Policy and Practice

Theme Papers

The global burden of oral diseases and risks to oral health

1 Denis Bourgeois, iroshi Ogawa,Saskia 1 H 1 Poul Erik Petersen, Day, 2 & EstupinanNdiaye 3 Charlotte

Abstrac This paper outlines the burden of oral diseases worldwide and describes the in uence of major sociobehavioural factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still t risk The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and persist. developed Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, countries. immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related oral disease and orodental trauma are major human health public problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease and development trends across countries and regions re ects distinct risk profiles and the establishment of preventive patterns health oral care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been in a large number of socioepidemiological surveys. In addition to poor living conditions, the major risk factors relate to shown lifestyles unhealthy(i.e. poor diet, nutrition and oral hygiene and use of tobacco and alcohol), and limited availability and accessibility of oral services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk health Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public factors. programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health health is urgently needed. The challenges of improving oral health are particularly great in developing countries. KeywordsMouth diseases/epidemiology; Tooth diseases/epidemiology; Oral manifestations; Dental care/economics; Dental caries/ epidemiology; Mouth neoplasms/epidemiology; HIV infections/complications; Noma/epidemiology; Tooth Developmental disabilities/epidemiology; Fluorosis, Dental/epidemiology; Risk factors; Cost source: of illness MeSH, ). erosion/epidemiology; ( NLM Soins dentaires/conomie; Mots cls Bouche, Maladie/pidmiologie; Dent, Maladies/pidmiologie; Manifestation buccale; dentaire/pidmiologie; Tumeur bouche/pidmiologie; Infection VIH/complication; Noma/pidmiologie; Erosion Carie dentaire/ pidmiologie; Troubles dveloppement enfant/pidmiologie; Fluorose dentaire/pidmiologie; Facteur risque; Cot source: MeSH, ). maladie ( INSERM claveEnfermedades de la boca/epidemiologa; Odontopatas/epidemiologa; Manifestaciones bucales; Palabras odontolgica/economa; Caries dental/epidemiologa; Neoplasmas de la boca/epidemiologa; Infecciones por Atencin VIH/complicaciones; Noma/epidemiologa; Erosin dentaria/epidemiologa; Incapacidades del desarrollo/epidemiologa; Fluorosis Factores de riesgo; Costo fuente: DeCS, ). dentaria/epidemiologa; de la enfermedad ( BIREME

Bulletin of the World Health Organization 2005;83:661669. Voir page 668 le rsum en franais. En la pgina 668 figura un resumen en espaol.

as dental caries, periodontal disease, tooth loss, oral lesions oropharyngeal cancers, human WHO recently published a global review of oral health 1) mucosal and virus/acquired ficiency syndrome which emphasized that despite great improvements in the immunodeficiency immunode ( (HIV/AIDS)-disease and orodental trauma are major public health oral of populations in several countries, global problems related oral problems worldwide. Poor oral health may have a still persist. This is particularly so among underprivileged groups health both effect on in developing and developed countries. Oral diseases profound general health, and several oral diseases are related such to
WHO Global Oral Health Programme, Department for Chronic Disease and Health Promotion, Avenue Appia 20, 1211 Geneva 27, Switzerland. Correspondence should be sent to Dr Petersen at this address (email: petersenpe@who.int). 2 WHO Regional Office for the Americas, Oral Health Programme, Washington, DC, USA. 3 WHO Regional Office for Africa, Oral Health Programme, Brazzaville, Congo. 05-022806 Ref. No. (Submitted: 31 March 2005 Final revised version received: 7 July 2005 Accepted: 7 July 2005 )
1

Introduction

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chronic diseases (e.g. diabetes). The experience of pain, countries as it affects 6090% of school-aged children and lems vast prob-with eating, chewing, smiling and communication due the majority of adults. In 2004, WHO updated the miological information available in the 2, ). to missing, discoloured or damaged teeth have a major impact epide3 At peoples daily lives and well-being. Furthermore, oral databanks ( distribution and severity of dental caries vary present, the on different parts of the world and within the same region diseasesactivities at school, at work and at home causing in restrict or lions mil- of school and work hours to be lost each year country. Fig. 1 illustrates the levels (severity) of dental caries measured in 12-year-olds by the Decayed, Missing and as throughout the Teeth The objectives of the present paper are to outline the Filled index (DMFT). Dental caries experience in children world. relatively high in the Americas (DMFT = 3.0) and in the oral disease burden globally and to describe the in uence of is pean sociobehavioural risk factors related to oral health. Sources Euro-Region (DMFT = 2.6) whereas the index is lower in major African of information are the WHO Global Oral Health Data 2), most countries (DMFT = 1.7) 13). Fig. 2 illustrates time trends in dental caries experience of 12-year-old the the WHO Bank ( Oral Health Country/Area Profile Programme 3) ( in developing and developed countries. In most children ( and scientific reports from population studies on oral developingthe levels of dental caries were low until recent countries, carried health out in various countries. For both developing and but prevalence rates of dental caries and dental caries years developed countries, the oral health surveys recorded and ence are were used based on nationally representative samples, obtained experi- now tending to increase. This is largely due to increasing consumption of sugars and inadequate exposure the using random sampling or pathfinder methodology either uorides. In contrast, a decline in caries has been observed nience (conve- sampling)4). WHO standardized criteria are used to most industrialized countries over the past 20 years or so. ( for clinical registration of oral disease conditions and in pattern was the result of a number of public health trials are calibrationconducted for the control of quality of data and This measures, effective use of including uorides, together with assess-of variability in results obtained by different ment living conditions, lifestyles and improved self-care changing (4). The data examiners stored in the databanks are updated regularly practices. it must be emphasized that dental caries as a However, and the WHO Global Oral Health Data Bank is currently of children has not been eradicated, but only controlled to linked being with new information systems for surveillance of disease certain degree. a chronic and risk factors disease 5). Worldwide, the prevalence of dental caries among ( is high as the disease affects nearly 100% of the population adults The burden of dental disease in majority of countries. Fig. 3 illustrates the levels of the Dental caries and periodontal disease have historically beendental caries among 3544-year-olds, as measured by the sidered the most important global oral health burdens. mean index 13). Most industrialized countries and DMFT conDental is still a major health problem in most ( some caries countries of Latin America show high DMFT values (i.e. industrialized 14
Fig. Dental caries levels (Decayed, Missing and Filled Teeth (DMFT) index) among 12-year-olds worldwide, December 2004 1.

De cay ed , missin g a n d fil led pe r man e n t te et h Ver y l ow : < 1. 2 Lo w : 1 . 2 2. 6 Mo d er at e : 2 . 7 4 .4 Hig h : > 4. 4 No d a t a av ail ab le

Source: refs. 3 . 1

W HO 0 5. 1 13

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Poul Erik Petersen et al. Fig. Changing levels of dental caries experience (Decayed, 2. Missing and Filled Teeth (DMFT) index) among 12-yearolds in developed and developing countries
5 4 3 2 1 0
1981 1982 1983 1984 1985 19 87 1 989 1991 1993 199 5 1997 19 86 1988 1990 199 2 1994 1996 1998

Special Theme Oral Global burden of oral diseases Health

Table Prevalence (percentage) of edentulousness in the 1. elderly reported for selected countries WHO region/Country edentulous (years) Africa n Madagascar 25 65 74 The Americas Canada 58 65+ 26 65 USA 69 Eastern Mediterranean Egypt 7 65+ Lebanon 35 65 75 Saudi Arabia 3146 65+ Europea n Albania 69 65+ Austria 15 65 74 Bosnia and Herzegovina 65+ Bulgaria 53 65+ Denmark 27 65 74 Finland 41 65+ Hungary 27 65 74 Iceland 72 65+ 13 65 Italy 74 Lithuania 14 65 74 Poland 25 65 74 Romania 26 65 74 Slovakia 44 65 74 Slovenia 16 65+ United Kingdom 46 65+ South-East Asia India 19 65 74 Indonesia 24 65+Lanka 37 65 Sri 74 Thailand 16 65+ Western Pacific Cambodia 13 65 74 China 11 65 74 Malaysia 57 65+ Singapore 21 65+ Percentage Age group

Developed countries Source: refs.13 .

All countries Developing countries

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teeth or more) whereas levels of dental caries experience much are lower in the developing countries of Africa and Asia. In several industrialized countries, older people have often their had teeth extracted early in life because of pain or discomfort, reduced quality of life. The proportion of leading to edentulous 65 years or more is still high in some adults aged (Table 1), countries although in many industrialized countries there has a positive trend of reduction in tooth loss among been adults older in recent years69). ( In developing countries, oral health services are mostly offered at the regional or central hospitals of urban centres little, and if any, importance is given to preventive or restorative Many countries of Africa, Asia and Latin dental care. America have a shortage of oral health personnel and the capacity of the systems is generally limited to pain relief or care. In emergency Africa, the dentist to population ratio is approximately compared with about 1:2000 in most 1:150 000 industrialized children and adults suffering from severe countries. In decay, tooth teeth are often left untreated or are extracted to relieve discomfort. Public health problems related to tooth pain or loss impaired oral function are therefore expected to and in many developing increase countries. loss in adult life may also be attributable to Tooth poor periodontal health. Severe periodontitis, which may result in tooth loss, is found in 520% of most adult worldwide. populations Fig. 4 illustrates the periodontal health status of 3544-year-olds by WHO region 2, 10), using the so( called Community Periodontal Index The data available from WHO indicate that the Global Oral Health Data Bank 2) ( symptoms of periodontal disease are highly prevalent among adults in all regions. Furthermore, most children and worldwide adolescents have signs of gingivitis. Aggressive periodontitis, a severe periodontal condition affecting individuals during and which may lead to premature tooth loss, puberty about affects2% of youth 11). (

Source: WHO Global Oral Health Data Bank and WHO 2) ( Country/ Area Profile Programme 3). (

Oral

Health

Leukoplakia is the most frequent form of oral precancer and appears in the oral cavity as a white patch that cannot be off, typically in the oral mucosa, lateral borders of the rubbed and oor of the mouth. The prevalence of leukoplakia tongue among (15 years or older) has been reported to range from adults in Cambodia 12) to 3.6% in Sweden13). Erythroplakias 1.1% pear as red patches and are less common but a have a ( ( apgreater tendency towards malignant transformation than (14). Erythroplakia apparently occurs less frequently leukoplakias population prevalences of 1% or with less. Oropharyngeal cancer is more common in developing than developed countries (Fig. 5a, b) 1, 15). The of men and ( oral cancer is particularly high among prevalence it is Oral mucosal lesions and oral cancer eighth most common cancer worldwide. Incidences for the It is noteworthy that few systematic epidemiological studies oral cancer vary in men from 1 to 10 cases per 100 000 of mucosal diseases at the global level have been carried inhabitants oral in many countries. In south-central Asia, cancer of the out. oral
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Fig. Dental caries levels (Decayed, Missing and Filled Teeth (DMFT) index) among 3544-year-olds worldwide, December 2004 3.

De ca yed , missi ng an d fi lle d p er ma ne n t te e th Ve r y lo w : <5 . 0 L o w : 5 .0 8 . 9 M o de r at e : 9 .0 1 3 . 9 H ig h : > 1 3 .9 N o d a ta a va il ab le

Source: refs. 3 . 1

W HO 0 5. 1 13

cavity ranks among the three most common types of cancer. the age-standardized incidence of oral cancer is In India, per 100 000 population. It is noteworthy that sharp increases 12.6 in incidences of oral/pharyngeal cancers have been the reported for several countries and regions such as Denmark, Germany, France, Scotland, central and eastern Europe and to a lesser Australia, Japan, New Zealand and the 1, 15). extent USA (

particularly in Africa and Asia (Fig. 6) 1). Noma starts as a localized gingival ulceration and spreads ( primarily rapidly the orofacial tissues, establishing itself with a through necrotic centre (21, 22). About 7090% of cases are fatal blackened in the absence of care. Fresh noma is seen predominantly in age the group 14 years, although late stages of the disease occur in adolescents and adults. WHO has suggested a global of 140 000 incidence cases with a prevalence in 1997 of 770 000 vic- (23). Poverty is the key risk condition for development tims Oral health and HIV/AIDS noma; the environment that induces noma is characterized of A number of studies have demonstrated the negative impact by severe malnutrition and growth retardation, unsafe on health of HIV infection oral 1620). Approximately 40 drinkingwater, deplorable sanitary practices, residential proximity ( people who are HIV-positive have oral disease caused to 50% of unkempt animals, and a high prevalence of infectious fungal, bacterial or viral infections that often occur early by such as measles, malaria, diarrhoea, pneumonia, diseases in course of the disease. Oral lesions strongly associated tuberculosis the and with infection are pseudo-membranous oral candidiasis, HIV HIV/AIDS. hairy oral leukoplakia, HIV gingivitis and periodontitis, Orodental trauma Kaposi and non-Hodgkin lymphoma. Dry mouth as a sarcoma result of decreased salivary ow rate may not only increase the risk In contrast to dental caries and periodontal disease, data on of dental caries but also have a negative impact on quality of reliable the frequency and severity of orode ntal trauma still because it leads to difficulty in chewing, swallowing and are lacking in most countrie s, particularly in deve life countries loping (22). Some countries in Latin America report tastingThe need for oral health care including immediate food. about care referral, treatment of manifest oral disease, prevention trauma in dental 15% of schoolchildren, whereas and of 512% have been found in children aged 612 years of problems and health promotion is particularly great among prevalences in Middle East. Furthermore, studies from certain the underserved, disadvantaged population groups of the alized countries have revealed that the prevalence of industrideveloping countries, including people infected with HIV 17, 19). dental traumatic injuries is on the increase, ranging from 16% ( 40% among 6-year-old children and from 4% to 33% to Noma (cancrum oris) among 1214-ye ar-old children 24). A significant proportion Noma, a debilitating orofacial gangrene, is an important dental trauma relates to sports, unsafe playgrounds or ( of conschools, accidents tributor to the disease burden on many developing road or countries, violence.
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Special Theme Oral Global burden of oral diseases Health

Fig. Mean percentages of maximum Community 4. Periodontal scores among 3544-year-olds, by WHO Index (CPI) Dental erosion is the progressive, irreversible loss of dental region hard that is chemically etched away from the tooth tissue

Dental erosion

by extrinsic and/or intrinsic acids. Dental erosion appears surface to a growing problem in several countries, affecting 813% be adults 25), and the increasing levels are thought to be due of ( to higher consumption of acidic beverages (i.e.sugary carbonated fruit juices). Worldwide, there is a need for drinks and systematic population-based studies on the prevalence of more dental erosion using a standard index of measurement.

10 0

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Developmental disorders

50

Of the developmental disorders, congenital diseases of 25 enamel or dentine of teeth, problems related to the the number, shape of teeth, and craniofacial birth defects size and as cleft lip and/or palate (CL/P) are most important. such 0 The incidence of CL/P varies tremendously worldwide. AFRO AMRO EMRO EURO SEARO Native Americans show the highest incidences at 3.74 per 1000 WPRO births, whereas a fairly uniform incidence of 1:600 to live CPI 0 CPI 1 CPI 2 CPI 3 CPI 4 1:700 live births is reported among Europeans. The incidences pear ap- high among Asians (0.824.04 per 1000 live CPI 0 = individuals with healthy periodontal conditions; CPI 1 = individuals with bleeding births), intermediate in Caucasians (0.92.69 per 1000 live from gums; CPI 2 = individuals with bleeding gums and calculus; CPI 3 = individuals with shallow periodontal pockets (45 mm); CPI 4 = individuals with deep periodontal pockets births) in Africans (0.181.67 per 1000 live births) and low 26). (=6 mm). AFRO = African Region; AMRO = Region of the Americas; EMRO = Eastern Mediterranean Region; EURO = European Region; SEARO = South-East Asia Region; causes of CL/P are complex involving numerous genetic ( The WPRO = Western Pacific Region. and environmental risk factors. In particular, risk factors such folic as acid deficiency, maternal smoking and maternal age Source: refs.1 3 . W HO 0 5 .1 1 6 have implicated in the formation of clefts26). been ( Malocclusion is not a disease but rather a set of The economic impact of oral disease deviations which in some cases can in uence quality of dental life. Estimates of different traits of malocclusion are Traditional treatment of oral disease is extremely costly; it from a number of countries, primarily in North America the available is fourth most expensive disease to treat in most ized countries. In industrialized countries, the burden of and northern Europe . For example, prevalences of dento- industrialdisease has been tackled through establishment of oral facial anomalies have been reported at about 10%, according to oral health Dental Aesthetic Index6). Other conditions that may lead advanced systems which primarily offer curative services the patients. Most systems are based on demand for care and ( to special oral health care needs include Down syndrome, to health care is provided by private dental practitioners to palsy, learning and developmental disabilities, and genetic oral cerebral with or patients, without third-party payment schemes. Some and hereditary disorders with orofacial including countries, those of Scandinavia and the United Kingdom, defects. There is no consistent evidence of any time trends organized public health services, providing oral health developmental disorders, or any consistent variation by have in particularly to children and disadvantaged population care, socioeconomic status, but these aspects have not been Traditional curative dental care is a significant economic groups. studied (26). adequately In addition, there are many parts of the world for many industrialized countries where 510% of public which littlein no information is available on the frequency burden or expenditure relates to oral health 30). Over the past 29, health of developmental disorders, in particular parts of Africa, ( years, savings in dental expenditures have been noted in Asia, Latin America, the Middle East and eastern central ized countries which have invested in preventive oral care industrialEurope. where positive trends have been observed in terms of and Fluorosis of teeth in the prevalence of oral disease 32). 31, reduction In most developing countries, investment in oral Dental uorosis develops during the formation of teeth ( care health In these countries, resources are primarily is low. in young children. Drinking-water with more than 1.5 to emergency oral care and pain relief; if treatment were allocated (parts ppm per million) of uoride can give rise to enamel able, avail- the costs of dental caries in children alone would defects and discolouration of teeth leading to endemic uorosis the total exceed health care budget for children 33). in population. Dental uorosis can differ in intensity the ( mild from to severe. For example in East Africa, in the Great Oral disease burdens and risk factors Rift Valley area, and in some parts of India and north the groundwater has very high levels of uoride. In such The current global and regional patterns of oral disease Thailand, areas, uorosis may be found in most of the people 27, 28). largely distinct risk profiles across countries, related to dental re ect ( Fluorosis of the teeth can also occur in individuals in conditions, lifestyles and the implementation of living countries developed due to widespread use of certain forms of oral health systems. The significant role of preventive uorides for prevention of dental caries, although the degree of sociobehavioural factors in oral disease and health has and environmental is mostly uorosis very mild when compared to that in countries been in numerous epidemiological surveys3436 ). Socioshown where is endemic. uorosis epidemiological studies have been carried out particularly ( in
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Special Theme Oral Health Global burden of oral diseases

Fig. Incidence of oral cavity cancer 5.
a) Incidence of oral cavity cancer among males (age-standardized rate (ASR) per 100 000 world population), December 2004

Poul Erik Petersen et al.

=3 . 2 3 .3 6 .8 =6 . 9 No da t a a vai la bl e

Source: ref.15 .

b) Incidence of oral cavity cancer among females (age-standardized rate (ASR) per 100 000 world population), December 2004

=3 . 6 3 .7 6 . 4 =6 . 5 N o d at a a va ila b le

Source: ref.15 .

W HO 0 5. 1 17

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Poul Erik Petersen et al. Fig. Distribution of cases of noma (cancrum oris) reported around the world, September 6. 2003

Special Theme Oral Global burden of oral diseases Health

Ca ses re p o rt ed Ca ses re p o rt ed Ca ses re p o rt ed Sp o ra d ic ca ses

be f or e 1 9 8 0 1 98 1 1 9 9 3 1 99 4 2 0 0 0 re ce n tly r ep o r te d

Source: ref.1 .

W HO 0 5. 1 18

relation to dental diseases. In developed and increasingly tobacco and alcohol consumption. That smokeless causes in developing countries these studies have noted that the tobacco oral cancer was confirmed recently by the of disease and the need for care are highest amongst the InternationalResearch on Cancer40). Agency for burden The strong correlation between several oral diseases poor ( or disadvantaged population groups. The behavioural and socio have been found to play significant roles in the noncommunicable chronic diseases is primarily a result of risk factors common risk factors. Many general disease conditions the rence occur- of dental caries in both children and adults have worldwide countries report that tooth loss is higher in also oral manifestations that increase the risk of oral (34). Some which, disease in turn, is a risk factor for a number of general women than in men as women more often seek dental care 6). conditions. Severe periodontal disease, for example, is ( A core group of modifiable risk factors is common health ated with diabetes mellitus and has been considered the many tochronic diseases and injuries. The four most associcomplication of diabetes41). prominent noncommunicable diseases cardiovascular diseases, sixth ( diabetes, cancer and chronic obstructive pulmonary diseases share common risk factors with oral diseases; these are Conclusion risk factors preventable that are related to lifestyles. For example, Given the extent of the problem, oral diseases are major dietary are significant in the development of chronic habits health public problems in all regions of the world. Their impact diseases and in uence the development of dental caries 37). Oral individuals and communities as a result of the pain and on bacteria are involved in the progression of dental diseases suffer( cavity ing, impairment of function and reduced quality of life such dental caries and periodontal disease. Most they is considerable. Globally, the greatest burden of as cause, importantly, excessive amounts and frequent consumption of sugars oral diseases is on the disadvantaged and poor population major are causes of dental caries and the risk of caries is high groups. The current pattern of oral disease re ects distinct risk if population exposure to uorides is inadequate. In across profiles countries related to living conditions, lifestyles addition, use has been estimated to cause over 90% of and tobacco environmental factors, and the implementation of cancers oral cavity, and is associated with aggravated preventive schemes. In several industrialized countries in the oral health breakdown, periodontal poorer standards of oral hygiene and thus there been positive trends in the reduction of dental caries have with premature tooth loss. Smoking has been shown to be a children and reduction of tooth loss among adults, but in major risk factor in periodontal disease, responsible for more dental has not been eradicated in children although it has caries than of the cases of periodontitis among adults38). half The been brought under control in some countries. The burden of for oral cancer increases when tobacco is used in oral ( risk disease among older people is high and this has a negative combination or areca nut 39). In Asia, the incidences of effect quality of life with alcohol on their 42). In several developing countries, ( oral the cancer are high and relate directly to smoking, use of ( general population does not benefit from preventive oral smokeless health
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programmes. It is expected that the incidence of dental impact on the oral health of people in several countries. will increase in the near future in many of these countries as Thus, strengthening of public health programmes global caries a result of growing consumption of sugars and inadequate through implementation of effective oral disease prevention sure to uorides. With the growing consumption of and health promotion is urgently needed, and common expomeasures tobacco in developing countries, the risk of periodontal disease, risk factors approaches should be used to integrate oral health loss national health O toothand oral cancer is likely to increase. Periodontal diseasewith and loss are also linked to chronic diseases such as programmes. tooth mellitus; diabetes the growing incidence of diabetes may have a Competing interests:none negative declared.

Rsum Charge mondiale de morbidit et risques dans le domaine bucco-dentaire

Le prsent article dcrit la charge daffections bucco-prventifs. Un grand nombre denqutes sociodentaires monde et lin uence des principaux facteurs depidmiologiques dans le ont mis en vidence lin uence consquente des facteurs socio-com portementaux sur la sant bucco- dentaire. sociocomportementaux et environnementaux sur la sant. En risque Malgr des amliorations considrables de la sant bucco-dentaire dehors des conditions de vie dfavorables, les principaux facteurs populations de plusieurs pays, des problmes persistentde risque sont la pratique dun mode de vie nuisible la sant des encore au niveau mondial. L a charge daffections bucco- ( savoir mauvaise alimentation ou hygine buccale dficiente pse particulirement sur les groupes de population pauvres et consommation de tabac ou dalcool) et une disponibilit et dentaires et une dfavoriss dans les pays en dveloppement, comme dans les accessibilit insuffisantes des services de soins bucco-dentaires. dvelopps. Des pathologies bucco-dentaires telles que les existe des liens entre plusieurs affections bucco-dentaires et pays Il caries, la parodontolyse, la perte dentaire, les lsions oromucosiques des pathologies chroniques non transmissibles en raison les de et cancers oro-pharyngs, les affections bucco-dentaires lies facteurs de risque communs. En outre, les pathologies principalement au VIH/SIDA et les traumatismes bucco-dentaires reprsententgnrales les diabtes ou le VIH/SIDA par exemple) (comme problmes de sant publique majeurs dans le monde entier etprsentent manifestations orales. Il est urgent de renforcer souvent des des une mauvaise sant bucco-dentaire a des rpercussions profondesles programmes de sant publique dans lensemble du monde la sant et la qualit de vie en gnral. La diversit des travers la mise en uvre de mesures efficaces de prvention sur schmas pathologiques bucco-dentaires et des tendances volutives des pathologies et de promotion de la sant dans le domaine les dentaire. selonpays et les rgions re te des profils de risques bucco- Lamlioration de la sant bucco-dentaire constituera distincts mise en place de programmes de sant une et la mission particulirement ardue dans les pays en buccodentaire dveloppement.

Resumen Carga mundial de enfermedades bucodentales y riesgos para la salud bucodental

En este artculo se presenta a grandes rasgos la carga mundial de los programas preventivos de atencin bucodental. Un de gran morbilidad bucodental y se describe la in uencia de los nmero de estudios socioepidemiolgicos muestran el factores de riesgo comportamentales en la salud importante tienen los factores sociocomportamentales y papel que principales bucodental. las grandes mejoras experimentadas por la ambientales bucodental. Adems de las malas condiciones de A pesar de en la salud bucodental de las poblaciones en varios pases, a nivel vida, los principales factores de riesgo guardan relacin con el salud mundialhabiendo problemas. La carga de enfermedades vida (una dieta, nutricin e higiene bucodental deficientes, modo sigue de es particularmente alta en los grupos de poblacin consumo de tabaco y alcohol) y con una escasa el bucodentales y desfavorecidos y po bres, tanto en los p ases en desarro llo como en disponibilidad y accesibilidad a los serv icios de salud bucodent al. desarrollados. Enfermedades bucodentales como la caries enfermedades bucodentales se asocian a enfermedades los Varias dental, las periodontopatas, la prdida de dientes, las lesiones decrnicas no transmisibles, debido principalmente a la existencia de la oral y de riesgo comunes. Adems, hay enfermedades sistmicas mucosa los cnceres orofarngeos, las enfermedades factores bucodentales con el virus de la inmunodeficiencia (por relacionadas ejemplo la diabetes o el VIH/SIDA) que causan a menudo de inmunodeficiencia adquirida (VIH/SIDA) y los bucodentales. El fortalecimiento mundial de los programas de humana/sndrome problemas traumatismos orodentales son importantes problemas de salud pblica en salud pblica mediante la aplicacin de medidas eficaces de el mundo, y una mala salud bucodental tiene profundos efectos las enfermedades bucodentales y la promocin de la de todo prevencin en salud y la calidad de vida general. La diversidad de las salud la bucodental constituye una necesidad urgente. Los retos que de morbilidad bucodental y las distintas tendencias segn el hay superar para mejorar la salud bucodental son que pautas pas regin re ejan los diferentes perfiles de riesgo y la in especialmente en los pases en y la importantes uencia desarrollo.

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