“A smile is a curve that sets everything straight”, said Phyllis Diller. Oral health is associated with a range of functions – chewing and swallowing food, speaking, smiling, touch and tasting. Good oral health boosts confidence and contributes to overall personality of a person.
The Federation Dentairel Internationale (FDI), the international representative body of dentistry based in Geneva, Switzerland, celebrates the 20th of March every year as World Oral Health day to raise awareness of the importance of good oral health and its impact on general health and well-being. This year’s theme - ‘live mouth smart’ - is aimed at empowering people to take control of their oral health throughout their life so they can enjoy a healthy and functional mouth from childhood into old age. With toolkits, posters, infographics, videos and a smartphone game called mad mouths, WOHD is being celebrated all over the world.
But why the 20th of March - it was chosen to reflect that the elderly should have a total of 20 natural teeth, at the end of their life, and children should have 20 deciduous or milk teeth, to be considered healthy. Also, healthy adults must have a total of 32 teeth and zero dental cavities and when expressed on a numerical basis, this can be translated as 3/20 hence March 20th was chosen as the WOHD.
Oral diseases and its causes
Globally, oral hygiene is one of the most neglected health areas and oral diseases affect nearly 3.9 million people worldwide. According to the global ‘Burden of Disease’ study, untreated dental decay is seen in almost half of the world’s population, making it the most prevent disease among the 291 diseases in the world. Oral disease is associated with significant pain and anxiety. Direct treatment costs due to dental diseases worldwide were estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure.
Alcohol, tobacco, sugars and stress, which are commonly associated with diseases such as cancers, heart diseases, diabetes and obesity, also trigger oral diseases such as tooth decay. Recent research highlight the role of poor oral hygiene contributing to dental decay and gum diseases, which in turn, can cause diabetes and heart-related diseases. Poor oral hygiene in pregnant women can trigger hormonal reactions, which can cause early delivery and sometimes, result in low birth weight in babies.
Recent research points to climate change as one of the factors affecting oral health. Increasing fluoride content in drinking water drawn from ground wells results in a condition called fluorosis, when such water is consumed. Fluorosis affects hard tissues like bones and teeth, making them brittle. Climate change is contributing to the increase in fluoride-rich water sources that were previously harmless. In addition, socioeconomic factors like poverty, unemployment, illiteracy, etc. affect oral health in disguise. According to a study conducted in Bhopal, dental decay was 2.5 times higher among children in slum areas compared to children living in rural areas. .
Oral diseases are the fourth most expensive disease to treat, hence forcing people to skip regular dentist visits and lose the opportunity to be treated in time. When the condition worsens and tooth pain becomes unbearable, people get the tooth extracted. As many of them cannot afford a replacement tooth, they become toothless, which affects their nutrition status. Those with weak teeth tend to eat soft food, thus narrowing their choice of food. As the lifespan of people is increasing, the presence of strong teeth becomes one of the most important factors affecting the quality of our life.
Oral health situation in India
India’s medical knowledge on oral health dates back to the days of Sushruta Samhita. Fleshy growths of the palate and cancerous growths over the wisdom teeth were often cut and tumours on the tongue or on the gums were burnt. There is a description of 101 yantras or dental instruments that were used including the dantashanka, a special forceps for extracting teeth. Knowledge on maintenance of oral hygiene and treatment measures for oral diseases are mentioned in Ayurveda, Siddha and Unani. Clove is the best numbing agent used for toothache in every house, while neem twigs are still used to clean teeth in many parts of rural India.
In spite of these traditional advances, the oral health situation in India is gloomy and is one of the most commodified health care industries with escalating costs. Toothpaste, a basic therapeutic agent, is instead considered a cosmetic necessity. A study co-authored in 2008 by Prof. Habib Benzian of the New York University found out that nearly two third of a day’s household expenditure is needed to purchase the annual average dosage (182.5 g) of the lowest cost toothpaste by the poorest 30% of the population in India.
Though India has the highest number of dental graduates in the world graduating out of nearly 300 dental colleges, the distribution of dentists is highly skewed with 80% of the dentists in urban areas. The lack of dental insurance, information on oral diseases and oral health policies pose a challenge today. Most of such policies, if present, focus more on curing them rather than prevention. “Oral diseases are not life threatening like malaria, HIV/AIDS or cancer, and hence has to compete for budget. But it cannot be neglected”, had opined Ms. K Sujatha Rao, former Union Health Secretary, when asked about it during a recent session in Bangalore.
Tackling the issues of oral diseases
Oral diseases today are a major public health problem owing to their high prevalence and incidence, mostly in the disadvantaged and socially marginalized section of the society. In addition to poverty, a shortage of economic resources and the lack of reliable information on available workforce and the prevalence of oral diseases, for health authorities, cripples plans to improve oral health and provide adequate training.
Some countries have tried to bring about a behavioural change among people by taxing sugar products, tobacco and alcohol, the major factors that spur oral diseases. Countries like Britain, Belgium, France, Hungary and Mexico levy ‘sugar tax’ - a tax on drinks with total sugar content above 5 grams per 100 ml. and thus joined, all of which have imposed some form of tax on drinks with added sugar.
In India, there are a few government programs like the Rashtriya Bal Swasthya Karyakram that focuses on prevention of tooth decay until 18 years. The Karnataka state government’s Dhantha Bhagya Yojane provides free denture to those below poverty line. The World Health Organization’s basic package of oral healthcare that provides primary care through health workers is one of the successful programs that have showed positive results in Bangladesh and some African countries.
The oral cavity is the gateway to our body and hence a good oral health leads to a healthy life. Days like WOHD aim to bring a paradigm shift in our understanding of oral diseases and the need to maintain a healthy mouth, which boosts our appearance and personality. It also provides an opportunity to spare a thought about those pearly teeth that bring a smile, the tongue that tastes our food and the gums that bring the blush.