Oral hygiene, once considered an afterthought when speaking of general health upkeep, is now emerging as a major health and wellbeing indicator, particularly in India. A recent study by scientists from the All India Institute of Medical Sciences (AIIMS), published in The Lancet Regional Health, shows that poor oral hygiene is increasingly proving to be a probable cause of cancer later in life. In fact, up to 79% of patients presenting with oral cancer in India also had poor oral hygiene at the time of diagnosis, according to Dr Rishi Khosa, consultant, oral and maxillofacial surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai.Dr Abhishek Shankar and Dr Vaibhav Sahni, the oncologists leading the Lancet study, say that oral health is particularly pertinent in cancer therapy as well. A systematic review reveals that radiotherapy to the head and neck region significantly alters the oral microbiome, typically reducing beneficial bacteria, while increasing potentially harmful species, leading to post radiotherapy complications.
A global crisis
Poor oral hygiene can not only be the cause of head and neck cancers – but the oral bacteria present in the mouth may also be linked to cancers of the digestive tract, prostate, breast, pancreas, oropharynx, uterus, and lungs.Another study in the journal, The Lancet Regional Health for South-East Asia, shows that oral health does not pose a public health concern in India alone, but in and around most of southeast Asia as well. Oral cancer is the second most common cancer in Bangladesh and Papua New Guinea.The last Global Oral Health Report of 2022, published by the World Health Organization, reveals that India faces some of the highest oral health burdens in the world. This includes tooth decay, severe gum disease, decaying deciduous teeth, total tooth loss and lip and oral cavity cancers. India makes up nearly 23.4% of the global case load of lip and oral cavity cancers, with 3.27 people in India diagnosed.
The report also reveals that 18.9% of the global burden of tooth decay of milk teeth is borne by India, and 9.9% of total tooth loss or edentulism.Dr Khosa informs that a large-scale Indian study showed that individuals with poor oral hygiene had nearly a sevenfold increased risk of developing oral cancer. “This risk is significantly amplified when combined with habits such as smoking or chewing tobacco,” he says.According to experts, oral cancer has long been a public health concern in India. “However, it is now approaching crisis proportions due to the combination of high prevalence, late-stage detection, and continued exposure to risk factors,” says Dr Khosa. “The crisis is also deepened by rapid urbanisation, population growth, lack of awareness, and easy availability of harmful oral products,” he adds.Dr Ankit Jain, senior consultant, medical oncology, at Indraprastha Apollo Hospital, New Delhi, agrees that while oral hygiene is not an unheard of phenomenon, its relevance now is on the rise due its recognition as a contributing or causal factor for different cancers.
At-risk populations
Dr Khosa shares a few telltale signs that one is not maintaining their oral hygiene, starting with chronic inflammation due to gum disease; physical trauma inside the mouth or gums due to poor cleaning methods or ill-fitted dental appliances; weakened mucosal barriers also allow carcinogenic substances or bacteria to enter the miniscule wounds in the mouth. Dr Khosa says that oral health differences are stark in India. “Rural populations often have less access to dental care, lower health literacy, and greater reliance on traditional cleaning practices,” he says. “Lower socio-economic groups face cost barriers and may use cheaper but harmful oral hygiene products.”He adds that education levels are also very pertinent to the way people maintain their oral hygiene.
He says the challenges are often different for different demographics — for rural populations, especially for older women, they do not have access to adequate dental care or hygiene products. In urban areas though, the urban poor suffer due to increased exposure to tobacco products and poor living conditions.According to Dr Jain, “In rural and lower-income communities, lack of access to dental care, poor awareness, and prioritisation of health expenses result in neglected oral health.” He adds, “That said, even in urban and higher-income groups, poor dietary habits, high sugar consumption, and irregular dental visits contribute to oral issues.”Dr Jain says that many can also be genetically disposed to develop oral health issues like early-onset periodontal disease, weak enamel, or autoimmune disorders affecting the oral mucosa.
Call for action
“The average five-year survival rate is 37%, but can be as low as 21% in rural areas,” says Dr Khosa. He adds that while early stage detection offers up to 80%-90% survival rate, over 60% of patients present at a much more advanced stage with oral cancer. “Treatment often involves surgery, radiation, and chemotherapy, which are not only invasive but also disfiguring and emotionally taxing,” he says.“We frequently see patients with long-standing poor oral health presenting with pre-malignant lesions or early symptoms that could have been mitigated with better hygiene,” says Dr Amkit Jain.
“This concern is compounded by the lack of regular dental checkups and awareness about oral health in large sections of the population,” he says.Dr Jain echoes the same from his experience, saying that while early detections tend to have a decent survival rate with radiotherapy and surgery. However, “advanced cancers typically require multimodal treatment surgery, chemotherapy, and radiotherapy which can impact speech, swallowing, and appearance. Recovery is possible, but it requires intensive rehabilitation, long-term follow-up, and lifestyle modifications,” he adds.“Public awareness, screening programmes, and integration of dental care into primary healthcare systems are crucial to improving outcomes,” opines Dr Khosa. He adds, “Poor oral hygiene is a serious, yet modifiable, risk factor for head and neck cancers in India. With simple interventions like education, routine oral care, cessation of harmful habits, and access to early screening we can prevent thousands of cancer cases and improve outcomes for those already affected.”
BOXTake Proper Care:
- Brush your teeth twice daily with soft-bristled brush & fluoride toothpaste
- Eat diet rich in antioxidants, fruits and vegetables
- Go for regular dental check-ups, ideally every 6 to 12 months
- Avoid tobacco in all forms
- Get HPV vaccination, particularly if you’re a young adult, to reduce risk of oropharyngeal cancers
- Limit consumption of high-proof spirits, and alcohol
- Floss regularly and rinse with antiseptic/fluoride mouthwash
