The present economic crisis in Sri Lanka has severely affected the oral health of the Sri Lankan population in general with the most common oral diseases seeing a sharp upward spiral in the recent months. However, most of these diseases are reversible and preventable with early treatment which is currently a low priority to the mainly cash strapped Lankan population .
Senior Registrar in Community Dentistry, Health Promotion Bureau (HPB), Health Ministry , Dr. N.A.R. Nanayakkara tells the Sunday Observer how seeking early treatment can prevent unnecessary pain and discomfort as well as disfigurement for life with early treatment from a qualified dental health professional.
Q: The current economic crisis has led to a spike in oral diseases, How do you rate the level of dental diseases in Sri Lanka now as compared to the figures of say five or ten years ago?
A. The main oral diseases prevailing in Sri Lanka are Dental Caries, Periodontal Diseases and Oral Cancers including Oral Potentially Malignant Disorders (OPMDs). The latest National Oral Health Survey was done in 2015/2016 by the Ministry of Health according to the basic methods of the World Health Organization. The survey revealed among index age group participants the prevalence of Dental Caries as follows: 5 Yrs – 60.7%, 12 Yrs – 24.2%, 15 Yrs – 35.3%, 35 to 44 Yrs – 63.8% and 65 to 74 Yrs 51.3%.
Q: What did these figures reveal in terms of the specific age groups you mentioned.?
A. That Periodontal diseases are comparatively common among adults and Caries among children .
Q: How does an adult know if he/she has Peridontal disease? What are the clinical signs?
A. Bleeding on probing, Calculus, Periodontal pockets and loss of periodontal attachment are clinical signs that indicate periodontal diseases.
The latest cancer fact sheet in 2020 also revealed an average 3 deaths per day due to oral cancer and about 6 new Oral cancer patients diagnosed per day.
Q: Has the current economic crisis contributed to the surge in oral diseases in Sri Lanka?
A. It has definitely had adverse effects on oral health in general among Sri Lankans.
Q: In what way?
A. The present health seeking behaviour of the public in general which has reduced drastically due to indirect and direct cost of treatments bears evidence of this. That and the fuel crisis and steep rise in the costs of living. Due to their limited buying capacity, many have now relegated dental care to a low priority especially the less privileged sectors.
We have observed that many low income persons are now switching to tooth powders instead of toothpaste. The former is a highly abrasive substance lacking in fluoride which is essential for healthy teeth. All dental surgeons now advocate twice daily brushing with fluoridated toothpaste as a Must to have good functional oral health throughout the life.
Q: Any other harmful substances that have contributed to the decline in oral health among Lankans?
A. People may tend to use substances like betel quid and smoking while they are waiting in long queues for domestic items, which are bad for oral health as well as general health.
Q: Are there changes age wise in persons with oral diseases ?
A. There are recent epidemiological changes in oral cancer, which indicate that now it is increasingly prevalent among younger males.
Q: What causes dental diseases in general? How can they be prevented ?
A. I will begin with the most vulnerable sector – young school going children Dental. Caries is the commonest oral disease that affects this particular population islandwide. Once a tooth erupted into the oral cavity (Mouth) it needed around a two year period for its complete maturation. During that crucial period proper brushing with fluoridated toothpaste, eating a healthy diet with minimum of sugar and refined carbohydrates, and regular dental checkups are essential. If they miss out on even one of the above three factors they will be at high risk of getting dental caries.
Dental caries are caused by some bacteria in the oral cavity act on refined carbohydrates and simple sugars. Fluoride in toothpaste makes your tooth stronger and more resistant to dental caries. Regular dental checks will identify dental disease at an early stage hence treatment at the initial stage is less costly, less time consuming and also with less pain.
Q: Periodontal diseases in adults?
A. The common risk factors are improper brushing, unhealthy habits like betel chewing, smoking, alcohol consumptions, co-morbidities, and side effects of general medications etc. which are common risk factors accumulated over a long period .
Q: Signs to look out for in 1) Caries? 2) Periodontal disease?
A. The initial stage of dental caries appear as white or brown patches which move towards the gingival (Gum) margin. Parents even can identify them in front teeth in sunlight once after brushing and wiping the teeth with a piece of cloth or cotton. At the initial stage of periodontal disease swollen red gums with or without bleeding when brushing can be identified.
Q: Symptoms of oral cancer?
A. Most of the oral cancers are preceded by the Oral Potentially Malignant Disorders, which can be Lekoplakia (white lesions), Erythroplakia (red lesions),Oral submucous fibrosis, Oral Lichen Planus, Palatal Changes due to reverse smoking, Dicoid Lupus Erythematosis, Actinic Keratosis in common OPMDs.
Q: What are the most severe and lasting health impacts of these cancers?
A. None of the above mentioned oral diseases are painful at the initial stage of the disease. With advanced stages they are very painful with subjective discomfort. Initially Periodontal diseases are acute, in advanced stages it becomes chronic condition. There is tooth substance loss in later stages of dental caries, periodontal tissue disfigurement in advanced periodontal disease and in oral cancers there is severe disfigurement.
Q: In general, can oral diseases be reversed? How?
A. White lesions of the Dental Caries can be reversed most of the time with Fluoride therapy and the adhering to the proper diet, twice daily tooth brushing with Fluoridated toothpaste and regular dental/oral checkups. Periodontal disease can be treated at the initial stage of the disease with simple measures. If there are any comorbidities or side effects of drugs, patients have to discuss this matter with their relevant physicians. oral cancers and OPMDs can be treated successfully at the initial stages with adhering to correct treatment protocols.
Q: Oro-dental trauma is a common oral disease among school children. What is it?
A. Oro-Dental trauma is not a disease; it is an injury, Common among School children due to forceful contacts while playing and during contact sports. More common among children with proclined anterior (front) teeth.
Q: What impacts do such injuries have on the young victims?
A. Oro-facial trauma causes psychological trauma to some extent, and depending on the developmental stage of the facial development it affects the oro-facial development.
Q: So what is the solution? How can we reduce these largely preventable diseases that affect people throughout their lifetime, causing pain, discomfort, disfigurement and even death?
A. To prevent Oro-facial trauma among school children, several measures can be taken such as early intervention with orthodontic treatments for children who are at risk of getting Oro-facial trauma, Develop life skills among school children how do their routine activities with the concept of safety first, empower children to wear personal protective equipments while engage in contact sports.
In the case of Non Communicable Diseases the WHO has identified a common strategy approach to reducing oral diseases . There is scientific evidence to prove that there is a link between periodontal disease and Diabetes Mellitus. Unhealthy diet is a risk factor for dental caries, as well as NCDs like cardiovascular diseases and Diabetes Mellitus. Smoking and alcohol has adverse impacts on NCDs like cardiovascular disease , Oral and other cancers etc.
Q: Unequal distribution of oral health professionals and lack of appropriate health facilities to meet population needs has reduced access to primary oral health services in most developing countries. In Sri Lanka regular access to oral health services has been disrupted by petrol shortages, transport coasts, ongoing strikes| by the health officers manning in state institutes, as wellas the ongoing pandemic. Your comments?
A. Yes, no doubt the pandemic as well as ongoing economic crisis has badly affected the oral health of the general population in Sri Lanka. Still this is not the time to quantify that effect.
Apart from treatment from Health care institutions, it has affected their normal personal oral hygienic practices such as twice daily brushing with Fluoridated toothpaste which has declined due to the reduced buying capacity of the population.
Q: Do you think the private sector should be allowed to play a more active role here as an alternative option? If so, should the state lay down a minimum fee in private hospitals providing this service?
A. Already it is observed that there is a shift in private to public oral health seeking behaviour due to increased cost of treatment. Dental treatments are costly whether borne by the state sector or by the patient. As most dental treatment materials are imported from other countries, due to import restrictions there is shortage of dental treatment materials. So given the above reasons it is difficult to expect to get services from private sector hospitals at a minimum fee.
Q: What gaps do you see in providing quality dental health care to all Lankans across the country? How would you like to fill them?
A. It is not the difference in the quality of dental health care, but the difference in the equal distribution of dental/oral health care that appears to be the most pressing problem right now. While every person in this country should have equal opportunity for dental/oral health care, it is evident that this is not happening at the moment due to multiple reasons other than pandemic and the economic crisis. Some of the leading causes are inadequate human resources, inadequate infrastructure and materials, as well as poor health literacy among Sri Lankan population, inadequate enthusiasm, and personal economic issues, poor access etc.
To overcome the above mentioned issues is not an easy task, because health related determinants depend on multiple factors. Hence as a lower middle income country (before the economic crisis) maintaining equity in dental/oral health care across the population as a whole is a difficult task. However, despite these new challenges, the Ministry of Health has assured the public of its continued support with its ongoing programs based on a multi-sectoral approach .
Q: Your message to the public on the importance of preventing oral diseases?
A. Most of the prevalent dental/oral diseases in Sri Lanka such as dental caries, periodontal disease and oral cancer, are preventable with proper brushing with fluoridated toothpaste.
Keep fluoridated toothpaste in your domestic grocery list as an essential item in this economic crisis.
In addition, maintain a balanced nutritional diet. Go for regular dental/oral checkups and avoid unhealthy habits such as smoking, betel quid chewing and alcohol consumption.
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