Lecture 13 Burden of Oral and Dental Diseases PDF

Burden of oral and dental diseases 5-1-2025 First semester 2024-2025 Dr.Lama Rafieh DDS,MPH Week 14  CONTENTS Introduction Measurements of Burden of Disease...

Burden of oral and dental diseases 5-1-2025 First semester 2024-2025 Dr.Lama Rafieh DDS,MPH Week 14  CONTENTS Introduction Measurements of Burden of Disease Major Oral Diseases and Health Conditions Conclusion 2  INTRODUCTION The Global Burden of Disease (GBD) provides a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved, and disparities can be eliminated. The GBD 2019 is the most comprehensive global health study, analyzing 286 causes of death, 369 diseases & injuries, and 87 risk factors. 3 Overview of global burden of oral diseases: The Global Burden of Disease Study 2019 estimated that oral diseases affect close to 3.5 billion people worldwide, with 2 billion people suffering from caries of permanent teeth (most common condition) and 520 million children suffer from caries of primary teeth. In most low- and middle-income countries, the prevalence of oral diseases continues to increase with growing urbanization and changes in living conditions. 4 5  MEASUREMENTS OF BURDEN OF DISEASE 1. Incidence rate: Defined as the number of NEW cases occurring in a defined population during a specified period of time. 2. Prevalence: Defined as the total number of all individuals who have an attribute or disease at a particular time (or during a particular period) divided by the population at risk of having the attribute or disease at this point in time or midway through the period. ‫ وﻳﻌﻜﺲ‬،‫ﺑﻨﺎء ﻋﻠﻰ ﺑﻴﺎﻧﺎت اﻟﻮﻓﺎة واﻟﻨﻤﻮ اﻟﺴﻜﺎﻧﻲ‬ ً ‫ ﻳﺘﻢ ﺣﺴﺎﺑﻪ‬.‫ﺑﻨﺎء ﻋﻠﻰ اﻟﻌﻮاﻣﻞ اﻟﺴﻜﺎﻧﻴﺔ واﻟﺒﻴﺌﻴﺔ واﻟﺼﺤﻴﺔ ﻓﻲ ﻓﺘﺮة زﻣﻨﻴﺔ ﻣﻌﻴﻨﺔ‬ ً ،‫اﻟﻔﺮد ﻓﻲ ﻋﻤﺮ ﻣﻌﻴﻦ‬ 3. Life expectancy:.‫ﻣﺴﺘﻮى اﻟﺼﺤﺔ اﻟﻌﺎﻣﺔ وﻓﻌﺎﻟﻴﺔ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﻓﻲ اﻟﺪوﻟﺔ أو اﻟﻤﻨﻄﻘﺔ‬ Life expectancy is the number of years that the average member of a group can expect to live. 6 3. Disability-Adjusted Life Years (DALYs): It is defined as the number of years of healthy life lost due to all causes whether from premature mortality or disability. Year of Life Lost: no of death at each age multiplied by the expected remaining years of life according to a global standard life expectancy. Years Lost to Disability: no of incident cases due to injury and illness is multiplied by the average duration of disease and a weighing factor reflecting the severity of disease on a scale from 0 (perfect health) and 1(dead). DALY = years of life lost + years lost to disability One DALY = One year of healthy life lost 7 4. Health Adjusted Life Expectancy (HALE): Based on the framework of WHO’s ICIDH (International Classification of Impairments, Disabilities, and Handicaps ) It is the equivalent number of years in full health that a newborn can expect to live based on current rates of ill- health and mortality. 5. Assessment of risk factors in the GBD: A three-level hierarchical organization system was established. Level 1 risks were clusters of risk factors linked by mechanism, biology or potential policy intervention. Level 2 risks represented the major proportion of the risk factors themselves. For some risk factors, such as occupational carcinogens, a third level was added to provide additional detail. 8 GBD classifies causes in a hierarchy of four levels. Level 1 causes are aggregates of non-communicable diseases; injuries; and a category combining infectious diseases, maternal and neonatal disorders, and nutritional deficiencies. Level 2, there are 22 disease and injury aggregate groupings such as respiratory infections and tuberculosis, cardiovascular diseases, and transport injuries. Level 3 includes specific causes such as tuberculosis, stroke, and road injuries. In some cases, these Level 3 causes are the most detailed classification, while for others a more detailed category is specified at Level 4. Examples of Level 4 causes include latent tuberculosis infection, ischemic stroke, and pedestrian road injuries. 9  Oral disorders was the tenth-ranked Level 3 cause of disability globally in 2019, causing 23·1 million YLDs. It was also ranked first and third globally for prevalence (3·48 billion cases) and incidence (4·35 billion cases) in 2019. Oral disorders comprises caries of deciduous and permanent teeth, chronic periodontal diseases, edentulism (total tooth loss), and other oral disorders (a heterogeneous group including a variety of tooth, tongue, and jaw disorders and malformations not included in the other causes). Source: https://www.healthdata.org/results/gbd_summaries/2019/oral-disorders-level-3-cause 10  MAJOR ORAL DISEASES AND HEALTH CONDITIONS Dental caries : Caries of permanent teeth — Level 4 cause Caries of permanent teeth is defined as permanent dentition showing unmistakable cavity, undermined enamel, a detectably softened floor or wall, a tooth with a temporary filling or a tooth that is filled but also decayed is present. Caries of permanent teeth caused 2·00 million YLDs globally in 2019. It was also ranked first and third globally for prevalence and incidence among all Level 4 causes, with 2·03 billion prevalent and 3·09 billion incident cases in 2019. 11 Periodontal diseases — Level 4 cause Chronic periodontal disease is defined as Community Index of Periodontal Treatment Needs (CPITN) Class IV, attachment loss (AL) >6 mm, or gingival pocket depth (PD) >5 mm. It is caused by chronic bacterial infection around the teeth. Chronic periodontal disease causes 7·09 million YLDs globally in 2019. It was also ranked seventh and 32nd globally for prevalence and incidence, with 1·09 billion prevalent and 91·5 million incident cases in 2019. 12  Lip and oral cavity cancer — Level 3 cause This cause includes death and disability resulting from malignant neoplasms of the lips and oral cavity, including (malignant neoplasm of lip, base of tongue, other and unspecified parts of tongue, gum, floor of mouth, palate, other and unspecified parts of mouth, parotid gland, other and unspecified major salivary glands). There were 373 000 incident cases , 199 000 deaths , and 5·51 million DALYs due to lip and oral cavity cancer globally in 2019. 13 Orofacial clefts — Level 4 cause Any livebirth with isolated cleft lip, isolated cleft palate, and combined cleft lip and cleft palate resulting from the tissues of the face not joining properly during fetal development. Orofacial clefts caused 2770 all-ages deaths. The combined global incidence rate was 1·42 per 1000 livebirths, and there were 4·62 million people living with orofacial clefts in 2019. 14 Edentulism and severe tooth loss — Level 4 cause Edentulism is defined as total tooth loss. Edentulism and severe tooth loss was the 22nd ranked Level 4 cause of disability globally in 2019, causing 9·62 million YLDs. It was also ranked 31st and 56th globally for prevalence and incidence, with 352 million prevalent cases and 25·0 million incident cases in 2019. 15 Oro-dental trauma Oro-dental trauma results from injury to the teeth, mouth and oral cavity. Around 20% of people suffer from trauma to teeth at some point in their life. Oro-dental trauma can be caused by oral factors such as lack of alignment of teeth and environmental factors. Treatment is costly and lengthy and sometimes can even lead to tooth loss, resulting in complications for facial and psychological development and quality of life. 16  ORAL HEALTH INEQUALITIES Oral diseases disproportionally affect the poor and socially disadvantaged members of society. There is a very strong and consistent association between socioeconomic status (income, occupation and educational level) and the prevalence and severity of oral diseases. This association exists from early childhood to older age and across populations in high-, middle- and low-income countries. 17  ACCESS TO ORAL HEALTH SERVICES Unequal distribution of oral health professionals and a lack of appropriate health facilities to meet population needs in most countries means that access to primary oral health services is often low. Out-of-pocket costs for oral health care can be major barriers to accessing care. Paying for necessary oral health care is among the leading reasons for catastrophic health expenditures, resulting in an increased risk of impoverishment and economic hardship. 18 WHO response The World Health Assembly approved a Resolution on oral health in 2021 at the 74th World Health Assembly. The Resolution recommends a shift from the traditional curative approach towards a preventive approach that includes promotion of oral health within the family, schools and workplaces, and includes timely, comprehensive and inclusive care within the primary health-care system. The Resolution affirms that oral health should be firmly embedded within the noncommunicable disease agenda and that oral health-care interventions should be included in universal health coverage programs. 19  The World Health Assembly delegates asked WHO: to develop a draft global strategy on tackling oral diseases for consideration by WHO governing bodies in 2022; and by 2023: to translate the global strategy into an action plan for oral health; to develop “best buy” interventions on oral health; 2021-2030. WHO was asked to report back on progress and results until 2031 as part of the consolidated report on noncommunicable diseases. 20  The sizable burden of oral disorders (measured as DALYs) and their socioeconomic impact make them an important global public health issue. The age-standardized rate (ASR) of the prevalence, incidence, and DALYs increased worldwide from 1990 to 2019. In 2019, Western Sub-Saharan Africa carried the heaviest burden of periodontitis, whereas the nation with the highest periodontitis burden was Gambia. The burden of periodontitis was negatively associated with the level of socioeconomic development. Although, the majority of periodontitis burden was observed among those aged 55–59 years, the incidence of periodontitis has shown an increasing trend among younger individuals. 21  Age-standardized prevalence of caries in permanent and deciduous teeth decreased 3.6% and 3.0% ,respectively. Population growth was the key driver of the changes in the number of caries cases, especially in sub-Saharan Africa (percentage contribution: 126.6%, permanent teeth; 103.0%, deciduous teeth). Globally, 64.6 million and 62.9 million prevalent cases of caries in permanent and deciduous teeth were attributable to sociodemographic inequality in 2019. 22  CONCLUSION Oral disease represents one of the most common public health issues and remains a major global health burden, yet it has frequently been neglected in public health strategy and policy. Various oral diseases and conditions have a significant socio-economic impact. Oral diseases and NCDs share risk factors, such as excess sugar/alcohol consumption and tobacco use. There should be an integration of oral health into the general health agenda for optimal health and well-being. The long-term sustainable strategy for global oral health must focus on health promotion and disease prevention, through controlling the modifiable common risk factors. 23 THANK YOU 24