Burden of Oral and Dental Diseases

Burden of Oral and Dental Diseases

• Untreated tooth decay affects 34% of the global population
• Oral diseases impact nearly 3.5 billion people worldwide
• 2 billion people suffer from tooth decay (caries) of permanent teeth
• 520 million children suffer from caries of primary teeth
• Prevalence of oral diseases is increasing in low- and middle-income countries, related to urbanization and changing living conditions.

Measurements of Burden of Disease

• Incidence rate: Number of new cases in a defined population during a specific time.
• Prevalence: Total number of individuals with an attribute or disease at a particular time, divided by the population at risk.
• Life expectancy: Average lifespan of a group's members.

Disability-Adjusted Life Years (DALYs)

• Measures years of healthy life lost due to premature mortality or disability
• Year of Life Lost (YLL): Number of deaths at each age multiplied by the expected remaining lifespan.
• Years Lost to Disability (YLD): Number of incident cases multiplied by average disease duration and disease severity.
  • DALY = YLL + YLD
  • 1 DALY = 1 lost year of healthy life

Health Adjusted Life Expectancy (HALE)

• Equivalent years of full health a newborn can expect to live, based on current ill-health and mortality rates.

Assessment of Risk Factors in GBD

• Hierarchical system with three levels.
  • Level 1: Clusters of risk factors linked by mechanism, biology, or potential policy intervention.
  • Level 2: Major proportion of risk factors themselves.
  • Level 3 (occasionally): Further detail on specific risk factors (e.g., occupational carcinogens)

GBD Classification of Causes

• Level 1: Aggregates of non-communicable diseases, injuries, and infectious diseases, maternal/neonatal disorders, and nutritional deficiencies.
• Level 2: 22 disease and injury aggregate groupings (e.g., respiratory infections, cardiovascular disease).
• Level 3: Specific causes (e.g., tuberculosis, stroke, road injuries).
• Level 4: More detailed categories of Level 3 causes (e.g., latent tuberculosis infection, ischemic stroke).

Oral Disorders - Level 3 Cause

• Oral disorders were the 10th ranked cause of global disability in 2019.
• The top 3 conditions are: caries of deciduous and permanent teeth, chronic periodontal diseases, and edentulism.
• Also, other oral disorders such as tooth, tongue, and jaw disorders and malformations.

Dental Caries (Level 4 Cause)

• Presence of a cavity, softened enamel, a temporary filling or a filled tooth that is also decayed.
• Caused 2 million YLDs globally in 2019. It ranked first and third for prevalence and incidence among Level 4 causes (2.03 billion prevalent cases; 3.09 billion incident cases in 2019).

Periodontal Diseases (Level 4 cause)

• Defined by Community Periodontal Index of Treatment Needs (CPITN) Class IV and attachment loss (AL) >6 mm or gingival pocket depth (PD) >5 mm.
• Caused 7.09 million YLDs globally (ranked 7th and 32nd for prevalence and incidence respectively). (1.09 billion prevalent cases/ 91.5 million incident cases in 2019)

Lip and Oral Cavity Cancer (Level 3 cause)

• Results from malignant neoplasms of the lips and oral cavity (e.g., lip, base of tongue, other parts of tongue, gum, floor of mouth, palate).
• Corresponding 2019 data were 373,000 incident cases, 199,000 deaths, and 5.51 million DALYs.

Orofacial Clefts (Level 4 cause)

• Caused by incomplete fusion of facial tissues during fetal development.
• A global incidence rate of 1.42 per 1,000 live births.
• 4.62 million people living with these conditions in 2019.

Edentulism and Severe Tooth Loss (Level 4 cause)

• Defined as total tooth loss.
• Ranked 22nd in the global burden of disability in 2019. (9.62 million YLDs in 2019, 352 million prevalent cases and 25,0 million incident cases).

Oro-Dental Trauma

• Injury to teeth, mouth, and oral cavity.
• About 20% of people experience at some point.
• Causes include oral factors (e.g., misaligned teeth) and environmental factors.

Oral Health Inequalities

• Oral diseases disproportionately affect those in poverty and socially disadvantaged groups.
• Strong and consistent association between socioeconomic status (income, occupation, and education) and the prevalence and severity of oral diseases.

Access to Oral Health Services

• Unequal distribution of oral health professionals and a lack of appropriate health facilities leads to lower access in most countries.
• Out-of-pocket costs and paying for care are significant barriers.

WHO Response

• The World Health Assembly approved a resolution to shift from a traditional, curative approach towards a preventive approach, that includes the family, schools, workplaces and timely, comprehensive care within primary healthcare systems.
• Oral health should be integrated into the non-communicable disease agenda.
• WHO was asked by the assembly to develop a draft global strategy on tackling oral diseases, develop tools, translate the strategy into an action plan for oral health and report on progress till 2031.

Burden of Oral Disorders

• Oral disorders represent a sizable burden of disease globally, impacting socioeconomic factors like public health, and thus are a significant global public health issue
• Factors like prevalence, incidence, and YLDs have increased globally from 1990 to 2019
• Western Sub-Saharan Africa bears the greatest burden of periodontitis, however the Gambia has the highest periodontitis burden
• The incidence of periodontitis is increasing among younger individuals.

Prevalence of Caries

• Age-standardized prevalence of caries in permanent and deciduous teeth decreased 3.6% and 3.0%, respectively.
• Population growth was a major driver in increased caries cases, evidenced by disproportionate percentage contributions observed in Sub-Saharan regions of Africa.
• Globally, 64.6 million and 62.9 million prevalent cases of caries were attributable to sociodemographic inequality in 2019.

Conclusion

• Oral disease is a substantial public health concern despite often being neglected in policies.
• Oral diseases and Non-Communicable diseases (NCDs) share common risk factors (e.g. excess sugar/alcohol consumption and tobacco use).
• Oral health should be integrated into the general health agenda for optimal health and well-being.
• Long-term sustainable strategy for global oral health emphasizes health promotion, disease prevention, and control of modifiable risk factors.

This quiz explores the burden of oral and dental diseases worldwide, including statistics on tooth decay and their impact on populations. You'll also learn about key measurements such as incidence rates, prevalence, and Disability-Adjusted Life Years (DALYs). Test your knowledge on these crucial public health issues.