Oral health in Nepal

"Oral hygiene education is essential for school children in Nepal." Oral disease qualifies as a major public health problem owing to its high prevalence and significant social impact.(1) Oral health is considered fundamental to general health and well-being. A healthy mouth enables an individual to speak, eat and socialize without experiencing any discomfort or embarrassment.(2)

Oral health knowledge is considered to be an essential prerequisite for health related behavior.(3) The World Health Organization (WHO) has defined oral health as “A standard of the oral and related issues which enables an individual to eat, speak and socialize without active diseases, discomfort or embarrassment and which contributes to general well-being”.(1) Oral hygiene is the practice of keeping the mouth and teeth clean to prevent oral problems and oral malodor. A preventive prophylaxis is the removal of dental plaque and debris from the teeth to prevent dental decay, periodontitis, and other oral diseases. Severe periodontal disease causes at least one third of adult tooth loss. Tooth decay is the most common global disease affecting many individuals and families.(4) According to oral health facts (WHO), the most common oral diseases are dental decay and periodontal (gum) disease.(1) Worldwide, 60-90% of school children have dental cavities. Similarly, severe periodontal (gum) disease, which may result in tooth loss, is found in 5-20% of middle-aged adults, and the rate varies across geographical regions. The incidence of oral cancer ranges from 1 to 10 cases per 1,000,000 populations in most countries.(5)

Oral disease shares common risk factors with the four leading chronic diseases: cardiovascular diseases; cancer; chronic respiratory diseases; and diabetes. Also, it shares risk factors with unhealthy diets, tobacco use, and alcohol use. Poor oral hygiene is also a risk factor for disease. Dental caries is the most prevalent oral disease in several Asian and Latin American countries. Globally most children show signs of gingivitis and among adults, gingivitis, the initial stage of periodontal disease, is prevalent.(6) It is said that children with poor oral health are 12 times more likely to have restricted daily activity then those who do not.(7) Due to poor oral health, especially in children, gingivitis may lead to necrotizing ulcerative gingivitis (NUG) and cancorum oris (noma). These conditions are very painful. More than 50 million school hours are lost annually due to oral health problems, which affect children’s’ school performance and success in later life.(8) The main purpose of dental hygiene regimens is to prevent plaque biofilm formation. Bacterial plaque amassed on teeth as a result of poor dental hygiene is the causative factor of a majority of major oral and dental problems. Poor dental hygiene allows the accumulation of acid producing bacteria on the surface of the teeth. The acid demineralizes the tooth enamel causing tooth decay (cavities). Dental plaque can also invade and infect the gingival tissue causing periodontal diseases. In both dental decay and periodontal diseases, the final effect of poor dental hygiene can be the loss of one or more teeth. One shouldn’t wait until a tooth is lost to understand the importance of oral hygiene and preventive care. Globally dental health is a major public health problem affecting a large number of people. Approx 5-10 % of public health expenditures relate to oral health. It has a high economic burden in developed countries and in developing countries, as well. Dental health problems are often neglected and only treated if pain or another problem arises. The prevalence of dental decay worldwide is 60-90% in school children. The incidence of oral cancer ranges from 1 to 10 cases per 1,000,000 populations in most countries.(5) According to the Nepal national pathfinder survey 2004, it was found that the prevalence of dental decay is low in adolescents who are studying in school (i.e., 25.6% for 12- to 13-year-olds and 25.6% for 15- to 16-year-olds). The probable reason for this is the use of fluoridated toothpaste. However, periodontal problems (especially gingivitis and calculus) in adolescence is high (i.e., 62.8% for 12 to 13 years and 61% for 15 to 16 years).(9) Nepalese are also not beyond oral health problems. According to the Annual Report (2009/10), 3,92,831 have dental caries/toothache, 73,309 have periodontal diseases (gum), 62,747 have other disorders of teeth and 1,13,819 have oral ulcer, mucosa and other related diseases. In the total OPD visit, 3.08%is related to oral health.(10) It shows that Nepal has a high incidence of problems in the area of dental health. There are different divisions working under the Department of Health Services, but not the Oral Health Division. The second long term health plan (1999-2017) has put oral health into essential health care services and oral health for the first time into a primary health care approach. Although the oral health policies and strategies are established, the limited fund resources and manpower are a constraint to implementation.

Oral health is a worldwide unrealized problem and is most common in developing countries. Poor oral health and untreated oral diseases and conditions can have a significant impact on quality of life. In developing countries like Nepal, oral diseases are the most common problems due to lack of education and poverty. The most common dental problem of the Nepalese is dental decay and periodontal diseases.

By maintaining good oral hygiene practices, various dental problems can be kept under control and uplift the health status of the Nepalese people. For this, oral health education and awareness plays an important role, especially for the school children of private as well as government programs. Thus, such education is essential for behavior change, improving health and quality of life.

Editorial Director’s Notes
* View the following resource:
Holt K, Barzel R. 2010. Pain and Suffering Shouldn’t Be an Option: School-Based and School-Linked Oral Health Services for Children and Adolescents. Washington, DC: National Maternal and Child Oral Health Resource Center. http://www.mchoralhealth.org/PDFs/schoolhealthfactsheet.pdf

* In August 2013, the International Federation of Dental Hygienists (IFDH) accepted the Dental Hygienists’ Association Nepal (DHAN) as a non-financial member. DHAN was formed in 2006 to develop communication and mutual cooperation among dental hygienists. Today, DHAN is the largest national organization representing the professional interests of the more than 600 registered dental hygienists (RDHs) in Nepal. http://dentalhygienistnepal.blogspot.com/

References
1. The World Oral Health Report 2003.Continuous improvement in the oral health in the 21st century- the approach of the WHO Global Oral Health Programme. http://www.who.int/oral_health/media/en/orh_report03_en.pdf.
2. Stalla Y, Kwan L et al. Health-promoting schools: an opportunity for oral health promotion 2005; 85: 677.
3. Al-Ansari J, Honkata E, Honkata S. Oral health knowledge and behavior among male health sciences college students in Kuwait. BMC Oral Health 2003.
4. Peter, Soben; 2003, Essential of preventive and community dentistry.
5. WHO, (Feb 2007) “Oral health facts” Available at: http://www.who.int/mediacentre/factsheets/fs318/en/index.html.
6. Peterson P.E, Coordinator of WHO global oral health program, WHO oral health report, Geneva, 2003.
7. Adams PF, Marano MA. 1995. Current estimates from the National Health Interview Survey, 1994. Vital and Health Statistics. Series 10, Data from the National Health Survey 193 (Pt 2):1–260.
8. S.N. Okolo et.al; oral hygiene and nutritional status of children age 1-7 in rural community, Ghana medical journal; 2006.
9. Yee, R. and Maveen, M. 2004. The Nepal National Oral Health 'Pathfinder' Survey. Summary for the Nepal Dental Association. http://www.nda.org.np.
10. Department of Health Services, Annual Report 2009/10 (2066/67), GoN, Ministry of Health and Population.