All Major Oral Diseases are discussed

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2. BY : Dr. Vini Mehta
MDS 1st Year
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Oral Disease Burden amongst Adults in India

3. Contents
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 Definition
 Introduction
 Major Oral Diseases
 Determinants of Disease Burden
 Need for Oral Health Survey
 Efforts to Mitigate Disease Burden
 Barriers to Disease Mitigation Efforts
 Conclusion
 References

4. Definition
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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

5. Introduction
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 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).

6. Major Oral Diseases
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• 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

7. Determinants of Disease Burden
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 Diet and Nutrition
 Tobacco smoking
 Abnormal oral habits
 Access to care
 Awareness and knowledge of dental problems
 Socio economic & demographic characteristics of
population

8. Need for Oral Health Survey
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 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.

9. Dental Caries
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•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

10. CCCc
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Dental Caries in India According to National
Oral Health Survey in India (2002-2003)

11. •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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12. •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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13. Periodontal Diseases
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 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

14. According to NCMH
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15. Mapping (2002-2003), Dental Council of India,
New Delhi, 2004 – first ever survey done in
India .15

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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%

18. •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

21. Dentofacial anamolies and malocclusion
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 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

22. According to National Oral Health Survey 2002-
2003
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23. Oral Cancer
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 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.

24. According to National Oral Health Survey 2002-
2003
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25. Distribution of oral mucosal conditions by location in mouth
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Location Oral cancer Leukopla
kia
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

27. Dental Fluorosis
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 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.

28. According to NCMH
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30. According to National Oral Health Survey 2002-2003
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31. Edentulousness (ToothLoss)
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 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

32. According to National Oral Health Survey 2002-
2003
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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

33. According to NCMH2005
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34. Effortsto Mitigate Disease Burden
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 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.

35. WHO Response
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 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.

37. Barriers to Disease Mitigation Efforts
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 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

38. Conclusion
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 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.

39. References
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 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

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