Mohsin Khan, a 42-year-old artisan from Bareilly, now brushes his teeth twice daily and is determined to quit smoking. But his efforts at maintaining dental health come too late.
Doctors have found leukoplakia—a pre-cancerous lesion—in Khan’s mouth. He also has stains and periodontal disease, a chronic inflammatory disease that destroys bone and gum tissues that support the teeth.
These are all the result of lack of good oral hygiene and excessive tobacco usage.
Khan, a master in embroidery and working for major Indian wedding attire companies, has been unable to concentrate on his needle and thread ever since his return from a Tobacco Cessation Cell in New Delhi, where doctors examined him.
“My friends persuaded me to smoke. Gradually, I became addicted to it. I was also chewing tobacco and used neem sticks and coal ash to clean my teeth instead of using a toothpaste. Doctors have told me that I have cancer in mouth and they are trying to treat me,” said a sad and depressed Khan. “I was never aware that cleaning teeth is so important and tobacco can give me oral cancer. I don’t want to die. I have a family to support,” he said.
Khan is probably the tip of the iceberg – rapidly deepening dental health crisis in India mostly the result of lack of awareness about dental hygiene.
The burden of dental diseases in India
Indians are largely affected by dental caries or toothy decay, periodontal disease, and oral cancer. According to ministry of health and family welfare, while dental caries affects about 60% and periodontal disease about 85% of the Indian population, the country is considered the world capital for oral cancer.
According to government estimates, more than 70% of school children are suffering from dental caries and more than 90% of the adult population is affected by periodontal disease.
“Dental caries is one of the major causes of pain, discomfort and absenteeism from school and sometimes office work too. Gingival and periodontal diseases also account for tooth loss and associated disabilities,” said Anil Kumar Chandna, member Dental Council of India (DCI).
According to the draft National Oral Health Policy 2018, the prevalence and recurrence of oral diseases in India is a silent epidemic. There has next to no improvement in oral health status of Indian population in the past three decades.
Oral disorders have remained the most prevalent disease group in India over the past three decades affecting almost 66.7 crore (49.2% in comparison to 43.2 crore; 50.2%) people in 2017. Different oral conditions such as untreated caries of permanent teeth, untreated caries of deciduous teeth and severe periodontitis have a significant burden affecting 43.2 crores (32%), 11.2 crores (8.3%) and 18.1 crores (13.3%) people in India. Despite the scale of the problem, only 12.4% of adults have ever got their oral cavity examined by a dentist, the draft National Oral Health Policy 2018 notes.
“Oral diseases and conditions such as dental caries, periodontal diseases, malocclusion, oro-facial anomalies, dental fluorosis, loss of teeth, temporo-mandibular joint disorders, dental trauma and oral cancers have the dubious distinction of affecting more than half of the population globally including India,” said Ratan Ranjan Pandey, Consultant Dentist, Columbia Asia Hospital.
“The problem of dental diseases is more staggering in rural areas owing to inaccessibility to dental professionals. Lack of dental infrastructure and public hospitals is also a worrisome situation as this makes even the simple dental procedures unavailable to the common man who then has to bear the treatment from out of his pocket expenses. In such a situation he is usually forced to get his tooth extracted as this seems to be relatively cheaper without any awareness of the associated morbidity,” said Chandna.
As India is one of the countries consuming maximum tobacco, a leading cause of oral cancer, the problem has only aggravated in recent past. “India has the highest number of oral cancers in the world with 75,000 to 80,000 new cases every year. All forms of chewing tobacco sold in small pouches across the country are a serious health hazard as they are targeted at the youth and children”, said Bhavna B Mukhopadhyay, Chief Executive, Voluntary Health Association of India.
What ails Indians’ dental health?
Dental health experts have pointed out that Indians consider oral health secondary to general health. Also, with growing modernisation, Indians are rapidly moving away from the traditional fibre rich diet to sugary and synthetic diet which is one of the highest contributory factor for dental caries. “The dietary patterns of Indians have changed gradually. Most of the Indians have irregular meals, have high sugar intake with carbonated drinks and juices which cause progression of dental caries specially among children,” said Kiran Sharma, nutritionist, QRG Central hospital and Research Centre, Faridabad.
The national oral health policy also states that risk factors for oral diseases include poor oral hygiene, tobacco use including pan masala, unhealthy cariogenic diet, stress and harmful use of alcohol. Many of these risk factors are in common with other Non-Communicable Diseases.
“Many people take dental care for granted until it is too late. Many people still perceive oral health and dental hygiene as secondary priority. Alcohol, tobacco and eating habits play a significant role in oral health. Our mouth is the breeding ground for lots of bacteria and more than 700 species of bacteria have been detected,” said Smriti Bouri, Principal Consultant – General and Aesthetic Dentistry, Max Multi Speciality Centre, Panchsheel Park.
Ignorant to dental hygiene? Know the unknown facts
While it is widely known that poor dental care causes tooth decay, unwanted stains, bad breath and tooth loss, there are several unknown facts related to poor oral and dental hygiene that may lead to serious health problems. Doctors say mouth and body are integral to each other as one’s mouth is a window into what’s going on in the rest of the body. Doctors claim that poor oral hygiene is also linked to heart diseases, diabetes, pregnancy complications.
“Bacteria present in gum diseases enter the blood stream and this in turn increases the risk of heart attacks, poorly controlled diabetes, respiratory diseases and dementia. Research has also shown that a diseased mouth may contribute to immune system disorders and preterm birth. Also, there are many general health conditions such as AIDS and skin diseases which often first manifest in the mouth,” said Ambereen Ali, Consultant-Dentistry at Jaslok Hospital and Research Centre.
The draft oral health policy outlines the social determinants of oral health. Oral diseases are associated with an array of socio-economic and environmental factors including income, literacy, hygiene, sanitation, housing, and safe drinking water.
“Untreated gum disease may eventually lead to progressive loss in the alveolar bone around the teeth and are also responsible for many ill effects on the body,” said Vimal Arora, Chief Clinical Officer, Clove Dental clinics.
Research suggests that good dental health can keep several chronic health complications at bay. “Not only does it prevent bad breath, tooth decay and gum disease, but also reduces the risk of health issues such as heart attack, stroke, poorly controlled diabetes and even preterm labor,” said Praveshh Gaur, Founder, Director, Srauta Wellness centre.