India’s Neglect of Oral Health Linked to Wide Range of Public Health Problems
Bacteria that enter the bloodstream from the mouth can worsen diabetes, increase heart disease and autoimmune disease risk, and more.
In India, the prevalence of oral disorders such as tooth decay, gum disease, and oral cancers has remained steadyfor the past three decades, but their incidence is only set to rise. The findings are published in a series of studies on oral health in The Lancet medical journal.
The Ministry of Health and Family Welfare estimates that currently, about 60% of India’s adult population and 70% of its school-going children are affected by dental caries (cavities) or tooth decay. And, periodontal disease — infections of the tissue around the teeth — has ended up affecting at least 85% of the population. The country is also considered the world capital for oral cancer.
“Dental caries is one of the major causes of pain, discomfort, and absenteeism from school and sometimes, office work, too. Gingival [gum–related] and periodontal diseases also account for tooth loss and associated disabilities,” Anil Kumar Chandna, member of the Dental Council of India (DCI) told LiveMint.
Decay, stains, loss of teeth and bad breath are side effects of maintaining poor oral health that most people are aware of. But our mouth is the breeding ground for more than 700 species of bacteria, says Smriti Bouri, a principal consultant in general and aesthetic dentistry at Delhi’s Max Multispeciality Centre that can ultimately lead to more serious conditions, such as heart diseases, diabetes, and pregnancy complications.
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“Bacteria present in gum diseases enter the bloodstream and this, in turn, increases the risk of heart attacks, poorly controlled diabetes, respiratory diseases and dementia,” Ambereen Ali, a consultant in dentistry at Mumbai’s Jaslok Hospital, told LiveMint. “Research has also shown that a diseased mouth may contribute to immune system disorders and preterm birth. Also, there are many general health conditions such as AIDS and skin diseases which often first manifest in the mouth.”
Speaking of how the two may be related, another study found that among those with established coronary heart disease, periodontal disease increased the likelihood of a recurrent coronary event by nearly 1.5 times.
In India, according to the draft National Oral Health Policy, the proportion of untreated caries of permanent teeth and severe periodontitis is the maximum compared to other oral disorders. Yet, only 12.4% of adults have ever had their mouth examined by a dentist, the draft suggests, potentially increasing the risk of other conditions. One reason, experts say, behind this abysmal figure is that people neglect oral hygiene or consider it secondary to general health. Additionally, on a broader level, oral care is rarely thought of as a mainstream part of health care practice and policy, despite the major global public health burden of such diseases, according to Dr. Jocalyn Clark, an executive editor at The Lancet.
In India, it was only in 2018, that creating awareness and provisions for screening and symptomatic care of oral diseases were mentioned in public schemes, like the Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana, which aim at strengthening primary health care and providing financial protection to the most vulnerable sections of society. These efforts also mentioned counseling for tobacco cessation and referral to tobacco cessation centers.
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But despite these provisions and scientific advancements in the field, according to The Lancet, the prevalence of oral disorders have only increased in low- and middle-income countries, including India. It has also risen especially among socially disadvantaged and vulnerable people, “with even basic dental care unavailable and most diseases remaining untreated,” LiveMint reported.
According to Chandna, this is because of the inaccessibility to dental professionals and the lack of infrastructure needed for dentistry. A dearth of both means, “even the simplest of procedures are unavailable to the common man — who then has to bear the treatment expenses. In such a situation he is usually forced to get his tooth extracted as this seems to be relatively cheaper without any awareness of the associated morbidity,” he told LiveMint.
“While this breakdown in the delivery of oral healthcare is not the fault of individual dental clinicians committed to caring for their patients, a fundamentally different approach is required to effectively tackle to the global burden of oral diseases,” said Professor Richard Watt, chair and honorary consultant in dental public health at University College, London, and lead author of The Lancet series on oral health. But until these steps are taken, he says, for now, “Dentistry is in a state of crisis.”
Anubhuti Matta is an associate editor with The Swaddle. When not at work, she's busy pursuing kathak, reading books on and by women in the Middle East or making dresses out of Indian prints.