Validation Study of Community Health Workers
Assessment of Oral Hygiene

GEETHA LOGANATHAN, RAVIKUMAR CHOCKALINGAM

Rationale for Study (Page 2 of 2)

Table 1: Oral health care system in India
In India oral healthcare is delivered mainly by the following establishments 12.

As per Dental Council of India there are more than 79,000 dentists for population of about 1090 million with dentist population ratio of 1:10,000 in urban areas and 1:1,50,000 in rural areas. There are 240 approved and recognised dental colleges in the country among which 17 dental colleges are in Tamil Nadu 12.

The number of dental colleges in the country increased to 240 in 2007 from three at the time of independence and the number of dental surgeons in the country increased to more than 79,000 in 2007 from a few hundreds. With the increase in population of about 3.5 times since then with the number of dentists increasing to more than 3000 times, it did not have any significant impact in reducing the prevalence of the oral diseases 12.

This is event from the graph given below 12. It shows that with increase in the number of dental surgeons in the country, the prevalence of the oral disease are also increasing rather than decreasing.

DMFT - it is an index to provide the estimate of the severity of the caries attack on each tooth, in this each carious surface is counted. DMFT is applied for permanent teeth. The deciduous teeth denote by small letters as dmft.

D - decayed: it indicates the number of permanent teeth that are decayed

M - missing: indicates the number of missing permanent teeth due to decay

F - filled: indicates the number of permanent teeth that have been attacked by caries, due to which they have been restored to keep them in a healthy condition in mouth

Inference

It is well understood that there is a large gap in the dental service available for the community especially at the rural area which constitutes about 70% of India. It is evident from the uneven distribution of dental colleges and hospitals between the government and private sector. Among the 240 colleges in India only 32 [13.3%] colleges are owned by government and the remaining 208 [87.7%] colleges are owned by the private sector. Even in Tamil Nadu among the 17 colleges only one college is owned by government and remaining 16 colleges are owned by the private sector. There is also a large gap in the dentist population ratio available at urban areas [1:10,000] and rural areas [1:1,50,000]. Moreover in India the dental procedures are more towards restorative and rehabilitative dental procedures than preventive dental care and the majority of dental services are provided by the private dental practitioners. Also the impact of oral diseases on the systemic health of the population and the impact of poor oral health on the economy of the individual, family and ultimately on the country is well understood.

Therefore with increasing dental problems, limited manpower resource and the impact of the oral diseases on the systemic health of the population and the economy of the individual, family and country, it is essential that preventive dental care be taken at all possible levels which is more cost effective, economical and beneficial way of preventing the oral diseases.

Preventive care including health education and promotion should be given prior importance to implement oral healthcare in India. This can be effectively done by a combination of community, professional and individual actions.

Early detection of oral diseases is more crucial for the control of oral disease. A thorough naked eye examination with adequate light can identify many oral diseases in the early stage. Since many oral diseases can be detected with thorough oral examination, it is possible that community health workers can be made use of as an alternate human resource.

Alternate human resource

One of the strategies considered by the developing countries to explain the preventive measures and in identifying oral disease is by making use of the community health workers and other health auxiliaries of the primary healthcare system.

Oral cancer is one of the few human cancers with high possibility of prevention. In one of the studies conducted in India and Sri Lanka it indicates that it is possible to train the community health workers in the primary prevention and early detection of oral cancer and precancerous lesions. Although the study did not show any evidence in the efficacy of the community health workers in reducing the incidence and mortality due to oral cancer 13, the role of community health workers in early diagnosis and referral was illustrated.

Thus Community Health Workers who when given sufficient training on oral disease and its prevention and identifying these diseases, will help in the prevention and control of oral diseases.

12 Hari Parkash et al., “Guidelines for Meaningful and Effective Utilization of Manpower at Detnal Colleges for Primary Prevention of Oro-Dental Problems in the Country”,GOI-WHO collaborative programme,(2007),12-22     (Continue reading)

13 Sankaranarayanan R., Health care auxiliaries in the detection and prevention of oral cancer, oral oncol 1997 May 33(3):149-54     (Continue reading)

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