Oral Health: Why your smile matters

A couple of days ago, the world celebrated World Oral Health Day, bringing attention to the importance of oral health in our overall well-being. While it has been twenty years since I have treated a patient, I still think about the dental profession and oral health in general. As a former dental surgeon who has practiced both in India and the UK, I have seen the effects of poor oral health firsthand, particularly among underserved populations. This is why I founded ToothAngels Foundation, a voluntary organization that aimed to provide oral health access to people living in slums and villages in and around Bangalore.

ToothAngels Foundation was established as a solution to address the burden of oral diseases that affect billions of people worldwide. According to the World Health Organization (WHO), nearly 3.5 billion people are affected by oral diseases, with three out of four people in lower-middle-income countries being affected. In India, for instance, almost half of the children aged 1 to 9 years old have caries in their milk teeth, while a third of untreated caries are in their permanent teeth. Fluorosis is also a severe public health problem in India, with almost two-thirds of states being fluoride endemic. Approximately, 25 million people are affected by fluorosis, and 66 million are at risk of developing fluorosis, including children.

Despite India having a high dentist-to-people ratio of one dentist per 5000 persons, it has a skewed distribution of dentists, with one dentist for about 2,500,000 persons in rural areas against the national average of 5,000 persons. There are also no other oral health professionals like oral hygienists, and dental colleges are concentrated in the southern states of Karnataka, Maharashtra, and Tamil Nadu, causing a serious demand and supply mismatch.

To me working on oral health never started and ended in the mouth. WHO estimates that oral diseases are directly linked to other health problems such as bacterial endocarditis, atherosclerosis, chronic obstructive lung diseases, and preterm low birth weight. For this reason, oral health should not only focus on the mouth but on the overall health of individuals. Unfortunately, the burden of the oral disease affects people disproportionately, particularly among underserved populations.

Several studies shed light on the demographic profile against the burden of disease, with the Paniya tribe in Kerala having a 76.9% periodontal disease and 40% caries prevalence. Among Sugali tribes, 80% had poor teeth due to tobacco, and 49% had dental fluorosis. Bharias in Madhya Pradesh also had 35.4% periodontal pockets (extreme gum disease). A study among 606 pregnant women in a government maternity hospital in Hyderabad found that 90.1% of them were unaware of oral hygiene aids, and approximately 74% of women were unaware that there is a relationship between oral health and pregnancy.

Treatment of oral diseases is expensive, with most care provided by private institutes, and there is limited or no insurance coverage for oral health problems. Globally, the total direct expenditure for oral diseases is about USD 50 per capita in 2019, with the lowest per capita direct expenditure in the South-East Asian region of USD 0.52 per capita. A study by the Department of Public Health Dentistry, Rungta College of Dental Science and Research, Bhilai, shows that Indians can incur an annual expenditure of ? 2254 to ? 7122 per person on dental treatment in a year.

As a champion of health equity, I believe that oral health is a fundamental aspect of overall health and well-being, and it is critical to meet the 3rd sustainable development goal. To achieve this goal, we must address the burden of oral disease by ensuring access to quality oral health care for all individuals.?

One simple intervention that can ease the burden of oral disease is promoting oral hygiene education and awareness. This can be achieved by incorporating oral health education in school curricula, community outreach programs, and through various media channels. Additionally, we need to promote access to affordable and quality oral health services, particularly in underserved areas.

To achieve these goals, there needs to be a concerted effort from governments, policymakers, dental professionals, and community leaders. This includes investing in dental education and training programs, incentivizing dental professionals to work in underserved areas, and implementing policies that promote affordable and accessible oral health services.

It is also important to address the systemic factors that contribute to poor oral health outcomes, such as poverty, lack of access to clean water, and poor nutrition. By addressing these underlying issues, we can prevent and reduce the burden of oral disease in vulnerable populations.

In conclusion, oral health is an essential aspect of overall health and well-being. The burden of oral disease is significant, particularly in low- and middle-income countries, and it disproportionately affects vulnerable populations. To achieve the Sustainable Development Goals by 2030, we must prioritize oral health education, increase access to affordable and quality oral health services, and address the systemic factors that contribute to poor oral health outcomes. By doing so, we can improve the oral health and overall health of millions of people worldwide.