Prevalence Study of Oral Hygiene and Dental Health
FATIMA A HUSSAIN, RAVIKUMAR CHOCKALINGAM
The Prevalence Study
Objective
The aim of this study is to understand the prevalence of oral health issues in Karambayam, Tamil Nadu. The study utilizes surveys and statistical analysis and is conducted by trained Community Health Workers (CHWs).
In addition, ICTPH will evaluate the CHW model as a means to diagnose and deliver preventative healthcare by addressing issues of life style and education. The oral health screening will be used as a surveillance system with follow- up screenings to track improvements.
Research question
The prevalence of dental caries and periodontal disease can be assessed by use of the Decayed, Missing, Filled Tooth (DMFT) Index, Basic Screening Surveys (BSS), and the Navy Periodontal Disease Index (NPDI) Gingival Scoring System in conjunction with a door to door survey. Such an assessment can provide an effective means for addressing gaps in oral health seeking behavior and to gauge the existing levels of knowledge, awareness, and practices of the community.
Research protocol
Karambayam, with population 3600, will be divided into index ages and age groups as designated by the World Health Organization (WHO) methodology for Basic Oral Health Surveys (OHS, 1987). Stratified sampling of ages 12, 15, 35-44, and 65-74 years will be used.
CHWs will use the modifiable risk behavior survey (See Appendix C) to assess the oral health seeking behaviors of the population and to measure the prevalence of oral disease by use of the suggested oral health scoring systems.
The CHWs will focus on dental caries and periodontal disease for the prevalence study, as these are the two most prevalent indicators of oral disease (Tandon, 2004). Epidemiological studies in Indian population show that dental caries and periodontal disease are widely distributed regardless of age, sex, socio-economic status and geographical location (Mahal, 2006).
Dental caries prevalence
After an extensive literature review on detection methodologies, the dental caries scoring system suggested 5 for the Community Health Workers in Karambayam will be the Decayed, Missing, Filled Tooth Index (DMFT) (See Appendix A). DMFT is the most recognized detection methodology for dental caries (WHO). It is used by the World Health Organization for dental health detection and is much simpler to use than its alternative, the DMFS index, which accounts for every tooth surface.
The DMFT index looks at each tooth in order, using the Universal tooth numbering system (See Appendix D). This is preferred for the CHW model and it provides a means to validate the effectiveness of the training methodology as well.
DMFT can be and has been used in previous studies by the WHO for follow up purposes and thus is perfect for the CHW preventative healthcare model.
Periodontal disease prevalence
Periodontal disease is highly prevalent and hazardous. Periodontal disease has been correlated with health problems such as diabetes, cardiovascular disease, stroke, pancreatic cancer, low birth weights and premature deliveries 6 and thus cannot be ignored. The methodologies in testing for periodontal disease, however, are not in the scope of the CHW model. All gum disease indexes involve the use of specific dental equipment and skilled methodologies that are suited for dental professionals only (See Appendix E).
It is thus proposed that the CHWs will diagnose periodontal disease more qualitatively, using only the NPDI gingival score and by determining the urgency for dental care on a 0-1-2 point scale, as indicated by the Basic Screening Surveys (BSS) Manual (indicator #6) (See Appendix B).
This screening and rating methodology can also be used for improvement tracking purposes. Seeing what households move from 2 to 1 or from 1 to 0 over time will be of great interest.
Modifiable risk behavior surveys
In addition to measuring the burden of oral disease, the prevalence study will involve a survey (See Appendix C) to analyze the dental hygiene behaviors, modifiable risk behaviors, and oral health perception of Karambayam. A separate survey will be used for the 12 and 15 year age groups and the 35-44 and 65-74 year age groups. The surveys are modeled after a similar geographical survey conducted in other parts of India, and address issues of brushing and cleaning methodology, tobacco and dietary habits, and oral care seeking behaviors. Trained CHWs will administer the surveys and at the same time note the oral health scores for caries and periodontal disease.
Discussion and recommendations
The Prevalence Study will develop an understanding of the oral disease burden in Karambayam, Tamil Nadu. In addition, modifiable risk behaviors that will need to be addressed in the community can be identified. Based on this study, ICTPH may be able to design an education program to meet well-defined needs assessment. Following the findings of the Validation study, ICTPH will be able to outline and define the role for the CHWs in preventative oral healthcare. The hypothesized role of the CHWs is one that is able to diagnose oral diseases and refer individuals to the Public Health Centers where primary care facilities and resources will be available. ICTPH is organizing for a dentist, village health nurse, or nurse practitioner 7 to be available at the PHC once a week to treat the referred patients.
The Oral Hygiene and Dental Health Initiative has many opportunities to further expand its outreach. In the future, oral cancers and fluorosis should be examined as well. As oral health is greatly affected by behavioral changes and increase in education, the ICTPH study has great potential to improve the oral health of the Karambayam community. It can also lay a foundation for other public health initiatives. It is the first study of its kind and will be of great use in future research.
5 All suggestions and recommendations present in this report are made by intern Fatima Hussain (Continue reading)
6 See references in ICTPH Oral Hygiene Proposal under the Human Capacity Vertical (Continue reading)
7 ICTPH is working on forming a nurse practitioner model to help fill in human resource gaps at the primary healthcare level. More information is available on their web site (ictph.org.in) (Continue reading)
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