Overview

Overview

The Indian Dental Research Foundation aims to support the dental profession in meeting the oral healthcare needs of our nation. There is a diverse challenge of magnanimous oral health problems coupled with increasing gap between the health needs and available healthcare services. This can only be dealt with advanced disciplined research.

We want to encourage young dentists, other professionals and doctors to take up the challenge of improving oral health of the nation while enhancing their research capabilities. IDRF’s strategic plan includes identifying and prioritizing new opportunities in research and adopting timely changes to cater to the people we serve. This strategic plan addresses healthcare research in its entirety with a focus on quality, new cutting-edge research work through identification of appropriate research channels for information dissemination.This platform can aid in stretching your innovation beyond confinement.

IDRF believes in your innovative thoughts and relevant ones gets materialized into powerful tools for the welfare of the community.

Amongst the multitude of challenges faced in oral health in India, one of the leading threats to the health of the citizens is Oral Cancers. Below is postulated strategy for tackling oral cancers in India:

  • Research advancement in clinical and population-based studies. Identifying new preventive and diagnostic techniques, study of progression of disease and treatment approaches for oral, dental and craniofacial diseases and disorders.
  • Research based on recent sciences that include genomics, proteomics, bio informatics including studies on molecular, cell biology fields, immune mechanism and regulations, and others. These areas of research would help provide an insight into the progression and causative mechanism of oral diseases.
  • Strengthening the research base through coordination with various streams of science, and achieving the target of optimal oral health through the merger of these sciences.
  • Overcoming research communication barrier, by identifying them and finding new ways to bridge them.
  • Recognizing the need to direct our efforts in areas that offer extraordinary scientific promise.

Oral health in India has still not received the kind of focus and attention that it deserves to get in view of the fact that it is very closely related to general health and well-being.The importance and significance of good oral health in combination with general health requires complete exploration and understanding in the society.

The IDRF is here to encourage you in your endeavours to find answers. We will not only assist dental professionals in their biomedical and public health research studies and clinical trials, but also ensure efficient transfer of knowledge from research to practice. Any research work is incomplete without publication and implementation of key results and discoveries. IDRF will thus help in communication of the research work to the masses, other allied professionals and media for its further development.

We shall provide the dental profession with the required support and lead the way as we progress in this constantly changing world of dentistry.Together we shall ensure that dental professionals are ready to face the challenges in future.

The evolution of a new way to look at oral diseases, through the perspective of prevention may make it possible to have a drill free dentistry in the coming future. Understanding the complex oral environment and its relation to food habits and lifestyle may throw light on many untouched aspects of oral disease process.

Sciences like genomics and proteomics could be applied to modify the progression and reversal of oral diseases. Cellular diseases like cancer, in particular oral cancer and other genetic disorders are targeted with these revolutionary sciences.

Through the above approaches it is certainly not difficult to imagine a day where people would be less sufferable if not free from the debilities, disabilities and mortalities caused by oral health diseases and conditions.

The Indian Dental Research Foundation holds a unique position with respect to oral and dental exploration. The IDRF draws its strength through the strong and prestigious platform of IDA which has a participation of enormous number of dental professionals all over the country.

Using this distinctive position held by IDA, an approach to channelize the scientific resources and the professional pool that IDRF has into other disciplines can unfold many possibilities.

It is through this coordination of sciences that IDRF looks to benefit from its investments, investigations and innovation.

The creation of multidisciplinary teams demands that we recruit new scientific disciplines to the field. Expanding the opportunities for training and career development requires that we work in amalgamation with our fellow medical graduates, public health professionals and engineering schools keeping our foundation in sync with dental, medical and other professional organizations.

Enhancing our partnerships with both public and private sector organizations is equally important to realize our goal of promoting the timely transfer of knowledge and its implications for health to every audience, in every aspect of the society.

Through the IDRF platform, the first dedicated platform for dental and craniofacial research in India makes us the pioneer in the field. It is through this futuristic idea that IDRF would begin its collaborations and contributions that will be one of its kind.

The sustenance of the endeavour will give us uniqueness in our leadership.

Also, the fact that IDRF is a union of all the researches, investigations and explorations that are carried out in institutions and communities in India can help achieve ground breaking success in research and development of India.

Leadership, leadership role sustenance and the integration of all the researches is the winning edge for IDRF.

Challenges

Oral diseases affect the most basic human needs: The ability to eat and drink, swallow, maintain proper nutrition, smile and communicate. Oral health and overall health and well-being are inextricably connected. Many systemic conditions such as human immunodeficiency virus HIV/AIDS, diabetes, Sjogren’s syndrome and osteoporosis have important oral symptoms, manifestations or complications which need to be addressed by IDRF.

The lips, tongue, gingiva (gums), oral mucosa and salivary glands all signal clinical disease elsewhere in the body. Long considered to be localized infections only, periodontal or gum diseases are now being investigated as potential risk factors for the development of systemic disease. For instance, accumulating evidence now points to a possible link between periodontal diseases and the incidence of premature, low-birth weight babies, cardiovascular disease and pulmonary disease.

Indians are largely affected by dental caries/ tooth decay, periodontal disease, malocclusion, oro-facial anomalies, dental fluorosis, loss of teeth, temporo-mandibular joint disorders, oro-facial trauma and oral cancer.

According to Ministry of Health and Family Welfare, dental caries accounts to approximately 60% and periodontal disease about 85% of the Indian population.

According to the drafted National Oral Health Policy 2021, the prevalence and recurrence of oral diseases in India is a silent epidemic. There is little to no improvement in oral health status of Indian population in the past three decades.

Oral disorders have remained the most prevalent problem in India affecting almost 66.7 crore population in 2017. Different oral conditions such as untreated caries of permanent teeth, untreated caries of deciduous teeth and severe periodontitis have a significant burden affecting approximately43.2 crores (32%), 11.2 crores (8.3%) and 18.1 crores (13.3%) people in India.

Despite the scale of the problem, only 12.4% of adults have ever got their oral cavity examined by a dentist. If we focus on the prevalence of dental caries, we can find that among the 12-year- old’s, it ranged between 23.0 % to 71.5 % whereas in adults aged 35-45 years, it was between 48.1% to 86.4%.

However, amongst the elderly between the age group of 65-74 years had dental caries in the range of 51.6 % to 95.1 %. If this percentage is extrapolated to below six years, then the children with untreated dental caries are approximately 10 crores.

The oral diseases affect not only the health of the oral cavity and associated craniofacial structures but can be detrimental to the overall health and well-being of individuals.

The foundation focuses on oral diseases, disorders, birth defects and conditions that are uniquely involved within IDRF’s mission to improve the oral health of the nation.

  • Dental caries is a multifactorial disease, caused due to the interplay of three basic factors, Saliva, diet (carbohydrates) and microorganisms. There are additional factors that contribute in the caries production and progression. The disease can be prevented, in the context of higher time and cost factor involved in the treatment, the obvious choice would be to prevent rather than cure. Dental caries and its consequences have an effect on not only the oral health but affects the overall well-being of the individual.
  • Significant increase in the incidence of dental caries has been witnessed in India, striking from a small number of 35% in 1947 to almost above 60% in 2019. This reflects the urgency to act over the rising crisis of the situation.
  • Tooth decay, the end result of a bacterial infection, remains the single most common chronic disease of childhood in the India.In children, occlusal caries is most common whereas recurrent caries and root caries are frequently seen in adults and elderly.
  • The subset of the general population most prone to caries are: lower socioeconomic group, youngchildren, elderly population and the immunocompromised group with medical conditions or disabilities.
  • There is a need to identify the most effective health education for the prevention of caries, particularly among under-served populations.
  • About 80 percent of children between 5-17 years of age have dental caries in permanent teeth. Dental caries begins early in life: 70 percent of pre-school kids in India have already experienced tooth decay and by age of 6. By the age of 17, more than 60 percent of the adolescent population are affected by caries.
  • There exists a great need to develop effective health education structure for increasing focus on prevention of caries. Simultaneously, preventive measures like water fluoridation and early detection of caries can prove to be cost effective and yield better benefits in reducing the burden of disease.

The Challenges :

  • With the rise in the dental caries, there is a significant impact on individual’s physical as well as their social and financial health.
  • The cost factor related to the treatment of dental caries pushes people to confide to cheaper means for dental treatment which is extraction, leading to tooth loss and furthermore with associated problems.
  • The inadequate availability of necessary dental care in most parts of India does nothing more but complicates the problem.
  • Similarly, there is no adequate infrastructure to support the dental health awareness, activity, and importantly to sustain these activities.

Distribution of the Disease:

There is a diverse distribution of caries that be noted among different groups:

  • Children: Childhood caries or rampant caries are the most common form of dental caries in children.This dental caries originates in the deciduous teeth and then extends their impact to the permanent teeth. The difficulty associated with this type of caries is its rampant nature of disease affecting multiple teeth simultaneously.This further causes difficulties in treatment of multiple teeth for parents, dentists and children.
  • Elderly: Root caries are common among elderly population and often occurs due to the gingival recession (exposure of the tooth root to the oral environment)or dietary and oral hygiene habits.
  • Geographical distribution: There is variation in dental problems according to the geographical areas due to Fluoride (Mineral in the water useful in prevention of dental caries), different food habits and lifestyle variations.
  • Economic Status: Poor socioeconomic class suffers greatly in terms of poor oral health as compared to the affluent. Education plays a key role in oral hygiene status of the people. Limited financial resources can pose a problem for people to gain access to the basic oral hygiene products. This is further complicated with the lack of awareness and limited resources causing differences in dental care of citizens.

Meeting the Challenges:

  • Prevention is the mainstay for dental caries in our country- In the preventive programmes the first need is to educate the masses about the importance of oral health and spot dental problems in its incipient stages before it progressed to require invasive treatment. Progression of dental problems leads to additional costs, time and resources for the patients.
  • Creation of continuous resources- This would not only involve the dental caries treatment but resources to continuously reach to the people with the importance of oral health. Making available simple oral health products like the toothpastes and toothbrushes are also important. Therefore, education is provided the supportive availability of products.
  • Education and Resources go hand in hand- Unless education is not given in an easy and understandable way, it is not possible that the people would access the resources and if the resources are unavailable education would go in vain.

Research has a major role to play in Dental Caries in the areas

  • Diagnosis
  • Prevention
  • Treatment

These areas are the major avenues of research oriented to control caries. Aimed to make the above three simplified; prompt, accurate and cost-effective approaches could be significant in making the facilities available.

Research could also be oriented towards getting a greater and better access to basic services that would help the masses and policy makers in combating dental caries.

Research also has a great role to play in the areas to not only determine the extent of diseases but also find out the varied effects that it has on the individual and the population at large. The primary data collection thus becomes crucial for additional research possibilities.

The above three form major research avenues directed towards caries control. By aiming to make the three areas simple, accessible and affordable; we can extend the reach of basic dental services to the masses

Research also plays a pivotal role, in not only determining the extent of disease but also find out the varied effects that it has on the individual and the population at large. The primary data can thus facilitate several additional research possibilities.

Periodontal diseases are a result of infections caused by bacteria in the plaque. It may be in mild forms such as gingivitis to severe disease that destroy the periodontal ligament and surrounding bone, in some cases leading to the loss of teeth.

Tobacco use is a major risk factor for the development and progression of periodontal diseases.

The major risk factors for the development and progression of periodontal diseases include smoking, diabetes, debilitating illnesses, certain medications etc.

The oral cavity is full of different kinds of bacteria which form a layer of plaque on teeth. This plaque needs to be removed daily by brushing and flossing teeth. If not efficiently removed it hardens to form ‘calculus’ which can only be removed by a dental professional. The bacteria cause inflammation of the gums that is called "gingivitis." In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

When gingivitis is not treated, it can advance to "periodontitis". In periodontitis, the gums pull away from the teeth and form spaces (called "pockets") that become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum.

The Disease

India being the second most populous country in the world with a population of over 1.39 billion, the prevalence of a plaque periodontal disease is high, which ranges in different population groups, although differing in severity between different age groups.

Statistics present the grim reality that 95% of the population in India suffers from periodontal disease. Periodontitis represents a range of clinical manifestations from mild sub clinical inflammation to advanced destructive forms, leading to tooth loss.

A disease of the supporting tooth supporting structure is a major cause of tooth loss in India. A plaque disorder, periodontal diseases develop basically due to poor oral hygiene. The toll of periodontal diseases is relatively high accounting of 95% of the population being affected by it.

The Challenges:

  • Unawareness similar to dental caries is also a major concern with periodontal diseases. But what makes periodontal diseases different from the dental caries is that the disease is very insidious in nature and symptoms like inflamed gums, calculus and stains on the teeth, do not alert the patient much as against the caries that do cause excruciating dental pain in the later stages.
  • Treatment of Periodontal diseases is relatively quite simple in the initial stages comprising of scaling and meticulous oral hygiene. But in advanced cases involving bone loss the treatment is highly expensive, needs expertise and many a time not completely successful, there may also be cases where a total treatment may be impossible.
  • Complexity of the Nature of disease due to it’s relation to diet, drugs, systemic diseases like diabetes and other factors like the age, create a greater concern towards many other relative factors of the disease. These additional factors have an impact on the occurrence, prevention and treatment of the disease.

Prevention can become a challenge in two ways:

Firstly due to the insidious nature of the disease and its slow progression it can offer a huge challenge in getting the message across to the patients.

Secondly, data collection for periodontal diseases is rather tedious and confusing. There are a multiple indices that can be used for evaluation of periodontal diseases, each with their advantages and disadvantages.

Wide distribution of the disease not only in the geographical distribution but also in the distribution in Sex, Age, economical status and other variations can create a rather diverse population distribution of the disease. The special criteria group would constitute:

Women: The hormonal changes that occur during their lifetime i.e. during puberty, menses, pregnancy and menopause; can significantly affect the periodontal health.

Elderly: In addition to the age related periodontal problems, the periodontal status may suffer due to the systemic diseases like Diabetes, Hypertension, etc. Malnutrition, Poor Oral Hygiene, lack of adequate dental care may further add to the problem.

Economical Status: Due to the lack of adequate finances, there may be not only the scarcity of oral care, but a paucity of basic oral hygiene may be quite prevalent amongst the poor sections of the society. What complicates the situation is the lack awareness in this section of the society, making prevention a challenge and crucial.

Meeting the Challenges:

  • Prevention is the mainstay and the first step that needs to be taken in order to deal with periodontal diseases, especially in a developing country like India. In prevention what needs to be emphasized is education of the masses because unless the masses are not educated it is not possible to get them for practicing preventive measures and approach for the treatment.
  • Making available the treatment and resources on a continuous basis that can support the provided education should be made available. Creating an infrastructure that can help the people access simple oral hygiene product like the tooth paste and the tooth brush, etc.

Research also has a great role to play in the areas to not only determine the extent of diseases but also find out the varied effects that it has on the individual and the population at large. The primary data can thus give way to many additional research possibilities.

  • Prevention with respect to periodontal diseases has a significant role. Under the title of prevention, various aspects like educating the people in the most effective way and on a sustained basis and provision of resources for prevention like the ready availability of cheap and effective oral hygiene products can be included.
  • Diagnosis related research can enable general dentists and other health professionals to diagnose the early stage periodontal disease and help them to determine suitable treatment. Development of guidelines for community projects, developing indices that would help the community oral health workers to gather significant data and also educate the people. These instances are just a few, example related to diagnosis related research.
  • Treatment effective for periodontal diseases and increase the tooth longevity, especially in case late stage disease, can be a challenge. The assurance of tooth longevity and good results, especially while considering complicated disease states like in case of Periodontitis in diabetics would be still more challenging.

The Disease

Oral cancer is the most common cancer in India amongst men (11.28% of all cancers), the fifth most frequently occurring cancer amongst women (4.3% of all cancers). The projected burden of cancers among males by the year 2020 in India shows the number of cases will be lung (102,300), mouth (99,495), prostate (61,222), tongue (60,669) and larynx (36,079). Cumulatively, this makes mouth cancer the leading cancer site for men in most of India.

Here are a few chilling facts of Oral Cancer scenario:

  • India leads the world with its high rate of oral cancer. Oral cancer has the highest mortality rate among the Indian “cancer death” population, and ranks as one of the leading public health problems.
  • Worldwide, tobacco kills one human being every six seconds.That works out to 560 people every hour, 13,440 people per day and 49 lakh people per annum.
  • Tobacco kills 15 times as many people as suicides, murder or manslaughter.

These statistics very well show the urgency and the need of oral cancer prevention and treatment in India.

With the mention of oral cancer, the greatest cause of oral cancer Tobacco cannot be afforded to miss.

Tobacco Facts:

  • Tobacco contains an alkaloid, nicotine, its main addictive agent, which results in physical and psychological dependence.
  • Nicotine is a deadly poison in high doses. One drop (70 mg) can kill an average adult.
  • Apart from nicotine, tobacco contains 230 toxic chemicals that play a role in the onset of cancer.

Forms of Tobacco

Tobacco can be classified into smoking and smokeless tobacco.

Nearly 3000 chemical constituents have been identified in smokeless tobacco while close to 4000 are present in tobacco smoke most of them being harmful.

Smoking

In India, tobacco is smoked in various forms like cigarettes, bidis, cheroots, chuttas, dhumtis, chillums, hookahs, etc.

Cigarettes

  • 1 billion cigarettes are smoked every day in India.
  • Cigarettes in the Indian market have higher levels of tar & nicotine content than those found in developed countries.
  • Every cigarette takes 7 minutes of your life.

Tobacco smoke contains over 4000 chemicals

Smokeless Tobacco

Smokeless tobacco is consumed in the following ways:

  • Chewed: gutkha, pan, mawa, mainpuri tobacco, khaini, click, etc
  • Applied on gums, and teeth: mishri, gudhaku, bajjar, tooth paste
  • Inhaled: snuff
  • Smokeless tobacco is not a safe alternative to smoking. Smokeless does not mean harmless.
  • Chewing tobacco is far greater health hazard than filtered cigarettes as the concentration of tobacco is significantly higher.
  • According to a survey, the use of smokeless tobacco (compared to smoking) is higher among females and teenagers.
  • Studies have shown that pan masala causes a condition called Oral Submucous Fibrosis (OSMF) that makes it 400 times more likely for a person to develop cancer than normal people. This is true even if the pan masala does not contain tobacco.
  • Use of smokeless tobacco is most prevalent in people between the ages of 20 and 44.
  • Smokeless tobacco users find it harder to quit and to withstand withdrawal than those who smoke.
  • School personnel believe that tobacco companies deliberately encourage youth to use smokeless tobacco.
  • Smokeless tobacco manufacturers target adolescents with “low nicotine” products with the intent of graduating them to high nicotine products over time.
  • Smokeless tobacco users are more likely to smoke cigarettes in future

Gutkha

  • Gutkha is available in more than 100 brands.
  • Gutkha has become an Rs 3,000-4,000 crore turnover industry since the eighties.
  • It is growing at a staggering rate of 25% annually.
  • Gutkha leads to Oral sub-mucous fibrosis (SMF), a pre-cancerous disease that is a first step to cancer. This has increased 20 to 30 times across the country. SMF has been linked to the chewing of areca nut (supari), one of the main components of gutkha along with tobacco.
  • The health effects of gutkha show up in shorter periods than those from other forms of tobacco.
  • This could be due to a combination of factors – higher intake, younger age during first intake and contents of the product itself.
  • The predicted epidemic of oral cancer almost completely attributable to gutkha, has already begun. It is especially affecting the young.

Passive smoking

  • 2/3rd of smoke from a burning cigarette does not reach the smoker's lung but instead goes directly into the air. The effects of this smoke are similar to smoke inhaled by active smokers. Inhaling of air containing tobacco smoke is called passive smoking.
  • An increased risk of lung cancer has been shown in wives of husbands who smoke.
  • The risks of passive smoking do not stop with cancer. There is an increased incidence of heart disease in passive smokers. Children of parents who smoke have an increased incidence of cough, bronchitis, ear infection and pneumonia. Children exposed to their parents cigarette smoke have six times the number of respiratory infections.

Tobacco, the major cause of Oral Cancer, has now itself, developed into a Pandemic.

Especially in the Indian Terrain, not only is the number of tobacco use a challenge but also the multiple forms in which it is being used.

Also, the global strategies that are developed become difficult to apply due to the variety in the forms of tobacco use and the varied distribution pattern.

Meeting the Challenges:

The Tobacco Challenge:

Anti-Tobacco work is carried out in the country tirelessly by many Government and Non Government Organizations and there are many grey areas in tobacco management that has to be addressed.

These can be in the areas of tobacco policies, its intervention, public education, etc. In order to understand these areas, they are well defined in the MPOWER Tobacco Control Measures.

Manpower:

India has also been one of the fore runners in signing the Framework Convention Tobacco Control FCTC, on 10th September 2003. This served as a great stride made by India in Tobacco legislation.

The Six tobacco control measures MPOWER given by WHO can counter the tobacco epidemic:

Monitor tobacco use and prevention policies

Protect people from second hand smoking

Offer help to Quit Tobacco

Warn against the dangers of Tobacco

Enforce bans on tobacco advertising promotion and sponsorship

Raise taxes on Tobacco

The Oral Cancer Challenge:

Tobacco and Oral Cancer go hand in hand. Tobacco intervention is the preventive measure for oral cancer, which itself as seen above, is a huge challenge.

When we consider Oral Cancer, multiple number of facts come into picture and we need to consider them with utmost priority.

Role of Research in Oral Cancer and Tobacco and Oral Cancer:

The research role in these two areas is huge and to club them together and to summarise the scope is huge and beyond the scope of discussion.

But from the above discussion it is clear that the area available for research in these two areas is enormous.

To Summarise:

There is huge scope OF RESEARCH IN Tobacco and Oral Cancer, especially in India, where the toll of oral cancer ranks foremost in smoking, with the highest availability of tobacco products. These challenges are coupled, due to high levels of illiteracy and poverty.

The context in which the work is carried it out is thus complex, due to the diversity in the pattern of Tobacco and its use and oral cancer distribution, thus offering numerous challenges and huge scope for research.

The presence of 28 or more natural teeth has been used worldwide as an indicator of functional ability. Yet in the India 58 percent of people 50 years or older and over one-quarter of the population over 19 years of age do not have 28 or more natural teeth. Low- income individuals, and in particular low-income adults, are most likely to be totally edentulous.

The standard treatment for tooth loss involves prosthetic devices such as full or partial dentures. Although these devices initially restore some of the ability to chew, but as people age and due to lose underlying bone, the fit and aesthetics of dental prostheses are often compromised. Replacement of teeth with dental implants provides more natural and stable function than what dentures do. But not every patient is an ideal candidate for implants. While continuing efforts to prevent tooth loss, there is a need to evaluate the appropriate replacement of tooth function and to pursue evolving technologies that are enabling the development of biologic materials to repair and eventually regenerate teeth.

Vast improvements in tooth retention have taken place in India over the past three decades. Total tooth loss or total edentulous, once a relatively common condition among middle age adults is now most prevalent in older persons, affecting approximately one- third of adults 65 years and older. There is evidence that people with impaired dentitions due to missing teeth must choose foods that do not provide optimal nutrition; in the elderly, total edentulous and poor oral health can lead to significant weight loss that can affect overall health.

IDRF has to resolve oral and pharyngeal cancer, as it is one of the six most common cancers. Each year, an estimated 1,25, 000 patients die. The most disturbing aspect about oral and pharyngeal cancer is the survival rate; the 5-year survival rate is approximately 50 percent, a statistic that has not improved over the past twenty years. Despite the devastating consequences of oral cancer, which include impaired ability to chew, swallow and speak, and often disfigurement from extensive surgery to remove parts of the face and oral structures, only a few percent of adults report receiving oral cancer exams that can detect early disease. Reconstruction and management of the oral cancer survivor come at a high price both economically and socially.

More efforts needed to increase public and professional knowledge about oral cancer and its prevention, there also is a critical need to develop biomarkers and diagnostic tests that can be used to improve cancer diagnosis and more accurately predict the course of the disease. There also is a pressing need to develop more effective, individualized treatments that spare healthy tissues and improve quality of life.

Orofacial pain, by itself or as a symptom of an untreated oral problem, is often a major cause of poor quality of life. Toothaches alone are associated with significant morbidity and high economic cost. Sources of Orofacial pain include caries, periodontal diseases, and neuropathic and musculoskeletal conditions. Orofacial pain also is a major symptom of temporomandibular muscle and joint disorders (TMJD). Orofacial pain may also be caused by conditions involving the dental pulp (the innermost part of a tooth that contains blood vessels and nerves) and the area around the root, leading to symptoms that can range from sensitivity to thermal changes to severe pain and/or abscesses. Facial palsies are also a significant part of this pain group.

Today, pain researchers have shown that chronic pain can become a disease in itself, causing long-term detrimental changes in the nervous system. These changes may affect resistance to other diseases, as well as effectively destroy quality of life.

There is considerable need for research that integrates knowledge gained from cell biology, genetics, molecular biology, imaging technologies, neuroscience, behavioral sciences and epidemiology to better understand the mechanisms underlying the causes and progression of orofacial pain and dysfunction associated with TMJDs and other pain conditions.

IDRF aims to improve quality of life by finding a solution for orofacial pain, which is a symptom of an untreated oral problem

Saliva is a remarkable fluid essential for oral health. It guards against infections by favouring the accumulation of ‘beneficial’ bacteria and helping to eliminate other microorganisms, lubricates the soft tissues of the mouth, buffers acids produced by cariogenic bacteria, aids digestion, and facilitates speech and swallowing.

Salivary gland hypofunction or obstruction can result in xerostomia or dry mouth.

There are a variety of potential causes of xerostomia, including dehydration, medication use, chemotherapy and/or radiation therapy of the head and neck, autoimmune diseases, other chronic diseases, and nerve damage.Patients can be variably affected.

The most common disorder involving the salivary glands is Sjögren’s syndrome, an autoimmune condition. Whether salivary glands are irreparably damaged by disease or by radiation for head and neck cancer, the resulting loss of saliva flow markedly impairs quality of life. Without adequate saliva, people may experience difficulty speaking, chewing and swallowing. They may also experience rampant tooth decay, mucosal infections such as candidiasis, loss of taste, and considerable oral discomfort. Currently, there is no effective treatment for this condition

Dental Implications of Xerostomia:
  • The goals of treating xerostomia include identifying the possible causes, relieving discomfort, and preventing complications, e.g., dental caries and periodontal infections.
  • Infections (e.g., oral candidiasis) and enlargement of salivary glands from sialadenitis may also be present. Other oral manifestations evident on examination may include angular cheilitis, mucositis, traumatic oral lesions, and/or difficulty in wearing/retaining oral prosthesis.

Xerostomia is a significant health problem, particularly among the elderly, owing to the over-the- counter and prescription drugs, including tricyclic antidepressants, antihistamines and diuretics that have xerostomic side effects.

Craniofacial defects are among the most common of all birth defects. Birth defects and developmental disorders can be isolated or may be part of complex hereditary diseases or syndromes. Cleft lip and cleft palate are among the more common birth defects. Numerous other disorders with oral and craniofacial manifestations such as ectodermal dysplasias, Treacher Collins syndrome, Apert’s syndrome, and Waardenburg syndrome, while considerably more rare than cleft lip/cleft palate, also have serious lifetime functional, esthetic and social consequences.

These disorders are often devastating to parents and children alike. Surgery, dental care, psychological counseling and rehabilitation may help ameliorate the problems, but often at a great cost and over many years.

The foundation faces the challenge of resolving these birth defects that have serious lifetime repercussions.

Facing the Challenges

The mouth is a delicately balanced and complex part of our body. The fine arrangement and coordination between its muscles, glands, hard structures including the bone and the teeth with the protective covering mucosa, not forgetting the very important saliva offers a unique set of conditions and a unique array of diseases.

Also the population dynamics that the oral diseases offer are not only to the higher side in the country but also varied. The complex situation of oral diseases due to unawareness and limited oral health knowledge dissemination and restricted/limited awareness is the crux of the problem.

In addition, the limited oral health knowledge and awareness among the general public add to this problem.

We believe that the scope for development of oral health in our nation would be limitless if the science of information and communication technology, genetic engineering etc are explored simultaneously. The essence is to maneuver the combination of these sciences to obtain the optimal and the best suited outcomes, while attracting new talent in the field.

Attracting and building new professional capacities.

The multiplicity of challenges has been discussed earlier. It is this multiplicity and the expanse of the oral diseases and disorders that needs to be addressed by attracting new competencies. The research in the area of oral health can attract a huge assortment of talents from fields of statistics, public health and epidemiology.

What is needed?

  • Proper sensitization and training of these new talents is necessary.
  • To complete their knowledge and understanding of oral diseases from the perspective of their sciences needs a quality training resource, both human and technical.
  • A centralization of these sciences through the unification of technical training of these sciences and supporting specific oral health oriented para/extra oral health science can help in a big way.

The IDRF provides a unique platform for the merger of competencies through research based projects.

The continuous surge in oral diseases/disorders/conditions is one major cause underlying the fact that there is a lack/inadequacy of communication to people.

Identification of these barriers and overcoming them is the need of day.

In a multilingual country like India different languages add to the heritage of the Indian culture do offer a challenge from the point of view of centralized public information dissemination system and put them out of question. This kind of challenge needs to be addressed with strategy and meeting all the technological and behavioural sciences possibilities.

Health communication is a major player in reduction of burden of oral diseases.

Oral diseases affect the most basic human needs: the ability to eat and drink, swallow, maintain proper nutrition, smile, and communicate. Oral health and overall health and well-being are inextricably connected.

  • Many systemic conditions such as human immunodeficiency virus (HIV)/AIDS, diabetes, Sjögren’s syndrome, and osteoporosis have important oral symptoms, manifestations or complications. The lips, tongue, gingiva (gums), oral mucosa and salivary glands can all signal clinical disease elsewhere in the body.
  • Long considered to be localized infections only, periodontal or gum diseases are now being investigated as potential risk factors for the development of systemic disease. For instance, accumulating evidence now points to a possible link between periodontal diseases and the incidence of premature, low-birth weight babies, cardiovascular disease, and pulmonary disease.

Oral diseases affect not only the health of the oral cavity and associated craniofacial structures, but can be detrimental to the overall health and well-being of individuals.

We are focusing on oral diseases, disorders, birth defects and conditions that are uniquely within IDRF's mission to improve the oral health of the nation.

The substantial gains in the oral health of the nation over the past generation have not benefited all Indians equally. The burden of oral and dental disease, particularly untreated disease, falls heaviest on individuals from lower socioeconomic groups, which include disproportionately large numbers of racial and ethnic minorities.

Individuals in lower socioeconomic status groups also have higher incidences of HIV infection and Oral Cancer, diseases that increase the risk for serious oral, viral, bacterial and fungal infections.

Children in low-income families are particularly vulnerable to oral health problems. Their nutrition may be poor, their oral hygiene inadequate and their access to oral health care lacking. A partial remedy for addressing health disparities lies in improving access to effective and appropriate health promotion, preventive, diagnostic, and treatment services.

The research challenges to reducing health disparities include elucidating risk factors, identifying and eliminating barriers to health care, designing better means of care delivery, and designing educational strategies to reduce risk and enhance health promotion that are appropriate to the social and cultural frameworks of the groups in question.

Capacity Building

The IDRF holds a bedrock position with respect to oral and dental research drawing its strength with IDA.

The foundation realizes that adequately trained professionals are the lifeblood of dental education and practice. Oral health, educators and practitioners should reflect the diversity of India and have the broad mix of skills needed to address complex oral, dental and craniofacial diseases. However, it the foundation has come to the conclusion that the professional dental workforce does not adequately represent the composition of the Indian population.

The IDRF with its interdisciplinary strategies and coordination of sciences looks to benefit from its investments.

  • An investment of expertise and knowledge by sourcing and directing it in the right pockets of research and implementation, would largely contribute to the input and thus the output in public health activities.
  • Funds generated from the health sector directly and indirectly should be sourced and directed appropriately in order to attain better returns for future investment and create a reservoir of funds and adequate manpower in situations of health emergencies that may call for immediate action.
  • Initiative undertaken, both individually or on the organizational level should be fostered and channelised in the appropriate directions. New investigations and investigators should be encouraged and driven into the areas of systemic research so that their efforts can be added up in the main stream.

Also, in order to prevent duplication of research and utilization of existing vast existing knowledge, there is a need to create a research knowledge repository which will enhance the overall science of dentistry. In addition, creating trained workforce for oral health research and to fund, promote and strengthen health research capacity for development and implementation of cost-effective preventive strategies in oral health.

Requisite infra structural scaffolding

The task force developed to address the Indian population must reflect the prevalent diversity in it. For this, it is essential to distribute the infrastructure and resources in all regions so as to aptly meet the demands of the said population. To attain a good distribution of services amongst all, boosting the number of women being trained for oral health care should be undertaken.

However, the aspect of research is largely untouched, more so amongst the women. IDRF would extend its support to various under-served segments through researches aimed at finding new ways of service delivery. It will also provide necessary support to bolster research, instill scientific enquiry amongst the young dental students, so as to strengthen the research professional work force.

The Indian population diversity needs to be reflected in the task force developed to address this diversity. For incorporating this diversity in the task force it is essential to distribute the infrastructure and resources in the regions so as to aptly meet the demands of the said population. In order to serve the minimally or less served segments of population various ways to pick up people from the segment and adequately train them to serve their population is one of the effective ways.

To attain a good distribution of services amongst the two genders, boosting the number of women being trained for oral health care can be undertaken. However, the aspect of research is largely untouched, more so amongst the women.

IDRF would extend its support to various underserved segments through researches aimed at finding new ways of service delivery. It will also provide necessary support to bolster research instill scientific enquiry amongst the young dental students, so as to strengthen the research professional work force.

Strong research-oriented academic environments are needed to develop the intellectual talent for research, and to enable existing investigators to acquire and expand their skills in new areas of science.

Oral health research can be carried out in a number of settings including dental schools, different components of academic health centres, hospitals and independent research institutions.

The capacity of dental schools to conduct research and to serve as training grounds for future investigators is the key to the future of clinical and applied oral health research.

However, major barriers must be overcome. These include a critical shortage of faculty, a lack of integration between the basic and clinical sciences, inadequate incorporation of research into the dental curriculum, and financial shortfalls.

Efforts to encourage the research infrastructure so as to ensure a workforce that is adequate both in numbers and in its ability is needed to meet the demands of the changing oral health needs of the community.

Research communication platform

In order to put the research outcomes in the frame work of attaining better oral public health, effective research communication is crucial.

While some research communication can provide direct public benefit, others may have to be carried out through indirect mode. In the component of research communication, identification of target audience and devising the effective combination of communication modes are two major essentials that IDRF will support.

IDRF would also support and provide opportunities to explore new communication modes, combination of modes and studying the public behavioural outcomes to test efficacy of the modes.

The combination of sciences on the IDRF platform would act as a great asset to this arena of research and development.

The generation of new knowledge through research is an integral and highly-valued activity at the IDA. The Dr. APJ Abdul Kalam Centre for Dental Research engages in world class clinical dentistry and basic sciences research.

It encourages cutting-edge basic and transactional science, clinical/health services research and educational research that is used to transform clinical practice and dental education. Such research broadens the definition of dental medicine, building upon advances in the basic, oral health and social sciences, and in education.

There is access to national and international journals, indexed articles for reference and labs for research purpose. There is also a wide database of clinical procedures and patients to conduct clinical trials on as per regulations laid down by the regulatory body on dental research.

Strategic Initiatives

We at the Indian Dental Research Foundationrecognize that oral diseases and disorders affect health and well-being through life. Within the Indian population there are profound and consequential oral health disparities caused by lifestyle behaviours such as tobacco use, excessive alcohol intake, and poor dietary choices affecting oral as well general health.

IDRF provides a framework for action and suggests findings to improve quality of life and to eliminate oral health disparities. This involves changing perceptions regarding oral health so that it becomes an accepted and important component of the general health. Accelerate research and its application to effectively create an oral health that meets the oral health needs of all.

The following are the action goals of the IDRF: -

  • Application of new technology
  • Development of new approaches and perspectives
  • Development of cadre of professionals for research
  • Bridging of research communication barrier
  • Bridging health disparities
  • The problem of scattered and unmanaged data
Goal 1: To advance the knowledge and understanding of oral health and diseases through application of new technology in deciphering the underlying processes of health and diseases.

Application of new technology such as genetics, proteomics and other allied sciences like biochemistry, pharmacogenetics, etc to understand the physiological processes in disease and health to deepen and widen our understanding of oral diseases and disorders.

To achieve this, we shall partner with organization and institutes that have the facility of such advanced studies so that IDRF efforts can branch out in these fields.

Prior to all this there is an increasing need to understand these streams and identify their utility in oral health and pitch them in at the right time. This strategy needs good planning. IDRF would come into interaction with such agencies as and when required.

Goal 2: To develop new improved approaches and perspective of methods for preventing, diagnosing, treating and eventually eliminating oral, dental and craniofacial diseases and disorders.

The area of prevention is one of the most promising and upcoming perspective and approach in the elimination of diseases. Since prevention itself involves many objects, research in prevention can be multidimensional. By giving importance to the preventive research IDRF looks to explore this avenue.

There is also a huge scope to train the professionals in the formative years for adopting preventive treatments; IDRF with its research seeks to strengthen the prevention curriculum.

Goal 3: To ensure an adequate and well-trained workforce that reflects the current and emerging needs of science and includes sufficient numbers of dental professionals.

The dental students should be diverted to research-based studies in the formative year. IDRF, by supporting student-initiated researches in their training year and providing a platform to share their research projects, seeks to foster the enquiry in them.

Acknowledging and scrutinizing their research papers through the IDRF website and related publication the IDRF can play a very supportive role in this kind of capacity building.

A similar kind of backing can be provided to students belonging to streams other than oral health sciences so as to guide their inputs into the stream of oral health development for the country.

Goal 4: To enhance the translation of research outcomes into clinical practice and communicate science-based health information to ensure that IDRF - supported research leads to improved health along with effective utilization of mass communication.

This goal is meant to be two-fold. Firstly, information provision to the dental professionals and auxiliaries, for dissemination of information related to new preventive, diagnostic, therapeutic means. Secondly; information dissemination to the general masses, using the right kind of mass communication modalities.

Under this goal it can be identified that there is a need to conduct research and exploratory studies in this area also.

In a country like India, the two major communication barriers are: Illiteracy and diversity in cultures and languages. Overcoming this communication barrier also serves as good means and areas for research. Utilizing means like pictures and other means to communicate can overcome few of these communication barriers.

IDRF envisions collaborating with many such mass communication agencies in order to explore the newer means of communication and also work with them to conduct surveys to find out the efficacy of various means.

Goal 5: To overcome health disparities prevalent in the countrydue to differences in socio-cultural practices, beliefs, religious dogmas, etc. and also the important concern of concentrated oral health services.

To encourage and establish a greater representation of the less served people in the system of oral health care. Achieving this is possible through encouraging the training of the interested individuals form the population. IDRF looks after giving them greater academic and research opportunities so that they can serve as the torch bearers of the community.

Sustenance of such efforts, through capacity building, adopting effective prevention programmes, establishing data base and replenishing it on a continued basis; are few of the ways to sustain services started.

Goal 6: To ensure the adequacy of systems to document and monitor the extent and impact of oral, dental and craniofacial diseases, disorders and conditions.

The modern facilities in information technology and data management, offers us a wonderful opportunity to store immense amount of data in a form that also permits easy retrieval.

The website of IDRF is one such rich resource that allows data storage that can be looked for using various search specifics. The facility of online contribution offers an opportunity of ever-increasing data base.

In order to keep the system in sync with the rapid development it would be revived timely and renewed to meet the demands of the ever-expanding research areas.

The data that is collected in the IDRF resource can be used for various public benefits like, conducting advocacy efforts, evidence based therapeutic practices, information on rare diseases and disorders.

Data management for easy data retrieval via the IDRF’s website is needed for various public benefits like, conducting advocacy efforts, evidence based therapeutic practices, information on rare diseases and disorders.

In addition, the IDRF relies on input learned through a variety of conferences and workshops. These include collaborative, conferences and workshops that constitute reviews of emerging scientific opportunities, public health concerns or state-of-the-science assessments, many of which outline specific areas that should be the target of future initiatives or activities. Consensus development conferences also may be held.

Goal 1 : To advance the knowledge and understanding of oral health and diseases through the application of new technology in deciphering the underlying processes of health and disease.

Application of new technology such as genetics, proteonomics and other allied sciences like biochemistry, pharmacogenetics, etc to understand the physiological processes in disease and health to deepen and widen our understanding of oral diseases and disorders.

To achieve this we shall partner with organization and institutes that have the facility of such advanced studies so that IDRF efforts can branch out in these fields.

Prior to all this there is an increasing need to understand these streams and identify their utility in oral health and pitch them in at the right time. This strategy needs good planning. IDRF would come into interaction with such agencies as and when required.

Goal 2 : To develop of new improved approaches and perspective along with methods for preventing, diagnosing, treating and eventually eliminating oral, dental and craniofacial diseases and disorders.

The area of prevention is one of the most promising and upcoming perspective and approach in the elimination of diseases. Since prevention itself involves many objects, research in prevention can be multidimensional. By giving importance to the preventive research IDRF looks to explore this avenue.

There is also a huge scope to train the professionals in the formative years for adopting preventive treatments; IDRF with its research seeks to strengthen the prevention curriculum.

Goal 3 : To ensure an adequate and well-trained workforce that reflects the current and emerging needs of science and includes sufficient numbers of dental professionals.

The dental students should be diverted to research based studies in the formative year. IDRF, by supporting student initiated researches in their training year and providing a platform to share their research projects, seeks to foster the enquiry in them.

Acknowledging and scrutinizing their research papers through the IDRF website and related publication the IDRF can play a very supportive role in this kind of capacity building.

A similar kind of backing can be provided to students belonging to streams other than oral health sciences so as to guide their inputs into the stream of oral health development for the country.

Goal 4 : To enhance the translation of research outcomes into clinical practice and communicate science-based health information to ensure that IDRF - supported research leads to improved health along with effective utilization of mass communication.

This goal is meant to be two fold. Firstly, information provision to the dental professionals and auxiliaries, for dissemination of information related to new preventive, diagnostic, therapeutic means. Secondly; information dissemination to the general masses, using the right kind of mass communication modalities.

Under this goal it can be identified that there is a need to conduct research and exploratory studies in this area also.

In a country like India, the two major communication barriers are: Illiteracy and diversity in cultures and languages. Overcoming this communication barrier also serves as good means and areas for research. Utilizing means like pictures and other means to communicate can overcome few of these communication barriers.

IDRF envisions collaborating with many such mass communication agencies in order to explore the newer means of communication and also work with them to conduct surveys to find out the efficacy of various means.

Goal 5 : To overcome health disparities prevalent in the country, due to differences in socio-cultural practices, beliefs, religious dogmas, etc. and also the important concern of concentrated oral health services.

To encourage and establish a greater representation of the less served people in the system of oral health care. Achieving this is possible through encouraging the training of the interested individuals form the population. IDRF looks after giving them greater academic and research opportunities so that they can serve as the torch bearers of the community.

Sustenance of such efforts, through capacity building, adopting effective prevention programmes, establishing data base and replenishing it on a continued basis; are few of the ways to sustain services started.

Goal 6 : To ensure the adequacy of systems to document and monitor the extent and impact of oral, dental and craniofacial diseases, disorders and conditions.

The modern facilities in information technology and data management, offers us a wonderful opportunity to store immense amount of data in a form that also permits easy retrieval.

The website of IDRF is one such rich resource that allows data storage that can be looked for using various search specifics. The facility of online contribution offers an opportunity of ever increasing data base.

In order to keep the system in sync with the rapid development it would be revived timely and renewed to meet the demands of the ever expanding research areas.

The data that is collected in the IDRF resource can be used for various public benefits like, conducting advocacy efforts, evidence based therapeutic practices, information on rare diseases and disorders.

IDRF is set to convert each research opportunity into tangible resource.

Data management for easy data retrieval via the IDRF’s website is needed for various public benefits like, conducting advocacy efforts, evidence based therapeutic practices, information on rare diseases and disorders.

In addition, the IDRF relies on input gleaned through a variety of conferences and workshops. These include collaborative, conferences and workshops that constitute reviews of emerging scientific opportunities, public health concerns or state-of-the-science assessments, many of which outline specific areas that should be the target of future initiatives or activities. Consensus development conferences also may be held.

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