Oral Health in Leprosy as a Public Health Issue in India: Review of Literature

Oral health is vital for the well-being of any person as it is related to many health problems. There is an impression that the oral manifestations of leprosy and oral health in leprosy have not received adequate attention although oral and nasal lesions of leprosy are probable sources of spread of bacilli and transmission of the disease. This review focuses on analysing the information about oral health in leprosy and oral manifestations of leprosy from literature documented in the PubMed database. A comprehensive review was carried out to assess leprosy's oral health, including both leprosy-specific and non-specific lesions, like erythematous/hypochromic macula, fissure, edema, periodontitis, bone involvement, caries and other dental problems. A search of the literature was done in the electronic database of PubMed for all indexed articles. The search strategy used oral leprosy, leprosy, non-specific, oral involvement, oral health in leprosy, India specific keywords. It was observed that of more than 5800 articles available on leprosy from India, less than 0.5% are on oral health in leprosy. The major oral problems associated in leprosy are gingival recession, attrition, mobility and tooth loss. Overall, among the major issues pertaining to oral health, periodontal disease and gingival recession are the predominant findings, followed by tooth loss, mobility, and attrition. 29 studies were eligible based on the inclusion criteria and selected for the review; of these 6 were institutional studies while others were outpatient studies. None of these studies deals with the epidemiology of these oral health issues at the community level. It has been observed that the majority (more than 60%) of leprosy-affected persons (LAPs) have manageable oral health problems. This analysis shows a lack of adequate and representative data on oral health problems in leprosy patients. Low access to public health dental services and poor self-perceived oral health reinforce the need to achieve comprehensive health care in this population. There is a clear need to undertake well-designed studies to understand the current status of oral health problems in leprosy to develop information material and strategies relevant for affected people, dental professionals and health personnel treating leprosy.