1. R. Venkitachalam, Amrita School of Dentistry
Common risk factors between Oral Diseases
&
Non Communicable diseases in Kerala
Chandrashekar J MS DNB PhD
Farheen Taha MDS
Joe Joseph MDS
AMRITA SCHOOL OF DENTISTRY
Amrita Vishwa Vidyapeetham

2. Point Prevalence studies
Introduction
Point Prevalence studies
Low evidence value
Sheiham A, Watt RG. The Common Risk Factor Approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000;28(6):399–406.
Varenne B. Integrating Oral Health with Non-Communicable Diseases as an Essential Component of General Health: WHO’s Strategic Orientation for the African Region. J Dent Educ May;79(5 Suppl):S32–7.

3. Introduction
"that renal, oral and eye diseases pose a major health burden for many countries and that these diseases share common risk factors and can benefit from common responses to non-communicable diseases”.
common risk factor approach

4. Conceptual model CRFA of Sheiham & Watt

5. R. Venkitachalam, Amrita School of Dentistry
Objective
Is there evidence in these statements??
Can there be presence of such commonalities between the NCDs and Oral Disease?
This is required by the policy makers for integrating Oral health into the NCD promotion programs
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ Sep;83(9):661–9.

6. Methodology Where: Two tertiary level hospitals Cochin
How: Cross-sectional design
Whom :
Recently Diagnosed NCDs Patients --DM, HT MI COPD Stroke
What:
the risk factors of their NCDs
Oral Diseases and its factors in same patients

7. R. Venkitachalam, Amrita School of Dentistry
Data collection
Interview with Physician
Oral diseases and its risk factors
MRD Records
Healthcare facility survey of a representative sample of public sector institutes offering oral care.
Survey of a sub-sample of pharmacies in the state
Key Informant Interviews (KII) with dentists employed in these centers and office bearers of professional associations related to oral care in Kerala for obtaining secondary data.
By means of Right To Information Act (RTI) from the central and state governments
Patient interview
Degree of agreement of the common risk factors with the oral diseases and the NCDs, using Cohen’s kappa

8. R. Venkitachalam, Amrita School of Dentistry
Results
Variables
Diabetes mellitus type II
Stroke MI
Hyper-tension
COPD
Asthma
Mean
age
60 (± 9.1) years
57 (±13) years
62 (±9) years
63 (±11) years
60 (±13) years
45 (±19.7) years
Gender
Male
51.4 60 80 74 43
Females
48.6 40 20 26 57
Marital status
Married
88.6
75.7
94.3
74.3 77 49
Single
11.4
24.3
5.7
25.7 23 51
Location
Rural 78
81.4
45.7 54
Urban 32
18.8
54.3 46

9. Common risk factors --Diabetes Mellitus and oral diseases
Results
Common risk factors --Diabetes Mellitus and oral diseases
COMMON RISK FACTORS
DMDC
DMPD
DMOD n %
kappa
Kappa
Obesity 12
17.1
0.02 11
15.7 16
22.9
0.03
Family history 33
47.1
0.14 26
37.1 42
60.0
History of smoking 10
14.3
0.15 15
21.4 17
24.3
Abnormal cholesterol levels
0.07 06
8.6
0.08
0.04
High blood pressure
0.05 09
12.9
0.00 14
20.0
DMDC= Diabetes Mellitus & Dental caries
DMPD= Diabetes Mellitus & Periodontal disease
DMOD= Diabetes Mellitus & Oral Disease

10. Common risk factors -Hypertension and oral diseases
Results
Common risk factors -Hypertension and oral diseases
COMMON RISK FACTORS
HTDC
HTPD
HTOD n %
kappa
Kappa
Genetics/positive family history 16
45.7
0.12 14
40.0
0.24 21 60
0.05
History of diabetes 10
28.6
0.00 06
17.1
0.11 12
34.3
History of smoking 07
20.0 05
14.3
0.01 08
22.9
Excessive alcohol intake 03
8.6
0.13 02
5.7
History of obesity
0.09
007
HTDC= Hypertension & Dental caries
HTPD= Hypertension & Periodontal disease
HTOD= Hypertension & Oral Disease

11. Common risk factors –All NCDs and oral diseases
Results
Common risk factors –All NCDs and oral diseases

12. DISCUSSION
Southerland JH, Taylor GW, Offenbacher S. Diabetes and Periodontal Infection: Making the Connection. Clin Diabetes Oct 1;23(4):171–8.
Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High Prevalence of Diabetes and Cardiovascular Risk Factors Associated With Urbanization in India. Diabetes Care May 1;31(5):893–8
López NJ, Valenzuela CY, Jara L. Interleukin-1 gene cluster polymorphisms associated with periodontal disease in type 2 diabetes. J Periodontol Oct;80(10):1590–8.

13. Rajeev Gupta, Soneil Guptha, Vijay P Gupta, Hari Prakash
Rajeev Gupta, Soneil Guptha, Vijay P Gupta, Hari Prakash. Prevalence and determinants of hypertension in the urban population of Jaipur in western India. J Hypertens. 1995;13(10).
Shearer DM, Thomson WM, Caspi A, Moffitt TE, Broadbent JM, Poulton R. Intergenerational continuity in periodontal health: findings from the Dunedin Family History Study. J Clin Periodontol Apr;38(4):301–9.
Lundberg V, Stegmayr B, Asplund K, Eliasson M, Huhtasaari F. Diabetes as a risk factor for myocardial infarction: population and gender perspectives. J Intern Med Jun;241(6):485– 92.

14. Common Risk Factor Approach (CRFA) model proposed by Sheiham and Watt and the model from the present study

15. CONCLUSION
There is common risk factors between the Oral disease and NCDs but association appears is weak
Biological plausibility of these association needs to explored
Clinically, both the dentists and physicians can work in tandem to help alleviate the risk factors.
Since, the present study was able to obtain an agreement with most risk factors being common to both NCDs and oral diseases, we were able to prove that NCDs shares certain risk factors with oral diseases. Hence, the following suggestions are put forth:
1. An integrated surveillance of the risk factors is proposed. The present day health promotion activities or preventive measures, aimed at isolated diseases will not bear any fruits! A more horizontal approach encompassing all the NCDs and oral diseases by integrating NCDs with oral diseases could avail positive results.
2. Oral disease prevention programs can be combined with the NCD prevention programs.
3. Clinically, both the dentists and physicians can work in tandem to help alleviate the risk factors. Dentists can assess the presence of the common risk factors, counsel the patient and refer to the concerned physician.
4. Government policies can promote a collaborative and collective approach by the dentists and physicians.

16. R. Venkitachalam, Amrita School of Dentistry
Acknowledgements
Late Aubrey Sheiham
Professor Dental Public Health
University College of London

17. R. Venkitachalam, Amrita School of Dentistry
Thank you