Oral Health, General Health and Quality of Life
Sheiham, Aubrey, Bulletin of the World Health Organization
The compartmentalization involved in viewing the mouth separately from the rest of the body must cease because oral health affects general health by causing considerable pain and suffering and by changing what people eat, their speech and their quality of life and well-being. Oral health also has an effect on other chronic diseases (1). Because of the failure to tackle social and material determinants and incorporate oral health into general health promotion, millions suffer intractable toothache and poor quality of life and end up with few teeth.
Health policies should be reoriented to incorporate oral health using sociodental approaches to assessing needs and the common risk factor approach for health promotion (1, 2). Oral diseases are the most common of the chronic diseases and are important public health problems because of their prevalence, their impact on individuals and society, and the expense of their treatment. The determinants of oral diseases are known--they are the risk factors common to a number of chronic diseases: diet and dirt (hygiene), smoking, alcohol, risky behaviours causing injuries, and stress--and effective public health methods are available to prevent oral diseases.
In some countries, oral diseases are the fourth most expensive diseases to treat. Treating caries, estimated at US$ 3513 per 1000 children, would exceed the total health budget for children of most low-income countries (3). The situation for adults in developing countries is worse, as they suffer from the accumulation of untreated oral diseases. There are few efficient dental care systems to cope with their problems, and where there are, the cost is beyond most people's means. Millions with untreated caries have cavities and suppuration, yet planners continue to overlook oral diseases, despite their significant impact on cost and quality of life. This oversight will lead to more decay and expensive, ineffective clinical interventions.
Oral health affects people physically and psychologically and influences how they grow, enjoy life, look, speak, chew, taste food and socialize, as well as their feelings of social well-being (W4). Severe caries detracts from children's quality of life: they experience pain, discomfort, disfigurement, acute and chronic infections, and eating and sleep disruption as well as higher risk of hospitalization, high treatment costs and loss of school days with the consequently diminished ability to learn. Caries affects nutrition, growth and weight gain. Children of three years of age with nursing caries weighed about 1 kg less than control children (W5) because toothache and infection alter eating and sleeping habits, dietary intake and metabolic processes. Disturbed sleep affects glucosteroid production. In addition, there is suppression of haemoglobin from depressed erythrocyte production.
Ninety per cent of pre-adolescents reported an impact related to oral health (W6). Prevalence of dental pain was found to be about 33% among Brazilian teenagers, of whom 9% reported distressing, excruciating pain (W7). Toothache leads to school absence, which is a ready indicator of children's health. …