oral disease burden amongst adults in india

BY : Dr. Vini Mehta

MDS 1st Year2

Oral Disease Burden amongst Adults in India

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Contents

DefinitionIntroductionMajor Oral DiseasesDeterminants of Disease BurdenNeed for Oral Health SurveyEfforts to Mitigate Disease BurdenBarriers to Disease Mitigation EffortsConclusionReferences

4Definition

Oral health is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity.

*World Health Organization survey 2003

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Introduction

Oral diseases have been identified as one of the priority health condition

High prevelance of dental diseases has led to substantial burden on individual, communities and health care system

The important role of sociobehavioural & environmental factors in oral health &disease has been shown in a large number of surveys.

Several oral diseases are linked to noncommunicable chronic diseases and general diseases have oral manifestations (e.g. diabetes or HIV/AIDS).

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Major Oral Diseases

• Dental Caries •Periodontal diseases•Dentofacial anamolies and malocclusion •Oral Cancer and other mucosal conditions•Dental Fluorosis•Edentulousness (Tooth Loss)•Other conditions : TMJ assessment , Enamel Opacities & Hypoplasia , Prosthetic Status

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Determinants of Disease Burden

Diet and NutritionTobacco smoking Abnormal oral habitsAccess to careAwareness and knowledge of dental problems Socio economic & demographic characteristics

of population

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Need for Oral Health Survey

Adverse effects of poor oral health necessitate preventive, curative & educational services

Requires people’s knowledge , awareness , attitude besides the magnitude of problems & treatment seeking measures

Basic information for formulation of policy, developing strategic measures , meeting appropriate manpower needs and creating programmes for improvement of oral health policies.

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Dental Caries

•Dental caries is an universal disease affecting all geographic regions, races, both the sexes and all age groups.

• Dental caries are the most common non-communicable disease in the world (Beaglehole, et al., 2009)

•The prevalence is expressed in terms of point prevalence & DMFT index

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CCCcDental Caries in India According to National Oral Health Survey in India (2002-2003)

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•Shourie(1941) for the first time in India conducted a multicentric epidemiological investigation in various parts of the country in the age group of 5-17 years.

•In India, dental caries directly affect around 60% of the population (Shah, 2005; Kaur, et al., 2010).

• The prevalence of dental caries is positively correlated with age (Agarwal, et al., 2010)

•Majority of older adults 65-74 years had a DMFT value between 25-32 (Bali, et al., 2004).

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•Tewari et al conducted a nationwide epidemiological study covering about 19 States and 2 Union territory

•The same 2004 survey by Bali, et al. found no gender difference in the prevalence of dental caries, but there was a higher prevalence of dental caries in rural populations as compared to urban.

•A recent study found that daily alcohol consumption was positively associated with dental decay (Borrell, 2009).

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Periodontal Diseases

Periodontal diseases are the commonest cause of tooth loos in India

High prevalence of periodontal diseases appears to have originated from early epidemiological studies using an index system

Albandar in an overview concluded that subjects of Asian ethnicity had the third highest prevalence of periodontitis

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According to NCMH

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National Oral Health Survey and Fluoride Mapping (2002-2003), Dental Council of India,

New Delhi, 2004 – first ever survey done in India .

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Under the Government of India and WHO, a multicentric oral health survey was done in 2004

The prevalence of loss of attachment (3 mm or more) was 78% in 35-44 years group and 96% in 65-74 years group in Maharashtra in the present study.

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Maharashtra 96%

Orrisa 90%

Delhi 85.5%

Rajasthan 75%

Uttar Pradesh 68%

Pondecherry 55%

Arunachal Pradesh 20%

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•Shah in her report for the National Commission on Macroeconomics observed that more advanced periodontal disease which could lead to tooth loss if not treated properly, may affect 40% to 45% of the population in India.

• Sood in a field survey in Ludhiana did a systematic sampling in the total population, 68.9% had bleeding gums, 97.0% had calculus, 29.1% moderate periodontitis and 12.5% had severe periodontitis . He found periodontal disease significantly associated with coronary artery disease

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Singh et al. did a prevalence study in the rural and urban subjects of Ludhiana. He found that the urban subjects had higher prevalence of moderate and severe periodontitis as compared to rural subjects.

Vandana et al. found 27% prevalence of periodontitis in fluorosis-affected patients . Prevalence increased with age and was significantly more among females.

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Greene’s study is one of the earliest studies. 97% of 11- 17-year had periodontal disease. Persons with obvious periodontal pockets constituted 0.2%, 0.4%, 1% and 6% in 11, 13, 15 and 17 year age groups, respectively.

Ramfjord et al. discussed a WHO survey done along with 4 other countries. They observed that there was 100% prevalence of periodontal disease in India

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Dentofacial anamolies and malocclusion

Malocclusion is not a disease but rather a set of dental deviations

Abnormal habits such as breathing from mouth, sucking/biting fingers, Tongue thrust , grinding nails

Andhra Pradesh, Gujarat , Himachal Pradesh and Maharashtra showed some prevelance of abnormal oral habits

There is a decrease in habits with increase in age

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According to National Oral Health Survey 2002-2003

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Oral Cancer

India has the highest prevalence of oral cancer in the world

It is the most common cancer in men and the fourth most common cancer in women, and constitutes 13%–16% of all cancers

Of all the oral cancers, 95% are related to the use of tobacco

Oral cancer has a high morbidity and mortality

Incidence varies between regions within a country.

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Distribution of oral mucosal conditions by location in mouth

Location Oral cancer Leukoplakia

Rural Hard and soft Palate Buccal mucosa

Urban Commisures of lip Buccal mucosa

National Vermilion border , hard and soft palate

Buccal mucosa

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Based on currently available data, males in Bhopal have the highest age incidence rates of cancer of the tongue (8.8 per 1 lakh) followed by Delhi(6 per 1 lakh)and Mumbai (5.7 per 1 lakh).

Similarly the rates of cancer of the oral cavity in both males and females in all urban registries are among the highest in the world

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Dental Fluorosis

Dental fluorosis is also known as ‘mottled enamel’

It manifests as chalky white or yellowish-brownish discoloration of the teeth

In India, a high fluoride content in ground water is endemic in some areas

The states that are most affected are AndhraPradesh, Gujarat and Rajasthan.

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According to NCMH

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Edentulousness (Tooth Loss)

Tooth loss results from dental caries, periodontal diseases and trauma. Tooth loss increases with advancing age.

Loss of the teeth results in decreased masticatory efficiency, causing a shift in dietary practices. This may result in nutritional deficiencies.

Tooth loss may also cause problems in speech and affect aesthetics, causing an overall and loss of self-esteem and confidence

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Age Group (in years)

Number of missing teeth

Edentulousness (%)

60-64 8.5 11.1

65-74 10.9 19.4

75+ 18.1 32.3

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According to NCMH 2005

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Efforts to Mitigate Disease Burden

ICTPH hired a dentist of Rural Micro Health Center (RMHC) for basic dental treatments.They have formulated 3 tiered intervention plan

National Oral Health Care Programme was established in 1998, targeted at providing oral health care (Kishor, 2010)

Oral health for all by 2010 was proposed by Indian government

National Commission on Macroeconomics and Health (NCMH) is working on improvement in reducing oral diseases.

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WHO Response

Public health solutions for oral diseases are effective when they are integrated with chronic diseases and with national public health programmes. The WHO Global Oral Health Programme aligns its work with the strategy of chronic disease prevention and health promotion. Emphasis is put on developing global policies in oral health promotion and oral disease prevention, including:

building oral health policies towards effective control of risks to oral health;

stimulating development and implementation of community-based projects for oral health promotion and prevention of oral diseases, with a focus on poor population groups;

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encouraging national health authorities to implement effective fluoride programmes for the prevention of dental caries

advocacy for a common risk factor approach to simultaneously prevent oral and other chronic diseases and

providing technical support to countries to strengthen their oral health systems and integrate oral health into public health.

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Barriers to Disease Mitigation Efforts

High cost for services, long travel to reach dentist and low dentist to population ratio

No follow-up care, or providing a referral for a treatment raises the prevalence of disease

Government has not implemented nation wide programmes

Government has focused on preventive care which is not enough

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Conclusion

India has vast geographic area divided into states, which differ with regard to their socioeconomic, educational, cultural and behavioral tradition.

These factors may affect oral health status. Hence to obtain nationwide representative data, nationwide multicentric study is required.

More practicable alternative is to develop regional database; review of such observations from various regions may give understanding of national scenario

With the continuing burden of communicable conditions, India is in the classic bind of facing a ‘dual’ burden of disease.

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References

Shawn Lin & Allison Mauk- Oral Health: Addressing Dental Diseases in Rural India

Nazeem Shah- Burden of diseases in India:National Commission on Macroeconomics and Health, Government of India (2005)

The global burden of oral diseases and risks to oral health- Poul Erik Petersen,1 Denis Bourgeois,1 Hiroshi Ogawa,1 Saskia Estupinan-Day,2 & Charlotte

Shah N, Pandey RM, Duggal R, Mathur VP, Rajan K. Oral Health in India

oral disease burden amongst adults in india

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