This World Diabetes Day, I want to talk about diabetes. “But you are not a doctor, you really are just a dentist.” The familiar lines from “The Hangover” is a statement I have heard often throughout my career. Dentists have for long been operating on the periphery of the medical system. Ironic really, considering that dentistry can help diagnose up to 120 different diseases by identifying signs and symptoms that first manifest in the oral cavity

. Research has repeatedly shown a strong correlation between deterioration in oral health and the onset and prevalence of several non-communicable diseases. Chief amongst these are diabetes, cancer, cardiovascular diseases, and respiratory ailments. Four of the most chronic, non-communicable diseases that together account for over half of all deaths in the country today.

Let’s talk diabetes. India is home to the second-largest population of diabetics in the world, with around 77 million diabetics, impacting nearly 9% of the population. It is the fastest growing disease in the country, predicted to affect about 109 million people by 2035. Worse still, nearly half of all diabetes and pre-diabetes cases remain undetected. Uncontrolled diabetes amongst the lower strata of society is a major cause of heart attacks, blindness, kidney failure, stroke, and lower limb amputation.

Let’s now talk oral cancer. Over 5 people in India die every hour every day because of oral cancer due to lack of awareness, timely detection, and care. It is amongst the top three types of cancer in the country and accounts for over 30% of all types of cancer. Early detection of oral cancer offers the best chance for affordable care and the possibility of improved treatment outcomes, with hopes for long-term survival.

Meanwhile, oral disorders continue to remain the most prevalent disease group in India. 60 per cent of the Indian population suffer from dental caries and nearly 85 per cent suffer from periodontal issues according to the MoHFW, making it a major public health issue. However, only 12.4% of adults across the country have had access to any kind of dental care, according to the National Oral Health Policy 2018 draft. Less than 20% of the rural primary healthcare centers (PHCs) have a dentist, fewer still have adequate infrastructure and equipment. Routine dental care unfortunately continues to remain the privilege of only a few of the urban elite.

The problems that afflict our healthcare system are obvious. A highly fragmented and specialized approach. Lack of awareness amongst the masses. Lack of access to primary healthcare facilities across the country. Poor doctor to patient ratio. But most importantly, delayed diagnosis, detection, and intervention. And lack of integrated guidance and care. Bringing dentists and oral healthcare into the core and center of the country’s healthcare strategy can have multiple benefits, helping address some of our biggest healthcare challenges. Here’s how:

The mouth and the human body are highly interlinked, and the mouth is a window to an individual’s overall health. Oral infections and chronic diseases including cardiovascular diseases, diabetes, stroke, oral cancer, and respiratory illnesses share a set of common risk conditions and factors. These include poor diet and lifestyle habits, poor oral hygiene, tobacco and alcohol consumption, smoking, and stress. Dentists are uniquely equipped to look beyond the presenting complaint and identify signs in the mouth that could be indicative of more chronic, systemic diseases. Studies show that over 90 percent of systemic diseases have some form of oral manifestations, including swollen gums, ulcers etc. For instance, bad breath, burning mouth disorder and bleeding gums could be indicators of diabetes. Dental x-rays can show the first stages of bone loss. There is convincing epidemiological evidence linking periodontal infections with diabetes and oral cancer apart from heart diseases. Bacteria present in gum diseases enter the blood stream and increase the risk of heart attacks, poorly controlled diabetes, respiratory diseases etc. Conversely, smoking and diabetes cause periodontal complications. So, early intervention and treatment of periodontal infection can be crucial to delaying the onset and progression of chronic diseases including oral cancer, diabetes, and cardiovascular diseases amongst others.

Primordial prevention addresses the root cause of risk factors contributing to the onset of diseases and is key to the health and development of the country. Primordial prevention and timely diagnosis are therefore crucial in stemming the spiraling growth of many of these chronic ailments, and this is where dentists can play a key role. For instance, dentists can use a VELscope to detect the onset of oral cancer in its early stages very quickly and efficiently within minutes, without invasive procedures like a biopsy. Dentists can also successfully develop markers for early detection of cancer. Authoritative bodies like the International Diabetes Foundation have repeatedly recommended that primary healthcare professionals must routinely ask about oral health and instruct patients to seek care from a dental professional. The European Society of Cardiology has stated that oral healthcare is an important component in the prevention of cardiovascular diseases. Sadly, oral health continues to be an afterthought for most individuals, including medical professionals and dentists are often relegated to a drill, fill and bill routine in patient care. We need to make a shift in mindset and integrate dentistry into mainstream medical care to assist in preventive and diagnostic care, early identification of diseases, and comprehensive treatment planning.

In a country like India with an overburdened public health system, the contribution of dentistry in raising awareness levels, preventive care and improving overall standards of healthcare can be game-changing. It is time to break down the compartmentalization and barriers demarcating oral care from mainstream medicine. Integrating oral and general healthcare strategies including comprehensive diagnosis, treatment planning and execution will help stem the spiraling growth of the ticking time bombs that are oral diseases, diabetes, and oral cancer. The benefits are manifold. Lower costs for both the individuals and the government, early diagnosis, timely intervention, greater efficiencies, and holistic treatment compared to disease specific approaches. Integrated and effective follow-up care to stem side effects and complications. Prolonged and better quality of life for the patients. Reduced burden on the healthcare systems downstream. And finally, a long overdue acknowledgement of the contributions of dentistry to healthcare, claiming its rightful place in the league of medicine.

By Dr. Srivats Bharadwaj
Founder & CEO, Vatsalya Dental, Bengaluru