The burden of oral diseases

March 20 marks the World Oral Health Day (WOHD). The day’s activities are dedicated to raising global awareness on the prevention and control of oral diseases. This year, the theme is ‘Think Mouth Think Health’. In Rwanda, the day will be celebrated in Gasabo and Bugesera districts, where according to organisers, the focus will be on dental health preventions. The theme calls for everyone to pay attention to oral health issues and think about what can be done to prevent dental caries and gum disease that have become a menace to the health of many Rwandans, adults and children alike. Organised by World Dental Association together with Rwanda Dental Surgeons, the occasion targets the general public, especially school-going children and expectant mothers. The WOHD campaign is starts March 19 to 24 and those who will turn up will receive diagnosis and treatment services for free. Christine Uwamwezi, president of Rwanda Dental Association working at Inkuru Nzinza Orthopedic Hospital in Gikondo, says they will educate children on techniques of brushing their teeth, and provide them with toothpaste and tooth brushes. “We believe by educating young people on oral care, they will not only pass the message to their families, but also be able to grow with the knowledge on how to take care of their teeth; which will provide a future generation free from dental caries,” she says. Uwamwezi adds that they will mostly focus on public schools, as most of them come from vulnerable families and toothpaste might be something they cannot afford, causing dental problems. Children will be followed up every three months just to make sure they have mastered the skills. Uwamwezi says many oral diseases come due to lack of knowledge, some never visit the dentist and only go there when they have a problem. “People should be aware that by keeping a healthy mouth, they are also maintaining their overall health,” she says. Uwamwezi explains that a healthy mouth and a healthy body go hand-in-hand. It’s important to understand the close relationship between oral health and general health and the impact that one has on the other, to be able to know how to protect the mouth and body at all ages. She adds that they also aim at teaching the public on the risk factors and how they can stay away from them. THE BURDEN OF DENTAL DISEASES Oral diseases are a major burden for almost all countries globally, and it urgently needs to be prioritised and addressed. Oral diseases affect 3.9 billion people worldwide, with untreated tooth decay alone impacting almost half of the world’s population (44 per cent). Agnes Gatarayiha, deputy dean in the School of Dentistry, University of Rwanda, says the burden of oral disease is further compounded by its association with other non-communicable diseases (NCDs), such as diabetes, cardiovascular disease, respiratory disease, and some cancers. She adds that it’s driven by common risk factors including tobacco use, alcohol consumption and unhealthy diets. Oral diseases and most NCDs can benefit from a comprehensive and integrated response. In Rwanda, the burden of dental and periodontal diseases (infections of the structures around the teeth, which include the gums) is portrayed by the findings released by National Oral Health Survey of Rwanda Draft Preliminary Report in August 2017. They indicate that nearly 50 per cent of children aged 2 to 5 and over 50 per cent of people aged 20 to 39 years have untreated dental caries. Over 60 per cent of people aged 40 and above were reported to have difficulty in doing their jobs, chewing or being self-conscious because of dental pain. With regard to the accessibility of dental services, the report revealed that nearly three quarters of the respondents (70.6 per cent) had never visited a dental practitioner. The report further stated that 98.7 per cent of those who did, did so because of dental pain, trouble with their teeth, gums or mouth. Higher percentage of untreated caries (56.0 per cent) was reported in rural locations than in urban areas (49.3 per cent). However, indicators for periodontal diseases are higher in adults aged 20 and older with 60.0 per cent having calculus (tartar), while 32.4 per cent have substantial oral debris covering a third of tooth surfaces. Based on the report, Gatarayiha says the burden of oral disease across the country is generally a menace to the health of many Rwandans, irrespective of their age. She adds that oral health affects general health by causing considerable pain and suffering, affecting the quality of life. Common oral diseases and complications Gonzalue Niyigaba, a dentist at University Teaching Hospital (CHUK), says dental decay and periodontal diseases are among the most common oral diseases that affect a large population, adults and children. He says dental decay is the destruction of tooth enamel, caused by a plague resulting from eating foods with a lot of sugar. While periodontal diseases are the gum diseases brought about by bacteria in the dental plague. With periodontal diseases, he says one can have tartar, which can’t be removed by a brush unless the patient seeks assistance from a dentist. “This is also a problem because it’s the cause of periodontal diseases. If it stays there for long without treatment, it can cause inflammation of the gum, infections which can affect the bone leading to shaking of the teeth and finally losing the tooth/teeth,” Niyigaba says. To prevent the oral diseases, Niyigaba says oral hygiene should be maintained by reducing sugar, staying away from unhealthy foods and visiting dentists at least twice a year. He says this includes adopting a healthy diet (one that is low in sugar), avoiding tobacco use and excessive alcohol consumption, all actions that will not only benefit oral health but help maintain general health and well-being. According to Uwamwezi, people with untreated teeth, especially children below the age of five, can develop heart diseases. She explains that this is so because the mouth has bacteria/microbes. If one has untreated teeth, the hole inside the teeth can be an entry of microbes which can affect the heart. She notes that if children (with milk teeth) are exposed to bad nutrition such as food with too much sugar, and have untreated decay; when such teeth are removed before the right time, the space for the new teeth (permanent teeth) reduces, which can lead to overcrowding of the teeth in the mouth. “Each and every tooth has its right time to be removed in children, if removed before its time, it leads to loss of space and when time for the permanent teeth comes, there is less space, thus overcrowding,” Uwamwezi says. She notes that avoiding removing teeth in children before the right time is important, and in case a child has a dental problem, treating the teeth instead of removing is vital. Crowding of the teeth can affect one’s self esteem. Joseph Sindabimenya, a dentist in Kigali, says dental decay, or other dental diseases, can cause pain and suffering. For example, he points out that if they are school-going children, if they have a problem with their teeth, they might miss out on going to school because of the pain. For adults, however, it affects their life because they won’t be able to work. Sindabimenya notes that there are studies that confirm that there is a link between periodontal diseases and pregnancy. If one is pregnant and has periodontal diseases, they can have a miscarriage or give birth to a child with low birth weight. He advises that people should practice good oral hygiene to avoid dental problems. EXPECTED OUTCOME According to Gatarayiha, beneficiaries are expected to understand the relationship between oral health and general health, as well as the impact that one has on the other. She says policymakers should integrate oral health agenda into the public healthcare system. Put greater emphasis on developing national policies in oral health promotion and oral disease prevention, and work towards effective control of risks to oral health, based on the common risk factors approach. National health authorities should be encouraged to implement effective fluoride programmes for prevention of dental caries (the use of affordable fluoridated toothpastes). “It needs to be acknowledged that prevention and control of NCDs are incomplete without measures to address major oral diseases like dental caries and gum disease. Oral diseases may directly affect a limited area in the human body, but their consequences and impacts affect the body as a whole,” she observes. Gatarayiha adds that it’s appropriate to recognise that preventive care is always the best option and that early detection and treatment are crucial to ensure the best outcomes against oral disease and associated health complications. A more integrated approach to healthcare can achieve better outcomes for patients with oral diseases. editorial@newtimes.co.rw