EPIDEMIOLOGY OF DENTAL & ORAL DISEASE Reference: WHO website Dental caries a major oral health problem in most

t industrialized countries, affecting 60-90% of schoolchildren and the vast majority of adults.

most prevalent oral disease in several Asian and Latin-American countries; less common and less severe in most African countries. Figure 1 highlights the dental caries experience among 12-year-old children in the six WHO regions in the year 2000, based on the DMFT (Decayed, Missing and Filled Teeth) Index, an index that measures the lifetime experience of dental caries in permanent dentition. DMFT (Decayed, Missing and Filled Teeth) Index, an index that measures the lifetime experience of dental caries in permanent dentition.

Currently, the disease level is high in the Americas but relatively low in Africa. however, it is expected that the incidence of dental caries will increase in many developing countries in Africa, due to a growing consumption of sugars and inadequate exposure to fluorides. Tooth Loss

In many developing countries, access to oral health services is limited teeth are often left untreated or are extracted because of pain or discomfort. Throughout the world, losing teeth is still seen as a natural consequence of ageing. While in some industrialized countries there has been a positive trend of reduction in tooth loss among adults in recent years, the proportion of edentulous adults aged 65 years and older are still high in some countries (Table 1). Periodontal Diseases

most children have signs of gingivitis among adults, the initial stages of periodontal diseases are prevalent.

Figure 2 illustrates the periodontal health status of 35-44-year-olds by WHO region, using the so-called Community Periodontal Index. Severe periodontitis, which may result in tooth loss, is found in 5-15% of most populations. Juvenile or early-onset aggressive periodontitis, a severe periodontal condition affecting individuals during puberty that leads to premature tooth loss, affects about 2% of youth.

In industrialized countries, studies have shown smoking is a major risk factor for adult periodontal disease. Risk decreases when smokers quit and the prevalence of periodontal disease has decreased in countries experiencing reductions in tobacco use. Oral Cancer

The prevalence of oral carcinoma is particularly high among men, and carcinoma of the lip is at least 8 times as common in men as in women in Britain. the eighth most common cancer of the world (Figure 3). Incidence of oral carcinoma, in countries like UK and USA, is low.

 India and Sri Lanka are exceptional; and oral carcinoma accounts for approximately 40% or more of all cancer. South Central Asia, cancer of the oral cavity ranks amongst the three most common types of cancer. sharp increases in incidence rates of oral/pharyngeal cancers have been reported for several countries such as Germany, Denmark, Scotland, Central and Eastern Europe and, to a lesser extent, Japan, Australia, New Zealand and USA.

The high incidence rates relate directly to risk behaviours such as smoking, use of smokeless tobacco (e.g. betel nut or miang chewing) and alcohol consumption. In Thailand, the prevalence of smoking is about 60%, betel nut chewing 15% while alcohol consumption is 35%. Qat : leafy narcotic substance that is popular in several countries in East Africa and the Arab Peninsula; consumed as a liquid in the form of tea or smoked like tobacco; most common mode of ingestion is by chewing the fresh leaves. -can lead to adverse oral effects including oral mucosal lesions, dryness of the mouth, discoloration of teeth, poor oral hygiene and periodontal disease. The incidence of oral cancer is clearly age related, which may reflect declining immune surveillance with age, time for the accumulation of genetic changes, and duration of exposure to initiators and promoters (these include chemical and physical irritants, viruses, hormonal effects, cellular aging, and decreased immunologic surveillance) immunosuppression increases the risk of the development of squamous cell carcinoma Oro-Dental Trauma Reliable data on the frequency and severity are still lacking in most countries, particularly in developing countries. Some countries in Latin America= 15% of schoolchildren the Middle East = 5-12% are found in children aged 6-12 years certain industrialized countries revealed that the prevalence of dental traumatic injuries is on the increase, ranging from 16-40% and 4-33% among 6-year-old and 12-14year-old children respectively. A significant proportion of dental trauma relates to sports, unsafe playgrounds or schools, road accidents or violence. In industrialized countries, the costs of immediate and follow-up care for dental trauma patients are high. Malocclusion Estimates of the frequency of different traits are available from a number of countries, primarily from Northern Europe and North America. Eg, prevalence rates of dento-facial anomalies are 10%, ( Dental Aesthetic Index). Malocclusion is not a disease but rather a set of dental deviations which in some cases can influence quality of life. insufficient evidence that orthodontic treatment enhances dental health and function. Treatment is often justified by the potential enhancement of social and psychological wellbeing through improvements in appearance. Orofacial clefts occur in around 1 per 500-700 births; varying substantially across ethnic groups and geographical areas. Other conditions that may lead to special health care needs include Downs syndrome, cerebral palsy, learning and developmental disabilities, and genetic and hereditary disorders with oro-facial defects.

substantial environmental causes= the higher risk first with maternal tobacco, alcohol and nutritional factors. little or no information available on the frequency of cranio-facial anomalies, in particular parts of Africa, Central Asia, Eastern Europe, India and the Middle East. Dental Fluorosis

Given the extent of the problem, oral diseases are major public health problems. Their impact on individuals and communities, as a result of pain and suffering, impairment of function and reduced quality of life, is considerable. Moreover, traditional treatment of oral disease is extremely costly, the fourth most expensive disease to treat in most industrialized countries. In low-income countries, if treatment were available, the costs of dental caries alone in children would exceed the total health care budget for children. A core group of modifiable risk factors are common to many chronic diseases and injuries. The four most prominent noncommunicable diseases (NCDs) - cardiovascular diseases, diabetes, cancer and chronic obstructive pulmonary diseases - share common risk factors with oral diseases, preventable risk factors that are related to lifestyle. For example, dietary habits are significant to the development of NCDs and influence the development of dental caries. Tobacco use has been estimated to account for over 90% of cancers in the oral cavity, and is associated with aggravated periodontal breakdown, poorer standards of oral hygiene and thus premature tooth loss. The greatest burden of all diseases is on the disadvantaged and socially marginalized. A major benefit of the common risk factor approach is the focus on improving health conditions for the whole population as well as for high risk groups; thereby reducing inequities. The solutions to the chronic disease problems are to be found through shared approaches. The WHO Global Strategy for the prevention and control of noncommunicable diseases is a new approach to managing the prevention and control of oral diseases. Continuing surveillance of levels and patterns of risk factors is of fundamental importance to planning and evaluating community preventive activities and oral health promotion.