Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. MethodsWe used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including

75Oral diseases are a major global public health problem affecting over 3.5 billion people. 76Dentistry however has failed to tackle this problem. A fundamentally different approach is 77 now needed. In this second paper on oral health, we present a critique of dentistry 78 highlighting its key limitations and the urgent need for system reform. In high-income 79 countries (HIC) the current treatment-dominated, increasingly high-tech, interventionist and 80 specialised approach, is failing to tackle the underlying causes of disease and is not 81 addressing oral health inequalities. In low-and middle-income countries (LMIC) the 82 limitations of "westernised" dentistry are most acutedentistry is often unavailable, 83 unaffordable and inappropriate to the majority of these populations, but particularly the rural 84 poor. Rather than being isolated and separated from the mainstream health care system, 85 dentistry needs to be more integrated with primary care services in particular. The global 86 drive for universal health coverage (UHC) provides an ideal opportunity for this. Dental care 87 systems should focus more on promoting and maintaining oral health and achieving greater 88 oral health equity, rather than the interventionist treatment approach that currently dominates. 89Sugar, alcohol and tobacco use and their driving social and commercial determinants are the 90 underlying causes of oral diseases, common risks shared with a range of other non-91 communicable diseases (NCDs). Coherent and comprehensive regulation and legislation is 92 needed to tackle these shared risk factors. In this paper we focus on the need to reduce sugars 93 consumption through the adoption of a range of upstream policies designed to combat the 94 corporate strategies used by the global sugar industry to promote sugar consumption and 95 profits. At present the sugar industry is influencing dental research, oral health policy and 96 professional organisations through its well-developed corporate strategies. There is a pressing 97 need to develop clearer and more transparent conflict of interest policies and procedures to 98 limit and clarify the influence of the sugar industry on research, policy and practice. 99

The findings showed that caregivers of young children with oral disease and disorders perceived that both the children and other family members had poorer quality of life. Oral health policies should be included into general health programs based on common risk approach.

The objective of this study was to assess the prevalence and type of accidents that resulted in traumatic injuries to the permanent dentition of 12-year-old school children in Florianópolis, Brazil. A dental trauma cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 307 12-year-old school children enrolled in public primary schools. Intra-examiner diagnosis variability was good, measured by kappa values on tooth-by-tooth basis. The prevalence of dental injury was 18.9%. There was no statistical difference in the prevalence between boys and girls (P = 0.103). The main types of accidents that resulted in dental injuries were falls and collisions with objects or people. It can be concluded that the prevalence of dental injuries in Florianópolis, Brazil is high and they have a great potential to be considered an emerging public health problem.

Summary Background Elevated blood pressure and glucose, serum cholesterol, and body mass index (BMI) are risk factors for cardiovascular diseases (CVDs); some of these factors also increase the risk of chronic kidney disease (CKD) and diabetes. We estimated CVD, CKD, and diabetes mortality attributable to these four cardio-metabolic risk factors for all countries and regions between 1980 and 2010. Methods We used data on risk factor exposure by country, age group, and sex from pooled analysis of population-based health surveys. Relative risks for cause-specific mortality were obtained from pooling of large prospective studies. We calculated the population attributable fractions (PAF) for each risk factor alone, and for the combination of all risk factors, accounting for multi-causality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific PAFs by the number of disease-specific deaths from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all inputs to the final estimates. Findings In 2010, high blood pressure was the leading risk factor for dying from CVDs, CKD, and diabetes in every region, causing over 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths; and cholesterol for 10%. After accounting for multi-causality, 63% (10.8 million deaths; 95% confidence interval 10.1–11.5) of deaths from these diseases were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7.1 million deaths; 6.6–7.6) in 1980. The mortality burden of high BMI and glucose nearly doubled between 1980 and 2010. At the country level, age-standardised death rates attributable to these four risk factors surpassed 925 deaths per 100,000 among men in Belarus, Mongolia, and Kazakhstan, but were below 130 deaths per 100,000 for women and below 200 for men in some high-income countries like Japan, Singapore, South Korea, France, Spain, The Netherlands, Australia, and Canada. Interpretations The salient features of the cardio-metabolic epidemic at the beginning of the twenty-first century are the large role of high blood pressure and an increasing impact of obesity and diabetes. There has been a shift in the mortality burden from high-income to low- and middle-income countries.

The objective of this study was to assess the prevalence, aetiology, place of occurrence and rates of treatment of traumatic dental injuries (TDI) among 12-year-old schoolchildren in Herval D'Oeste, Brazil. A cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 297, 12-year-old schoolchildren enrolled in public and private schools. Intra-examiner diagnosis variability, measured by kappa values on tooth-by-tooth basis was above 0.7. The prevalence of TDI was 17.3% (95% CI 12.7-21.9). Children who had an incisal overjet size >5 mm were 3.5 (95% CI 1.5-8.1) times more likely to have TDI than children who had an incisal overjet of <5 mm (P = 0.005). The most common type of injury found was enamel fracture alone. Of the total of 87 traumatized teeth, only 27.6% were treated. Acid etch restorations were the most common treatment provided. Acid etch restorations were the most common type of treatment needed. The majority of the cases of TDI occurred at home (17.8%) and at school (17.8%). Collisions (24.5%), mainly with doors, and physical leisure activities (20.0%) such as cycling and playing soccer were the main activities related to TDI aetiology. It can be concluded that there is a great treatment need reflecting neglect of TDI treatment. The main causes of TDI were collisions and physical leisure activities.

Harmful social and biological risk factors accumulated in early life contributed to the development of a high level of dental caries in childhood.

The prevalence of dental erosion in 12-year-old schoolchildren living in a small city in southern Brazil appears to be lower than that seen in most of epidemiological studies carried out in different parts of the world. Further longitudinal studies should be conducted in Brazil in order to measure the incidence of dental erosion and its impact on children's quality of life.