• Overview
• Definition
• Incidence, prevalence and trends
• Risk factors
• Health consequences
• Costs
• Contributors

Risk Factors

The risk factors for some of the major preventable oral diseases, such as dental caries and oral cancer, are often shared with other public health issues, such as tobacco smoking, poor diet, alcohol consumption, trauma, poor hygiene and exposure to ultraviolet radiation. ¹

Moreover, control of oral disease depends on availability and accessibility of oral health systems but reduction of risk is only possible if services are oriented towards primary health care and prevention. This model of oral disease control emphasizes the role of intermediate, modifiable risk behaviours, i.e. oral hygiene practices, sugar consumption (amount, frequency of intake, types), tobacco use and excessive alcohol consumption. Such behaviours may not only negatively affect oral health status, as expressed by clinical measures, but also impact on quality of life.

Most importantly, there is a strong link between socio-economic status and health, and this is reflected in patterns of oral health and disease. For example, unhealthy diet, tobacco use and excessive alcohol consumption are higher in low socio-economic groups. ¹

Common risk factors for poor oral health

Poor diet

The frequent and high consumption of sugars is the major cause of dental caries. This includes soft drinks, confectionary and biscuits, but in addition, there are foods that contain ‘hidden’ added sugars: foods that would not be expected to contain sugars, such as fruit juices.

Diet and nutrition also impacts on tooth wear due to chemical dissolution of teeth. Snacking on fruit and vegetables rather then foods high in sugar helps to promote good oral health.

Poor oral hygiene

The health of periodontal tissues, the mucous membrane lining the mouth, and the bone supporting the teeth is compromised when teeth and gums are not brushed regularly and dental plaque accumulates.

Exposure to fluorides

Effective twice-daily brushing with toothpaste containing fluoride is responsible for improving periodontal health. Exposure to fluorides can cause fluorosis; however, the British Dental Health Foundation believe that the adverse effect is minimal compared with the benefit of exposure to fluorides. An extensive review by the University of York found a 15% average incidence of caries-free children in communities with fluoridated water. ²

Tobacco use

Tobacco use, especially smoking, increases the prevalence and severity of periodontal disease. It is by far the greatest risk factor for oral cancer. Tobacco use is also linked to a range of other oral health problems and reduces the success rate of dental treatments such as implant surgery.

Alcohol consumption

Excessive alcohol consumption, particularly spirits, is a further risk factor for oral cancer, especially when combined with smoking and a poor diet.

Inappropriate infant feeding practices

This includes feeding babies and young children undiluted juices, soft drinks and sweetened milk.

Injury

Broken or traumatised teeth are a common problem among certain groups, such as adolescent boys. The risk of oral injury increases with playing contact sports, violence and falls.

Medical conditions

A range of medical conditions may adversely affect oral health. These include eating disorders and chronic diseases requiring multiple long-term medications, for example, multiple sclerosis.

Dry mouth (xerostomia)

Xerostomia is often associated with the long-term use of medication and other diseases such as autoimmune disorders.

Socio-economic risk factors

Ethnic minority groups

Inequalities persist and greatly increase the risk of oral disease. Many countries report increased incidence of poor oral health amongst ethnic minority and socio-economic groups. These include people living in deprived communities and people with special needs in the UK and Europe.

Poor living conditions

According to the World Health Organisation, high relative risk of oral disease relates to socio-cultural determinants such as poor living conditions. Communities and countries with inappropriate exposure to fluorides have a higher risk of dental caries and settings with poor access to safe water or sanitary facilities carry environmental risk factors to oral as well as general health.

Low education

An inability to access public health messages promoting dental hygiene is often associated with low education. For example, irregular attendance at education institutions which may be the site for public health communication; or a lack of traditions, beliefs and culture in support of oral health.