The Impact of Oral Conditions on Life

Though toothache is frequently ranked as one of the top three most painful and debilitating afflictions, the global impact that it has on life is likely to be overlooked because its sequelae are generally mild and easily treated when compared to some of the more serious conditions analysed by the Global Burden of Disease study that took place in 2010. The study, whose data came from three independent systematic reviews of observational studies, reported the global burdens of 291 conditions ranging from those such as cataracts and acne to drug abuse to cancers and infectious diseases. The project was a collaboration of nearly 500 researchers in 50 countries with aims to aid healthcare system design and create an appropriate public health policy.

Three dental afflictions were considered as part of the survey: untreated caries (cavities), severe periodontitis and severe tooth loss. To quantify burden, the survey used disability adjusted life years (DALYs) and years lived with disability (YLDs), though YLDs proved a more relevant figure as mortality is very rarely caused by oral conditions. Definitions of all three conditions were defined along with parameters to classify whether or not they were ‘disabling’: for untreated caries, a disability was described as ‘a toothache, which causes some difficulty eating’; disability associated with gum disease was ‘bad breath and a bad taste in the mouth and gums that bleed a little from time to time, but this does not interfere with daily activities’; severe tooth loss (having fewer than 9 permanent teeth remaining) was considered disabling if there was ‘great difficulty eating meat, fruits and vegetables’. Perhaps unsurprisingly due to these common parameters, 3.9 billion people were shown to be affected by the investigated oral conditions, with 35% of people suffering from untreated caries.

Pleasingly, the global burden caused by severe tooth loss has decreased in the last ten years according to the Global Burden of Disease surveys; this is in-keeping with the knowledge that many people are keeping their teeth longer. However, the degree of both severe periodontitis and untreated caries has increased. Though this may seem disheartening, it is crucial to note that with more people retaining their teeth longer, untreated caries and periodontal disease are bound to increase. Retained teeth with such afflictions are arguably better than no teeth at all, as used to be the case in 1990 when tooth loss was more commonly disabling than cavities and gum disease.

Despite being seemingly trivial when compared to other conditions, such as the highest ranked cause of death, ischaemic heart disease, oral conditions played a dominant role in the survey. Untreated carried in permanent teeth was the most prevalent condition evaluated by the entire survey and severe tooth loss was the main cause of DALYs in over 60s. Oral conditions were shown to be equally spread amongst men and women and increased with age.

The latest Global Burden of Disease survey (2013) is due to be published in 2014 and aims to expand on all aspects of the survey established in 2010. The oral results will once again show were future dental education is necessary.

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