Oral health is an integral element of general health and wellbeing. Good oral health enables individuals to communicate effectively, to eat and enjoy a variety of foods, and is important in overall quality of life, self-esteem and social confidence (1). However, oral diseases affect a significant proportion of the world's population and exact a heavy toll in terms of morbidity and mortality (2). A range of diseases and conditions can be classified as oral diseases including dental caries, periodontal diseases, oral cancers, noma, dental erosion and dental fluorosis. Oral diseases are highly prevalent and their impact on both society and the individual is significant. Pain, discomfort, sleepless nights, limitation in eating function leading to poor nutrition, and time off school or work as a result of dental problems are all common effects of oral diseases.
Although overall improvements in oral health have occurred in many developed countries over the last 30 years, oral health inequalities have emerged as a major public health challenge because lower income and socially disadvantaged groups experience disproportionately high levels of oral disease (2). In many developing countries economic, social and political changes have had a significant effect on diet and nutrition with a shift occurring from traditional towards more "westernized" diets (3). As a consequence the consumption of sugars has risen and levels of dental caries have increased (2). This is a particular problem in the primary dentition in which most caries remain untreated. In some parts of the developing world, oral cancers and noma are a significant cause of premature death and extreme disability.
Oral diseases are however largely preventable. The challenge is to create the opportunity and conditions to enable individuals and communities to enjoy good oral health. Although advances in clinical operative techniques have made dental treatment more effective and acceptable, treatment approaches alone will never eradicate oral diseases. Indeed in many low-income countries in the developing world, the total costs of providing traditional operative dental care would exceed the entire health care budget (4). Effective public health approaches are therefore required to prevent oral diseases and promote oral health across the population. The aim of this paper is to outline public health strategies to promote oral health and reduce inequalities. An overview of the Ottawa Charter and other public health policy frameworks developed by WHO is presented. The evidence base for preventive interventions for oral disease is then summarized. The principles underlying oral health strategies are outlined, and finally some case studies are presented to illustrate the approaches recommended.
A collection of published information sources was used as reference material for this paper. A series of WHO policy reports and reviews provided valuable guidance on the public health principles underpinning the development of oral health strategy. A range of Cochrane and other systematic reviews that have assessed the effectiveness of oral health interventions are summarized below. In addition, key publications on oral health and a collection of international case-studies have been used to provide practical details of the public health approaches used to promote oral health.
Global context for health promotion and public health policy
In recognition of the limited ability of health education and clinical prevention to produce sustainable improvements in health and to reduce inequalities, WHO organized an international conference in Canada in 1986 to develop a more radical public health approach to prevention. Following the discussions at this conference the Ottawa Charter was published to provide a set of guiding principles for health promotion (5).
The Ottawa Charter defined health promotion as: "The process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health. …