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research-article2015
JDRXXX10.1177/0022034515602879Journal of Dental ResearchGlobal Economic Impact of Dental Diseases

Research Reports: Clinical


Journal of Dental Research
2015, Vol. 94(10) 1355­–1361
Global Economic Impact © International & American Associations
for Dental Research 2015

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DOI: 10.1177/0022034515602879
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S. Listl1,2, J. Galloway3, P.A. Mossey3, and W. Marcenes4

Abstract
Reporting the economic burden of oral diseases is important to evaluate the societal relevance of preventing and addressing oral
diseases. In addition to treatment costs, there are indirect costs to consider, mainly in terms of productivity losses due to absenteeism
from work. The purpose of the present study was to estimate the direct and indirect costs of dental diseases worldwide to approximate
the global economic impact. Estimation of direct treatment costs was based on a systematic approach. For estimation of indirect
costs, an approach suggested by the World Health Organization’s Commission on Macroeconomics and Health was employed, which
factored in 2010 values of gross domestic product per capita as provided by the International Monetary Fund and oral burden of disease
estimates from the 2010 Global Burden of Disease Study. Direct treatment costs due to dental diseases worldwide were estimated at
US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure. Indirect costs due to dental diseases worldwide
amounted to US$144 billion yearly, corresponding to economic losses within the range of the 10 most frequent global causes of death.
Within the limitations of currently available data sources and methodologies, these findings suggest that the global economic impact of
dental diseases amounted to US$442 billion in 2010. Improvements in population oral health may imply substantial economic benefits
not only in terms of reduced treatment costs but also because of fewer productivity losses in the labor market.

Keywords: treatment costs, indirect expenditures, health expenditures, costs and cost analysis, oral health, teeth

Introduction consider in terms of productivity losses due to absenteeism


from school and work, yet relatively little evidence exists in
Identifying the economic burden of a disease is useful to this regard. Recent findings from Canada suggest that oral dis-
understand the maximum amount of resources that could be eases accounted for productivity losses >$1 billion yearly for
saved or gained if that disease were to be partially or fully Canada alone (Hayes et al. 2013). A recent US study estimated
eradicated (Rice 1967). Describing and highlighting the mag- the labor market value of the marginal tooth to be nearly $720
nitude of the economic impact of dental diseases on society or per year for an urban-residing woman earning $11/h and work-
on different population groups would provide relevant infor- ing full time (Glied and Neidell 2010).
mation for decision makers in public health policy to evaluate Different economic approaches exist to estimate the eco-
the importance of addressing oral diseases. In the context of nomic burden of a disease. The cost-of-illness approach views
oral health and care, however, information about the economic the cost of disease as the sum of several categories of direct
impacts of disease has been very limited so far. To our knowl- (treatment) costs and indirect costs (Byford et al. 2000). This
edge, there is not a comprehensive worldwide estimation of the typically includes personal medical care costs (diagnosis, treat-
economic burden of oral diseases, including direct and indirect ment, drugs), nonmedical costs for travel associated with
cost, to the extent that this is possible today given the currently
available primary data recently reported. 1
Heidelberg University, Translational Health Economics Group,
Although the World Health Organization (WHO) estimates Department of Conservative Dentistry, Heidelberg, Germany
that oral diseases are the fourth-most expensive diseases to 2
Max Planck Institute for Social Law and Social Policy, Munich Center for
treat in most industrialized countries (Petersen 2003), its anal- the Economics of Aging, Munich, Germany
3
ysis was done only for direct cost and included only a subset of University of Dundee Dental School, Dundee, UK
4
countries. Few sound studies reported estimates for individual Queen Mary University of London, UK
countries (Beaglehole et al. 2009; Patel 2012; Wall et al. A supplemental appendix to this article is published electronically only at
2014). Across Organisation for Economic Co-operation and http://jdr.sagepub.com/supplemental.
Development (OECD; 2013) countries, on average 5% of total
Corresponding Author:
health expenditures have been reported to originate from treat- S. Listl, Heidelberg University, Translational Health Economics Group,
ment of oral diseases. While treatment is a costly consequence Department of Conservative Dentistry; Im Neuenheimer Feld 400,
of oral diseases, reductions in morbidity may also imply other 69120 Heidelberg, Germany.
economic benefits. Importantly, there are indirect costs to Email: stefan.listl@med.uni-heidelberg.de

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1356 Journal of Dental Research 94(10)

health care, and nonpersonal costs (e.g., costs for research, synthesis and heuristic piloting to test the feasibility of various
income losses, and sometimes pain and suffering). Another approaches. The most suitable approach to estimate worldwide
approach relates to measuring the value of lost output (i.e., the direct and indirect costs of oral diseases was determined by
economic growth approach), which estimates the expected consensus among all authors. To facilitate alignment with the
impact of disease on aggregate economic output (gross domes- GBD 2010, the year 2010 was defined as the primary target
tic product [GDP]) due to depletion in labor, capital, and other period for estimation of global economic impacts of dental
production factors (Bloom et al. 2012). The value-of-statisti- diseases.
cal-life approach seeks to identify a population’s willingness to
pay to reduce the risk of disability or death due to disease,
hence factoring in other factors than GDP alone (Bloom et al. Estimation of Direct Costs:
2012). While such methods to estimate the economic impact of Dental Health Care Costs
diseases are, in principle, well founded, limited availability of Selection of studies.  Our search strategy was oriented to identify
comprehensive data sources and nonharmonized international country-specific yearly national expenditure for outpatient den-
reporting standards make estimating the full economic impact tal care in 2010 or nearest year available. An electronic search
of oral diseases difficult. was performed focusing on the following online resources:
New data from the Global Burden of Disease Study 2010
(GBD 2010) provided comparable worldwide information on WHO Global Health Expenditure Database: http://www.
disability-adjusted life years (DALYs) by country. The data who.int/health-accounts/ghed/en/
also showed that oral conditions remained highly prevalent in OECD Data: https://data.oecd.org/
2010 and collectively affected 3.9 billion people in the globe. FDI Oral Health Atlas: http://issuu.com/myriadeditions/
Untreated caries in permanent teeth was the most prevalent docs/flipbook_oral_health
condition evaluated for all of the GBD 2010 (global prevalence Platform for Better Oral Health in Europe: http://www.oral
of 35% for all ages combined; Kassebaum et al. 2015), whereas healthplatform.eu
severe periodontitis and untreated caries in deciduous teeth Council of European Chief Dental Officers: http://www.
were the 6th- and 10th-most prevalent conditions affecting, cecdo.org/
respectively, 11% and 9% of the global population. On the con- Intergovernmental Organization Search: http://www.uia.
trary, the prevalence and burden measured by DALYs associ- org/igosearch
ated with tooth loss have decreased in the past 20 y; specifically, Google (noncustomized search): http://www.google.com
tooth loss was the 36th-most prevalent condition, with a global
estimate of 2.3% in 2010 (Marcenes et al. 2013; Kassebaum Search words for dental expenditure included “expenditure,”
et al. 2014). “expenditures,” “cost,” “costs,” or “treatment costs” combined
Following publication of the Budapest Declaration under with “dentist,” “dental,” “dentistry,” “oral health,” “oral health
the auspices of the Global Oral Health Inequalities Research care,” “oral health services,” or “dental care.” The search was
Agenda of the International Association for Dental Research focused on 187 countries as defined in Murray et al. (2012).
(IADR-GOHIRA®), 1 objective for future research was to esti- For each country, individual searches were carried out with the
mate the global costs (direct and indirect) of oral disease respective “[country name]” as an additional search term. We
(Mossey and Petersen 2014). The purpose of the present study also searched MEDLINE via PubMed (keyword- and MeSH-
was to systematically produce comparable estimates of the based searches), EMBASE via OVID, LILACS via BIREME,
economic burden of the 3 most prevalent oral conditions as the Cochrane Database of Systematic Reviews, the Database
specified above in 2010. We aimed to consolidate all economic of Abstracts of Reviews of Effects, the Health Technology
data about the direct and indirect costs of these conditions and, Assessment Database, and the NHS Economic Evaluation
subsequently, to generate internally consistent estimates for all Database for relevant information on dental expenditure (see
countries where data are available and to provide estimates for Appendix for details). Additional hand searches focused on
all 21 world regions. reference lists of relevant publications.
Information sources were included if they fulfilled the fol-
lowing criteria: country-specific representative reporting; over-
Methods
all expenditures for dental services reported, including public
A systematic approach was used to generate information to and private source of funds, as specified in the International
estimate the current direct and indirect costs of dental diseases Classification of Health Accounts (categories: HC.1.3.2, “out-
worldwide. Direct costs were defined as overall expenditures patient dental care”; HP.3.2, “offices of dentists”; OECD 2000);
for dental health care (including public and private expendi- annual expenditures reported for at least 1 y between 2000 and
tures). Indirect costs were intended to capture productivity 2014; and expenditures reported either as absolute monetary
losses due to the 3 most common oral conditions—namely, values or as a percentage of GDP. An information source was
untreated caries in permanent and deciduous teeth, severe peri- excluded if it was nonrepresentative of a country’s entire popu-
odontitis, and severe tooth loss. Identification of appropriate lation (selective sample; e.g., only representative for a local
methods was informed by current best practice in evidence patient group with specific morbidity), or it reported only

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Global Economic Impact of Dental Diseases 1357

limited parts of overall dental expenditures (e.g., only private to approximate productivity losses. Following this approach,
out-of-pocket or only government expenditures). we factored in 2010 values of GDP per capita (International
Two authors (S.L., J.G.) performed all searches and selected Monetary Fund 2011) and extracted DALY estimates for
information fulfilling the inclusion criteria independently and untreated caries, severe periodontitis, and severe tooth loss (<9
in duplicate. Those information sources found to be relevant remaining permanent teeth) in 187 countries from a recent
after initial screening were kept in the database. It was distin- study (Marcenes et al. 2013). Note that untreated caries included
guished between countries for which there was “relevant infor- deciduous teeth, whereby respective productivity losses include
mation identifiable” versus countries for which there was “no parents taking time off to look after their children. Country-
relevant information identifiable.” Remaining uncertainties specific GDP values were aggregated on the level of the 21
were resolved by consensus among all authors. Duplication GBD 2010 regions and weighted according to country-specific
between results was removed. All information sources meeting population sizes (International Monetary Fund 2011). In case of
the criteria for inclusion in this review were used in the estima- missing information, supplementary values were extracted
tion of the direct costs of oral diseases. from UN data (United Nations 2015). Relevant data for estima-
tion of indirect costs (i.e., GDP per capita in US dollars and
Data extraction and imputation.  For countries for which rele- DALYs in thousands [2010 values]) are summarized in Table 1.
vant information was identifiable, yearly dental expenditure All analyses were carried out with Microsoft Excel (v.
values were extracted in terms of absolute values and as pro- 14.0.7015.1000).
portion of GDP. Annual expenditure values were reported in or
converted to US dollars (midyear conversion rates for the
reporting year [http://www.xe.com]; purchasing power adjust- Results
ment based on inflation rates relative to 2010 US dollars [http://
www.usinflationcalculator.com]). If expenditure information Direct Costs: Treatment Costs
was originally reported as proportion of GDP, it was translated The systematic information search started with identification
to absolute US dollar values by using the relevant country’s of countries relevant to estimate global expenditures.
GDP in US dollars in the reporting year and applying inflation Accordingly, 187 country-specific electronic searches were
rates relative to 2010 US dollars. Estimates of GDP per capita carried out and submitted to initial screening. At this stage, 107
and population size were extracted from the World Economic countries were excluded because no relevant information could
Outlook Database (International Monetary Fund 2011). In case be identified. Of the remaining 80 countries, 14 more countries
of missing information, supplementary values were extracted were excluded because the respective information did not meet
from UN data (United Nations 2015). As a robustness check, the inclusion/exclusion criteria. For the remaining 66 coun-
worldwide dental expenditures were also computed by using tries, relevant information was found to be identifiable. Full
solely GDP information from UN data (United Nations 2015). lists of included and excluded information sources (with rea-
Estimation of worldwide dental expenditures involved sons for exclusion) are presented in Appendix Tables 1 and 2.
imputation of missing expenditure values, which leaned on Worldwide expenditure estimations are presented in Table
expenditure information from the nearest geographic unit for 2. Aggregate direct treatment costs due to dental diseases
which expenditure information was identifiable. To this end, worldwide were estimated at $297.67B; 82% of the estimated
countries were grouped into 21 regions and 7 super-regions, expenditures ($244.40B) occurred in high-income countries
following the classification of the GBD 2010 (Fig.). When (North America: $120.08B; Western Europe: $91.05B; High-
expenditure information was not available for a particular Income Asian Pacific: $23.30B; Australasia: $7.03B; Southern
country, its 2010 expenditure was approximated by multiply- Latin America: $2.93B). Latin America and the Caribbean
ing the average expenditure (in proportion of GDP) of the near- accounted for $14.06B (Tropical Latin America: $6.92B;
est geographic unit (region, super-region, world), which Central Latin America: $5.79B; Andean Latin America:
included primary expenditure information with the GDP value $0.76B; Caribbean: $0.59B). South Asia contributed $12.84B.
of the country without primary data. As an additional robust- Eastern Europe ($6.12B), Central Europe ($2.75B), and
ness test, worldwide dental expenditures were estimated by Central Asia ($0.45B) together contributed $9.32B. North
using the mean (95% confidence interval) expenditure level of Africa and the Middle East contributed $8.33B. The region
all GBD 2010 regions containing primary expenditure infor- comprising East Asia ($5.02B), Southeast Asia ($0.75B), and
mation to impute missing expenditure values. Oceania ($0.02B) accounted for $5.79B; $2.96B was attrib-
uted to Sub-Saharan Africa (Southern: $2.70B; East: $0.20B;
West: $0.04B; Central: $0.01B).
Estimation of Indirect Costs
The results from robustness checks are shown in Appendix
Indirect costs were estimated according to an approach sug- Tables 3 and 4. Findings in Appendix Table 3 show somewhat
gested by the WHO’s Commission on Macroeconomics and higher worldwide expenditures of $299.61B if GDP values
Health (WHO 2001), which was recently used to estimate from UN data are compared with $297.67B when based on GDP
global economic costs of cancer (Cancer Society 2010). This values from the World Economic Outlook Database. Appendix
approach is based on valuing 1 DALY at 1 y of per capita GDP Table 4 highlights the extent of uncertainty in the estimation of

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1358 Journal of Dental Research 94(10)

Figure.  Map of GBD 2010 regions and super-regions. Reprinted from: Murray CJ et al. (2012). GBD 2010: design, definitions, and metrics. Lancet.
380(9859):2063-2066. Copyright 2012, with permission from Elsevier.

worldwide dental expenditures. Using the mean expenditure ($404.06 million), Sub-Saharan East Africa ($433.61 million),
level (95% confidence interval) of all GBD 2010 regions with and Sub-Saharan West Africa ($450.81 million).
primary expenditure information to impute missing expenditure Severe tooth loss accounted for the highest proportion of
values, worldwide expenditures were estimated at $311.14B productivity loss in High-Income Asia Pacific, Western
(lower bound: $281.43B; upper bound: $340.85B). Uncertainty Europe, High-Income North America, Central Europe, and
stems mostly from areas with sparse primary information on Eastern Europe. Severe periodontitis accounted for the highest
expenditure. proportion of productivity loss in Australasia, Southern Latin
America, Tropical Latin America, Central Latin America,
Southeast Asia, Central Asia, and Sub-Saharan East Africa. In
Indirect Costs Andean Latin America, severe tooth loss and severe periodon-
The estimates of worldwide productivity losses are set out in titis had the largest share in productivity loss. Untreated caries
Table 3. Indirect costs due to major dental diseases amounted to in permanent teeth accounted for the highest proportion of pro-
$144.25B. Thereof, $63.03B (44%) was attributable to severe ductivity loss in North Africa and Middle East, South Asia,
tooth loss, $53.99B (37%) to severe periodontitis, $25.14B Oceania, Sub-Saharan Southern Africa, Sub-Saharan Central
(17%) to untreated caries in permanent teeth, and $2.09B (1%) Africa, and Sub-Saharan West Africa.
to untreated caries in deciduous teeth. The highest productivity
losses are found for Western Europe ($40.98B), High-Income
Discussion
North America ($30.19B), East Asia ($15.70B), High-Income
Asia Pacific ($13.82B), and Eastern Europe ($6.17B); the low- The findings of the present study suggest that direct treatment
est productivity losses are found for Oceania ($21.46 million), costs due to dental diseases worldwide were $298B in the year
Sub-Saharan Central Africa ($202.82 million), the Caribbean 2010, corresponding to 4.6% of global health expenditure

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Global Economic Impact of Dental Diseases 1359

Table 1.  GDP per Capita and DALYs: 2010.

DALYs, ×1,000

  Untreated Caries Teeth Severe

Region GDP per Capita, US$ Deciduous Permanent Periodontitis Tooth Loss

Asia Pacific, High Income 36,848.52 3 35 149 188


Europe, Western 38,771.20 6 114 391 546
Australasia 51,809.58 0 4 35 34
North America, High Income 46,805.05 8 57 224 356
Europe, Central 10,951.79 4 116 133 140
Latin America, Southern 10,047.62 1 20 95 60
Europe, Eastern 8,427.02 7 183 265 277
Asia, East 5,180.64 71 1,023 1,265 672
Latin America, Tropical 10,561.95 13 97 250 212
Latin America, Central 7,819.41 13 135 210 167
Asia, Southeast 2,732.69 50 432 544 281
Asia, Central 3,609.36 5 61 69 54
Latin America, Andean 4,228.81 4 32 46 46
North Africa/Middle East 6,919.93 33 297 257 287
Caribbean 4,753.69 2 23 21 39
Asia, South 1,227.88 129 1,413 943 1,015
Oceania 1,788.10 1 6 2 3
Sub-Saharan, Africa Southern 5,747.58 4 52 34 38
Sub-Saharan, Africa East 658.98 32 206 292 128
Sub-Saharan, Africa Central 1,361.21 9 60 48 32
Sub-Saharan, Africa West 1,053.29 29 187 129 83

DALY, disability-adjusted life year; GDP, gross domestic product.

($6.5 trillion in 2010; WHO 2012). In addition, the annual Table 2.  Estimated Worldwide Dental Expenditures: 2010.
global indirect costs due to dental diseases (i.e., productivity Super-region: Region US$ Billion
losses) were estimated at $144B. Direct and indirect costs
together amounted to an annual economic impact of $442B for Southeast Asia, East Asia, and Oceania 5.79
  Asia, East 5.02
2010 alone; 83% of direct treatment costs were attributable to
  Asia, Southeast 0.75
high-income countries. The global region with the next-largest  Oceania 0.02
amount of dental expenditures was Latin America and the Central Europe, Eastern Europe, and Central Asia 9.32
Caribbean (5%), followed by South Asia (4%), Central/Eastern   Asia, Central 0.45
Europe and Central Asia (3%), North Africa and the Middle   Europe, Central 2.75
East (2%), Southeast Asia, East Asia and Oceania (2% of   Europe, Eastern 6.12
High Income 244.40
global expenditures), and Sub-Saharan Africa (1%). Forty-four
  Asia Pacific, High Income 23.30
percent of productivity losses were attributable to severe tooth  Australasia 7.03
loss, 38% to severe periodontitis, and 17% to untreated caries   Europe, Western 91.05
in permanent teeth. Economic losses of the top 10 global   Latin America, Southern 2.93
causes of death were recently estimated through a similar   North America, High Income 120.08
approach as the present study, to range between $895B (can- Latin America and Caribbean 14.06
cer) and $126B (lower respiratory infections; Cancer Society  Caribbean 0.59
  Latin America, Andean 0.76
2010). Therefore, the present study’s estimate for productivity
  Latin America, Central 5.79
loss due to dental diseases ($144B) may be interpreted in the   Latin America, Tropical 6.92
sense that indirect costs due to dental diseases worldwide cor- North Africa/Middle East 8.33
respond to economic losses within the range of the 10 most Asia, South 12.84
frequent global causes of death. Sub-Saharan Africa 2.96
Due to limitations in the underlying data sources, the find-   Sub-Saharan, Africa Central 0.01
ings of the present study should be interpreted with caution.   Sub-Saharan, Africa East 0.20
  Sub-Saharan, Africa Southern 2.70
For estimation of direct costs, relevant information was identi-
  Sub-Saharan, Africa West 0.04
fiable for only 66 of 187 countries (35%). Expectedly, our Global 297.67
results emphasize considerable uncertainty in estimating
global costs of dental diseases. Routine health expenditure
information was found to be primarily published by depart- information availability tended to be better for high-income
ments of health or international organizations. Although countries, there is ample room for improvement in the quality,

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1360 Journal of Dental Research 94(10)

Table 3.  Estimated Productivity Losses due to Untreated Caries, Severe Periodontitis, and Severe Tooth Loss (US$ Million): 2010.

Untreated Caries Teeth Severe

Super-region: Region Deciduous Permanent Periodontitis Tooth Loss Total

Southeast Asia, East Asia, and Oceania  


  Asia, East 367.83 5,299.79 6,553.51 3,481.39 15,702.51
  Asia, Southeast 136.63 1,180.52 1,486.59 767.89 3,571.63
 Oceania 1.78 10.73 3.58 5.36 21.46
Central and Eastern Europe and Central Asia  
  Asia, Central 18.05 220.17 249.05 194.91 682.17
  Europe, Central 43.81 1,270.41 1,456.59 1,533.25 4,304.05
  Europe, Eastern 58.99 1,542.14 2,233.16 2,334.28 6,168.58
High Income  
  Asia Pacific, High Income 110.55 1,289.70 5,490.43 6,927.52 13,818.20
 Australasia 0 207.24 1,813.34 1,761.53 3,782.10
  Europe, Western 232.63 4,419.92 15,159.54 21,169.07 40,981.16
  Latin America, Southern 10.05 200.95 954.52 602.86 1,768.38
  North America, High Income 374.44 2,667.89 10,484.33 16,662.60 30,189.25
Latin America and Caribbean  
 Caribbean 9.51 109.33 99.83 185.39 404.06
  Latin America, Andean 16.92 135.32 194.53 194.53 541.29
  Latin America, Central 101.65 1,055.62 1,642.08 1,305.84 4,105.19
  Latin America, Tropical 137.31 1,024.51 2,640.49 2,239.13 6,041.43
  North Africa/Middle East 228.36 2,055.22 1,778.42 1,986.02 6,048.02
  Asia, South 158.40 1,734.99 1,157.89 1,246.30 4,297.58
Sub-Saharan Africa  
  Sub-Saharan, Africa Central 12.25 81.67 65.34 43.56 202.82
  Sub-Saharan, Africa East 21.09 135.75 192.42 84.35 433.61
  Sub-Saharan, Africa Southern 22.99 298.87 195.42 218.41 735.69
  Sub-Saharan, Africa West 30.55 196.97 135.88 87.42 450.81
Global 2,093.76 25,137.72 53,986.91 63,031.61 144,249.97

standardization, and reporting of dental expenditures. In the approaches available to estimate the economic burden of a spe-
absence of more comprehensive information, estimates of cific disease, these have been rarely applied (Cancer Society
global expenditure are at risk of substantial upward or down- 2010). In this regard, oral health is no exception. Data relevant
ward bias. Moreover, it is important to appreciate that without to comprehensively assess the full magnitude of direct and
appropriate detail on coding the direct costs, figures cannot indirect costs of dental and oral diseases still seem very sparse.
distinguish between the percentage of the economic burden
aimed toward different treatment categories (e.g., disease
avoidance [checkup, diagnosis, prevention]) and interventive Conclusion
treatment of dental disease (restorative, periodontal, and
optional cosmetic care [tooth whitening]). For estimation of Within the limitations of currently available data sources and
indirect costs, it was assumed that each DALY can be valued at thus still restricted methodologies to estimate the full costs of
1 y of per capita GDP. In addition to limitations implied by the oral diseases, the findings of the present study suggest that the
concept of DALYs themselves (Anand and Hanson 1997), the global economic burden of dental diseases amounted to $442B
economic value of DALYs is affected by the size of per capita in 2010, of which $298B was attributable to direct treatment
GDP of the various regions examined. Prioritization of health costs and $144B to indirect costs in terms of productivity
policies to improve oral health according to regions with high losses due to caries, periodontitis, and tooth loss. The actual
estimated economic impacts may impose risks of neglecting burden and cost of oral conditions are likely to be much higher
regions and countries with comparably small GDPs. as dental conditions such as oral cancer dysplasias of the oral
Nevertheless, the results of the present study may serve as mucosa, oral infections, oral developmental disorders (e.g.,
informative approximation of global economic impacts of oral clefts of the lip and palate) and noma could not pertinently be
diseases. included in this study. Further research on the cost of oral con-
The present study emphasizes the urgent need to increase ditions should include all oral conditions, rather than be
the availability of internationally comparable data on dental restricted to the most common dental conditions. Improvements
treatment costs, disease-specific absenteeism from work and in population oral health may imply substantial economic ben-
school, as well as intangible costs of oral diseases in terms of efits not only in terms of reduced treatment costs but also
quality of life. While in principle there are a number of suitable because of fewer productivity losses in the labor market.

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Global Economic Impact of Dental Diseases 1361

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Galloway, contributed to conception, design, data acquisition, and 13:17.
analysis, critically revised the manuscript; P.A. Mossey, contrib- International Monetary Fund. 2011. World Economic Outlook Database,
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tation, critically revised the manuscript. All authors gave final pubs/ft/weo/2011/02/weodata/index.aspx.
Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W.
approval and agree to be accountable for all aspects of the work. 2014. Global burden of severe tooth loss: a systematic review and meta-
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