Oral Health


    Oral diseases encompass a range of diseases and conditions, notably dental caries, periodontal (gum) disease, oral cancer, orofacial trauma, oral manifestations of HIV infection, birth defects, and noma in the WHO African Region. While largely preventable, oral diseases are the most common diseases globally and regionally, affecting an estimated 480 million people (43.7%) in the WHO African Region in 2019.

    Oral diseases disproportionately affect the most vulnerable and disadvantaged populations. People of low socioeconomic status carry a higher burden of oral diseases and this association remains across the life course, from early childhood to older age, regardless of countries' overall income level.

    Access to oral health services is uneven within and among countries. The availability of oral health services is not aligned with the needs of the population. Those with the greatest need often have the least access to services.

    Causes and symptoms

    Most oral diseases and conditions share modifiable risk factors with the leading noncommunicable diseases (diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders). These risk factors include tobacco use, alcohol consumption and unhealthy diets high in free sugars. There is a proven relationship between oral and general health. It is reported, for example, that diabetes is linked with the development and progression of periodontitis. Moreover, there is a causal link between high consumption of sugars and diabetes, obesity and dental caries.

    Like overall health, the social and commercial determinants of health influence oral health outcomes. The social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. The commercial determinants of health comprise the private sector activities that affect people’s health positively or negatively.

    When oral health is compromised by disease or injury, general health is also affected. The pain and discomfort associated with oral diseases make concentrating difficult, cause people to miss school or work, and can lead to social isolation. Oral diseases impose a severe social and economic burden on individuals and families by increasing household expenditures and seriously affecting people’s quality of life and well-being.

    WHO Response

    The WHO Regional Office for Africa has led the promotion of oral health as well as the prevention and control of oral diseases in the WHO African Region by providing strategic direction, such as developing the regional oral health strategy 2016–2025. In line with the global strategy on oral health and its action plan, such strategic direction is meant to guide Member States in developing national plans to promote oral health, reduce health inequalities, and strengthen efforts to address oral diseases and conditions as part of noncommunicable disease (NCD) prevention and control toward universal health coverage (UHC) for oral health for all by 2030.

    To advance the implementation of these ambitious strategies, in collaboration with partners, the WHO Regional Office for Africa supports Member States by:

    • advocating for increased political and financial commitment at the highest levels to address oral health as part of NCDs, primary health care (PHC), and UHC
    • providing holistic guidance, tools, and standards to Member States in their efforts to develop and implement national oral health policy documents for the prevention and control of oral diseases as part of NCDs, PHC, and UHC
    • supporting the inclusion of oral health services in essential health packages as part of the UHC benefit package and including oral health medicines/consumables in the essential medicines list
    • mobilizing resources to support countries in developing and implementing national oral health policy documents
    • developing a priority oral health research agenda and supporting operational research to generate evidence on the cost-effectiveness and feasibility of population-wide measures and their public health impact
    • supporting the development and implementation of an efficient oral health workforce model within the overall national workforce strategy
    • building the capacity of oral health focal points in ministries of health and other professionals to accelerate the oral health agenda at the country level
    • monitoring disease burden, risk factors, health service use, and other health trends related to oral health.

    Regional Noma Control Programme

    Hilfsaktion Noma e.V.
    Credits: Hilfsaktion Noma e.V.

    Noma, a necrotizing noncommunicable disease starting in the mouth, is estimated to be fatal for 90% of affected children in poor communities, mostly in Africa, but it has also been reported in other regions such as South-East Asia.

    In the absence of reliable epidemiological data, the WHO noma estimates from 1998 remain the most widely cited, with prevalence of 770 000 cases and incidence of 140 000 new cases every year. Without health care management, mortality was estimated at 70–90%.

    The WHO Regional Office for Africa established the Regional Noma Control Programme in 2001. As part of the programme, the WHO Regional Office for Africa has supported 11 noma-priority countries to develop, implement and monitor national noma control activities, which have been financially supported since 2013 by the German NGO, Hilfsaktion Noma e.V. These national programmes focus on strengthening and developing the capacities of health workers, social actors and communities to prevent, promptly detect and manage cases of noma. Improved awareness of the disease among populations helps to remove stigma and enhances the reintegration of noma survivors and their families into society. Integration of noma into existing health surveillance systems improves data availability and accessibility and strengthens the leadership of ministries of health through improved inter- and multisectoral collaboration.

    For noma priority countries, the quarterly reporting platform can be accessed through this link:













    Other Materials


    There are six conditions that make up the bulk of the oral disease burden in the WHO African Region. These are dental caries, or tooth decay; periodontal (gum) disease; oral cancers; oral manifestations of HIV infection; oro-dental/facial trauma; cleft lip and palate. Specifically in the Region, the spectrum of oral diseases also includes noma, which is a gangrenous disease that affects mainly children between the ages of 2 and 6 years. Almost all of these conditions are largely preventable or can be treated in their early stages.

    Dental caries/tooth decay

    Untreated dental caries/tooth decay of permanent teeth is most prevalent diseases globally and regionally, and 28.5% of the population ages greater than 5 years in the WHO African Region was estimated to be suffering from untreated caries of their permanent teeth in 2019.

    In deciduous (primary) teeth, untreated caries is the single most common chronic childhood disease, 38.6% of children aged 1-9 years in the Region was estimated to be affected by untreated caries of their deciduous teeth in 2019.

    Dental caries/tooth decay occur when microbial biofilm (plaque) formed on the tooth surface converts the free sugars contained in food and drinks into acids that dissolve tooth enamel and dentine over time. With continued high intake of free sugars, inadequate exposure to fluoride and without regular microbial biofilm removable, tooth structures are destroyed, resulting in development of cavities and pain, impacts on oral-health-related quality of life, and, in the advanced stage, tooth loss and systemic infection.

    Periodontal (gum) disease

    Periodontal (gum) disease manifests as swollen, painful, or bleeding gums and bad breath.  Like dental caries/tooth decay, it is caused by poor oral hygiene, but can also be caused by smoking.  In severe cases, the teeth can be detached from the gum and supporting bone and become loose.  It was estimated that 22.8% of persons aged 15 years or more in the WHO African Region suffered from severe periodontal (gum) disease that may cause tooth loss in 2019.

    Oral cancer

    Oral cancer includes cancers of the lip and all subsites of the oral cavity, and oropharynx. They often appear initially as a persistent ulceration, and can cause pain, swelling of the soft tissue in the mouth and throat, bleeding, or difficulty in eating or speaking.

    Estimated age-standardized incidence rates of oral cancer (cancers of the lip and oral cavity) vary from low to high across countries within the WHO African Region, with a range of between 0.4 and 6.6 per 100 000 people in 2020. These differences largely follow patterns of the main risk factors for oral cancer, including tobacco use, alcohol use and Khat, and oral cancers have increased in countries with a rising prevalence of these risk factors.

    Oral manifestations of HIV

    Lesions in the mouth are common among people with HIV. Oral manifestations occur in 30–80% of people with HIV, with considerable variations depending on factors such as affordability of standard antiretroviral therapy (ART).

    Oral manifestations include fungal, bacterial, or viral infections of which oral candidiasis is the most common and often the first symptom early in the course of the disease. Oral HIV lesions cause pain, discomfort, dry mouth, eating restrictions and are a constant source of opportunistic infection.

    Early detection of HIV-related oral lesions can be used to diagnose HIV infection, monitor the disease’s progression, predict immune status, and result in timely therapeutic intervention. The treatment and management of oral HIV lesions can considerably improve oral health, quality of life and well-being.

    Oro-dental/facial trauma

    While absence of surveillance data, oro-dental/facial trauma is a widespread yet often overlooked condition, defined as an impact injury to the teeth and/or other hard and soft tissues inside or around the mouth and oral cavity. Trauma to the teeth and face can result from a wide range of causes, including interpersonal violence, conflict, road traffic injuries, or accidents in the home, school, or workplace. Common conditions include chipped, broken, or lost teeth, dislocated jaws, and fracturing of facial bones and jawbones. 

    Cleft lip and palate

    Clefts of the lip and palate are heterogeneous disorders that affect the lips and oral cavity and occur either alone (70%) or as part of a syndrome, affecting more than 1 in 1000-1500 newborns worldwide.

    Although genetic predisposition is an important factor for congenital anomalies, other modifiable risk factors such as nutrition deficits and smoking during pregnancy, also play a role. This underlines the importance of antenatal care and support for pregnant women. Diagnosis and treatment of clefts present a significant challenge to public health, particularly in lower-middle income countries where availability, access and affordability of complex, multidisciplinary care are limited and complications from untreated clefts may result in high rates of infant mortality. If lip and palate clefts are properly treated by surgery, complete rehabilitation is possible.


    Noma is a noncommunicable gangrenous disease that affects mainly children between the ages of 2 and 6 years suffering from malnutrition, affected by infectious disease, living in extreme poverty and with weakened immune systems. Noma is mostly prevalent in sub-Saharan Africa, but sporadic cases are also reported from other world regions. Noma starts as a soft tissue lesion (a sore) of the gums, inside the mouth. The initial gum lesion then develops into an ulcerative, necrotizing gingivitis that progresses rapidly, destroying the soft tissues and further progressing to involve the hard tissues and skin of the face.

    In 1998, WHO estimated that there were 140 000 new cases of noma annually. However, due to the lack of robust estimate and systematic reporting, the true global burden of noma and its distribution have been difficult to plot accurately. Without treatment, noma is fatal in 70 to 90% of cases. Where noma is detected at an early stage, its progression can be rapidly halted, through basic hygiene, antibiotics, and nutritional rehabilitation. Such early detection helps to prevent suffering, disability, and death. However, the great majority of affected communities in Africa are situated in peri-urban and rural areas where traditional beliefs and stigma are prevalent, and early detection, diagnosis and access to care are difficult. Survivors suffer from severe facial disfigurement, have difficulty speaking and eating, face social stigma, and require complex surgery and rehabilitation.

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