Tooth decay and gum disease are largely preventable with fluoride and less sugar, yet they affect almost half of humanity, and most people live where basic oral health care is neither covered by health systems nor affordable.
Written from the sources listed below, not independently peer-reviewed.
Out of every 100 people in the world, roughly how many are entitled to essential oral health care services?
3.7 billion
People living with a main oral condition
Modelled estimate for 2023 (uncertainty range 3.45 to 4.06 billion), up from 3.62 billion in 2019. The age-standardised prevalence was about 45%.
Data year 2023. Source: Bernabe E et al., The Lancet Public Health 2026; 11: e630–41, 2026
2.26 billion
People with untreated tooth decay in permanent teeth
Another 509 million had untreated decay in their milk teeth. Untreated decay in permanent teeth is the most common health condition worldwide.
Data year 2023. Source: Bernabe E et al., The Lancet Public Health 2026; 11: e630–41, 2026
23%
Population entitled to essential oral health care
17% in the WHO African Region. The global target is 80% by 2030.
Data year 2021. Source: WHO Regional Office for Africa, 2025
Unit: % of population (world)
Modelled estimates from the Global Burden of Disease Study 2023, age-standardised so that population ageing does not affect the comparison. The rate fell by only 1.55% in relative terms, while the number of people affected rose from 3.62 to 3.73 billion. Data from surveys after 2019 are scarce, partly because COVID-19 disrupted fieldwork, so the estimates for recent years rely heavily on earlier data. WHO's own baseline of 47% uses an earlier round of the same model.
SDG target 3.8 calls for universal health coverage by 2030, and WHO's Global oral health action plan 2023–2030 sets two overarching targets: 80% of the world's population entitled to essential oral health care, and a 10% relative reduction in the combined prevalence of the main oral diseases. Coverage stood at about 23% in 2021. Between 2019 and 2023 the age-standardised prevalence of the main oral conditions fell by 1.55%, which the authors of the latest Global Burden of Disease analysis judge too slow to meet the 2030 target. Policy targets are also far off: in WHO's 2024 baseline, 21% of countries had policies to reduce free sugar intake and 29% had guidance on fluoride use, against targets of 50%, and 1% included dental preparations in their essential medicines lists.
Three out of four people with oral diseases live in low- and middle-income countries, and within every country the burden is higher among people with lower incomes.
Source: World Health Organization, 2022The WHO African Region had about 56,800 oral health workers in 2022, or 3.7 per 100,000 people, against an estimated need of 13.3 per 100,000. Oral health workers made up only 1.1% of the region's health workforce.
Source: WHO Regional Office for Africa, 2025Of the 47 countries in the WHO African Region, only three were classified as having affordable fluoride toothpaste, and more than 70% spent less than US$ 1 per person on oral health treatment in 2019.
Source: WHO Regional Office for Africa, 2025Sub-Saharan Africa saw the largest rise in the number of people living with the main oral conditions between 2019 and 2023, an increase of 9.5%, as its population grew.
Source: Bernabe E et al., The Lancet Public Health 2026; 11: e630–41, 2026Instead of one “percent solved” score, DO GOOD rates three separate dimensions. A problem can have mature solutions that still reach too few people. These ratings are an editorial reading of the sources on this page, not a measured index.
Has the situation improved in the real world?
LowThe age-standardised prevalence of the main oral conditions fell by just 1.55% between 2019 and 2023, while the number of people affected rose by about 3%, to 3.73 billion. Untreated decay in permanent teeth and severe gum disease barely changed.
How mature and validated are the available solutions?
HighFluoride toothpaste, fluoride varnish, silver diamine fluoride, sealants and lower sugar intake are well established ways to prevent and stop tooth decay, and WHO's 2026 guideline sets out how to use them with less invasive, mercury-free treatment. Severe gum disease and oral cancer are harder to prevent and treat.
How widely are effective solutions actually used?
LowOnly 23% of the world's population was entitled to essential oral health care in 2021, and in WHO's 2024 baseline only 1% of countries included dental preparations in their essential medicines lists. In the WHO African Region, only three countries had affordable fluoride toothpaste.
Disease figures are modelled estimates with wide uncertainty, and primary data are scarce in many regions; the 2023 estimate of people with oral conditions ranges from 3.45 to 4.06 billion. COVID-19 disrupted surveys, so recent trends rest largely on older data.
Age-standardised rates are almost flat and, in the high-income super-region, rose slightly between 2019 and 2023. Population growth means more people are affected each year, and coverage and policy indicators remain far from the 2030 targets.
Oral diseases include tooth decay (dental caries), severe gum disease (periodontitis), the loss of all natural teeth and cancers of the lip and mouth. Untreated tooth decay in permanent teeth is the single most common health condition in the world. Estimates from the Global Burden of Disease study put the number of people living with one of the main oral conditions at 3.73 billion in 2023, including 2.26 billion with untreated decay in permanent teeth, 509 million with untreated decay in milk teeth and 1.09 billion with severe periodontitis. The main causes are well known and largely preventable: diets high in free sugars, tobacco use, harmful use of alcohol and too little exposure to fluoride. Left untreated, these conditions cause pain, infection and tooth loss; almost a quarter of people aged 60 and over have lost all their teeth.
Oral diseases follow a steep social gradient: people of lower socioeconomic status carry more disease in every country and income group, and three out of four people affected live in low- and middle-income countries. Care is usually paid for out of pocket because prevention and treatment are rarely included in national health benefit packages, and paying for dental care is among the leading causes of catastrophic health spending. WHO estimates that only 23% of the world's population was entitled to essential oral health care in 2021. In the WHO African Region there were about 3.7 oral health workers per 100,000 people in 2022, and more than 70% of countries spent less than US$ 1 per person on oral health treatment in 2019, compared with a global average of US$ 50.
Few countries run regular national oral health surveys, so global figures on disease are modelled estimates that combine surveys and studies with statistical models. WHO tracks progress with a mix of disease and health system measures:
Untreated tooth decay
The share of people with at least one decayed tooth that has not been treated, counted separately for milk (primary) teeth in children and for permanent teeth. It shows both how much disease there is and how little of it is treated.
Severe gum disease and tooth loss
Severe periodontitis is an advanced gum infection that destroys the tissue and bone holding the teeth. Edentulism means having lost all natural teeth, the end point of untreated decay and gum disease.
Main oral conditions combined
WHO's 2030 disease target uses the combined prevalence of the main oral diseases over the life course. Because populations are ageing, progress is judged on age-standardised rates rather than on the number of people affected.
Coverage of essential oral health care
The share of a country's population entitled to essential oral health services through public health systems or insurance. This is WHO's main measure of oral health within universal health coverage.
What works
Adequate exposure to fluoride is one of the most important protections against tooth decay. WHO encourages brushing twice a day with toothpaste containing 1,000 to 1,500 ppm fluoride, a cheap measure that people can use at home.
Limits
Toothpaste is still too expensive for many families: in the WHO African Region only three countries were classified as having affordable fluoride toothpaste. In WHO's 2024 baseline, only 29% of countries had national guidance on fluoride use.
What works
High intake of free sugars is a main driver of tooth decay and is also causally linked to obesity and diabetes. Policies such as fiscal measures on foods and drinks high in free sugars aim to lower intake across a whole population, not only among people who see a dentist.
Limits
Such policies need agreement beyond the health sector. In WHO's 2024 baseline only 21% of countries had policies to reduce free sugar intake, and 4% in the WHO African Region.
What works
Fluoride varnish on early lesions, silver diamine fluoride twice a year to arrest decay, sealants on the back teeth of children at high risk and simple fillings with glass ionomer cement can prevent or stop much decay without drilling. WHO's 2026 guideline recommends these approaches, which need less equipment and can be offered in primary care.
Limits
These materials are rarely on national essential medicines lists, and front-line staff need training, curricula and supplies to use them.
What works
Including essential oral health services in primary care and in the benefit packages of public insurance or national health services reduces out-of-pocket payments and brings care closer to people. In WHO's 2024 baseline, 81% of countries reported oral health care in primary care facilities.
Limits
Being available in some clinics is not the same as being covered: only 23% of people worldwide were entitled to essential oral health care in 2021, and most countries still leave dental treatment out of their benefit packages.
What works
Nurses, midwives and community health workers can be trained to give oral health advice, apply fluoride and spot problems early, extending services where dentists are scarce. WHO's online courses on oral health for community health workers and on noma had more than 14,300 enrolments by January 2025.
Limits
Task sharing does not replace the need for more oral health professionals: the WHO African Region had 3.7 oral health workers per 100,000 people in 2022, against a need estimated at 13.3. Rules on who may provide which care often have to change first.
Promising, but not proven at scale. The stage shows how far each approach has come; it is not a recommendation.
WHO's first global guideline on this topic, published in March 2026, makes eight recommendations that put prevention and non-invasive treatment first and replace mercury-based amalgam with alternatives such as glass ionomer cements and resin composites. Countries are only starting to adapt their clinical rules, training and procurement, and the effect on coverage is not yet known.
Under the Minamata Convention on Mercury, countries are reducing the use of amalgam fillings. In WHO's 2024 baseline, 31% of countries were phasing down or phasing out amalgam, against a 2030 target of 90%. How quickly countries with few resources can switch depends on access to affordable mercury-free materials and trained staff.
WHO's STEPS surveys of noncommunicable disease risk factors include an optional oral health module, which 10 countries in the WHO African Region had used since 2016. Wider use could fill large data gaps, but only 6% of countries worldwide had an oral health monitoring framework in WHO's 2024 baseline.
Implementation gap
Oral health care is usually excluded from national benefit packages, so most people pay out of pocket, and paying for dental care is among the leading causes of catastrophic health spending. Only 23% of the world's population was entitled to essential oral health care in 2021.
Implementation gap
Oral health professionals are unequally distributed, and access to primary oral health services is often low. In the WHO African Region there were 3.7 per 100,000 people in 2022, about a quarter of the estimated need.
Coordination gap
Fluoride toothpaste and other dental preparations are often unaffordable or hard to obtain, and in WHO's 2024 baseline only 1% of countries included dental preparations in their national essential medicines lists, against a 2030 target of 50%.
Coordination gap
Cutting sugar intake depends on fiscal, trade, agriculture and food-industry policy. Only 21% of countries had policies to reduce free sugar intake in WHO's 2024 baseline, against a 2030 target of 50%.
Technology gap
Most dental care still relies on specialist staff, costly equipment and invasive treatment, which is hard to scale in primary care. WHO's 2026 guideline aims to shift practice towards prevention and minimally invasive, mercury-free treatment, but training curricula and payment systems have yet to follow.
Knowledge gap
Few countries survey oral health regularly. Only 6% of countries had an oral health monitoring framework in WHO's 2024 baseline, and COVID-19 disrupted surveys, leaving recent global trends to rest largely on older data and models.
Unresolved questions, not vetted breakthroughs. Answering any of them would change what is possible.
Which services should a low-income country include first in its benefit package, and how much would it cost per person to provide them through primary care rather than specialist dental clinics?
How much do taxes and other sugar policies lower tooth decay in children over the long term, and which designs work best where most sugar is eaten in unprocessed or unpackaged foods?
When nurses and community health workers apply fluoride or arrest decay with silver diamine fluoride, how much disease do they prevent, how good is the quality over time, and what supervision and supplies are needed?
Glass ionomer and resin materials perform differently depending on equipment, humidity and skill. Which alternatives to amalgam last long enough, at a low enough cost, in clinics with limited equipment?
Use a toothpaste containing 1,000 to 1,500 ppm fluoride, and help young children brush until they can do it well themselves.
Free sugars drive tooth decay. Keeping sweet foods and drinks to mealtimes and choosing water between meals protects teeth and lowers the risk of obesity and diabetes too.
If you can, have your teeth and gums checked regularly; early decay can often be stopped without drilling. Do not ignore a mouth sore or ulcer that has not healed after a few weeks, especially if you smoke or drink alcohol.
Back organisations that bring prevention and basic care to underserved communities, check whether they report what they achieve, and let elected representatives know you support covering essential oral health care and removing taxes on fluoride toothpaste.
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Bernabe E et al., The Lancet Public Health 2026; 11: e630–41 (author manuscript, University of Technology Sydney repository), published 2026
Peer-reviewed modelled estimates for 204 countries and territories. Source of the 3.73 billion people with main oral conditions in 2023 (3.62 billion in 2019), the age-standardised prevalence (45.9% in 2019, 45.2% in 2023, a 1.55% relative fall), 2.26 billion with untreated caries in permanent teeth, 509 million in deciduous teeth, 1.09 billion with severe periodontitis, the 9.5% rise in cases in sub-Saharan Africa, the slight rise in the high-income super-region, the judgement that progress is insufficient for the 2030 targets and the data limitations.
WHO Regional Office for Africa (25 August 2025), published 2025
Regional Committee document that reproduces the Global oral health action plan 2023–2030 targets with global and regional baselines from WHO's 2025 baseline report. Source of the 23% (global) and 17% (African Region) population coverage with essential oral health care, the 80% target, the 21% / 29% / 31% / 1% / 6% / 81% country policy baselines, the African Region workforce (56,772 workers, 3.7 per 100,000; need 13.3), spending under US$ 1 per capita versus US$ 50 globally, affordable toothpaste in three countries, STEPS oral health module in 10 countries, 14,300 course enrolments and noma's recognition as a neglected tropical disease.
World Health Organization (17 March 2025), published 2025
WHO's overview of oral diseases. Source of the nearly 3.7 billion people affected, edentulism (almost 7% of adults 20+ and 23% of people 60+), oral cancer (389,846 new cases and 188,438 deaths in 2022), tobacco as a main risk factor for periodontal disease, the 1,000–1,500 ppm fluoride toothpaste recommendation, the sugar link, exclusion from UHC benefit packages, catastrophic expenditure and noma (about 140,000 cases a year in 1998 estimates, fatal in 90% of untreated cases), the 2022 global strategy and 2024 Bangkok Declaration.
World Health Organization (18 November 2022), published 2022
News release for WHO's Global oral health status report 2022, the first global report since 2003, with country profiles for 194 Member States. Source of the statements that three out of four affected people live in low- and middle-income countries and that untreated dental caries is the single most common condition globally.
World Health Organization (3 March 2026), published 2026
Launch of the WHO guideline on environmentally friendly and less invasive oral health care for preventing and managing dental caries. Source of the eight recommendations, fluoride varnish, twice-yearly silver diamine fluoride, sealants for high-risk children, glass ionomer and resin restorations, and the replacement of mercury-containing amalgam under the Minamata Convention.
World Health Organization, published 2024
WHO's health topic page. Source of the social gradient in oral disease across the life course and all income groups, shared risk factors (tobacco, alcohol, free sugars), the causal link between high sugar intake and diabetes, obesity and caries, and the link between diabetes and periodontitis.
DO GOOD International (2026). Oral Health for Everyone. Global Challenges. Updated October 15, 2026. https://www.dogood.world/challenges/oral-health
For figures, please cite the original sources listed above.