Our age of Covid, which threatens to continue for years to come, is one where Covid will continue to hog the headlines. Other even more prevalent diseases such as cardiovascular disease and all the wide variety of cancers get so little publicity during this time. It’s the same for dental diseases – but almost all diseases seem to flourish more where there is poverty. Even obesity!
Periodontal diseases are prevalent both in developed and developing countries and affect about 20-50% of the global population. High prevalence of periodontal disease in adolescents, adults, and older individuals makes it a public health concern. Several risk factors such as smoking, poor oral hygiene, diabetes, medication, age, hereditary, and stress are related to periodontal diseases. Robust evidence shows the association of periodontal diseases with systemic diseases such as cardiovascular disease, diabetes, and adverse pregnancy outcomes.
Periodontal disease is likely to cause 19% increase in the risk of cardiovascular disease, and this increase in relative risk reaches to 44% among individuals aged 65 years and over. Type 2 diabetic individuals with severe form of periodontal disease have 3.2 times greater mortality risk compared with individuals with no or mild periodontitis.
Periodontal therapy has been shown to improve glycemic control in type 2 diabetic subjects. Periodontitis is related to maternal infection, preterm birth, low birth weight, and preeclampsia.
Oral disease prevention strategies should be incorporated in chronic systemic disease preventive initiatives to curtail the burden of disease in populations. The reduction in the incidence and prevalence of periodontal disease can reduce its associated systemic diseases and can also minimise their financial impact on the health-care systems. It is hoped that medical, dental practitioners, and other health-care professionals will get familiar with perio-systemic link and risk factors, and need to refer to the specialised dental or periodontal care.
Increased cancer risk because of periodontal disease has been demonstrated by Michaud and colleagues. The risk of tongue cancer increases 5.23 times with each millimeter loss of alveolar bone. Fitzpatrick and Katz observed that the relationship between periodontitis and oral, esophageal, gastric, and pancreatic cancers have been reported more consistently in literature than with lung and prostate cancers.
The challenge in both poorer and more developed countries is that periodontal and gum disease treatments take time to work and when it comes to medical centres, time is money, and like any business they are time-poor.
The WHO response
Eight years after the United Nations High-Level Meeting on Noncommunicable Diseases recognised that oral diseases pose a major health burden for many countries, 2019 saw the inclusion of oral health in the Political Declaration on Universal Health Coverage. During the same period, Members States, with the support of the WHO, developed and endorsed strong regional strategies and calls for action in favour of oral health in the African, East Mediterranean, South-East Asia and Western Pacific regions.
In such a context, WHO is committed to ensuring promotion of oral health and quality, essential treatment for oral health conditions for all people in all countries without individual financial hardship.
Reducing oral health conditions calls for a reform of oral health systems to shift the focus from invasive dental treatment to prevention and more minor treatment.
WHO has identified key strategies for improving oral health, with a focus on low-income and marginalised populations where access to oral health care is most limited. These include strengthening both cost-effective population-wide prevention and patient-centred primary health care.
This work is being implemented through a three-year roadmap (2019-2021) that comprises a mix of normative work and practical support to countries. A top priority is the development of a global oral health report, which will provide information about the status of oral health globally. The report will serve as the evidence base for the development of a global oral health action plan.
WHO also supports countries in this area by:
supporting interventions to accelerate the phase-down of dental amalgam in the context of the Minamata Convention on Mercury;
building capacity and providing technical assistance to countries to support a life-course approach and population-based strategies to reduce sugar consumption, control tobacco use, and promote fluoride-containing toothpaste and other vehicles of fluoride;
providing assistance to strengthen oral health systems such that they are an integral part of primary health care and do not cause financial hardship; and
reinforcing oral health information systems and integrated surveillance with other noncommunicable diseases to demonstrate the scale and impact of the problem and to monitor progress achieved in countries.
Cultural superiority is a foul-smelling state of mind and yet we still see Westerners who visit Third-World countries and then comment that the locals had bad breath as well as body odour. And it’s true that with periodontal disease, it often begins with foul breath and bleeding gums so foreign snobs are making a semi-valid point. Doesn’t excuse their pomposity though. Blame the British royals, lords and land-owners for their lousy breeding that makes them so selfish.