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2 Global Scenario, Aetiology and Risk Factors Associated with Oral and Maxillofacial Diseases: An Overview
12
2.2.2 Periodontal Disease
Similar to dental caries, periodontal disease comprising of gingivitis and periodontitis is a disease
that affects the supporting structures of the teeth namely the gingiva, periodontal ligament and
alveolar bone and are also highly prevalent, with an age-standardised prevalence of severe periodontitis estimated to be 1.1 billion with the number of prevalence rate of 13,109 per 100,000 personyears according to the GBD study (5, 6). Further, the global age- standardised prevalent cases rate
of severe periodontitis has increased by around 8.44% between 1990 and 2019 (6). The highest
age- standardised prevalence was observed in sub- Saharan Africa with a prevalence rate of 19,577
per 100,000 person- years, while the lowest prevalence rate was observed in South East Asia, East
Asia and Oceania (10,060 per 100,000 person- years)(6).
2.2.3 Oral Cancer
Oral cancers, comprising the cancers of the lip, other parts of the mouth and the oropharynx, are
the 13th most prevalent among all cancers. In 2020, the incidence rate of lip and oral cavity cancers
was 377,713 new cases. The number of deaths recorded due to oral cancer was 177,757 (2).
Although many oral cancers can be malignant, the most common type of oral cancer is squamous
cell carcinoma, which accounts for nearly 90% of malignancies(7). The main risk factors for oral
cancers are tobacco and alcohol consumption and human papillomavirus (HPV) infections(8– 10).
Five- year survival rates range from 40 to 50%, and complications usually arise as a result of metastasis to cervical lymph nodes(7). Incidence of oral cancer has consistently risen in all countries.
However, countries in the Southeast Asian and Western Pacific regions exhibit a higher prevalence
of oral cancer. In contrast, countries in the region of the Americas exhibit the lowest prevalence
rates for oral cancer. Despite the increasing burden, data from the GBD (2019) study reveals that
the age- standardised incidence rate for oral cancer showed a downward trend in the following
countries: Bangladesh, Brazil and the United States; a stable trend in Russia; and an upward trend
persists in China, India, Indonesia, Japan and Pakistan(11).
The age- standardised incidence rate for all cancers of the lip and oral cavity and the mortality
rates associated with all cancers of the lip and oral cavity for the year 2020 are depicted in the figures below (Figures2.1 and 2.2); these are maps published by the Global Cancer Observatory
(GLOBOCAN) and help visualise the incidence of oral cancer in various regions across the
world(83). Generally, the highest incidence and mortality rates were observed in Melanesia and
South- Central Asia, while the lowest rates were observed in western Africa and Central America.
2.3 Oral Potentially Malignant Disorders
Oral potentially malignant disorders (OPMDs) are conditions with a high likelihood of a malignant transformation rate of around 8%(12, 13). While oral leukoplakia (OL), oral submucous fibrosis (OSF), oral erythroplakia (OE), actinic cheilitis and lichen planus(14) are the most prevalent
OPMDs; inherited diseases such as xeroderma pigmentosum and Fanconi’s anaemia could also
undergo malignant transformation(15). The main risk factors for developing the most prevalent
OPMDs, OL and OSF, are tobacco and areca nut, respectively(16). Different regions of the world
have differing prevalences of OPMDs according to the lifestyle and risk factors more common in a
specific region or country. For example, OL and OE are associated with tobacco and alcohol consumption and are prevalent in Southeast Asian countries(17). Likewise, OSF is also more prevalent
in Southeast Asian countries owing to a high prevalence of areca nut use(18). Actinic cheilitis (AC)
t.me/Dr_Mouayyad_AlbtousH
Estimated age-standardised incidence rates (World) in 2020, lip, oral cavity, both sexes, all ages
ASR (World) per 100,000
All rights reserved. The designations employed and the presentation of the material in this publication
do not imply the expression of any opinion whatsoever on the part of the World Health Organization/International Agency for Research on Cancer concerning the legal status of any country, territory,
city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted
and dashed lines on maps represent approximate borderlines for which there may not yet be full
agreement.
h
≥4.0
2.6–4.0
1.7–2.6
1.3–1.7
<1.3
Not applicable
No data
Figure2.1 Incidence of all cancers of the lip and oral cavity in 2020 (GLOBOCAN).
t.me/Dr_Mouayyad_AlbtousH
Data source: GLOBOCAN 2020
Map production: IARC
(
ttp://gco.iarc.fr/today)
World Health Organization
Estimated age-standardised mortality rates (World) in 2020, lip, oral cavity, both sexes, all ages
ASR (World) per 100,000
g
≥1.6
1.2–1.6
0.87–1.2
1.63–0.87
<0.63
All rights reserved. The designations employed and the presentation of the material in this
publication do not imply the expression of any opinion whatsoever on the part of the World
Health Organization/International Agency for Research on Cancer concerning the legal
status of any country territory, city or area or of its authorities, or concerning the delimitation
of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate
borderlines for which there may not yet be full agreement.
Not applicable
Not data
Figure2.2 Mortality rates due to all cancers of the lip and oral cavity in 2020 (GLOBOCAN).
t.me/Dr_Mouayyad_AlbtousH
Data source: GLOBOCAN 2020
Map production: IARC
(http://
co.iarc.fr/today)
World Health Organization
is associated with solar radiation, and hence, it is frequently observed in tropical regions and
susceptible individuals (white males and outdoor workers)(19). Although there are no global surveys that estimate the prevalence of OPMDs worldwide, a recent systematic review has estimated
the pooled prevalence of all OPMDs to be 4.47%(20). In this review, the prevalence rates were
reported to be 4.96% for OSF, 4.11% for OL, 0.17% for OE and 2.08% for AC. The highest prevalence
of OPMDs was observed in Asian population (10.54%), and the lowest prevalence (0.11%) was
observed in North Americans. Comparatively, OPMDs were more prevalent among males in
comparison to females(20).
2.4 Risk Factors forOral Diseases
Risk factors for common oral diseases such as dental caries, periodontitis, oral cancer and OPMDs
could be classified into individual and system- level risk factors. Individual risk factors are related
to an individual’s lifestyle and behaviours, along with genetic factors, which include modifiable
and non- modifiable risk factors. System- level risk factors are risk factors that are outside of the
individual’s control and are related to the setup of the health system and health care services.
2.4.1 Individual- level Risk Factors
2.4.1.1 Diet
Diet plays a major role in dental caries in children and adults. Sucrose is the most commonly
occurring free sugar in carbohydrate- rich diets(21). Cariogenic bacteria in the oral cavity readily
metabolises fermentable carbohydrates and produce organic acids, which causes a decrease in pH,
leading to demineralisation of the tooth structure when the pH falls below 5.5 (critical pH)(21).
The frequency of consumption of a sugar- rich diet is more detrimental than the quantity of sugar
consumed because of the subsequent fall in pH, maintained throughout the day when the
frequency of consuming a sugar- rich diet increases. The WHO recommends that ‘free sugars’ in
the diet must be limited to no more than 10% of total calories for adults to prevent the incidence
ofdental caries(22).
A diet high in sugar and saturated fat and low in fibre and polyunsaturated fat is a risk factor for
periodontitis in addition to common chronic diseases such as cardiovascular disease, diabetes and
cancer(23). A diet low in fresh fruits and vegetables is a significant risk factor for oral cancer and
OPMDs (24, 25). This is because micronutrients in fresh fruits and vegetables confer a bioprotective effect by mediating the damage caused by free radicals through their antioxidant properties. In particular, Vitamin A and related carotenoids, Vitamin C and selenium are protective
against most epithelial cancers and their precursor lesions(26, 27). A meta- analysis concluded
that each portion of fruits and vegetables consumed daily reduces the risk of oral cancer by
about50%(28).
15
2.4.1.2 Oral Hygiene Practices
Good oral hygiene practices are essential for the maintenance of oral health. The two most common
diseases that can occur in the oral cavity (dental caries and periodontitis) are primarily influenced
by the presence and accumulation of dental plaque(29). Dental plaque is a biofilm comprising a
matrix of bacteria and its by- products that adheres to the teeth and dentures. Dental plaque must
be regularly removed by brushing twice daily with fluoridated toothpaste. When not routinely
removed, dental plaque can accumulate, and microbial communities in the biofilm are driven to
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2 Global Scenario, Aetiology and Risk Factors Associated with Oral and Maxillofacial Diseases: An Overview
16
dysbiosis(29). This ecological shift results in greater pathogenic activity, leading to dental caries
and periodontal disease.
Poor oral hygiene has also been demonstrated to be an additive risk factor in the occurrence of
oral cancer; however, the evidence for this association is still inconclusive(30).
2.4.1.3 Genetic Risk Factors
Genetic susceptibility has been discussed as a potential aetiological factor in the occurrence of
dental caries since the 1920s(31). Several studies, such as experimental studies in animals, observational studies involving humans such as familial aggregation and analysis, twin studies and linkage and association studies, have demonstrated that genetic factors play a role in dental caries(32).
For example, in twin studies with monozygotic twins, high concordance rates were observed for
dental decay(33). Although environmental and biological risk factors primarily cause dental caries, the role of genetic susceptibility cannot be ruled out, as preventive strategies targeting other
factors in the aetiology of dental caries have not entirely been successful in controlling the disease.
The link between genetic factors and periodontitis has been well established through previous
literature (34). However, the genetic variability of host responses determines an individual’s
susceptibility to disease development and periodontitis progression rate. Periodontitis occurs due
to the host immune response, and genes responsible for producing immunoregulatory molecules
such as cytokines, chemokines, membrane surface receptors and antigen recognition proteins
have been implicated in the pathogenesis of periodontitis(35, 36). A recent systematic review
hasconcluded that polymorphisms in molecules such as interleukins (IL), including IL- 1A, IL- 1B,
IL- 6, IL- 10, matrix metalloproteinase (MMP- 3 and MMP 9 chronic form), are associated
significantly with the risk of developing periodontitis(34).
There is a strong genetic predisposition in the occurrence of oral squamous cell carcinoma
(OSCC), especially in sites such as the tongue and buccal mucosa(37, 38). There is some evidence
to suggest that people who inherit the inability to metabolise carcinogens or procarcinogens are
unable to repair DNA damage and are, therefore, at higher risk for oral cancer(39). For example,
polymorphisms in the P450 enzymes and xenobiotic metabolising enzymes, which are responsible
for the metabolism of carcinogens related to tobacco consumption, are strongly implicated in
cancer development(40).
2.4.1.4 Smoking
Smoking is considered a risk factor for dental caries, periodontitis, oral cancer and OPMDs.
Cigarette smoking promotes the growth of cariogenic bacteria, lowers the buffering capacity of the
saliva and changes salivary composition, thereby enabling the formation of a caries- susceptible
environment in the oral cavity(41). Tobacco use in any form is associated with a higher risk of
developing severe periodontitis(42). Tobacco consumption influences the exacerbation of periodontal disease through several mechanisms, such as (i) decreased gingival perfusion, (ii) immune
response suppression, (iii) suppression of the periodontium’s morphological and functional recovery and (iv) dysbiosis and increased infectivity of oral microbiota. These factors impair wound
healing and promote the progression of periodontitis(42).
Consumption of tobacco is also one of the primary risk factors in the occurrence of OSCC,
and smokers are seven to ten times more likely to develop oral cancer in comparison to nonsmokers(43). Tobacco consumption affects the oral epithelium in many ways through various
carcinogenic pathways, namely epigenetic alteration of epithelial cells, inhibiting multiple
systemic immune functions, oxidative stress alterations and cooperation with viruses implicated in the development of oral cancer such as Epstein– Barr virus (EBV) and HPV(44).
t.me/Dr_Mouayyad_AlbtousH
Tobacco consumption in any form is also a risk factor for OPMDs, such as oral leukoplakia and
erythroplakia. A recent systematic review has concluded that tobacco consumption, either
through smoking or smokeless forms, is associated with a higher incidence of OPMDs(45, 46).
2.4.1.5 Alcohol Consumption
Alcohol consumption in excessive quantities is a risk factor for periodontal disease; consuming
alcohol excessively alters immune functions, especially t- cell and neutrophil function, leading to
an increased susceptibility to developing infection(47). Although the evidence is inconclusive,
andthere have been studies where no association has been observed between alcohol consumption and periodontitis, a meta- analysis conducted in 2016has revealed that alcohol consumption
is significantly associated with periodontal disease(48).
Heavy alcohol consumption is also associated with a fivefold increase in the risk of developing
oral cancer and oesophagal squamous cell carcinoma (49). Alcohol consumption and tobacco
smoking also have a synergistic effect on the occurrence of oral cancer. Almost 26.4% of lip and
oral cavity cancers worldwide are attributed to heavy drinking. The damaging effect of alcohol
on the oral mucosa occurs due to ethanol metabolites, especially acetaldehyde, which readily
damages DNA to cause mutations, resulting in carcinogenic genes(50).
2.4.1.6 Smokeless Tobacco andAreca Nut
The relatively higher prevalence of oral cancer in Southeast Asia compared to other parts of the
world is attributed to areca nut and tobacco chewing, which is prevalent in this region. Areca
nutisthe seed of the fruit of the oriental palm, Areca catechu. The major areca nut alkaloids are
arecoline, arecaidine and arecolidine, which have been classified as carcinogens by the International
Agency for Research on Cancer (IARC)(51). Experimental studies in animal models and laboratory studies have demonstrated that long- term exposure to areca nut and its alkaloids results in
oxidative stress and genetic damage in human keratinocytes(52). The use of areca nut alone or in
combination with tobacco is strongly implicated in developing OSF and OSCC. In the Indian subcontinent and Taiwan, approximately 50% of the oral cancer cases reported are attributable to betel
quid chewing(53).
17
2.4.1.7 Hormonal Changes
Hormonal changes play a significant role in the occurrence of oral diseases, especially among
women. Hormonal fluctuations during periods such as puberty, menstruation, pregnancy and
menopause all influence oral health(54). In particular, the reduced production of sex- steroid hormones among women in their post- menopausal period directly affects the oral cavity due to oestrogen receptors in the oral mucosa(55). The composition of saliva is altered, and the salivary flow
rate decreases due to changes in oestrogen levels, resulting in xerostomia(56). Xerostomia can, in
turn, lead to post- menopausal women being more prone to develop dental caries. Fluctuations of
hormone levels during menopause also affect periodontal health by causing inflammatory changes
in the gingiva, hypertrophy or atrophy(55). Women in their post- menopausal period present with
severe periodontitis more often. It is also observed that osteoporosis after menopause can cause
alveolar bone resorption in the maxilla and mandible, resulting in tooth loss(57).
Oestrogen has also been implicated in the development of oral cancer. Sex hormones control the
rate of cell division, cell differentiation and the number of susceptible cells. Some oestrogen metabolites, like estradiol, are also mutagenic and cause direct damage to DNA(58, 59). There is evidence
that salivary gland tumours are similar to breast cancer from a molecular and cellular point of
view. In both these tumours, there is a similar expression of progesterone, which is associated with
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2 Global Scenario, Aetiology and Risk Factors Associated with Oral and Maxillofacial Diseases: An Overview
18
cancer progression(60). There is also evidence to suggest that oestrogen induces movement of
precancerous cells in the mouth and may play a role in the spread of head and neck cancers(61).
2.4.1.8 Stress
Stress is an equated response to continual adverse stimuli. Psychological stress can cause several
negative effects, including downregulation of the immune system (62). A direct association
between periodontal disease and stress is difficult to prove as a multiple number of factors influence periodontal disease. However, recent evidence has shown that stress could play a role in periodontal disease through several mechanisms, such as endocrine changes including alterations in
adrenal corticoids,depression of immunity, neglecting oral hygiene due to mental stress, changes
in dietary intake through behaviours like stress- induced overeating which can once again influence the production of cortisol, coping through smoking or other harmful habits, impairment in
gingival circulation and upregulation of systemic inflammation(62).
Stress, anxiety and depression are also associated with oral cancer progression, and this is
because stress causes neurohormonal dysregulation and activates the sympathetic nervous system
and hypothalamic- pituitary- adrenal axis, triggering the release of stress hormones such as cortisol
and catecholamines(63, 64). Cortisol has been demonstrated to have a role in oral cancer progression by stimulating cell proliferation and increasing angiogenesis(65, 66).
2.4.2 System- level Risk Factors
2.4.2.1 Working andLiving Conditions
It is well known that oral diseases are multifactorial in origin where many factors of host and environmental origin are implicated in the disease process. A system- level risk factor that modulates the
exposure to other risk factors and protective factors for oral diseases, including dental caries is socioeconomic status (SES)(67). The inequalities in oral diseases distribution observed in many parts of
the world prove that working and living conditions play a significant role in developing oral diseases(68). Higher burden of oral diseases, including dental caries, tooth loss and periodontal disease, has been observed among the disadvantaged groups of the population(68, 69). Working and
living conditions can predispose people to develop dental diseases for several reasons, such as not
being able to choose healthy food options, not being able to afford materials necessary for regular
maintenance of oral health, such as fluoridated toothpaste and toothbrushes, and not being able to
access appropriate preventive or curative dental services due to the cost of dental treatment(68).
Likewise, there is a strong socioeconomic gradient in the occurrence of oral cancer, and this is
easily observable in the fact that the incidence and mortality due to oral cancer are higher in
underdeveloped and developing countries (70, 71). One of the reasons for this disparity is the
unique setup of health systems in various countries where universal access to health care is not
available. In many health systems, high- quality complex medical care is only readily available to
patients in the high SES bracket; this, in turn, affects the treatment and survival rates of patients
with oral cancer in such countries(72). Systematic reviews conducted on this topic have also found
a strong socio- economic gradient in oral cancer occurrence in studies conducted worldwide(70).
2.4.2.2 Access toDental Care
It is well established that equal access to oral health care is not available to all people and that
disadvantaged people continue to experience significant barriers in accessing dental care(73).
Accessing oral health care, especially preventive oral health care, is essential in maintaining good
oral health and impeded access is one of the significant risk factors for oral diseases. Oral health
t.me/Dr_Mouayyad_AlbtousH
services are available to a majority of the population in several developed Western countries. Still,
the dysregulation and unequal distribution of these services mean that private dental practitioners
predominantly provide dental care. The United States of America, Southern Europe and Central
and Eastern Europe are some of the developed regions where extensive privatisation of dental care
has resulted in people from low socioeconomic backgrounds being unable to access dental care due
to the high costs and health systems being set up in a way where patients have to pay out- of- pocket
for dental care(74). In the developing world, there is a shortage of oral health personnel and care
provided is limited to emergency treatments and pain relief. For example, the dentist- to- population
ratio in Africa and China is 1:150,000 and 1:60,000, respectively, compared to 1:2000in most developed countries(73, 74). Many countries in Africa, Latin America and Asia offer dental services
only at regional or central hospitals in urban areas, and this care is often limited to the management of dental pain, with very little importance given to preventive or restorative dental care(73).
Aside from the set- up of health systems across the world, it is also observed that dental practices
are concentrated in urban areas and cities in many countries, leaving people living in rural or
regional areas with limited options for accessing dental care(74).
2.4.2.3 Cost ofDental Care
High dental care costs have been frequently cited as a barrier to accessing dental care by people
worldwide(75– 77). For example, in Australia, the proportion of people who avoided dental treatment due to cost being a barrier increased from 27.1% in 1994 to 34.3% in 2008(75). Likewise,
anationwide survey conducted in Canada demonstrated that 17.3% of people avoided seeing a
dental professional due to cost, and 16.5% patients declined recommended dental treatment due
tobeing unable to afford treatment due to high cost(76). People who experience cost barriers to
dental care are frequently seen to exhibit poor oral health and more treatment needs compared
topeople who do not experience such barriers(78, 79). Even today, fee- for- service is the predominantly used reimbursement system for dental treatment, and patients pay out of pocket more
often(74). This puts people from a low SES at a disadvantage as public dental health care and
insurance coverage are not universally available for dental care.
19
2.5 Global Trends inthe Prevalence ofOral Diseases Over
thePast Three Decades
According to the GBD study, the burden of oral disease is still huge worldwide, with nearly 3.5
billion recorded cases of oral conditions in 2017. Of which, 2.3 billion are cases of untreated
dentaldecay in the permanent teeth, 796million are cases of severe periodontitis, 532million are
cases of untreated dental decay in the deciduous teeth, and 139million are other oral conditions,
which include a variety of oral diseases but not oral cancers, congenital malformations or
temporomandibular disorders(80).
2.6 Trends ofOral Diseases inDeveloping
andDeveloped Countries
Economically developed countries generally exhibit the lowest burden of untreated dental caries
and severe periodontitis. For instance, the age- standardised prevalence per 100 people of untreated
caries in deciduous and permanent dentition among high- income countries is 6.1 and 29.5,
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2 Global Scenario, Aetiology and Risk Factors Associated with Oral and Maxillofacial Diseases: An Overview
Year
20
respectively, while the corresponding figures in low- income countries are 7.5 and 33.4,
respectively (80). Across the last three decades, from 1990 to 2019, a slight decline has been
observed in the prevalence of untreated dental caries in deciduous and permanent dentitions
globally. In particular, the highest reductions have been observed among high- income countries,
while the reduction in low- income countries has been minimal.
The age- standardised prevalence rate for severe periodontitis (presence of deep periodontal
pockets or clinical attachment loss >4 mm) has slightly increased globally from 1990 to 2019, with
an age- standardised prevalence rate of 9.8% in 2019, a percentage change of 5.8% from 1990(81).
Countries classified as upper- middle income, lower- middle income and low- income had higher
levels of age- standardised prevalence of severe periodontitis with 9.4%, 12% and 9.6%, respectively,
while the age- standardised prevalence rate in high- income countries was 6.6% (Figure2.3)(82). In
addition, high- income countries demonstrated a significant reduction in the prevalence of severe
periodontitis from 1990 to 2017, contrary to other countries, which showed an increase(80). On
the other hand, the burden of tooth loss has been observed to be high in high- income countries
compared to middle- and low- income countries, owing to the interventionist approach and high
levels of access to dental treatment in the high- income countries. However, a contrasting trend is
observed with a gradual decline in the prevalence of tooth loss in high- income countries compared
to the increasing burden of tooth loss in lower- middle and low- income countries (Figure2.4).
According to the GBD data, from 1990 to 2019, the incidence of oral cancer has steadily
increased in all countries in the world over the past three decades. In China, the number of
cases of oral cancer increased from 12,390 in 1990 to 45,216 in 2019, which represents an
increase of about 264.9%. Russia had the smallest increase (38.48%) from 1990 to 2019. The agestandardised incidence rates for oral cancer showed an upward trend in five countries (India,
China, Indonesia, Japan and Pakistan), a downward trend in Brazil, the United States
ofAmerica, Mexico and Bangladesh, and a stable trend in Russia(11). Over the past 30 years,
the age- standardised mortality rates for oral cancer were higher in men than women.
The incidence rate and mortality rate due to oral cancer were highest in three countries
Periodontal diseases
15%
10%
5%
Percent of total prevalent cases
0%
1990 1992 1994 1996 1998 2000 2002 2004
Both sexes, Age-standardised
2006 2008 2010 2012 2014 2016 2018
World bank high income
World bank low income
World bank lower middle
income
World bank upper middle
income
Figure2.3 Age- standardised prevalence of periodontal disease from 1990 to 2019 according to World
Bank income levels. The figure was generated using the Global Burden of Disease Study data
visualisation tool.
t.me/Dr_Mouayyad_AlbtousH
2.7 Summary
Edentulism
6.0%
5.0%
4.0%
3.0%
2.0%
Percent of total prevalent cases
1.0%
0.0%
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
Both sexes, Age-standardised
Year
World bank high income
World bank low income
World bank lower middle
income
World bank upper middle
income
Figure2.4 Age- standardised prevalence of tooth loss from 1990 to 2019 according to World Bank income
levels. The figure was generated using the Global Burden of Disease Study data visualisation tool.
(India,Pakistan and Bangladesh), with the highest prevalence of chewing tobacco, moderate
prevalence of smoking tobacco and low prevalence of alcohol consumption, showing a strong
link between chewing tobacco and oral cancer(11).
Unfortunately, there are not a lot of global surveys conducted worldwide on the prevalence
and incidence of OPMDs. Hence, it is harder to understand the trends of their occurrence.
From surveys conducted so far, it has been ascertained that OL is the most common OPMD,
and its occurrence in people aged 15 years and above has been reported to range from 1.1%
in Cambodia to 3.6% in Sweden (84). Erythroplakias occur less frequently, with a prevalence rate of about 1% in the population, but they have a higher potential for malignant
transformation(84).
21
2.7 Summary
In this chapter, we have presented at the prevalence and incidence of common oral diseases and
found that the burden of oral diseases is still very high, according to data from recent studies and
surveys conducted globally. While the age- standardised prevalence of dental caries decreased
slightly, severe periodontal disease increased somewhat between 1990 and 2019. Also, the incidence of oral cancer has risen steadily during this period. The distribution of oral diseases varied
between the countries, aligning with the differences in the burden of individual and system- level
risk factors. For instance, economically developed countries exhibited the lowest dental caries and
severe periodontal disease levels. While many sources of data were available for oral cancer and
other oral diseases, there were only a limited number of surveys conducted on OPMDs from which
we were able to ascertain that oral leukoplakia is the most encountered OPMD and that the prevalence of OPMDs tended to be higher in Southeast Asian regions because of the high prevalence of
risk factors associated with OPMDs in Southeast Asian regions.
t.me/Dr_Mouayyad_AlbtousH
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