International journal of scientific and research publications | 2021
Oral Health: A Review through Eyes of Sri Lanka
Abstract
The burden of oral diseases is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Evidence exists to reduced healthcare costs and improved efficiency due to quality primary health care which is also the key to affordable and accessible oral health care which is often neglected in many countries. The public sector in Sri Lanka commenced oral health services in 1925 that expanded greatly up to date and visited by 3.4 million people annually for routine outpatient dental care. Currently, the public sector provides oral health services from primary care to tertiary care free of charge at the point of delivery. There is a dynamic preventive oral health care delivery model catering to children, adolescents and pregnant mothers with oral diseases. The last National Oral Health Survey conducted in 2015/2016 revealed steady improvements in oral health status among all age categories assessed especially among 12-year-old school children which were achieved with 1.67% of the GNP. Ranked by cases the most prevalent (14.8%) cancer among the male population in Sri Lanka is oral cancer. Many interventions have been implemented by Sri Lanka to improve oral health care among which integration of oral health care services into the public health care delivery model, establishing school dental clinics and screening for population subgroups for oral premalignant disorders/ oral cancer are noteworthy. The challenges still faced include lack of an established referral system, lack of designated oral diseases preventive staff at the grass-roots level and inadequate continuous education programs for primary health care staff and dental surgeons to update their knowledge. Inadequate funding sources and lack of policy dialogues in controlling oral diseases underlies these challenges that require further attention. I. GLOBAL BURDEN OF POOR ORAL HEALTH isadvantaged and poor population groups in both the developing and developed countries share a substantial burden of oral diseases. Major public oral health problems around the world pertaining to oral diseases such as dental caries, periodontal diseases, oropharyngeal cancers, orodental trauma and HIV-associated oral diseases [1]. Poor oral health has a profound effect on general health and quality of life. The challenges of improving oral health are particularly great in developing countries due to factors such as high expenses for treatment and the scarce number of dental professionals as well as its irregular distribution. Standards and norms of health evolve over time. In the past, an edentulous person may be accepted by society but today edentulousness is understood as a preventable malady and is socially unacceptable. Edentulousness could also be considered as an indicator of poor socioeconomic conditions which signifies inequality of access to oral health care services. Approximately 3.5 billion people are affected by oral diseases, which is half of the world s population. According to the Global Burden of Disease 2017 study, the commonest oral disease condition was untreated dental caries in permanent teeth which accounted for 2.3 billion people and 530 million children or more suffered from dental caries of primary teeth. Almost 10% of the global population suffers from a severe periodontal disease which may lead to tooth loss. Among the most prevalent cancers in the countries of Asia and the Pacific oral cancer takes a significant place [2]. Most treatment for oral diseases is costly which makes it hard for lowand middle-income countries to provide services to prevent and treat oral health conditions. Poor access to oral health care services in the community contributes to further darken the scene. Marketing campaigns that promote food and beverages high in sugar, tobacco, and alcohol have led to an increase in its consumption that has contributed to worsening oral disease conditions and other non-communicable diseases [3]. The good news is that oral health conditions are mostly preventable and can be treated in their early stages by an array of evidence-based, costeffective strategies. Lack of appropriate health facilities and the maldistribution of oral health professionals impedes access to oral health services. According to a survey conducted among adults on the access to oral health services, a range of accessibility from 35% in lowincome countries to 60% in lower-middle-income countries, 75% in upper-middle-income countries, and 82% in high-income countries have been observed [3]. Dental treatment is found to be costly even in high-income settings, averaging 5% of total health expenditure and 20% of out-of-pocket health expenditure [3]. Therefore policy implementations that support Universal Health Coverage can help strengthen weak primary oral health care services and address substantial out-of-pocket expenses for oral health care in many countries. In a study conducted in the USA, it was found that among the 17-year-olds five out of six have at least one decayed, missing, or filled tooth surface (DMFS), with a mean of eight DMFS per 17-year-old. Minority children, rural dwellers, those with lesser exposure to fluoride and those from less educated or poorer families tend to have a greater caries experience and edentulism [6]. Forty percent of those age 65 and over were edentulous and only 2 percent had all 28 teeth. An estimated 30,000 new cases and 8,000 deaths were attributed to oral cancer in 1991. One in D International Journal of Scientific and Research Publications, Volume 11, Issue 4, April 2021 509