Developing leadership in dentists and schoolteachers to improve oral health inequalities

Introduction

Within this decade, we must prioritise reducing dental inequalities to end the spiralling problems associated with poor oral health. This problem is on a global health scale. With over half the world’s population suffering from oral disease (1), there is an urgent need for better oral health literacy across all populations. The emerging generation of young dental professionals are highly skilled, communicative and capable of driving forward new initiatives that will improve world oral health, but what they need are the skills to lead the way forward. Dental leadership training is needed to equip not only these professionals but also schoolteachers to become first-class leaders and advocates for oral health. Only through robust and cross-sectoral dental leadership occurring in parallel can we finally eliminate oral health inequalities worldwide.

Oral diseases: the need for integration

Oral diseases are a neglected pandemic affecting people of all ages in every country throughout the world (2). Vulnerable populations and high-risk groups such as children, the elderly, those who are medically compromised and those with lower incomes and education levels may have greater difficulty in accessing oral health services. They will also be more likely to suffer from oral infections (3). This is a costly public health issue: globally it has been estimated that direct treatment costs owing to oral disease are US$298 billion per year (4).

The mouth and the body cannot continue to be compartmentalised. We desperately need new population-based approaches making the maximum use of limited existing resources. In some regions dental professionals are scarce and cannot singlehandedly promote oral health without the help of allied health professionals. On an upstream level, dental public health capacity must be increased worldwide so that oral health can become an integrated part of public health, particularly within Universal Health Coverage programmes to ensure accessible care to all. There is an acknowledged lack of oral health leadership and integration in lesser developed parts of the world (5); however, it is surprising to note that even a developed country such as France does not have a Chief Dental Officer nor an active dental public health system (6).

Within the next few decades, 80% of the ageing world population will reside in developing countries where there is limited access to healthcare, let alone oral healthcare (7). Here we need to train sufficient dental workforces to avoid unsustainable overseas reliance. Community-based initiatives with an integrated focus will become essential in promoting healthy lifestyles. Radical action is needed to highlight the fact that oral health shares the main risk factors of other non-communicable diseases and thus needs a more prominent place on the global health agenda (8). However, despite all of this, the authors argue that oral health inequalities will never be fully eradicated without a more widespread approach, that is, through dental leadership.

Leadership training for dental professionals

The global cadre of dental health professionals has been, up until now, an unharnessed force for positive change. Dentists are extremely well placed to deliver positive and engaging oral health messages to their local communities. It has already been documented how effective senior dental leadership programmes can transform oral health on a national level (9); however, unlike other professions, leadership in dentistry is not a skill that has historically been emphasised at a grassroots level. Without leadership skills, how can we hope to drive forward change and diminish inequalities?

Traditionally, dental schools have not prepared dentists of tomorrow to be agents of change. Dental public health faculties within dental schools must start to better shape the training and thinking of young dentists as they enter the profession. Leadership must underpin the heart of dental curricula so that dentists may become leaders of oral health in the wider community. Dentists need to become more involved in wider public health agendas so they can advocate and collaborate with their public health colleagues.

Dental advocacy and the drive to improve oral health literacy must target every community in the world to reach the people who need it the most. Dental leaders must have the communication skills to clearly and simply advocate how to improve oral health at grassroots level. However, health professionals cannot be solely relied upon to rally the message that oral health is a part of general health. If we can educate and empower care-givers about oral health from the very first day of their child’s life, we can hope to end the spiral of oral disease repeating through generations.

School teachers eliminating dental inequalities

Poor child oral health worldwide combined with insufficient oral health knowledge and limited access to dental care means that, more than ever, schoolteachers must possess basic oral health knowledge and advocacy skills to lead their local communities to better health. Schoolteachers are at the forefront of the battle to implement good oral health behaviours and minimise inequalities from a very young age. They have a multifaceted role in the community as educators, caregivers, leaders and role models. Since over 1 billion children spend a significant proportion of childhood in schools, they are a vital platform in fostering oral health education (10).

Educating schoolteachers and school nurses in basic oral health and leadership is vital to implementing healthy behaviours early on in a child’s life. The authors believe that all schoolteachers must, at the very minimum, understand the fundamentals of oral health. That is, toothbrushing, diet, fluoride, the importance of regular dental examinations and what to do in trauma cases. This is the first pillar of dental leadership in schools. Oral health inequalities can also be greatly minimised in children if daily toothbrushing and prevention becomes an integral part of the school day. This should be an initiative led and owned by schools. In Mexico City, for example, daily supervised toothbrushing in schools has been mandatory since 2016 (11).

A second pillar of dental leadership is knowing how to effectively communicate knowledge to children and parents. Learning persuasion and influence skills is crucial in providing a positive and constructive influence on young children during key developmental and habit-forming stages. The dental profession must seek to focus on educating schoolteachers in parallel to dental professionals about oral health leadership. Some dental leadership programmes for dentists and schoolteachers have been developed to date (12); however, the authors call for greater attention and action towards recognising the potential of both groups working together to overcome oral health inequalities.

Conclusion

There is a gulf between dental professionals and the populations most needing access to dentistry. We need to bridge the gap between our vast knowledge and resources as a profession and the global population. Through dental leadership involving both health professionals and school teachers, we can improve the oral health knowledge level of the world, eliminate inequalities and sustainably prevent the suffering that accompanies poor oral health.