Prevalence Study of
Oral Hygiene and Dental Health

FATIMA A HUSSAIN, RAVIKUMAR CHOCKALINGAM

Introduction (Page 1 of 2)

Fatima A Hussain is a candidate for a Bachelor of Science in Environmental Engineering at the Massachusetts Insitutute of Technology. She has worked as an undergraduate research laboratory intern at Pre-UROP (Material Science and Engineering), MIT, as a laboratory intern at the National Cancer Insitute, Ft. Detrick and at the CVS Pharmacy as a pharmacy service associate. She has also worked on a Potable Water System Project in Santa Ana, Ecuador, led by the MIT Public Service Center through which she gained experience in international development work and public health.

Ravikumar Chockalingam graduated from Madras Medical College, one of the oldest in India, in 2003. He has five years of post-graduate clinical experience including training in Surgical Laparoscopy and Intervention Gastroenterology in Buffalo, NY. He worked as a Registrar in the Critical Care unit in Apollo Hospitals for a year and a half after which he joined ICTPH as Assistant Vice-President – Human Capacity.

Dr. Chockalingam is the founding member of the CHW (Community Health Worker) focus at ICTPH, looking at alternative disease focus areas e.g. mental health, oral health and sexual health. Dr. Ravikumar also played an instrumental role in operationalising the CHW pilot in Tanjore district of Tamil Nadu – from coordinating field teams for mobilizing the CHWs to designing and implementing the in-house three phase training programs. Dr. Chockalingam is currently pursuing his Masters in Public Health (MPH), at The Warren Brown School of Social Work, Washington University, USA.

Executive summary

Oral health is a rising concern for the Indian population. The IKP Center for Technologies in Public Health (ICTPH) has taken an initiative in oral health from a public health systems perspective. ICTPH is a research-based, not-for-profit, organization aiming to improve the health of poor populations in India. It aims to accomplish this goal by integrating the scientific knowledge of factors influencing health and disease with regular evaluation and impact assessments of existing health systems, and appropriate technologies for optimal healthcare delivery (ictph.org.in). The overall aim of ICTPH’s dental health initiative is to create a framework for public oral healthcare by integrating preventative and primary care models with alternative human resources.

In this context, the Human Capacity Vertical of ICTPH has completed a validation study to assess the utility of Community Health Workers (CHWs) in identifying dental caries and periodontal disease at the Karambayam field site. This study was based on a representative sample of the population.

The next phase in the ICTPH initiative is to determine the burden of disease in Karambayam, and to examine the oral healthcare seeking behaviors within the community. For the Prevalence Study, the CHWs will be trained to use different scoring systems to evaluate the oral health of the community as part of establishing a baseline, and for follow up studies. The Prevalence Study will use the Decayed, Missing and Filled Tooth (DMFT) index (See Appendix A) and the Navy Periodontal Disease Index (NPDI)/Basic Screening Survey (See Appendix B) in conjunction with a door to door survey to gauge modifiable risk behaviors and existing knowledge, awareness, and practices of oral hygiene (See Appendix C). The study itself is scheduled to be carried out in the second half of the year 2009.

Introduction

The Burden of Disease and ICTPH’s Role Thus Far

Oral healthcare problems and the Indian perspective

Poor oral hygiene and dental health have a profound impact on the overall health of an individual. Oral health problems such as pain, missing and discolored teeth, along with dental and gum disease, affect the ability to eat, communicate, and perform other daily activities. The impact of poor oral hygiene is observed at school and the workplace, with the loss of millions of work hours world wide (Petersen et al. 2005).

Oral health often receives lower priority than other health concerns such as HIV/AIDS and maternal healthcare. This is largely due to the false notion that oral health does not lead to serious diseases and other illnesses.

ICTPH’s literature review on oral illnesses revealed:

There is increasing evidence linking impaired oral hygiene to various health conditions such as pancreatic cancer in men, role of periodontal disease as a risk factor for stroke/TIA, greater prevalence of severe periodontal disease among individuals with type I and II diabetes among individuals in the age group 15-24 years of age. There is also increasing evidence that periodontal disease has been associated with low birth weight and pre-term deliveries (Chockalingam et al. 2009).

In addition, the four most prominent non-communicable diseases – cardiovascular disease, diabetes, cancer, and chronic pulmonary disease – share several common risk factors with oral diseases (Petersen et al. 2005).

Community dentistry in India

There is no specific allocation of funds for oral health in the Indian health budget (Tandon, 2004), and there is a substantial lack of human resources in public dental health. The overall ‘dentist:population’ ratio in India is 1:30,000, and, there is a significant geographic imbalance. While the ratio in the urban setting is roughly 1:10,000, in rural regions it averages about 1:250,000 (Tandon, 2004). For comparison, in most developed countries, the ratio is about 1:2,000 (Peterson et al. 2003). This disparity is illustrated below, in Figure 1.

Figure 1: Number of patients per dentist

Furthermore, in India, only about 2% of specialists in dentistry are trained in community dentistry (Tandon, 2004).

With 72% of the Indian population living in rural areas with no access to the private dental health sector (IJCM, 2004), there is an acute need to develop public dental initiatives. The first access to dental care is only available beyond the community health center level; there is no dentist or dental technician at the Sub-centre, PHC, or CHC level (IJCM, 2004).

This lack of access to dentists in the rural setting is a major concern. However, if the oral healthcare needs can be switched from surgical treatment and tooth removal to more of a preventative methodology (Tandon, 2004), the lack of access to dentists could be addressed via dental auxiliaries.

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