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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 36-39

Dental hygiene and noncommunicable diseases – Current trends and future perspective


1 Intern, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
2 Dean and Research Director, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
3 Dental Surgeon (B.D.S), Pune, Maharashtra, India
4 Dental Surgeon (B.D.S), Bhuj Kachchh, Gujarat, India
5 Dental Surgeon (B.D.S), Nagpur, Maharashtra, India

Date of Submission05-Oct-2021
Date of Acceptance19-Dec-2021
Date of Web Publication9-Mar-2022

Correspondence Address:
Sanjana Agrawal
VSPM Dental College and Research Centre, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcdoh.jpcdoh_39_21

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  Abstract 


Dental hygiene is an integral and also a major part of a person's general health, thereby better prevention of oral disease would save millions of rupees for the health-care systems. Noncommunicable diseases (NCDs) and their rising global burden are the primary reason for disability among people worldwide. Oral health is one of the reflections on the overall health and well-being of a person, and several oral diseases are even associated with chronic diseases like diabetes and periodontal diseases. Oral health is a heterogeneous entity composing the ability to chew, swallow, smile, smell, speak, taste and touch to convey a wide spectrum of emotions via expressions of face with confidence and without craniofacial complex discomfort, pain, and disease. Oral health remains a neglected and an under-recognized global health issue, where oral diseases affect around 3.9 billion people globally. Exacerbation of certain NCDs predisposes to oral dysbiosis and poor dental hygiene that may further lead to increased edentulism and periodontal diseases. The organizations and policymakers must shift the programs, policies, and public perceptions and viewpoints in support of sustaining adequate hygiene for overall health and well-being.

Keywords: Dental hygiene, edentulism, noncommunicable diseases, oral dysbiosis, periodontal diseases


How to cite this article:
Kutikuppala L V, Ram S, Unani N, Memon MA, Agrawal S. Dental hygiene and noncommunicable diseases – Current trends and future perspective. J Prim Care Dent Oral Health 2022;3:36-9

How to cite this URL:
Kutikuppala L V, Ram S, Unani N, Memon MA, Agrawal S. Dental hygiene and noncommunicable diseases – Current trends and future perspective. J Prim Care Dent Oral Health [serial online] 2022 [cited 2022 May 27];3:36-9. Available from: http://www.jpcdoh.org/text.asp?2022/3/2/36/339308




  Introduction Top


According to the World Health Organization (WHO), “Non-Communicable Diseases (NCDs) are defined as diseases of long duration, generally progress slowly and are the major cause of adult mortality and morbidity worldwide.”[1] The rising global burden of NCDs is the primary reason for disability among the majority of the general population. Cardiovascular diseases, diabetes mellitus (DM), cancers, and chronic respiratory diseases constitute bulk of the NCDs, of which more than 85% deaths occur in the low income and middle-income countries.[2] The expected mortality rate of NCDs is thought to have increased by another 10%–15% between 2010 and 2020. Most of the NCDs are preventable and treatable as observed from many years, where NCDs are causing an emergent and severe toll on the overall health, social and economic security of low-income and middle-income countries. This further suggests a strong connection between NCDs and oral diseases that have been drawn by many studies.[3]

Various risk factors such as tobacco usage, unhealthy diet (sugars), alcohol intake, and lack of physical activity are similar for both NCDs and oral diseases. Moreover, poor oral health is a direct reflection on the general health of a person and this is how several oral diseases are related to chronic diseases such as periodontal diseases and diabetes.[4]

Adequate amount of literature is available on the alliance between periodontal infection with cardiovascular disease (CVD), gastroesophageal reflux disease, DM, preterm low birth weight, pregnancy, stroke, osteoporosis, rheumatoid arthritis, heart diseases, etc., Numerous studies have shown the elevated prevalence of periodontal diseases among diabetic patients. Substantial literature from developed countries has reported the association of oral diseases with NCDs such as diabetes, chronic respiratory diseases, CVDs, renal failure, and osteoporosis. The factors that play an important role in this association include – changes in systemic inflammatory mediators, commonality of risk factors, and body metabolism.[5]

The epidemiological transition in India has led to a burden of communicability and NCDs posing a huge challenge to the health systems which are unprepared for such challenges. In India, it has been reported that NCDs contribute to approximately 56% of the total disease burden. The vast spread of oral diseases is the most common NCDs and is the leading difficulty to the development and achievement of the Millennium Development Goals. Chiefly in poor resource settings, there is a strong need to understand the gaps between oral diseases and NCDs. The substantial global mutual action is the most substantial need of the time.[6]

Knowledge, attitude, behavior, awareness, and education play pivotal roles in determining the importance of overall health. Changes in oral health also have an impact on systemic health.[7]


  Definitions of Noncommunicable Diseases and Dental Hygiene/Oral Health Top


NCDs, which are also called chronic diseases, tend to last for longer durations and are the result of a mix of genetic, environmental physiological, and behavioural factors.[8]

The WHO defined “oral health as a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual 's capacity in biting/chewing, smiling, speaking, and psychosocial well-being.”[9]

Oral health is “multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.” It is a basic component of health and physical and mental well-being, existing along a continuum influenced by the values and attitudes of individuals and communities, reflecting the physiological, social, and psychological attributes that are essential to the quality of life. It is influenced by the individual's changing experiences, perceptions, expectations, and ability to adapt to circumstances.[10]


  Burden of Oral Diseases and Noncommunicable Diseases Top


The greatest oral disease burden is on the socially marginalized and disadvantaged populations, where CVDs are the leading NCD. Approximately half of the 36 million deaths due to NCDs are caused by CVD.[11] NCDs are acknowledged as a global health priority and the oral diseases were more specifically referred to as a major health-care burden. Despite the undesirably high disease burden, oral health is still not considered as a priority issue and has neglected and remained low on the development and global health agenda.[12]

NCDs are currently and widely recognized as a major challenge to the health and sustainable development of mankind in the era of 21st century. NCDs are the leading cause of disability and death globally, being responsible for 70% of global mortality. In the developed and increasingly developing countries, it is being recognized that the oral disease burden and the need for the essential care are highest among the disadvantaged or poor populations. There is a strong association between the oral diseases and diabetes, through a strong pathophysiological basis in addressing oral health problems within the general health-care practice. Oral, renal, and ophthalmic diseases pose a major burden of health care for many countries, sharing the common risk factors and have a potential benefit from the common responses.[13]


  Oral Health: The Missing Link in Tackling Noncommunicable Diseases Top


Oral health is considered as an integral part of the general and overall health, where better prevention can save millions of euros or dollars for the health systems. Dentistry plays an important role in this juncture, as oral and general diseases share the common risk factors and social determinants. Hence, preventive measures can target both oral diseases and medical NCDs and this approach not only responds to the need of intervention with the objective of reducing premature morbidity and mortality of chronic NCDs, but also the need to incorporate health promotion, primary, secondary, and tertiary preventive measures, and associated programs and interventions across different sectors and disciplines. NCD programs in the most LMICs do not encompass and promote oral health, and even the data on the co-occurrence of oral diseases in relation to NCDs are insufficient.[14]


  Relation between Oral Health and Noncommunicable Diseases Top


All the major NCDs, including many of the oral diseases share the similar social determinants and some of the common modifiable risk factors. Also, oral diseases are connected with a number of other NCDs, including diabetes, respiratory diseases, CVDs, pancreatic and gastrointestinal cancers. It is already a known fact that NCDs such as the chronic respiratory diseases, CVDs, cancers, and DM are responsible for the most deaths worldwide.[15]

Various studies among the high-income countries have reported strong association between oral health and diabetes. The astonishing link between periodontal disease and heart health is considered crucial, where the dental profession can be regarded as a key assessor of not just the oral health, but also the heart health.[16] The researchers have also found that people with existing periodontal disease are almost twice as likely to develop heart disease, and this risk can be even greater for people with higher levels of cholesterol. Health education to the patients about the oral-systemic connection between the periodontal disease and CVD can eventually help saving their lives.[17]


  Understanding the Link between Periodontal Disease and Heart Disease: The Suspected Role of Bacteria and Inflammation Top


Scientists worldwide suspect a link between the two diseases (oral and NCDs) due to similar bacteria that is found in the infected gum tissue around teeth. These bacteria break down the barrier between the gums and the connective tissue underlying causing altered homeostasis and inflammation. Hence, bacteria can enter the bloodstream from the infected gum tissue moving to the other parts of the circulatory system including the heart and blood vessels during the brushing or normal chewing, contributing to the formation of CVD.[18]

Swelling or inflammation is the natural bodily response toward the infection. There is a possibility that the oral bacteria travel through the body triggering a similar response, which further leads to the arterial plaque formation. Oral bacteria have been found significantly in the fatty deposits of people with atherosclerosis. These deposits can narrow or damage the arteries and even clog them totally, leading to heart attack or ischemic stroke.[19]


  Dental Hygiene as an Indicator of Noncommunicable Diseases Management Top


Oral diseases are qualified as major public health problems due to their high incidence and prevalence in all regions of the world. Oral diseases have a considerable impact on the quality of life of individuals, their contribution in the society and economic efficiency as well as on health systems, making oral diseases a major public health concern integration of oral health with the national chronic disease programs require serious consideration given the high burden of oral diseases, NCDs and shared set of risk factors.[20]


  Oral Health Should not be Forgotten While Managing Noncommunicable Diseases Top


Oral health still remains as a neglected and under-recognized global health issue, where the oral diseases affect approximately 3.9 billion people globally and the untreated tooth decay (dental caries) reaches almost half of the world's population (44%) making it the most prevalent among all the other health conditions. Oral diseases such as dental caries, tooth loss, oral mucosal lesions, periodontal disease, dental trauma, and oropharyngeal cancers are considered as the major public health problems worldwide. Oral health problems are associated with pain, compromised mastication, xerostomia that profoundly affect overall quality of life, loss of work hours and are often expensive to treat. Despite the unacceptably high disease burden, oral health is still not considered a priority issue and has remained low on the global health and development agenda.[21] As a profession, we can help educate patients about the oral-systemic connection by looking for early symptoms of periodontal disease and offering minimally invasive treatment options that patients will accept.[22]


  Oral Health Promotion in Noncommunicable Diseases Top


The overall impact of oral diseases on quality of life is huge, where the oral diseases affect almost 100% of the world's population at least once during their lifetime, creating an unnecessary financial burden on the patients, their families and even the health-care systems. The latest developments in dentistry provide organizations and policymakers with the opportunity to critically reflect on the current and future orientation toward the oral health promotion and oral disease prevention. The core concept behind the integrated common risk approach of the NCDs and oral disease is to promote the general health of an individual by controlling a number of risk factors that tend to have a major impact on the number of diseases. These integrated approaches when compared to the routine disease-specific approaches can even reduce the economic burden and improve the efficiency of the interventions. It is being understood that these integrated services should primarily be based on education for increasing the awareness and influencing the attitude of the people in seeking oral health care.[22]


  Need for Integrative Approach to Dental Hygiene and Noncommunicable Diseases Top


Oral health is conventionally more disease-oriented, curative, serving a limited number of people due to the high costs involved. The important and much required way to prevent and control NCDs is to concentrate on risk factor reduction associated with the disease, where the oral health conditions account for the fourth highest health-care expenditure in comparison to the other NCDs. Effective strategies and interventions at regional and national levels for promoting oral health and preventing oral diseases have a much bigger potential in showing population-wide improvement of oral health, contributing to the prevention of the leading NCDs. The impact of various oral diseases and NCDs on the health and welfare of an individual is troublesome, hence integration of oral health components in NCD management in formulating policies, action plans for the control and prevention of NCDs incorporated with oral diseases is required.[23]


  Noncommunicable Diseases Policy Agenda for Oral Health Top


Promotion of Oral health and prevention of oral disease must be integrated and further termed as “the common risk factor approach,” to ensure broader health promotion outcomes. Countries with poor health insurance coverage are less likely to provide universal access to the essential NCD interventions.[1] Oral diseases and NCDs combinedly share modifiable risk factors and even common social determinants leading to a major proportion of global NCD deaths under the age of 70 years.


  FDI-NCDA Partnership Top


According to the FDI World Dental Federation, oral diseases are said to affect around 3.9 billion people worldwide having a significant impact on the lives of individuals, communities, economies, health systems, and even the entire society as a whole. Adopting a combined strategy targeted toward general health and oral health by improving access to the health services, implementing various cost-effective and evidence-based population-wide oral health promotion measures, strengthening the interprofessional collaboration, including the special focus on oral health in the academic curricula, integrating oral and NCD care into current programs for improving the collaboration is very essential in tackling the global NCD burden.[3]


  Conclusion Top


Indigent dental hygiene has a potential to produce a persistent chronic inflammatory response, starting with low-grade illness could causing a multitude of complications correlated with NCDs. The other way, exacerbation of certain NCDs predisposes to oral dysbiosis and poor dental hygiene which may further lead to increased edentulism and periodontal diseases. The organizations and policymakers must shift the programs, policies, and public perceptions and viewpoints in support of sustaining adequate hygiene for overall health and well-being.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Boutayeb A, Boutayeb S, Boutayeb W. Multi-morbidity of non communicable diseases and equity in WHO Eastern Mediterranean countries. Int J Equity Health 2013;12:60.  Back to cited text no. 11
    
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Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet 2006;367:1747-57.  Back to cited text no. 13
    
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Tazeen HJ, Benjamin AH, Atif R, Junaid R, Marcel B, Mohsen N, et al. Health transition in Pakistan non-communicable disease and injuries in Pakistan strategic priorities. Lancet 2013;381:2281-90.  Back to cited text no. 14
    
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Singh A, Gambhir RS, Singh S, Kapoor V, Singh J. Oral health: How much do you know? – A study on knowledge, attitude and practices of patients visiting a North Indian dental school. Eur J Dent 2014;8:63-7.  Back to cited text no. 15
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  In this article
Abstract
Introduction
Definitions of N...
Burden of Oral D...
Oral Health: The...
Relation between...
Understanding th...
Dental Hygiene a...
Oral Health Shou...
Oral Health Prom...
Need for Integra...
Noncommunicable ...
FDI-NCDA Partnership
Conclusion
References

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