Validation Study of Community Health Workers
Assessment of Oral Hygiene

GEETHA LOGANATHAN, RAVIKUMAR CHOCKALINGAM

Rationale for Study (Page 1 of 2)

Oral health status in India

Oral diseases are widely prevalent in India. Dental caries and Periodontal diseases are the two leading oral disease burden of the World. India is no exception to this problem. Epidemiological studies over the Indian population also show that dental caries and periodontal disease are widely distributed throughout the country. The other common oral diseases in India are Oral cancer, Malocclusion and Fluorosis.

Dental Caries: It is a microbial disease resulting in the gradual destruction of tooth. It is the second most common cause of tooth loss and is found universally irrelevant of age, sex, caste, geographic location and socioeconomic status. In India the prevalence of dental caries is found to be 50%-60% 4.

Periodontal disease: It is a microbial disease which affects the supporting structures of the teeth [gingival, periodontal ligament, alveolar bone and cementum]. It is the leading cause of tooth loss and is more common among the adults than children. It is found that in Indian population periodontal diseases affect 90% of the population, but most of them have mild gingivitis which is reversible by good oral hygiene. But more advanced periodontal disease with pocket formation, bone loss, ultimately resulting in tooth loss, is found in about 40%-45% of the Indian population 4.

It has been projected that these diseases will increase by 25% in the next decade 5

Impact of oral diseases

Oral health is an integral part of general health. Though oral diseases are not life threatening, they are very painful and very badly affect the day to day activities. Moreover, the treatment of dental diseases is expensive and time-consuming. When the person suffers from pain due to the oral diseases he may not be able to work properly or may not be able to work at all, leading to loss of working hours.

It is estimated that the disability adjusted life-years [DALYs] lost in India during 1998 due to Oral disease alone accounts for 12,47,000 years 5. This is especially important in a country like India where 27.5% of the population is below poverty line and 75% of the population depends on daily wages 6.

Besides that poor oral health affects mastication [chewing] of food leading to change in the dietary habits resulting in nutritional deficiencies. Poor oral health causes difficulty in speech, affects the aesthetics, leading to loss of confidence and overall well-being of the individual.

Oral health and systemic health

Oral health and general health are interlinked. Oral infections have an adverse effect on other organs of the body. There are number of studies also explaining that oral diseases in particular periodontal disease have an adverse effect on many of the systemic diseases.

Effect of periodontal disease on diabetes

Periodontal disease is often considered the sixth complication of diabetes. Studies show that diabetic patients are at 2-4 times higher risk of getting periodontal disease 7. Periodontal disease and diabetes are considered as two-way relationship, because, as said, diabetic patients are at increased risk of getting periodontal disease and, once periodontal disease sets in a diabetic patient, this in turn makes it more difficult to control the blood sugar.

Effect of periodontal disease on pregnancy outcomes

Studies have shown that pregnant women with periodontal disease are 7 times 8 more likely to give birth to premature babies. Periodontal disease triggers high level of subjects that induce labour, and this is further more exacerbated in women with diabetes.

Effect of periodontal disease on heart disease

Studies show that people with periodontal disease are twice more likely to suffer from cardio-vascular diseases 9. Studies propose two hypotheses for the occurrence of heart attack in person with periodontal disease. One is that periodontal pathogens enter the blood steam, invade the blood vessel wall and cause atherosclerosis and the second one is that periodontal disease increases the plasma levels of inflammation like fibrinogen, c-reactive proteins.

Effect of periodontal disease on cerebrovascular disease [stroke]

Studies show that subjects with severe periodontitis have 4.3 times increased risk of getting stroke than those with mild periodontitis or no periodontitis 10. This may be due to the bacteria found in the periodontitis develop blood clots increasing the likelihood of stroke.

Effect of periodontal disease on respiratory disease

Studies show that bacteria found in the periodontal disease are aspirated into the lungs, causing respiratory diseases like pneumonia 11.

4 Naseem Shah. “Oral and dental diseases: Causes, prevention and treatment strategies”, NCMH Background papers – Burden of Diseases in India,(2005), 276-298     (Continue reading)

5 “Disease burden in India:Estimations and causal analysis”, NCMH Background papers Burden of Diseases in India,(2005), 1-6     (Continue reading)

6 Poverty in India [online] Available from: http://en.wikipedia.org/wiki/Poverty_in_India     (Continue reading)

7 Helping Patients with Diabetes Understand the 2-Way Relationship Between Diabetes and Gum Disease [online] Available from: http://www.azmoudehdental.com/images2/diabetesgumdisease.pdf     (Continue reading)

8 Gum disease and pregnancy problem [online] Available from: http://www.perio.org/consumer/mbc.baby.htm     (Continue reading)

9 Gum disease links to heart disease and stroke [online] Available from: http://www.perio.org/consumer/mbc.heart.htm     (Continue reading)

10 Gum disease and stroke link [online] Available from: http://www.medicalnewstoday.com/articles/5982.php     (Continue reading)

11 Gum disease and respiratory disease [online] Available from: http://www.perio.org/consumer/mbc.respiratory.htm     (Continue reading)

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