How to solve the great Indian oral health puzzle

The almighty mouth

The Bhagavata Purana tells an incredible story. Once, baby Lord Krishna was playing with his brother Balarama and other boys, when he casually put some mud into his mouth. The other boys immediately shouted out to Yashoda, Krishna’s mother, who came running and chastised her son for eating mud.

Krishna protested that the boys were lying. Yashoda sternly demanded that he open his mouth and show it to her. Finally, Krishna opened his mouth and Yashoda witnessed the entire universe: stars, planets, galaxies, all beings, all of creation, everything that ever existed, inside it. 

While this story may be a metaphor of how Krishna, the almighty creator, keeper and destroyer, holds everything within him, the average Indian citizen’s oral cavity is itself quiet a ‘receptacle’ of many a thing. And unfortunately, not in a divine way!

The orifice of issues

According to the Indian Dental Association (IDA), 85-95% adults have dental cavities. Almost 30% children have crooked teeth. But what’s appalling, is that in the country which has one of the highest GDP growths of the previous decade, only about half the population receives dental treatment or advice. On an average, the lack of awareness and access to reasonably priced dental treatments, is a bane of oral hygiene in India.

Besides, India contributes to the highest number of oral cancers globally and has the dubious distinction of being called the ‘oral cancer capital of the world’. Alcohol abuse, smoking, chewing tobacco, extensive use of areca nut and betel quid, viral infections (HPV, HSV-1), poor oral hygiene and nutritional deficiencies are some causes behind this enormous burden.

What ails India’s oral health?

There are several factors, both environmental and human, that have led to this situation:

Poor oral health habits

Indian cuisine is just as rich and diverse as the subcontinent and its inhabitants. An essential and sought after part of our food are curries, often acidic in nature. While they’re everyone’s favourite, foods like these must be rinsed off well with water after each meal, otherwise they can cause enamel erosion and tooth sensitivity. 

Additionally, the Indian food platter is never complete without sugary and syrupy treats. Some foods that contain phosphoric and critic acids and stick to the teeth like sweets, starchy items, can potentially damage the teeth, if right cleaning habits are not inculcated. 

However, Indian cuisine isn’t the villain. We also include ingredients in our food like onions and sesame seeds that help clean and protect teeth. The real key to better oral health is to clean or rinse teeth after each meal or snack. And the absolute need to inculcate this habit early in life.

Lack of oral health maintenance

That brings us to the real problem. Traditionally, India has had great practices like chewing on neem tree twigs, etc., as an essential part of oral hygiene. Called daatoon, it still has a lot of takers among the older generation and rural areas.  

Ironically, brushing teeth has taken a back seat in modern India. Surveys have revealed that more than 80% of people aren’t aware of proper brushing techniques. Moreover, only half of the population brushes twice daily. Poor oral hygiene leads to bad breath, cavities and gum diseases that, in turn, result in severe health issues like diabetes and cardiovascular diseases. 

Meanwhile, only a fraction of people in India, visits the dentist for regular checkups. Confirmation bias plays a big role here, wherein people believe that they are taking enough care (I brush twice!) and only those that have a problem, need to go to the dentists. Add to that the lack of accessibility in some areas, and the problem becomes worse.

Tobacco, areca nut and betel quid (paan) and alcohol

The high incidence of smoking and chewing tobacco, is playing havoc with the oral health of Indians. Nicotine in tobacco reduces saliva flow, leading to dry mouth symptoms that increases chances of tooth decay and gum diseases.

Studies have indicated that majority of tobacco chewers have oral lesions of some kind. Medically, it’s well established the tobacco use (in any form), leads to cancer and pulmonary and cardiovascular diseases. Despite large scale campaigns to raise awareness about these ill effects, almost 120 million Indians are active smokers and are at risk of serious oral issues. 

Paan-Supari-Gutkha, on the other hand, causes staining and tooth decay. Alcohol also has a dry mouth causing effect, apart from other problems it causes. All these factors, collectively, have led to a gigantic oral health burden in India and, worse, one that is under-reported.

Lack of access to good dental care

It’s ironical that though India has the highest number of dental colleges in the world, the per capita availability of a dentist is low, especially in the rural areas, where a sizeable population lives. The problem becomes further aggravated due to an overall bias of treating dental health as less important that general health, and compounded by other constraints like low affordability, inadequate infrastructure and difficulty of access. 

How do we alleviate the situation?

What can potentially solve this huge puzzle is building a comprehensive oral health ecosystem that leverages human behavioural nudges, harnesses the power of digital, backed by credibility of healthcare professionals and reaches out to the under-served and unaware.

The creation of such a mobile-first platform could help in several ways, including:

Raise awareness of good oral cleaning practices, including early education in both private and government schools, and encouraging regular visits to dentists. (Thus, involving the dentist community as well.)

Reduce the usage of tobacco through spreading information on the ill-effects and designing behavioural nudges.

Employing digital tools and physical activation to providing equal and greater access to good oral healthcare and early detection of oral cancer, especially in rural areas.

Help modify lifestyles and habits regarding intake of refined sugar and importance of post-meal cleaning.

India’s oral health puzzle isn’t something that can be taken care of by a single entity or an awareness campaign. It will require a collaborative effort on the part of the government and leading brands in the health and oral care segment to take up the baton and alleviate the situation.

(Atin Roy is senior VP at Ogilvy)