Burden of Oral and Dental Diseases

Burden of Oral and Dental Diseases

• Untreated tooth decay affects 34% of the global population.
• The Global Burden of Disease (GBD) 2019 study examined 286 causes of death, 369 diseases & injuries, and 87 risk factors.
• Disease burden is measured in Disability-Adjusted Life Years (DALYs). One DALY represents one lost year of healthy life.
• Oral disorders are among the top causes of disability worldwide.
• Global oral diseases affect approximately 3.5 billion people.
• Two billion people have caries in their permanent teeth, and 520 million children have caries in their primary teeth.

Measurements of Burden of Disease

• Incidence rate: The number of new cases within a defined population during a specific time period.
• Prevalence: The total number of individuals with an attribute or disease at a particular time or during a period, divided by the population at risk.
• Life expectancy: The average number of years a member of a group is expected to live.

Disability-Adjusted Life Years (DALYs)

• DALYs measure the overall health burden due to premature mortality or disability
• YLL (Years of Life Lost) – The number of deaths at various ages multiplied by the expected future life expectancy.
• YLD (Years Lived with Disability) – The number of incident cases multiplied by the average disease duration and severity scoring.

Health Adjusted Life Expectancy (HALE)

• HALE estimates the average number of years a newborn is expected to live in full health, based on current rates of ill-health and mortality.

Assessment of Risk Factors in the GBD

• The GBD uses a three-level hierarchical system for risk factors:
  • Level 1: Clusters of risk factors with shared mechanisms.
  • Level 2: Major risk factors within clusters.
  • Level 3 (and 4): More detailed subdivisions, with Level 4 being the most detailed.

GBD Classification of Oral Diseases

• GBD categorises disease causes into a four-level hierarchy.
• Level 1 combines aggregates including non-communicable, and infectious diseases.
• Level 2 groups these into disease and injury aggregates.
• Level 3 provides more specific causes such as tuberculosis and road injuries.

Oral Disorders - Level 3 Cause

• In 2019, Oral Disorders were the 10th major cause of disability globally with 23.1 million YLDs.
• For the same year, these disorders ranked 1st and 3rd for prevalence(3.48 billion cases) and incidence (4.35 billion cases).
• These disorders cover caries of teeth (deciduous and permanent), chronic periodontal diseases, edentulism (total tooth loss).

Dental Caries - Level 4 Cause

• Dental caries of permanent teeth, in 2019, caused 2 million YLDs and ranked 1st and 3rd in terms of global prevalence and incidence.

Chronic Periodontitis - Level 4 Cause

• Chronic periodontal disease caused 7.09 million YLDs globally in 2019, also ranked 7th and 32nd for prevalence and incidence.
• This disease is caused by chronic bacterial infections around the teeth.

Lip and Oral Cavity Cancer - Level 3 Cause

• In 2019, there were almost 6 million DALYs due to lip and oral cavity cancer
• Malignant neoplasms (tumours) of the lips, base of the tongue, mouth, palate, and salivary glands were classified under this category.

Orofacial Clefts - Level 4 Cause

• Orofacial clefts are birth defects that cause the face tissues not to fuse properly during fetal development.
• The incidence of combined cleft lip and palate was 1.42 per 1000 livebirths.
• There were over 4.62 million cases in 2019.

Edentulism - Level 4 Cause

• Edentulism, total tooth loss, was the 22nd cause of global disability in 2019.
• There were over 9 million YLDs and 352 million prevalent cases, as well as 25.0 million incident cases in 2019.

Oro-Dental Trauma

• Oro-dental trauma results from injuries to the teeth, mouth and oral cavity.
• Around 20% of people experience some form of dental trauma in their lifetimes.
• Oro-dental trauma can be caused by several factors including poor dental alignment and environmental influence.

Oral Health Inequalities

• Oral diseases disproportionately affect people in poverty and marginalized communities.
• There is a strong link between socioeconomic status and oral health.
• This association affects populations all over the globe, including high-, middle-, and low-income countries.

Access to Oral Health Services

• Unequal distribution of dental professionals, and poor equipment access impacts oral healthcare access.
• Out-of-pocket costs, and lack of affordable options are significant barriers to care.
• These factors can create hardship for many individuals, particularly in developing countries.

WHO Response

• A WHO resolution on oral health was adopted in 2021 to promote prevention over treatment.
• This resolution emphasizes the importance of integration with broader health promotion strategies.
• These changes are designed to improve the general health and well-being.

Other Findings

• The study also shows a decrease in the age-standardized prevalence of cavities in permanent and deciduous teeth.
• Population growth has significantly influenced the number of caries cases, especially in sub-Saharan Africa.
• Socioeconomic inequality accounts for a considerable portion of the prevalent cases of caries.

Conclusion

• Oral diseases are a significant global public health issue, despite being neglected in strategies and policies.
• Integration of oral health into the general healthcare system is essential for better health and well-being.
• Future strategies must prioritize health promotion and prevention to control modifiable risks globally.