The impact of social and commercial determinants on the unequal increase of oral disorder disease burdens across global, regional, and national contexts

Over the past three decades, oral disorders have emerged as a pressing global public health issue, affecting more than 3.5 billion people by 2021. Despite being largely preventable, the burden of oral disorders remains disproportionately high in low- and middle-income countries (LMICs), where fragile healthcare systems, limited access to oral health professionals, and increased consumption of unhealthy products exacerbate existing inequalities. The Global Oral Health Action Plan and the Bangkok Declaration underscore the importance of addressing commercial determinants as key drivers of oral health inequities. We utilized data from the Global Burden of Disease 2021 (GBD 2021) study to analyze the burden of oral disorders—including incidence, prevalence, and disability-adjusted life years (DALYs)—across 204 countries and territories, stratified by Socio-demographic Index (SDI). Temporal trends were examined using the Age-Period-Cohort (APC) model, and spatial heterogeneity in social and commercial determinants (e.g., income, urbanization, dentist density, sugar and alcohol consumption) were assessed using Geographically Weighted Regression (GWR). In 2021, oral disorders accounted for 23.24 million DALYs globally, with LMICs experiencing the most pronounced increase in burden, particularly in South Asia and Latin America. Middle-SDI regions exhibited the highest annual growth in incidence (EAPC = 0.3274), associated with rapid socioeconomic transitions and adoption of Westernized lifestyles. The APC model revealed divergent age effects: incidence peaked in younger cohorts (0–9 years), whereas DALYs increased with age and peaked in middle-aged adults in LMICs. GWR analysis identified substantial spatial variation in determinants. Among social factors, higher income and urbanization were associated with reduced burden in LMICs, while dentist density was more effective in high-income countries (HICs). Among commercial factors, sugar and tobacco consumption significantly increased risk in LMICs—especially in East Asia and Africa—whereas the effects of alcohol consumption were mixed. Oral health inequities are driven by unequal exposure to social and commercial determinants, with LMICs shouldering the greatest share of preventable burden. Policy efforts should prioritize intersectoral actions to regulate harmful commercial practices, strengthen primary oral health care in underserved regions, and integrate oral health into universal health coverage frameworks. Addressing upstream determinants—rather than focusing solely on clinical care—is essential to reducing global disparities in oral health.