Oral diseases: a global public health challenge

We read the Series paper by Marco Peres and colleagues1Peres MA Macpherson LMD Weyant RJ et al.Oral diseases: a global public health challenge.Lancet. 2019; 394: 249-260Summary Full Text Full Text PDF PubMed Scopus (950) Google Scholar and woul dlike to highlight the state of oral health in India. In India, the mean prevalence of dental caries is 49% in children aged 5–12 years, 60% in people aged 15–34 years, 78% in people aged 35–44 years, and 84% in people aged 65–74 years.2Jankiram C Antony B Joseph J Ramanarayanan V Prevalence of dental caries in India among the WHO index age group: a meta-analysis.J Clin Diagn Research. 2018; 12: ZE08-ZE13Google Scholar The incidence of oral cancer in India (50% of total cancers) is higher than in other countries and has been attributed to tobacco chewing, repeated use of masheri (a paste prepared from incompletely burned tobacco; appendix p 1), bidi smoking (small, hand-rolled tobacco cigarettes), betel nut and gutkha chewing, and alcohol consumption.3Varshitha A Prevalence of oral cancer in India.J Pharm Sci Res. 2015; 7: 845-848Google Scholar Many individuals continue habits such as tobacco chewing, even after surgical treatment for oral cancer (appendix p 2). Since 1976, when we opened our rural medical practice, we have been writing “stop smoking and tobacco chewing” in red ink in the first line of our prescriptions.4Bawaskar HS General practice in rural areas.Issues Med Ethics. 2002; 10: 16Google Scholar We also allow patients with leukoplakia caused by tobacco chewing to see the lesions that form where the tobacco has been held in the mouth (appendix p 3). We have found that these practices, along with warnings about the risk of developing oral cancer after leukoplakia, induce some individuals to break their addiction to chewing tobacco. Patients who chew betel nut or tobacco often have severe submucous fibrosis and are unable to fully open their mouths. Submucous fibrosis (appendix p 4) results in bad oral hygiene, caries, and malnutrition. Tobacco causes one death every 6 s worldwide,1Peres MA Macpherson LMD Weyant RJ et al.Oral diseases: a global public health challenge.Lancet. 2019; 394: 249-260Summary Full Text Full Text PDF PubMed Scopus (950) Google Scholar and India is the second leading consumer, with farmers being given permission to grow tobacco in Karnataka state. In India, sugar-sweetened foods are very popular. People of all ages routinely drink heavily sweetened tea, and children often enjoy chocolate, ice cream, and candy. At social occasions, such as weddings, bidis, betel nuts, and gutkha are freely distributed to guests. These social norms and customs are important factors in the high prevalence of oral diseases in India. We agree with Richard Watt, who claimed that “the mouth really is a marker of people's social position and future disease risk, and oral diseases are a canary in the coal mine for inequality”.5Davies R Richard Watt: time to tackle oral diseases.Lancet. 2019; 394: 209Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar Social stigma is another important element of oral health and disease. A girl aged 16 years was brought to our medical practice by her mother because, despite being healthy, she refused to attend school. The girl stated that she was being teased by her peers because of the way her teeth looked (appendix p 5), and that she often tried to avoid laughing so as to avoid showing her teeth. This 16-year-old had dental fluorosis, which is irreversible damage to the teeth, caused by excessive ingestion of fluoride. We investigated the drinking water that the girl had access to and found that fluoride concentrations were very high.6Bawaskar HS Bawaskar PH Endemic fluorosis in an isolated village in western Maharashtra, India.Trop Doct. 2006; 36: 221-223Crossref PubMed Scopus (7) Google Scholar Dental fluorosis and many other social issues surrounding oral health, were not addressed by Peres and colleagues.1Peres MA Macpherson LMD Weyant RJ et al.Oral diseases: a global public health challenge.Lancet. 2019; 394: 249-260Summary Full Text Full Text PDF PubMed Scopus (950) Google Scholar In India, the numbers of undergraduate dental surgeons going into private practice are increasing, but their services are expensive, and most people in India are unable to afford their services. We declare no competing interests. Download .pdf (.79 MB) Help with pdf files Supplementary appendix Oral diseases: a global public health challengeOral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Full-Text PDF Oral diseases: a global public health challenge – Authors' replyWe thank Jean-Noel Vergnes and Marco Mazevet for their interest in our Series paper on the global public health challenge of oral diseases,1 and we thank Himmatrao and Pramodini Bawaskar for sharing their experience of oral health in India. Full-Text PDF Oral diseases: a global public health challengeIn their Series paper, Marco Peres and colleagues1 reproduce a map of the estimated global prevalence of untreated dental caries in permanent teeth for 2017. France is reported to be one of the five countries in the world where prevalence is higher than 50%. This prevalence seems surprisingly high for a country where the public health insurance system leaves routine dental treatments (examinations, extractions, restorations, and endodontic treatments) with no out-of-pocket charges for more than 95% of the population. Full-Text PDF