Absence of toothache syndrome oral health and treatment needs among urban Pakistanis

Dental caries and periodontal disease are among the most common diseases affecting mankind. Oral diseases have a negative impact on an individual s quality of life and also represent a burden for health care systems worldwide. Populations in the developing nations are afflicted by a panorama of oral diseases similar to that of the developed nations: dental caries, periodontal diseases and oral mucosal diseases. In both developed and developing countries, the burden of oral disease is particularly high in underprivileged groups. Pakistan, a developing nation, is excessively burdened by oral diseases, particularly dental caries and periodontal disease. The oral health status of adult Pakistanis is poorly documented.

The general aim of this thesis was to survey oral health and oral treatment needs among an adult population from a deprived area in Karachi, acquiring baseline data for future treatment strategies and research. The specific aims of the thesis were to describe perceived oral health and perceived treatment needs among adult Pakistanis; to survey oral health with special reference to habits, knowledge and attitudes; to investigate the influence of betel quid (pan) and betel nut (chalia) chewing on oral health; to relate objectively assessed dental treatment needs to perceived treatment needs; to relate objectively determined oral health status to risk factors such as betel nut habits; and finally, to determine whether - in this population with relatively poor oral health and poor oral hygiene - diabetes is associated with any specific oral problems.

Study I disclosed that over half the population in this sample of underprivileged adults perceived oral health problems, predominantly esthetics, followed by pain and dental caries. Study II demonstrated that in this typical population of a deprived urban area, betel nut habits and frequency of oral hygiene had a strong influence on perceived oral health, while cleaning method and sugar intake did not. Study III showed that this population had poor oral health with a high prevalence of plaque, calculus and bleeding on probing. Moreover, they did not perceive oral health to be a major concern. A further finding was that while there was little need for major restorative work, the oral health of the community would benefit considerably from preventive measures such as scaling, minor restorative treatment and improvement in oral hygiene habits. In Study IV, diabetes was found to have a strongly negative influence on the oral health of this population with poor oral hygiene: compared to non-diabetics, those diagnosed with diabetes had fewer remaining teeth, more plaque and a higher prevalence of moderate to severe periodontal disease.

In conclusion, the results of the studies on which this thesis is based show that among urban adult Pakistanis, oral health is not perceived as a major concern and has low priority. No association was found between poor oral health and educational levels or socio-economic status. In general, major restorative treatment is not required: the primary unmet treatment need is for minor restorative work or preventive measures such as scaling. Improving oral hygiene habits and dental health education could achieve major improvements in oral health. In this population with poor oral hygiene, diabetics have more missing teeth and a higher prevalence of peridontitis.

List of scientific papers

I. Tanwir F, Altamash M, Gustafsson A (2006). "Perception of oral health among adults in Karachi." Oral Health Prev Dent 4(2): 83-9.
https://pubmed.ncbi.nlm.nih.gov/16813136

II. Tanwir F, Altamash M, Gustafsson A (2008). "Influence of betel nut chewing, dental care habits and attitudes on perceived oral health among adult Pakistanis." Oral Health and Preventive Dentistry 6: 89-94.
https://pubmed.ncbi.nlm.nih.gov/18637386

III. Tanwir F, Altamash M, Gustafsson A (2008). "Periodontal and cariological status of adults of Karachi, Pakistan." [Submitted]

IV. Tanwir F, Altamash M, Gustafsson A (2008). "Effect of diabetes on periodontal status of a population with poor oral hygiene." Acta Odontological Scandinavia. [Accepted]
https://doi.org/10.1080/00016350802208406