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About us Faculty of Law Research Centres of Expertise Groningen Centre for Health Law Onderzoeksprojecten Health determinants

Child Oral Health

Oral diseases are the most common noncommunicable diseases (NCD) globally: they affect almost half of the world population. [i] The most common oral NCD, dental caries, is preventable, as it is largely driven by lifestyle patterns. [ii] Despite its preventability, the Global Burden of Disease 2019 marked untreated dental caries in permanent teeth as the most common health condition. [iii] The numbers are shocking: globally, two billion people suffer from untreated caries in their permanent teeth, while almost 520 million children suffer from untreated caries in their primary teeth. [iv]

The harm of (early) childhood caries does not end when adolescence is reached, as there are clear intergenerational and intra-generational links related to poor child oral health (COH): because of socio-behavioral factors, children with high caries experience continue to be at high risk of caries in their later lives and are also likely to pass this on to their own children. [v] Given that poor COH, including dental caries, is more prevalent among children of lower socioeconomic status, interventions are necessary to address and reduce existing inequalities. [vi] The current focus on individualized care has proven to be ineffective to solve the problem, and it is increasingly acknowledged that a systemic approach is required. [vii] In such an approach, law plays a decisive role in the regulation of behavioral risk factors, including sugars ingestion and hygiene practices, through upstream policies.

On the one hand, law can serve as input for requiring upstream regulations: the right to oral health, as recognized by the World Health Organization (WHO) and derived from, among other provisions, the right to the highest attainable standard of health as prescribed by the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of the Child (CRC) requires not only the regulation of the healthcare system, but also the regulation of other behavioral risk factors. [viii] By means of illustration, human rights law can require States to protect the maintenance of COH and regulate the cariogenic living environment, an environment in which sugary products are readily available, affordable and widely advertised. [ix]

On the other hand, law also serves as output in the shape of regulation: how can, among other things, sugars be regulated to effectively reduce the incidence of dental caries among children? It is important to emphasize here that a reduction of sugars intake alone does not necessarily benefit caries prevention: for the prevention of caries, frequency of sugars intake plays a particularly important role as well. [x] Legal epidemiology, the study of the role of law in the prevention, distribution and cause of the incidence of diseases and injuries, can contribute to answering the question posed above. [xi] The method can assess the effectiveness of suggested measures based on, among other things, existing data and statistical models. Making use of this method requires interdisciplinary cooperation and can thereby provide for relevant insights that cannot be developed from the perspective of a single discipline.

The research project on child oral health and law aims to cross the borders of the disciplines of dental and legal research, by combining the available knowledge in both disciplines. For this reason, the research is conducted in an interdisciplinary research group with researchers of the University of Groningen’s Faculty of Law, Dominique Mollet and professor Brigit Toebes , and the University Medical Center Groningen, professor David Manton . The interdisciplinary component of the project contributes to our understanding of the role of law in public health promotion and furthers legal epidemiology in the European context as an interdisciplinary method of public health law research.

This research project is part of a Collaborative Doctoral Partnership between the University of Groningen and the Joint Research Center .

[i] Global oral health status report: towards universal health coverage for oral health by 2030 (Geneva, World Health Organization, 2022) 1.

[ii] ibid.

[iii] ‘Global burden of disease 2019 (GBD 2019) results’ (Seattle: Institute of Health Metrics and Evaluation, 2020) < > accessed 27 January 2023; ‘Oral health’ (World Health Organization, 18 November 2022) accessed 27 January 2023.

[iv] Global oral health status report (n i) 30.

[v] DM Shearer and others, ‘Family history and oral health: findings from the Dunedin Study’ (2011) 40 Community Dent Oral Epidemiol 105.

[vi] ‘Oral health’ (World Health Organization, 18 November 2022) accessed 27 January 2023.

[vii] Watt and others, ‘Ending the neglect of global oral health: time for radical action’ (2019) 394 Lancet 261; P Moynihan and C Miller, ‘Beyond the Chair: Public Health and Governmental Measures to Tackle Sugar’ (2020) 99 J Dent Res 871.

[viii] ‘Draft Global Oral Health Action Plan (2023-2030)’(World Health Organization, WHO Discussion Paper, 12 August 2022) para. 14; Convention on the Rights of the Child (adopted 20 November 1989, entered into force 2 September 1990) 1577 UNTS 3 Art. 24; International Covenant on Economic, Social and Cultural Rights (adopted 16 December 1966, entered into force 3 January 1976) 993 UNTS 3 Art. 12; General Comment No. 14: The right to the highest attainable standard of health (art. 12) (Committee on Economic, Social and Cultural Rights, E/C.12/2000/4, 11 August 2000); General Comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24) (Committee on the Rights of the Child, CRC/C/GC/15, 2013).

[ix] See, for example, paras. General Comment No. 14 (n viii) 35-37.

[x] P Moynihan, ‘Sugars and Dental Caries: Evidence for Setting a Recommended Threshold for Intake’ (2016) 7 Adv Nutr 149.

[xi] See, for example, S Burris and others, ‘The Growing Field of Legal Epidemiology’ (2020) 26 Journal of Public Health Management and Practice S4; S Burris and others, ‘A Transdisciplinary Approach to Public Health Law: The Emerging Practice of Legal Epidemiology’ (2016) 37 Annu. Rev. Public Health 135.

Last modified:17 August 2023 1.02 p.m.