A new Global Oral Health Status Report published recently by the World Health Organization (WHO) provides the first-ever comprehensive picture of oral disease burden with data profiles for 194 countries, giving unique insights into key areas and markers of oral health that are relevant for decision-makers. The HEALTH PIONEER takes stock of dental health status in India.
The WHO report paints a bleak picture on dental status, saying that almost half of the world’s population (45% or 3.5 billion people) suffer from oral diseases, with 3 out of every 4 affected people living in low- and middle-income countries. Global cases of oral diseases have increased by 1 billion over the last 30 years—a clear indication that many people do not have access to prevention and treatment of oral diseases.
“Oral health has long been neglected in global health, but many oral diseases can be prevented and treated with the cost-effective measures outlined in this report,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “WHO is committed to providing guidance and support to countries so that all people, wherever they live and whatever their income, have the knowledge and tools needed to look after their teeth and mouths, and to access services for prevention and care when they need them.”
Rapid increase of
The most common oral diseases are dental caries (tooth decay), severe gum disease, tooth loss and oral cancers. Untreated dental caries is the single most common condition globally, affecting an estimated 2.5 billion people. Severe gum disease is a major cause of total tooth loss. It is estimated to affect 1 billion people worldwide. About 380 000 new cases of oral cancers are diagnosed every year.
The report underscores the glaring inequalities in access to oral health services, with a huge burden of oral diseases and conditions affecting the most vulnerable and disadvantaged populations. People on low incomes, people living with disabilities, older people living alone or in care homes, those living in remote and rural communities and people from minority groups carry a higher burden of oral diseases.
This pattern of inequalities is similar to other noncommunicable diseases such as cancers, cardiovascular diseases, diabetes, and mental disorders. Risk factors common to noncommunicable diseases such as high sugar intake, all forms of tobacco use, and harmful use of alcohol all contribute to the global oral health crisis.
Barriers to delivering oral health services
Only a small percentage of the global population is covered by essential oral health services, and those with the greatest need often have the least access to services. The key barriers to delivering access to oral health services for all include:
l Oral health care requires high out-of-pocket expenditures. This often leads to catastrophic costs and significant financial burden for families and communities.
l The provision of oral health services largely relies on highly specialized providers using expensive high-tech equipment and materials, and these services are not well integrated with primary health care models.
l Poor information and surveillance systems, combined with low priority for public oral health research are major bottlenecks to developing more effective oral health interventions and policies.
Opportunities to improve global oral health
The report showcases many promising opportunities to improve the state of global oral health including:
l Adopting a public health approach by addressing common risk factors through promoting a well-balanced diet low in sugars, stopping use of all forms of tobacco, reducing alcohol consumption and improving access to effective and affordable fluoride toothpaste.
l Planning oral health services as part of national health and improving integration of oral health services in primary health care as part of universal health coverage.
l Redefining oral health workforce models to respond to population needs and expanding competencies of non-dental healthcare workers to expand oral health service coverage; and
l Strengthening information systems by collecting and integrating oral health data into national health monitoring systems.
In 2022, the World Health Assembly adopted a global strategy on oral health with a vision of universal health coverage for oral health for all individuals and communities by 2030. A detailed action plan is under development to help countries translate the global strategy into practice. This includes a monitoring framework for tracking progress, with measurable targets to be achieved by 2030.
Betel quid: Dangerous yet popular carcinogen in India?
Betel quid chewing with tobacco is one of the most common forms of smokeless tobacco and is used by approximately 600 million individuals worldwide, with a higher prevalence in South and South-East Asia and the Pacific islands. The effect of betel quid chewing is a general stimulation, similar to the effects of tobacco or caffeine.
Betel quid is a mixture of areca nut (nut of a palm tree, Areca catechu), slaked lime (calcium hydroxide) and betel leaf (leaf of the piper betel vine), and it can have tobacco (mainly in South-Central Asia) or not (in East Asia and Melanesia). All of the ingredients are wrapped inside the betel leaf and made into a bunch commonly known as a "quid," which is then chewed. It stains teeth and tissues dark red and is spit out after chewing for a few hours.
Dental Health Care Market Surge Ahead
According to The Business Research Company's research report on the oral care market, increased awareness of dental health care is significantly contributing to the growth of the oral care market. Dental or oral health includes teeth, gums, and mouth and aims to keep the mouth healthy and avoid
gum disease and tooth decay. Various factors, including sugar consumption, cigarette use, alcohol use, and poor oral hygiene, are the root causes of oral diseases.
Oral care helps to maintain hygiene and keep the mouth disease free. According to the 2022 State of America's Oral Health and Wellness Report, a US-based association that provides crucial education and research and supports key policies to prevent dental disease, 92% of adults and 96% of parents say maintaining good dental health is very important for overall health. One in five (20%) persons think that a problem with their oral health directly impacted their general health. Therefore, awareness of dental health care drives the oral care market growth.
Technological advancement too is not left behind
It is gaining popularity in the oral care market trends. According to reports, major players in the oral care market are adopting CAD/CAM technology for providing oral care services. CAD stands for "computer-assisted design" that uses computer-based software to assist in design processes and producing two-dimensional (2-D) drawings and three-dimensional (3-D) models. Computer-Assisted Manufacture (CAM) helps to automate a production process via software and computer-controlled equipment. In oral care with CAD/CAM technology, the tooth is prepared for the crown by drilling it and then a computer image is taken. The crown is made in-office using a machine that receives this image. For instance, in February 2022, Planmeca, US-based dental imaging and CAD/CAM equipment manufacturer, introduced the Planmeca PlanMill35. The new Planmeca PlanMill 35 is one of three components of the Planmeca FIT CAD/CAM system.
“Placing people at the heart of oral health services is critical if we are to achieve the vision of universal health coverage for all individuals and communities by 2030. This report acts as a starting point by providing baseline information to help countries monitor progress of implementation, while also providing timely and relevant feedback to decision-makers at the national level. Together, we can change the current situation of oral health neglect.”
—Dr Bente Mikkelsen
WHO Director for Noncommunicable Diseases.
Growing Burden of Oral Health Care in India
According to reports, in India, about 85 per cent to 90 per cent of adults have dental cavities, along with about 60 to 80 per cent of children. Also, around 30 per cent of children have misaligned jaws and teeth. Over 50 per cent of Indians with dental health issues receive treatment or advice from someone other than a dentist, such as chemists.
About 51 per cent of Indians use a toothbrush and toothpaste to brush their teeth. Around 28 per cent brush their teeth the recommended two times a day, find the reports.
The 136 000 new cases and 75 000 deaths occurring in India alone account for 36% of all new cases and 42% of deaths from oral cancers worldwide. The South-East Asia Region has a 52% share of deaths from oral cancer.
The burden of the main oral diseases 49 Oral cancer contributes to about 30% of cancer cases in India, with more than 130 000 new cases diagnosed in 2020, according to the Global Cancer Observatory. This represents two thirds of registered cancer cases of the National Cancer Registry Programme. In 2021, it was reported that nearly one out of every four adults in India consumes betel nut, of which around 10% is mixed with tobacco. The large number of users of betel nut, a known carcinogen and risk factor for oral cancer, presents a huge public health challenge for the country.