain the highest standard of health through the implementation of programmes that address the underlying determinants of health.”14
An approach to oral health based on children’s rights tackles the root causes of oral disease with preventive policies such as those targeting the availability and accessibility of dietary sugars and oral hygiene.15 It also emphasises a life course approach, including the importance of (preventive) measures targeting children,14 given the intergenerational and intragenerational effects of poor oral health in childhood.1011 Finally, in response to the universal social gradient in oral diseases, with disadvantaged groups being affected disproportionately,6 a focus on child rights offers a framework to inform the development and implementation of more equitable policies.14
WHO’s recognition of the right to oral health is a welcome first step towards better oral health for all children globally. But a rights based approach to implementing the WHO strategy in national settings9 would provide important additional benefits for all relevant actors—including policy makers, clinicians, and patients—and should be prioritised. A rights based framework would help target limited health budgets more efficiently, as studies suggest that preventive population level policies are associated with substantial cost savings for health systems, including the NHS.17 It would also benefit clinicians by reducing the treatment burden on overstretched healthcare services such as emergency departments.1718
Policies that uphold every child’s right to oral health benefit patients directly but also have a broader societal impact. Children’s oral health can be a “canary in the coalmine,”6 since poor oral health is a precursor for other systemic non-communicable diseases such as diabetes and cardiovascular disease,4 given their shared risk factors and intergenerational effects1011 Better oral health is associated with better general health during childhood and in later life. Moreover, as poor oral health in childhood is associated with missed school days and poorer educational outcomes,219 effective policy making in this area can help reduce educational inequality.
Finally, a rights based approach to reform of oral health systems would contribute to the fulfilment of other related rights such as the rights to (general) health, education, and rights related to children’s development and wellbeing throughout the lifespan. This approach should underpin all national and international efforts to improve the oral health of children.
Acknowledgments
We thank David Manton, David Patterson, and Regien Biesma for their support and comments.
Footnotes
Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare no other interests. Further details of The BMJ policy on financial interests are here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf
Provenance and peer review: Not commissioned; externally peer reviewed.
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