“Without teeth.” The expression caused a stir when ten years ago, Valerie Trierweiler said she heard it from the lips of her president and ex-husband, François Hollande, when talking about the poor. In fact, this literal translation from English “toothless”, which figuratively means “poor, without power, without influence”, says what it means: the poorest classes, due to lack of means, are excluded from most oral health care. They are also among those who suffer the most from the absence of a real prevention policy in this area.
Inadequate oral and dental prevention
However, WHO reminds us, K “Oral diseases and conditions, although largely preventable, are the cause of a significant burden of morbidity in many countries and their impact is felt throughout life, causing discomfort, pain, aesthetic damage or even death”France does not have an oral health strategy.
As France Assos Saint condemned in November 2023: “The preventive aspect is absent from the strategy of health authorities, access to oral and dental care is approached mainly from a financial angle. “100% healthy“. Prevention and conservative care are still often sidelined in favor of artificial care. Supporting the idea that dental care is arcane in the West, locked in a techno-centric model and managed late, the association also added: “Insisting on prevention means avoiding thousands of pathologies every year, but also high costs to public finances and to previously treated people.”
Let us add that many so-called “advanced” oral care treatments, such as implantology or root planing in case of periodontal pathology, are not covered by health insurance even though they are extremely expensive.
It must be recognized that today, oral and dental prevention is a blind spot in public health policies, and the messages sent to the population do not correspond to scientific data. Indeed, if you were told “oral prevention,” you’d probably think of “scaling and regular visits to the dentist.” However, their effectiveness has not been demonstrated to date.
So what works? First brush your teeth twice a day, with fluoride toothpaste, and at the end of brushing, without rinsing your mouth, i.e. just spitting out the excess toothpaste, to retain more fluoride for longer.
Are you surprised? That is normal. The general message, at least when it is transmitted, is mainly based on the duration and frequency of brushing, or the type of toothbrush, electric or classic, and not on practical methods.
Why not refill toothpaste and toothbrushes?
The fact that it is a habit – a bit boring, some would say – to adopt from childhood for a lifetime, still needs to be the subject of widespread public communication, which it is not. Going forward today, we must ensure that everyone has access to a personal toothbrush (no scientific data recommends one type of toothbrush over another) and toothpaste.
In its fourth “Hygiene and uncertainty in France” barometer conducted by IFOP, the Dons Solidaire association notes that due to a lack of resources, 12% of French people have given up buying toothbrushes and 10% toothpaste. Certainly, these don’t seem to be luxury products, but in a context where 22% of French people already have to choose between buying food and hygiene products, it would be more beneficial to arrange compensation, or even free, simple things like fluoride toothpaste and toothbrushes. For oral and dental prevention tools, especially for 18-24 year olds, who are most affected by poor hygiene.
Convenient access would also be a strong signal to emphasize the importance and effectiveness of regular tooth brushing for prevention. In other areas, prevention tools whose effectiveness no longer needs to be demonstrated, such as condoms, are also made accessible to young people in France.
Tobacco and alcohol, enemies of oral health
Another line of measures has proven itself in terms of oral and dental prevention – and it joins the fight against cardiovascular, metabolic, neurodegenerative diseases, mental illnesses and cancer, smoking and problematic alcohol consumption.
Let’s talk about smoking first. It doesn’t just blacken or yellow teeth and cause bad breath: it causes devascularization of the gums, making them more susceptible to periodontal conditions—the treatment of which smoking also risks rendering ineffective. It is also a risk factor for ENT cancer.
Here, we can welcome public policies that have made smoking among youth a thing of the past. But, as with all other addictions, we want better support for addicts, with addiction counseling more accessible to everyone. All smokers should also be expressly recommended to at least rapidly switch to non-combustible tobacco devices if not to give up cigarettes. Patches, gums, electronic cigarettes, or heated tobacco generally do not cause as much damage to health, and oral health in particular, as tobacco combustion.
We cannot be satisfied with sensible messages: we need strong and ambitious political action.
Next, let’s talk about the fight against problematic alcohol consumption. When we talk about oral and dental prevention, we think less about it, but alcohol abuse is not only directly responsible for gum pathology, cavities and ENT cancer, but also indirectly responsible for accidents. .
On this aspect, we can only condemn the weak commitment of the state and measure the huge weight of the industry lobby in France. This is particularly visible in the government’s refusal to support the “Dry January” initiative, which invites its participants to think about their alcohol consumption and whose effectiveness has been widely demonstrated.
Furthermore, in its June 2023 report, Addiction Organization France condemned this fact “To the detriment of public health, many senators, deputies, ministers and even the President of the Republic defend the private interests of the alcohol industry”. The association adds that “This lack of ambition in terms of public health is not the result of chance. Certainly, it is undeniable that when it comes to alcohol, France knows how to generate jobs in the regions. But this factual and historical element, which the alcohol lobbies cover with cultural imagination and false scientific claims, becomes an essential argument to oppose any health proposal that could damage the sector and its economic model, so that the turnover of the industry becomes excessive, pathological. , too. Consumption
Today we cannot be satisfied with wise messages “Consuming in moderation”, Basing the fight against excessive alcohol consumption on individual responsibility alone: strong and ambitious political action is needed. Italy can serve as an example, because it competes with France for the first place as a wine producer and, despite the lobbies that should not fail to influence the policies of the country, the daily consumption of the Italian population is 30% less than the French.
We can, for example, try to age out alcohol consumption, as we do with cigarettes among young people. We can do more to promote alcohol-free beer, alcohol-free spirits and added sugar. In short, it’s finally time to crack down on excessive alcohol consumption in France, which remains on the top step of this sad podium in Western Europe.
The food industry lobbies against oral health
A final area of prevention in terms of oral health: adopting a healthy diet, especially one low in added sugars, meaning less soda, sweets, pastries and other junk food products. Here again, it is good to promote healthy nutrition through messages like “Eat five fruits and vegetables a day”, But more proactive and ambitious policies should be implemented to better inform everyone about nutritional recommendations, make them more accessible and enable their adoption.
Here, too, we know the weight of the lobby: the European reluctance to Nutri-Score, denounced by its creator, epidemiologist and nutritionist Serge Hercberg, is a very good example of this. Set that “do soda”? Why not, but at the same time, we should be able to reduce the products on healthy products to allow the most vulnerable people to have them. This will not solve the problem completely because, as the sociologist Denis Colombi said on Slate.fr, the poorest, although ignorant in matters of nutrition, are implementing. “Strategies allow you to quickly and cheaply enjoy and live a life otherwise full of deprivation and uncertainty.”
As we can see, the challenges of oral and dental prevention include numerous determinants of health: personal and behavioral, medical, social, commercial, environmental, economic and political. When we know that 61% of French people report periodontal bleeding from the gums and 14% every time they brush – a possible sign of periodontal disease – it’s time to stop rolling up our sleeves and disconnecting oral health. -For overall dental health.
Oral conditions are actually conditions that affect most of humanity. Caries and periodontal problems are at the top of this list, and their prevention is thought of and implemented throughout life, so as not to suffer unnecessarily and be forced to empty your wallet too late.
