Epidemiology of Oral and Dental Diseases

Epidemiology of Oral and Dental Diseases

• Oral diseases are among the most prevalent globally, causing significant health and economic burdens, affecting quality of life
• Key oral diseases are dental caries, periodontal disease, tooth loss, and cancers of the lips and oral cavity
• Oral diseases persist due to social and economic inequalities, and inadequate funding
• Oral diseases are largely preventable, but remain untreated, especially in low-income and middle-income countries (LMICs)
• Treatment costs exceeded available resources in LMICS
• Oral diseases are prominent global public health priorities including dental caries, periodontal disease, and oral cancers
• Oral diseases are chronic inflammatory conditions affecting the tissues surrounding and supporting teeth
• Initially, gingivitis, a reversible inflammation of periodontal tissues, results in bleeding and swelling
• Periodontal disease progressively destroys the periodontal tissue support, leading to attachment loss, periodontal pocketing, gingival bleeding, and bone loss.
• Poor oral hygiene leading to accumulation of pathogenic biofilm (plaque) is a significant cause of periodontal disease
• Tobacco use is also a risk factor for periodontal disease
• Periodontal disease is linked to diabetes, cardiovascular diseases, and dementia
• Periodontal disease can lead to tooth loss and negatively impacts chewing, aesthetics and quality of life
• Oral cancers are primarily oral squamous cell carcinoma
• Oral cancer presents as a white/red patch, ulcerated lesion, large fungating ulcer or indurated lesions of varying sizes, potentially including a super-added infection.
• Tobacco use, alcohol consumption, and areca nut chewing are major risk factors for oral cancers
• Human Papilloma Virus (HPV) infection is responsible for a rise in oropharyngeal cancers among young adults
• Oral cancers are prevalent in men and older adults, often from individuals from disadvantaged backgrounds.
• Oral cancer is mostly a disease of older adults and is a significant public health concern
• Significant ethnic disparity in oral cancer disease burden and outcomes
• Delay in diagnosis due to difficulty in identifying early symptoms, impacting treatment outcomes for oral cancers
• Worldwide five-year survival rate is generally less than 50% but women usually have higher rate
• Oral cavity carcinoma is the sixth most common cancer, often detected late.
• Oral squamous cell carcinoma (SCC) is a disfiguring and deadly type of oral cancer
• Globally, around 3.5 billion people live with dental conditions, mainly due to untreated dental caries in deciduous and permanent teeth, severe periodontal diseases, edentulism (complete tooth loss), and severe loss.
• According to the International Agency for Research on Cancer (IARC) lip and oral cavity cancers were among the 15 most common cancers in 2018.
• Lifetime prevalence of dental caries has decreased in the last few decades but mainly in high-income countries (HICs)
• Untreated caries in deciduous teeth ranked 10th most prevalent among global children in 2010 (affecting 9% of global children).
• Untreated caries in permanent teeth ranked as the most prevalent health condition, affecting 35% (2.4 billion) of the global population in 2010.
• Global age-standardized prevalence of untreated dental caries remained stable around 35% between 1990 and 2010.
• Peak prevalence in untreated caries in the permanent dentition was observed in 15-19 age group in 2015. Prevalence of untreated dental caries was 7.8% among children in deciduous teeth(1-4 years old). Prevalence of untreated dental caries in permanent dentition has remained at approximately 34.1%
• Significant decrease in cases of untreated dental caries occurred globally from 1990-2017
• The global burden of untreated dental caries has remained relatively stable for 30 years, contradicting the common view of an improved burden of dental caries.
• Socioeconomic status significantly impacts oral health
• Studies suggest a negative correlation between lower socioeconomic status, and oral health conditions
• Low educational levels and lower socioeconomic status have a strong positive association with oral disease in countries with high Human Development Index scores.
• Marginalized groups like homeless people, prisoners, and indigenous groups, face significant oral health challenges
• In Australia (employed adults), 9% of employees missed work days due to dental issues
• In Canada, on average 3.5 hours of work hours were lost due to dental issues resulting in a lost productivity of approximately 1 billion Canadian dollars
• In Brazil, approximately 15% of working adults were absent from work due to orofacial pain leading to a substantial productivity loss

Tooth Loss

• Tooth loss, a consequence of dental caries or periodontal issues, reflects the final stage of severe oral health issues
• In 2010, 158 million people (2.3% global population) were completely edentulous
• Prevalence of severe tooth loss declined between 1990 and 2010, from 4.4% to 2.4%

Oral Cancer

• Lip and oral cavity cancers are among the top 15 most common cancers worldwide (around 500,550 cases in 2018).
• In 2018, there were 177,384 deaths due to cancers of the lip and oral cavity (67% in males)

Economic Burden of Oral Diseases

• Worldwide, oral diseases in 2015 accounted for USD 356.80 billion in direct costs (treatment) and USD 187.61 billion in indirect costs (productivity losses)
• Oral diseases may exacerbate other diseases like poor glycemic control in diabetics

Impacts on Children and Adults

• Dental pain prevalence in children increases with age, severity of caries, and socioeconomic status. Dental issues in children affect school performance and exacerbate social inequalities
• Adults struggle with access to dental care, leading to untreated issues and increased reliance on hospital emergency departments and diminished quality of life

Older Adults

• Adults in high-income countries are retaining more natural teeth.
• Older adults (65+) often have substantial restorative needs and periodontal disease.
• Difficulty accessing oral care and late-stage diagnoses are substantial challenges for older adults, compounded by decreased mobility and transportation issues

Social and Commercial Determinants

• The WHO framework emphasizes the influence of structural factors like economic and social policies on oral health outcomes
• Socioeconomic status, educational background, and living conditions are also prominent influences

Oral Health Policy Recommendations

• Addressing oral health needs requires a radically different approach with bold leadership, robust evidence of intervention efficacy, innovative policies, and an openness to global change
• Oral health must be considered an integral part of sustainable development