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Decades of neglect: Oral health crisis demands urgent policy reform and action

Decades of neglect: Oral health crisis demands urgent policy reform and action
Sudeshni Naidoo and Habib Benzian
By Sudeshni Naidoo and Habib Benzian
20 Mar 2025
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South Africa’s Constitution from 1996 promised a 'progressive realisation' of health services, aiming for stepwise expansion of healthcare access and quality over time. This principle aligns with Ubuntu — the belief that 'I am because we are': emphasising shared welfare, dignity, and collective wellbeing. Yet, for oral health, the reality has been the opposite.

The newly crowned Miss South Africa 2024 enjoys a year of free dental care as part of her prize package. Offering dental care as a reward is a reminder that South Africa’s oral healthcare system is sharply divided: for a select few, dental care is a luxury they can afford; for the majority, it’s an unattainable dream. 

Those reliant on the public health system face decades of systemic neglect. As a result, millions of South Africans are left to endure toothache and tooth loss, with limited access to dental care. 

South Africa’s Constitution from 1996 promised a “progressive realisation” of health services, aiming for the stepwise expansion of healthcare access and quality over time. This principle aligns with Ubuntu — the belief that “I am because we are”: emphasising shared welfare, dignity, and collective wellbeing. Yet, for oral health, the reality has been the opposite. Rather than progress, public dental services have seen a sharp decline in availability and quality, even as oral disease rates continue to rise. 

Conditions such as tooth decay, gum disease, and oral infections not only cause pain, but also have far-reaching effects on general health, disrupt lives, harm self-confidence, reduce productivity and result in lost working days. 

This crisis is not unique to South Africa; it reflects larger, global public health challenges. The World Health Organization (WHO) in 2022 called the state of oral health “alarming”, with almost half the world’s population affected. In Africa alone, more than 480 million people struggle with untreated oral diseases every day. Yet, the African region has the lowest numbers of oral health professionals, and almost 60% of countries have no national plan on how to address oral diseases.

A system of pain and tooth extraction


What is driving this crisis? Beyond decades of underfunding, systemic negligence has played a major role. South Africa produces highly skilled dental professionals, with approximately 6,350 dentists, 780 dental therapists, and 1,250 dental hygienists registered with the Health Professions Council in 2024. To address staff shortages, newly qualified dentists must complete a year of community service in the overwhelmed and under-resourced public sector. However, this experience has become something many young dentists dread, as they are often limited to performing tooth extractions in overcrowded clinics rather than providing comprehensive care.

These clinics function as little more than “tooth-pulling” centres, focused almost entirely on emergency care to relieve pain and infections, rather than preventive or restorative treatments that could preserve oral health. The stark inequalities of apartheid-era healthcare persist: those who can afford private care receive high-quality treatment, while the majority must rely on extractions as their only option. Access to private or public healthcare remains largely divided along racial and socioeconomic lines, with more than 80% of the population dependent on public services, while only 16% are accessing private healthcare facilities.
Glaring leadership gaps

Further compounding the issue is the Ministry of Health’s near-total silence on oral health within the broader health policy landscape. The absence of the Oral Health Directorate from discussions and negotiations surrounding the National Health Insurance (NHI) Bill, which aims to provide universal access to quality healthcare for all South Africans, is a missed opportunity and underscores the lack of leadership and advocacy. The NHI could have been a vehicle to expand access to dental care; instead, the absence of dental care in these pivotal conversations reveals the disconnect from South Africa’s broader public health agenda. 





Additionally, South Africa has not conducted a national oral health survey in more than 20 years, leaving the country without accurate, up to date oral disease data. Without current information advocating for funding and policy improvements is hard. The lack of recent data keeps oral health out of sight and out of mind for policymakers, reinforcing the neglect.

In December 2024, the Ministry of Health finally released a new national oral health policy that has been in the making for more than five years. Its focus is on integrating oral healthcare with primary and chronic disease care, but it remains unclear how to achieve this goal. The policy seems outdated from the start and is not aligned with recent national, regional and international developments.

Silence of key stakeholders


Such neglect is not solely the government’s failing. The South African Dental Association (Sada), the main professional body for dentists, has done little to advocate for improvements in public oral health, despite its mission and mandate. Ideally, advocacy is central to the role of strong dental associations, in pushing for better policies, increasing public funding, and broadening awareness.

Yet, Sada’s priorities seem focused on private dental practitioners and their interests. The organisation's website lists no position statement on national oral health policy; instead, Sada opposed the signing of the National Health Insurance Bill in 2024, based (among others) on concerns about the “livelihood of practitioners”, without presenting a constructive alternative proposal.

Similarly, South Africa’s five dental schools remain largely out of the national policy discourse. Despite their potential and influence to advocate for science-based solutions for the country’s oral healthcare crisis, they focus almost entirely on education rather than actively engaging in the urgent need for policy change.

A return to Ubuntu: solutions for oral health reform


While the challenges are immense, they are not insurmountable. There are concrete steps that South Africa and other countries facing similar crises can take to reverse the neglect of oral health:

  1. The Ministry of Health must develop a strong, clear voice for oral health within national health policy discussions; all other stakeholders need to take up the mantle of advocacy and reunite behind a strong national oral health agenda.

  2. Integrate oral health into primary healthcare to ensure that essential oral healthcare is universally available at community clinics; and equip them with the required infrastructure and supplies.

  3. Expanding access through National Health Insurance (NHI) presents a critical opportunity to incorporate appropriate oral health services, and policymakers must ensure that dental care is not sidelined.

  4. Investing in prevention and public awareness is more cost effective than treatment; oral diseases can be largely avoided by self-care with daily oral hygiene and healthy diets.

  5. Strengthen the dental workforce by providing effective incentives to work in underserved areas; and expand service provision by mid-level providers like dental therapists and hygienists.

  6. Enhance data collection and policy research, because without accurate data, oral health remains invisible to policymakers.


At its core, Ubuntu teaches us that collective wellbeing depends on how we care for one another. Addressing the crisis in oral health requires a shared commitment from governments, professional organisations, and civil society to ensure that access to care is not a privilege but a fundamental right. 

If we are to truly honour Ubuntu in our healthcare system, we must recognise that oral health is an essential part of human dignity and social justice. Only then can we build a healthcare system that reflects the values of shared responsibility, equity, and compassion.

Sudeshni Naidoo is Professor Emeritus at the University of the Western Cape, Cape Town, and is director of the only World Health Organization Collaborating Center on Oral Health in the African region. Habib Benzian is a Professor at the College of Dentistry of New York University, New York, US, and is co-director of the only World Health Organization Collaborating Center on Oral Health in the region of the Americas. He is a former global health research fellow at the Stellenbosch Institute of Advanced Study and is a Public Voices Fellow of The OpEd Project.

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