Public Health Paradox: Past and Present Concerns of Oral Health

Public health is a truly interdisciplinary field. It is at the crossroads of social science, medicine and the natural sciences. It is holistic and concerns us all. The intersections of these fields can discover peculiarities and paradoxes of wealth and health.

There is substantial evidence indicating you should be concerned with your oral health; most importantly, oral health is said to be indicative of overall health. From a 30,000-foot view, some measures of dental well being across the planet do not completely track other social indicators that follow poor health. These initial findings ask for further investigation into the past and the present to determine the true causes and costs of oral disease.

Time has obfuscated our ability to have a crystal view of the past. Where the records and fossils exist, a picture of the past can help us understand our present and plan for our future. Approximately 1.5 million years ago we have evidence of a tooth abscess in an adolescent boy known as Narikotome Boy. The oldest known record of dental caries (or cavities) is from a 400,000-year old skull from Broken Hill in Zimbabwe.

Cavities and other dental diseases were very rare until the advent of agriculture and the subsequent development of refined sugars. During the Viking Age and Medieval Times,children of the North Atlantic had little to no missing teeth. Before refined cane sugar became widespread, honey would have been the only extremely cariogenic substance available to humanity.

The World Health Organization measures oral health in children by the number of “bad teeth” (decayed, missing or filled teeth) as a proxy for the prevalence of cavities in the population. These statistics can be compared to other public data to look for relationships and patterns. The accompanying map image compares the average number of “bad teeth” per child to GDP per capita (adjusted to 2000 US dollars), total health spending (US dollars), sugar consumption per person per day (grams) and fluoridated water.


The statistics used to create the map were taken from and their collection of data from The World Health Organization, The World Bank, FAO, and the British Flouridation Society.

For example, Liberia has one of the lowest rates of bad teeth per child (0.4) while having a low GDP per capita ($376/year) and low total health spending per person ($7). Canada, on the other hand, has a higher GDP per capita ($34,347) and spends more dollars on health per person ($3,037), but has approximately fives times the bad teeth per child (2.1).

What do the human ancestors, medieval peoples of the North Atlantic and modern Liberians have in common? Limited access to sugary foodstuffs. Although we are told oral health reflects overall health, we must delineate and sparse other measures of health. Liberians have maintained traditional tooth health but have not gained a cornucopia of health because of this. Although tooth health inversely tracks GDP slightly, other health concerns like HIV and the present Ebola outbreak continue to plague lower income countries.