Why prevention is failing in oral health and a wake up call for rethinking strategies for the world’s most widespread non communicable disease (NCD)

Abstract Despite decades of evidence demonstrating that dental caries, periodontal disease, and tooth loss are largely preventable, oral diseases remain the most prevalent noncommunicable diseases worldwide. Traditional prevention strategies—focused heavily on individual behavior, clinical advice, and downstream treatment—have failed to alter the global trajectory of disease. This commentary analyzes why prevention is not working in oral health and argues that the field has been constrained by an outdated biomedical model, commercial determinants of health, structural inequities, and chronic underintegration with the wider NCD agenda. We propose a paradigm shift: from chairside advice to population-level regulation; from treatment-focused financing to prevention-driven incentives; and from an isolated dental sector to a fully integrated component of primary health care and public health systems. To conceptualise this shift, we introduce the STRUCTURE framework, a systems-oriented model that integrates policy reform, regulatory action, health system integration, financing transformation, and equity-focused prevention strategies. Without addressing the structural, political, and commercial forces driving poor oral health, prevention will continue to underperform, and oral diseases will remain the world’s most neglected global health crisis.