Prevalence Study of Oral Hygiene and Dental Health
FATIMA A HUSSAIN, RAVIKUMAR CHOCKALINGAM
Introduction (Page 2 of 2)
ICTPH’s oral hygiene and dental health initiative
The Human Capacity Vertical’s Plans:
The Human Capacity limb of ICTPH has conceptualized and implemented a Community Health Worker (CHW) program with a primary objective towards educating the community and improving the overall health seeking behavior. We [HC] envisage integrating field research, community understanding through feedback from the community as well as from our community health workers to address key issues in public health through a process of organizing training and dissemination at the community level.
ICTPH’s efforts to study and improve oral hygiene at the community level, the Human Capacity vertical program has a three-pronged strategy: (1) Studies conducted at various levels, (2) the community health workers' efforts to disseminate information, and, (3) community-based interventions based on training through didactic and practical learnings (Chockalingam et al. 2009).
The Oral Hygiene and Dental Health Initiative consists of a Validation study, Prevalence study, and Impact Analysis. The Validation study aims to assess the ability of the CHWs to diagnose oral disease following an interactive training session. The Prevalence Study will evaluate the burden of disease in Karambayam by means of a selected oral health scoring system and survey analysis. Finally, the impact analysis will study the role of the CHWs in improving oral hygiene and dental health at the community level. This paper describes and discusses the Prevalence Study.
Focusing on Dental Caries and Periodontal Disease
Throughout the oral hygiene and dental health study, ICTPH is focusing on dental caries and periodontal disease. Cavities and periodontal disease are the two most prevalent oral diseases in India, followed by malocclusion and oral cancers (Tandon, 2004). About 45% of people above the age of 15 suffer from periodontal disease (Mahal, 2006), and 80% of children suffer from dental caries (IJCM, 2004). In addition, dental caries and periodontal disease are the two leading causes of tooth extraction and removal (Upadhyaya, 2009).
Dental caries has been referred to as a pandemic; it is globally distributed, affecting all populations (Edelstein, 2006). Developing countries, including India, have shown an upward trend in DMFT 1 (Decayed, Missing, and Filled Teeth) values (See Figure 2) due to an increase in the prevalence of processed foods in the diet (Petersen et al. 2005).
Figure 2: Changing levels of dental caries experience
(Decayed, missing and filled teeth (DMFT) index) among
12-year-old in developed and developing countries
1 DMFT is a severity indicator of dental caries calculated by summing up the number of decayed, missing, and filled teeth a person has.
(Explained in detail in the prevalence study)
The developed countries have the reverse trend in dental caries severity due to increasing availability of dental care and education. The DMFT score for Tamil Nadu is 3.94, which is well above the accepted value of 3 or less (WHO, 2009).
Periodontal disease affects 90% of the population above the age of 30 (IJCM, 2004) in India. Periodontal health is correlated with the other non-communicable diseases mentioned above and is of primary concern due to HIV/AIDS oral manifestations and relations to oral cancers.
The World Health Organization (WHO) has developed a Global Oral Health Program that targets common dental diseases by focusing on modifiable risk behaviors. Professor Shobha Tandon, Dean of Manipal College of Dental Sciences, recommends that, “Human resource planning and utilization should be based on the aim for sustained development along with a system of monitoring and evaluation programs” (Tandon, 2004).
This recommendation is reflected in ICTPH’s Validation and Prevalence Study.
Validation Study 2
The aim of the oral hygiene validation study is to understand the role community health workers can play in preventative oral healthcare at the community level. The study focused primarily on the CHW’s ability to detect the presence of dental plaque, caries and gingivitis. Their assessment was validated by means of reexamination by a certified dentist. From the three villages in Thanjavur, Tamil Nadu, included in the ICTPH baseline survey, Karambayam was chosen as the model for the oral hygiene and dental health initiative.
Karambayam has a population of 3600 people and 907 households. For the validation study, a random sample size of 92 citizens between the ages of 19 to 64 was selected. 20 volunteers were mobilized from the community by ICTPH to work as CHWs. A group of 5 CHWs was randomly selected for the validation study.
The CHW training was completed over two days at the ICTPH field site office by trained specialists. Training methodology included didactic tools and practical sessions on diagnosing dental caries, gingivitis and dental plaque. The CHW’s diagnosing capabilities were evaluated using assessment tools developed by ICTPH that included theoretical as well as practical components 3.
The CHWs were prepared to conduct the prescribed dental examinations according to an in-house developed protocol. Due consent was obtained from each subject and documented according to the Institutional Review Board approved consent form.
Results from the validation are currently pending. Preliminary findings comparing only one CHW to the professional dentist evaluation (See Figure 3) revealed an ability to correctly identify the number of teeth present in both upper and lower jaws 90% of the time 4. Caries were accurately detected only 55% of the time, and on average .75 caries were missed by the CHW. Gingivitis was correctly detected 83% of the time.
The reexamination, as per the validation protocol, is scheduled for completion by the end of July 2009. Until that time, ICTPH will continue with the Oral Hygiene and Dental Health Prevalence Study. If necessary, ICTPH will reevaluate and re-administer the validation study training.
1 DMFT is a severity indicator of dental caries calculated by summing up the number of decayed, missing, and filled teeth a person has. (Explained in detail in the prevalence study) (Continue reading)
2 A detailed report of the Validation study is available through ICTPH (Continue reading)
3 The CHWs were evaluated immediately preceding the training session and have not been reexamined for verification. (Continue reading)
4 Findings were collected by intern Fatima Hussain on a field site visit on 12 June 2009 and include 10 evaluation samples chosen at random. (Continue reading)
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