Burden Of Oral Diseases Research Articles

Promoting Oral Health and Quality of Life of Older People - The Need for Public Health Action.

This report intends to review the global burden of oral disease among older people and to examine their oral health needs. The evidence on the inter-relationships between poor oral health conditions of older people, general health and quality of life is highlighted. Finally, WHO strategies to improve oral health of older people are reviewed. The information relevant to this review was extracted from the WHO Global Oral Health Data Bank, the PubMed database, and the Cochrane Library. Surveys were carried out according to the criteria recommended by the WHO epidemiological manual Oral Health Surveys - Basic Methods. In addition, global data were sought on coverage of oral health care among older people. Finally, WHO policy documents on health care for aged people were gathered through the WHO website. Across the globe, many older people suffer from oral pain or discomfort. Poor oral health during old age is mostly manifest in high caries experience, high prevalence rates of advanced periodontal disease, severe tooth loss, dry mouth, and oral pre-cancer/cancer. In both developing and developed countries, the burden of disease is particularly high among underprivileged and disadvantaged older people. In numerous countries, high proportions of the aged population are not covered by primary oral health care; this is mainly the case in low and middle income countries due to a critical shortage of dentists. In 2015, the WHO published the World Report on Ageing and Health, which outlines a framework for action to foster healthy ageing. The policies are highly relevant to the improvement of oral health. Transformation of oral health systems away from a disease-based curative model and towards disease prevention, as well as the provision of older-person-centred integrated care are required. Moreover, wide-ranging public health action on ageing is urgently needed.

Utilisation of Oral Health Services and Economic Burden of Oral Diseases in China.

To evaluate the use of oral health services, the economic burden of oral diseases and related influential factors in China. Using the multistage, stratified, equal proportion, random sampling method in the 4th National Oral Health Survey of China conducted in 2015 to 2016, residents aged 3 to 5 years, 12 to 15 years, 35 to 44 years, 55 to 64 years, and 65 to 74 years respectively were recruited, clinically examined and answered a questionnaire. Utilisation of oral health services were assessed in all the age groups and the economic burden of oral diseases in the past 12 months were assessed in the 3 to 5 years and 35 to 74 year-old groups. Chi-squared tests, t tests, correlation analysis and a one-way ANOVA were used to determine the relationships of different factors with utilisation of oral health services and the economic burden of oral diseases. In the subject groups - 3 to 5 years, 12 to 15 years and 35 to 74 years - the prevalence of the utilisation of oral health services in the past 12 months was 14.6% (5,876/40,353), 23.6% (27,936/118,592), and 20.1% (2,708/13,461), respectively. In all three groups, receiving dental treatment was the most common reason for subjects' recent dental visit. The average dental cost in the past 12 months was 403.43 CNY (median = 100) for 3 to 5-year-old children and 850.83 CNY (median = 300) for adults aged 35 to 74 years old. Area, education and annual household income per person were the socio-economic influential factors. Oral health status, oral hygiene and attitudes to and knowledge of oral health affected the utilisation of oral health services and the economic burden of oral diseases. The percentage of dental service utilisation was relatively low, and the economic burden was high. The related factors for both utilisation of oral health services and the economic burden of oral diseases included living in area, educational attainment, household income, perceived oral health status, and oral hygiene.

Added Sugar Consumption and Chronic Oral Disease Burden among Adolescents in Brazil

Chronic oral diseases are rarely studied together, especially with an emphasis on their common risk factors. This study examined the association of added sugar consumption on “chronic oral disease burden” among adolescents, with consideration of obesity and systemic inflammation pathways through structural equation modeling. A cross-sectional study was conducted of a complex random sample of adolescent students enrolled at public schools in São Luís, Brazil (n = 405). The outcome was chronic oral disease burden, a latent variable based on the presence of probing depth ≥4 mm, bleeding on probing, caries, and clinical consequences of untreated caries. The following hypotheses were tested: 1) caries and periodontal diseases among adolescents are correlated with each other; 2) added sugar consumption and obesity are associated with chronic oral disease burden; and 3) chronic oral disease burden is linked to systemic inflammation. Models were adjusted for socioeconomic status, added sugar consumption, oral hygiene behaviors, obesity, and serum levels of interleukin 6 (IL-6). All estimators of the latent variable chronic oral disease burden involved factor loadings ≥0.5 and P values <0.001, indicating good fit. Added sugar consumption (standardized coefficient [SC] = 0.212, P = 0.005), high IL-6 levels (SC = 0.130, P = 0.036), and low socioeconomic status (SC = −0.279, P = 0.001) were associated with increased chronic oral disease burden values. Obesity was associated with high IL-6 levels (SC = 0.232, P = 0.001). Visible plaque index was correlated with chronic oral disease burden (SC = 0.381, P < 0.001). Our finding that caries and periodontal diseases are associated with each other and with added sugar consumption, obesity, and systemic inflammation reinforces the guidance of the World Health Organization that any approach intended to prevent noncommunicable diseases should be directed toward common risk factors.

Building Capacity in the Sikh Asian Indian Community to Lead Participatory Oral Health Projects

Building Capacity in the Sikh Asian Indian Community to Lead Participatory Oral Health Projects Rucha Kavathe, PhD, Nadia Islam, PhD, Jennifer Zanowiak, MA, Laura Wyatt, MPH, Hardayal Singh, and Mary E. Northridge, PhD, MPH What Is the Purpose of This Study? • To increase understanding of Sikh Asian Indians as an immigrant group with a unique cultural, linguistic, and social profile. • To demonstrate the importance of local data in prioritizing the health needs of community members. • To detail how UNITED SIKHS, a community-based organization serving the Sikh Asian Indian community, was able to strengthen its ability to lead participatory oral health projects. What Is the Problem? • Oral health conditions such as dental caries (cavities) and gingival and periodontal (gum and bone) diseases are largely preventable. • The burden of oral diseases is higher in groups such as racial/ethnic minorities, immigrants, and non-English speakers than in more advantaged groups. • Many immigrant groups, including Sikh Asian Indians, lack access to dental care because they do not have dental insurance and cannot afford to pay the cost of dental services themselves. What Are the Findings? • Fewer than one-half of Sikh Asian Indians (43%) reported ever receiving a check-up or a screening by a dentist. • Even among Sikh Asian Indians who had seen a dentist, only one-half (50%) visited a dentist in the past year. • Most Sikh Asian Indians were born in India (96%–98%, depending on the survey). and speak Punjabi as their primary language (76%–90%, depending on the survey). • Most Sikh Asian Indians lacked both health insurance (71%) and dental insurance (80%). • Nearly two-thirds of Sikh Asian Indians have a regular doctor (65%), but only about one-third (35%) have a regular dentist. • Very few Sikh South Asians have ever smoked cigarettes or use other tobacco products (about 1%). Who Should Care Most? • Community-based organizations, government agencies, and services providers supporting immigrant groups, especially those that serve Asian communities. • Dental schools, medical schools, and schools of public health that engage in community-based service delivery and community-based participatory research. • Policymakers who work to cover immigrant populations with public insurance options. [End Page 1] Recommendations for Action • Collaborate with community partners to enhance culturally competent service delivery, including integrated primary care and oral health care screening in community settings. • Disseminate study findings through social media and community networks. [End Page 2] Rucha Kavathe United Sikhs Nadia Islam New York University School of Medicine, Department of Population Health Jennifer Zanowiak New York University School of Medicine, Department of Population Health Laura Wyatt New York University School of Medicine, Department of Population Health Hardayal Singh United Sikhs Mary E. Northridge New York University College of Dentistry, Department of Epidemiology and Health Promotion Copyright © 2018 Johns Hopkins University Press

Burden of oral diseases and noncommunicable diseases: An asia-pacific perspective.

At a population level, there are no systematic data to correlate the pattern of prevalence of noncommunicable diseases (NCD) with oral disease burden in South Asian countries. The influence of the age, gender, and geographical distribution on these diseases is not reported. We attempt to provide a population level correlation of occurrence using the Global Burden of Disease approach. Using the data from the Global Burden of Diseases, 2016, the occurrence of oral diseases (dental caries of permanent teeth, edentulism (including severe tooth loss), and periodontal diseases) and various NCDs, based on geographical region, gender and age groups were collected and subjected to correlation statistics. Statistical Package for Social Services (Version 23) was used to analyze the results. P ≤ 0.05 was considered as statistically significant. Geographical location and age had a significant role in the occurrence of dental diseases. There was a considerable difference in rates of dental diseases and NCD prevalence in the various regions of Asia-Pacific. It was observed that for most of the NCDs, there was a linear significant relationship for edentulism as well as periodontal diseases with high statistical significance. The factors that contribute to the discrepancies, phenomenon, and relationship between the oral diseases and NCDs are discussed. The current state of the importance of oral health, in maintaining overall health is discussed. Methods by which policymakers could bring about a change by utilizing the principles of "Overton window" for mobilizing the support of people are presented.

Building oral health research infrastructure: the first national oral health survey of Rwanda

ABSTRACTBackground: Oral health affects quality of life and is linked to overall health. Enhanced oral health research is needed in low- and middle-income countries to develop strategies that reduce the burden of oral disease, improve oral health and inform oral health workforce and infrastructure development decisions.Objective: To implement the first National Oral Health Survey of Rwanda to assess the oral disease burden and inform oral health promotion strategies.Methods: In this cross-sectional study, sample size and site selection were based on the World Health Organization (WHO) Oral Health Surveys Pathfinder stratified cluster methodologies. Randomly selected 15 sites included 2 in the capital city, 2 other urban centers and 11 rural locations representing all provinces and rural/urban population distribution. A minimum of 125 individuals from each of 5 age groups were included at each site. A Computer Assisted Personal Instrument (CAPI) was developed to administer the study instrument.Results: Nearly two-thirds (64.9%) of the 2097 participants had caries experience and 54.3% had untreated caries. Among adults 20 years of age and older, 32.4% had substantial oral debris and 60.0% had calculus. A majority (70.6%) had never visited an oral health provider. Quality-of-life challenges due to oral diseases/conditions including pain, difficulty chewing, self-consciousness, and difficulty participating in usual activities was reported at 63.9%, 42.2% 36.2%, 35.4% respectively.Conclusion: The first National Oral Health Survey of Rwanda was a collaboration of the Ministry of Health of Rwanda, the University of Rwanda Schools of Dentistry and Public Health, the Rwanda Dental Surgeons and Dental (Therapists) Associations, and Tufts University and Harvard University Schools of Dental Medicine. The international effort contributed to building oral health research capacity and resulted in a national oral health database of oral disease burden. This information is essential for developing oral disease prevention and management strategies as well as oral health workforce and infrastructure.

"Burden of the Triumph:" Burden of peri-implantitis in Indian population - A mathematical model.

India suffers from a heavy burden of oral diseases. Dental implants (DIs) are prescribed widely by the dental practitioners to replace lost natural teeth. There is no estimate, however, to determine the number of DIs or the number of people with peri-implantitis or the failure of implants after placement. In this modeling study, we attempted to estimate the prevalence of adult Indians who would choose DI in the near future and to calculate the peri-implantitis and failure of DI. Using the Global Burden of Disease database (2016), the number of dental caries in permanent dentition, periodontal diseases, and edentulism was obtained. Empirical assumptions of patients with anodontia in urban and rural areas who opted for DI, percentage of implants placed, the affordability factors, and mathematical models for DI were formed and executed. Peri-implantitis and survival data from literary evidence were collated. Based on assumptions, 909,643 Indians, (830,231-858,703) would choose DI. Estimated number of peri-implantitis would be 145,543-254,700 and estimated number of failures should be 50,940-79,412 in the near future. In spite of the high economic challenge and the risks or complications of peri-implantitis, DIs are gaining prominence. It is the dentists' burden to face the renewed challenges due to emerge and provide remedial measures.

"Seniors only want respect": designing an oral health program for older adults.

Persistent socioeconomic disparities in the oral disease burden contribute to pain and suffering among vulnerable and underserved populations who face systemic barriers to access oral health care, including older adults living in disadvantaged urban neighborhoods. The aim of this study is to gain the views of racial/ethnic minority older adults regarding what they believe would support them and their peers in visiting the dentist regularly. Focus groups were conducted and digitally audio-recorded from 2013 to 2015 with 194 racial/ethnic minority women and men aged 50 years and older living in northern Manhattan who participated in one of 24 focus group sessions about improving oral health for older adults. Analysis of the transcripts was conducted using thematic content analysis. The majority of recommendations from racial/ethnic minority older adults to help older adults go to the dentist regularly were centered at the organization and provider level. The preeminence of respectful treatment to racial/ethnic minority older adults may be useful to underscore in oral health programs and settings. There is a need for greater engagement of and attention to patients and other stakeholders in developing, testing, and disseminating interventions to close the gaps in oral health care disparities.

Implications of WHO Guideline on Sugars for dental health professionals.

The burden of oral disease is high in populations across the world. This is because of high consumption of free sugars. The WHO Guideline on Sugars Intake for Adults and Children recommended limiting free sugars to no more than 5% energy intake to protect oral health throughout the life-course. The objectives of this paper are to consider the implications of the Guideline for dental health practice and to advocate use of the common risk factor approach when providing dietary advice. As part of a broad range of actions needed to reduce free sugars intake, improved education for dental health professionals and supporting patients to eat less free sugars are key actions for the dental profession. All dental health professionals should have the skills and confidence to provide their patients with healthier eating advice, including how to limit free sugars intake. It is therefore important that dental health professionals receive adequate education in diet and nutrition, and there is a need for dental educational regulating bodies to define the content of the dental curriculum with respect to nutrition. All patients, or their parents or carers, should receive dietary advice to reduce free sugars within the context of a healthy diet for the prevention of all NCDs. Dietary advice should: (i) focus on reducing the amount of free sugars consumed; (ii) be tailored according to the patient's body mass status (eg underweight, overweight, normal weight); (iii) encourage the consumption of fresh fruits and vegetables, nuts, seeds, and wholegrain starch-rich foods; (iv) discourage the consumption of foods high in saturated fat and salt; and (v) discourage the consumption of all drinks containing free sugars. The dental health professional has an opportunity to support patients to reduce their intake of free sugars-such advice and support will have positive impacts beyond the mouth.

Political priority of oral health in India: analysis of the reasons for neglect.

To examine the political priority of oral health in India and to understand the underlying reasons for the political support oral health receives. The analysis is based on the political power framework developed by Shiffman and Smith and modified by Benzian et al. to examine the factors that contribute to the political priority of oral health in India. The framework comprises four main analysis categories, further subdivided into 11 dimensions. Based on the set of criteria, each dimension was analyzed and rated by assigning a score to assess to what extend the criteria were met. There is a good understanding on what defines an oral health problem, however, there is no consolidated and comprehensive approach to address oral diseases. Despite India's efforts to improve oral health-related research, its poor utilization in terms of public health and population-based approaches is apparent. The absence of a national surveillance system for oral health masks the severity and extent of the oral disease burden and limits the basis for advocacy on improving oral health to health decision makers. The fragmentation of actors and institutions and the absence of leaders uniting various actors in oral public health impede changes toward improving the oral health status of the population. Limited accessibility to oral health care, poor portrayals of the severity and extent of the burden, and inertia to address-related challenges are important factors contributing to the low political priority of oral health.

Prevention of tooth loss and dental pain for reducing the global burden of oral diseases

Population ageing is a global phenomenon and is predicted to become one of the most significant social transformations of the 21st century. The anticipated demographic shift provides governments the opportunity to proactively align policies with the estimated demands for housing, transportation, social protection, and health and well-being. Oral health is a fundamental component of health and physical and mental well-being, and is influenced by the individual's changing experience, perceptions, expectations and ability to adapt to circumstances. As such, prevention of oral disease and maintenance of oral health contributes to the systemic health, well-being, and quality of life of older adults. Dental caries, periodontal disease, and tooth loss in older adults are global health concerns because they are highly prevalent worldwide, socio-economic inequalities contribute to these diseases, many of the risk factors are modifiable, and these diseases result in compromised oral health-related quality of life. Oral care must be tailored to the needs and level of dependency of older adults through the use of evidence-based approaches and inter-professional collaboration. The persistence of between countries and within countries oral health disparities indicate that population-based policies are also needed to address the underlying social, environmental, and economic causes of oral diseases.

Oral health for healthy longevity in an ageing society: maintaining momentum and moving forward

The ageing of populations worldwide is rapidly accelerating. However, the global burden of oral disease remains a critical and often underestimated problem. As ageing progresses globally, oral health maintenance becomes a matter not only of public health, but also of human rights. Therefore, in low- and middle-income countries, policymakers are seeking to realize universal health coverage even as they struggle with severe resource limitations. To achieve and maintain global oral health, we propose an ongoing global monitoring cycle consisting of the following four steps: needs assessment, implementation of appropriate health care systems and provisions, reducing the global burden of oral disease, and working to achieve a healthy ageing society. Rather than a unidirectional information flow from high income to low- and middle-income countries, the proposed system would establish a multidirectional information-sharing cycle that would benefit all countries. To make this possible, however, we must develop a standardized set of core oral health indicators that all countries use, as well as a global repository for gathering, compiling, and sharing the data. This system would allow each country to move forward at its own pace and in locally-appropriate ways, making it more effective and efficient in the long run than the current pattern of setting unrealistic goals that all countries are expected to achieve by a certain point in time.

Refugees: addressing the burden of oral disease through prevention.

In February 2017 a cohort of dental students travelled to Athens, Greece where they assisted in providing dental care to refugees and conducted oral hygiene workshops in Skaramagas Refugee camp. With respect to patient presentation, caries was found to be extremely prevalent due to patient diet, accessibility to care and oral hygiene practices. Due to the extensive nature of the work, time constraints and resource availability focus was directed on reducing disease burden through prevention. This article explores the challenges of delivering preventative treatment as well as its advantage over conventional therapeutic care in the context of a humanitarian crisis. It also seeks to inspire other healthcare professionals to undertake outreach work within the UK and abroad.

Status and analysis of oral disease burden: comparison of the domestic and overseas data

At present, it has been regarded that oral disease was one of the most prevalent problems for people's general health around the world. Oral disease burden study focuses on the pressure and effect of oral diseases to the whole social economy and people's health. Oral disease burden, as a public health problem, needs to be attached importance in China and foreign countries. By means of retrieving the literature, this review article summarizes the progress of domestic and oversea studies on oral disease burden, analyses the epidemiological burden through the indicators such as the prevalence rate, decayed missing and filled teeth, disability adjusted life years, disability weights, and illustrates the economic burden of oral diseases by using part of the data. Results shows that the oral disease burden is obvious in most countries and regions both in China and foreign countries. The study of oral disease burden in China has not been well developed. Giving priority to dental caries, periodontal disease and tooth loss, the prevalence of oral diseases in China is high. The rate of seeking dental treatments is low and the proportion of self-supporting treatments is high. In general, the epidemiological and economic burden of oral diseases is heavier in China than that in the rest of the world.

Impact of delayed gratification on oral health and caries status in the primary dentition

ObjectiveThe ability to delay gratification (ATDG) is naturally linked to key regulatory psychological traits involved in self-discipline/regulation. The aim of this study was to ascertain the normalized impact of ATDG as an early predictor of oral health, on the primary dentition. Methods404 subjects [202 children (4–6 years old) and 202 mothers] were enrolled in a case-control study. Systematic data collection included: i) extraoral diagnostic parameters; ii) intraoral health status; iii) behavioral aspects; iv) baseline socio-demographic data. The ICC, the paired Student’s t-test and kappa statistic were used to evaluate intra-observer reliability. Distributions were explored with the chi-squared test [Odds ratio;95%CI;p<0.05]. Conditional logistic regression was used to evaluate associations between all clinical diagnostic data and ATDG. ResultsOverweight/obese children and those diagnosed with ADHD are more prone to lack ATDG (p<0.001). Higher deft values were observed in children who lacked ATDG, who were also strongly associated with higher sugar consumption and more impulsive personalities (p<0.001;OR:.107/0.031;95%CI:036–0.316/0.008–0.115). By contrast, children with responsible personality traits were associated with this skill (p<0.028;OR:3.33;95%CI:1.1–9.7) and obtained the lowest deft (p<0.306;OR:0.539;95%CI:0.165–0.176) and gingival index values (p<0.001;OR:10.44;95%CI:2.6–40.9), which are clear indicators of better current and future oral health. ConclusionsThese data provide insights into a novel predictor for identifying individuals at a higher risk of dental caries in early childhood. Clinical significanceThe present study offers a new hypothesis for identifying individuals with poor oral health status. Early tools to detect the most vulnerable population sectors are critically important to reduce the global burden of caries and other oral diseases.

Global Burden of Sugar-Related Dental Diseases in 168 Countries and Corresponding Health Care Costs

Oral diseases such as dental caries, edentulism (tooth loss), periodontal disease (PD), and oral cancer currently constitute an increased major public health burden across the globe, with significant differences between countries. One of the main drivers of caries, edentulism, and PD is the excessive intake of sugars. Here, we aimed to quantify the global sugar-related dental health and cost burden in the year 2010. This study used a health-econometrical model to calculate the disease burden as well as the direct and indirect costs attributable to the intake of free sugars (mono- and disaccharides [MDS]). To this end, several databases from the Institute for Health Metrics and Evaluation (IHME), Organisation for Economic Co-operation and Development (OECD), Food and Agriculture Organization (FAO), and World Bank were used. In total, the corresponding disease burden in 168 countries and economic burden in 31 OECD countries were quantified. In 2010, the consumption of MDS was associated with a global dental disease burden of 4.1 million disability-adjusted life years (DALYs; 95% uncertainty interval [UI]: 2.1 to 7.4 million DALYs), with 2.7 million DALYs from MDS-related caries and 1.4 million DALYs from PD. In terms of economic costs, MDS-related dental diseases were associated with a global financial burden of 172 billion US dollars (USD; 95% UI: 91 to 295 billion USD), the largest share of which (151 billion USD) was incurred in OECD countries. Overall, 26.3% (95% UI: 13.3% to 47.5%) of the total global oral disease burden was attributed to the consumption of MDS. The present study emphasizes the need to further address the role of free sugars in oral health and nutrition policy. Although the largest share of the economic burden was accounted for by OECD countries, emerging economies should address this challenge early on in national public health policies if they are to avoid disease and the prospect of increased cost burdens.

Exploring the role of the dental hygienist in reducing oral health disparities in Canada: A qualitative study

Reducing oral health disparities has been an ongoing challenge in Canada with the largest burden of oral disease exhibited in vulnerable populations, including Aboriginal people, the elderly, rural and remote residents, and newcomers. Dental hygienists are a unique set of professionals who work with and within communities, who have the potential to act as key change agents for improving the oral health of these populations. The purpose of this qualitative study was to explore, from the dental hygiene perspective, the role of dental hygienists in reducing oral health disparities in Canada. Dental hygienists and key informants in dental hygiene were recruited, using purposeful and theoretical sampling, to participate in a non-directed, semi-structured one-on-one in-depth telephone interview using Skype and Call Recorder software. Corbin and Strauss's grounded theory methodology was employed with open, axial, and selective coding analysed on N-Vivo Qualitative software. The resulting theoretical framework outlines strategies proposed by participants to address oral health disparities; these included alternate delivery models, interprofessional collaboration, and increased scope of practice. Participants identified variation in dental care across Canada, public perceptions of oral health and dental hygiene practice, and lack of applied research on effective oral health interventions as challenges to implementing these strategies. The research confirmed the important role played by dental hygienists in reducing oral health disparities in Canada. However, due to the fragmentation of dental hygiene practice across Canada, a unified voice and cohesive action plan is needed in order for the profession to fully embrace their role.

The Global Burden of Oral Disease: Research and Public Health Significance

The Global Burden of Oral Disease: Research and Public Health Significance

Burden of oral diseases in 2016: Newer opportunities for further research

Burden of oral diseases in 2016: Newer opportunities for further research

Tobacco use, oral cancer screening, and oral disease burden in Indian women.

India lacks data on national level adaptation of oral cancer screening measures and burden of oral diseases. We intend to address the issue through a secondary data analysis of existing data and reports. Data were acquired from the National Family Health Survey-4 (2015-2016). Of the 699,686 responses, representing 99% of India's women population living in all of India, the following data from the age group of 15-49 years were mined - any tobacco use, desire to quit tobacco use, and oral cavity screening for cancers. Data from Central Health Intelligence Bureau 2016 was used to identify population served by dentists in each state. The state-level data of the District Level Household and Facility Survey-4 (2012-2013) were mined for household population having symptoms of chronic illness including mouth/dental illness persisting for more than 1 month and had sought treatment. SPSS version 20; Descriptive statistics for values in proportions; Pearson's correlation test assessed between the various factors. Tobacco use in any form was highly prevalent among the North Eastern states, and there was also a lack of willingness to quit the habit. There was unequal distribution of dentists in different states. No significant statistical correlation was found between the proportions. There is disparity existing in treating seeking behavior of the general population as well as the need for dental treatment. The skewedness in dentists' distribution among the nation as compared with oral burden of diseases needs to be correlated before oral health policies are planned.