Assessment of Oral Health Status and Normative Treatment Needs of Residents of Nimbut Village, Pune, Maharashtra, India

Transcription

1 International Journal of Dental Health Concerns (216), 2, 1-5 Doi: /ins.ijdhc.16 ORIGINAL ARTICLE Assessment of Oral Health Status and Normative Treatment Needs of Residents of Nimbut Village, Pune, Maharashtra, India Saurabh P. Kakade 1, Sahana Hegde-Shetiya 2, Amit Vasant Mahuli 3, Simpy Amit Mahuli 3, Deepti Agrawal 2 1 Department of Public Health Dentistry, Bharati Vidyapeeth Deemed University Dental College & Hospital, Pune, Maharashtra, India. 2 Department of Public Health Dentistry, Dr. D.Y. Patil Dental College & Hospital, Pune, Maharashtra, India. 3 Department of Public Health Dentistry, NIMS Dental College, Jaipur, Rajasthan, India. Correspondence: Dr. Saurabh P. Kakade, Dr. D.Y. Patil Dental College & Hospital, Pune , Maharashtra, India. Phone: saurabh. kakade17@gmail.com How to Cite: Kakade SP, Hegde-Shetiya S, Mahuli AV, Mahuli SA, Agrawal D. Assessment of oral health status and normative treatment needs of residents of Nimbut Village, Pune, Maharashtra, India. Int J Dent Health Concern 216;1(2):1-5. Received: Accepted: ABSTRACT Introduction: Poor oral health is an important public health issue of the world and as considerable one in India. Oral problems are not only causing pain, agony, functional, and esthetic problems but also lead to loss of working man-hours. Hence, the study was carried out to assess the normative oral health need of residents of Nimbut village in Pune district of the state of Maharashtra, India. Materials and Methods: A community-based cross-sectional study was conducted. The World Health Organization (WHO) oral health assessment form 1997 pro forma was used to assess oral health status. Using systematic random sampling technique recruitment of 625 (125 participants per ward of each WHO age group) were assessed for oral health status. Results: About 336 (53.8%) participants with the presence of calculus and this was found to be highest in the years old. The presence of pockets was seen to be highest in years old. There were 85 (58.21%) mean number of 2.6 per person carious teeth in 5 years old. There were 277 (63.5%) mean number of 1.69 teeth per person carious and out of which majority belong to years old. There were 43 (6.9%) participants who were edentulous. The participants requiring various curative and preventive treatment needs were found to be high. Pre-cancerous lesions and conditions such as leukoplakia (14.88%) and oral sub-mucosal fibrosis were detected. Conclusion: The lack of awareness and motivation of having good oral health are the burning issues in this population. There is a need for primary public oral health measure to be made available to one who really needs it and that is in the rural parts of India. Oral health program planning and intensive measures for implementation are must especially for rural India. Key words: Needs assessment, oral health status, rural India INTRODUCTION Poor oral health is a major public health issue of the world and specially in Indian sub-continent. Loss of working man-hours is the burden caused by oral problems such as pain, agony, functional, and esthetic problems. Oral diseases are significant in terms of personal suffering and financial burden for both individuals and society. Hence, in the long run, they are bound to have a significant impact on our economy. Dental caries and periodontal disease are the two most common oral diseases that begin in childhood mainly caused due to frequent intake of sweets, improper oral hygiene practices, smoking, alcohol consumption, and irregular dental attendance. This behavior could be from early years of life or related to an increasing autonomy from parental influence as age progresses. Oral diseases can be prevented by better understanding the attitude and beliefs and then motivating them for a behavior change and influencing their oral hygiene practices. [1] About 5% of schoolchildren are suffering from dental caries, and more than 9% of adults are having periodontal diseases. [2] Use of tobacco products, smoking, or smokeless form is widely prevalent in our country. Hence, oral pre-cancers and cancers are emerging as major threats to younger people and are increasing to alarming proportions in India. Though gains of public education and motivation appear impressive at the wider stage, at the sub-population level the changes in most parts of the country are confined to middle and high socio-economic groups, but the decline in risk factors is either not present or very small in the low socio-economic status individuals. The following has led to major health inequities among the population of this country with respect to both acute and chronic oral disease. What is needed is a strategy 1

2 that, regardless of the times, can be used on an ongoing basis to ensure that the nation will maintain a workforce with the skills and cultural competence to provide the care that the nation demands. Nimbut is a small village with population of 567 (as per 21 census) on the bank of river Nira, in Baramati Taluka of Maharashtra state of India. It has only a primary healthcare subcenter with no dentists posted in it. There are no dental clinics in the village to provide oral health care. Due to the burden of oral health problems, in recent past, many oral check-up camps were organized in this place. It was noticed that there lies a high need for oral health care, but the factors associated with it may go unnoticed. There is a lacunae felt as no study so far has been conducted in this place. Hence, this study majorly focuses on the assessment of normative oral health need of residents of Nimbut village, Pune. MATERIALS AND METHODS Community-based oral health survey was conducted. Before commencing the study, scientific and ethical approval was taken from the Institutional Scientific and Ethical Committee. The required permission for conducting the study was taken from the Nimbut gram panchayat and the Talathi officer of Nimbut village. On a monthly basis courtesy, reporting was done to the officials of the gram panchayat and the local community leaders. Nimbut village was divided into five wards. 25 individuals from each age group, i.e., 5 years, 12 years, 15 years, years, and years were selected using stratified cluster sampling from each of the 5 wards yielding a total sample of 625 (125 participants per ward). [1,3] Using systematic random sampling technique, 5 th house was considered for recruitment of the participants. The following formula was used; (k = N/n) where k is the quotient value; N is the total sample size, and n is the required sample in each age group (k = 625/125). Before the beginning of the study, informed consent was obtained from participants in the study. The study was explained in local language (Marathi) to the participants. All the individuals fulfilling the inclusion criteria such as peormanent resident who were co-operative and were willing to participate in the study were included. Data collection was done by a clinical examination to assess the normative need using the World Health Organization (WHO) oral health assessment form [4] Data were entered in the excel sheet (Microsoft Office Excel 27) and was compiled and analyzed statistically. Frequency and percentage distribution of participants responses were calculated based on responses using Microsoft Office Excel 27. Using appropriate tables and graphs, data are presented. RESULTS A total of 625 participants were recruited for the study. The villagers were mainly Hindus and Muslims were in minority. Majority were housewives (14.24%), farmers (11.84%), and laborers (7%), and the majority had the habit of cleaning their teeth once daily using toothbrush and toothpaste (Table 1). All the participants had normal extraoral appearance with only one participant contraindicated for examination. Clicking of temperomandibular joint was seen in about 3.52% of the adults. Smokeless form of tobacco products was used (Table 1). On oral mucosal examination, it was seen that leukoplakia (14.88%) and oral sub-mucosal fibrosis (OSMF) (.96%) were detected mostly in buccal mucosa (Figure 1). The number of subjects with enamel opacities and questionable dental fluorosis was found in only 21 (3.36%) and 12 (1.92%), respectively, and it was mostly seen in the 12 and 15 years of age group. The most seen enamel defect was found to be demarcated opacities, which were seen across the age groups of years old. There were 336 (53.8%) the presence of calculus, and this was found to be highest in the 12 and 15 years old. Mean number of bleeding sextants was found to be 2.32, and this was found to be highest in the 12 and 15 years old. The presence of pockets was seen to be highest in years old. There were about 11.36% the presence of loss of attachment ranging from 4 to 5 mm and which was found to be most in years old. Mean number of sextants with loss of attachment ranging from 4 to 5 mm was found to be.43 per person, and this was found to be highest in the years old. About 43 (6.9%) participants are edentulous. There were 125 (2%), 21 (3.36%), and 14 (16.64%) deciduous, mixed, and permanent dentition, respectively. The dental caries status of the population is shown in Figures 2 and 3. On oral examination, there were 619 (99%) and 616 (98.5%) no prosthesis in upper and lower jaw, respectively, and the need for partial or full prosthesis was found to increase from to years old. The dentofacial anomalies data shows that majority of the participants had minor malocclusion (15.4%) which is followed by definite malocclusion (.64%) among the children. There were only 38 (6%) pain or infection but was majorly seen in years old. The participants requiring various curative and preventive treatment needs are given in Figure 4. The lack of awareness and motivation of having good oral health are the burning issues in this population. DISCUSSION This study was undertaken to of oral health status and normative treatment needs of residents of Nimbut village, Pune, Maharashtra, India. As per the knowledge of the investigators, 2

3 no such study has been undertaken in this population. When oral health is integrated with health and its importance is very significant, this could eventually help in the formal introduction of good oral health practices at the community levels. Second, in future, it might help in promoting oral health and preventing oral disease at pre-school, school, college, and community level at large. Children, adolescents, elderly people, and village poor being a high-risk group are the ones needing focus and care; getting to know their exact oral health status and normative treatment need of oral health will definitely help them securing good oral health status. Tooth brushing is the most popular oral hygiene practice across the world; same can be noticed in this study. All the participants responded that they practiced oral hygiene daily which contradicted the data on rural India by Bali et al. [3] which may be due to the social desirability bias. Most of the participants spend about two or more minutes in cleaning their teeth once daily. The regular tooth brushing helps in maintenance of oral hygiene, but the method and technique practiced will have Leukoplakia Oral Sub mucous Fibrosis Oral mucosal lesion/condition Figure 1: Number and percentage of oral mucosal lesion/condition caries untreated caries Dental caries status of primary dentition four or more dmft 5 yrs Figure 2: with caries, with untreated caries, and with four or more decayed, missing, filled of the primary dentition adverse effects. Though majority (84.48%) of the participants reported using toothbrush and toothpaste to clean their teeth, use of finger and herbal stick is still prevalent (15.52%) in the study population. The use of toothbrush and toothpaste in this study decreased among the elderly. In this study, use of herbal stick, neem stick, and datun is more likely to be used in the higher age group participants which is also seen in a usual Indian village. [3,5,6] This could be due to the fact that in a country like India all cannot afford toothpaste and toothbrush. [7] In the sub-continent region, popular type of chew tobacco is available which is known as guthka and pan masala, which are usually sold in small attractive sachets with a lower price tag which are commonly used by people of lower socio-economic status in India. [8,9] The same was observed in this study, high use of smokeless form was noticed in the age groups and years as compared to smoke form of tobacco as usually seen in rural area. [3,8] In general, tobacco use and drinking alcohol goes hand in hand, which may lead to cancerous lesions Participants who Participants with Participants with have or have haduntreated carious four or more caries lesion DMFT Dental caries status of permanent dentition 15 yrs Figure 3: who have or have had caries, with untreated caries and with four or more decayed, missing, filled of the permanent dentition Treatment need 5 yrs 15 yrs Figure 4: requiring preventive or caries-arresting care, sealant, surface filling(s), crown, veneer or laminate, pulp care and restoration, extraction, or other treatment 3

4 Table 1: Distribution of total participants by oral health practices and tobacco habit Age and age n (%) group (years) Oral health practices Tobacco habit Toothbrush and toothpaste Herbal stick Finger Smokeless Smoke None Both (2) 125 () (2) 125 () (2) 125 () (17.92) 3 (.48) 1 (1.6) 61 (9.76) 14 (2.24) 43 (6.88) 7 (1.12) (6.56) 1 (1.6) 74 (11.84) 7 (11.2) 2 (3.2) 16 (2.56) 9 (1.44) 528 (84.48) 13 (2.8) 84 (13.44) 131 (2.96) 34 (5.44) 434 (69.44) 16 (2.56) in the mouth [1] and same was witnessed in this study. Another observation in this study was the regular use of mishri, which is a form of smokeless tobacco which is often used to clean teeth by the women in Nimbut village. Use of mishri is also prevalent in several parts of rural India, especially in Maharashtra. [11] Another striking observation was that there was no use of tobacco in the younger age groups which is in contrast with the study conducted by Dongre et al., [12] which showed consumption of any tobacco products among rural adolescents to be very high. This observation may be due to social desirability bias. With high use of smokeless form of tobacco pre-malignant lesions are bound to be noticed. In this study, oral mucosal condition appears to be normal in most participants. However, few cases of leukoplakia (14.88%) and OSMF were detected. The pre-malignant lesions such as OSMF and leukoplakia were mostly detected in buccal mucosa. Oral mucosal changes or lesions may be due to chronic stimulation or local irritation of the oral mucous membrane caused by the use of tobacco. In this study, leukoplakia was found to be most in years old which is in accordance with the survey conducted by Bali et al. [3] It can be mainly attributed to high consumption and long duration of use of smokeless tobacco. [9] Although India has a history of legislative measures undertaken from many years, loopholes exist in control of production, sale, and marketing of tobacco. In the midst of 212, several states in India such as Maharashtra, Kerala, Gujarat, and 15 other had banned the sale, manufacture, and storage of guthka, a smokeless tobacco product containing areca nut. Hence, this government initiative in the future may help in the reduction of pre-malignant lesions/conditions. Dental fluorosis was found to be quite low which was majorly seen in the questionable form in the years old. Although this area is not known to have endemic dental fluorosis, the source of water may influence this outcome as the major source of water supply is from deep wells and bore-wells. The enamel opacities/ hypoplasia may be due to the previous history of any infections or diseases. The results of the assessment of temporomandibular joint, teeth with enamel opacities and hypoplasia is in accordance with the survey conducted by Bali et al. [3] The periodontal assessment of the participants showed calculus to be the most prevalent condition followed by bleeding throughout the groups. In this study, the presence of calculus was found to be the major cause for periodontal tissue inflammation in years old as seen in other studies. [13,14] The prevalence of shallow and deep periodontal pockets are high in the elderly which is also seen in other studies. [13-15] Loss of attachment is highest in years old. Across the age groups, the least severe form of loss of attachment (4-5 mm) is more than the more severe form of loss attachment. The prevalence of periodontal disease is always slightly higher in rural areas compared to the urban areas. [3,15] Better periodontal health in the urban areas than in the rural areas may be due to higher dentist population ratio serving in urban areas. [2,5,6,14] Second, it may be due to less awareness of maintaining good oral hygiene in the rural areas. [2,5,6,14] Furthermore, the majority of the dental clinics and dental colleges are located in urban areas. [2,5,6,14] In this study, as the age progressed mean number of teeth present in the mouth decreased considerably, which may no longer be a universal finding. The decayed teeth component was found to be the most in the 5, years old. In this study, missing teeth were found to be more in the age group, which is also observed in the study conducted by Bali et al. [3] The proportion of subjects with root caries was higher for the than the groups. In this study, high number of decayed and missing teeth, together with negligible numbers of filled teeth, suggests that most participants have not utilized oral health care services which could be due to unaffordability and existing dental fear. This finding was consistent with a couple of previous studies. [3,16] The ever increasing cost of dental instruments and materials leads to increase in the final cost of the treatment to the individuals. [14] With no good insurance for oral health and high out of pocket expenditure on dental treatment, this may lead to decrease in utilization of oral health services. [14] Preventive treatment need was found to be highest, followed by one surface filling, the need for extractions and pulp care and crowns throughout the age groups. Preventive care can be made available in the form of mouth rinsing programs and tooth brushing drills. This preventive care would help in prospects of 4

5 the oral disease burden of rural India. [1] In the years age group, the maximum need was for extractions and one or more surface fillings, which is in accordance with previous studies. [3,17] There were about 6% pain or infection which may be due to participants being from a rural area. The percentage of dental prostheses increased as the age advanced to years. The highest need for prostheses was in the age group followed by age groups. Full denture prosthesis was the most required unmet need in the elderly group, which is in accordance with survey conducted by Bali [3] and Goel et al. [17] The drawback of this study is that it involves only one village and only 625 individuals. However, the strength is that it gives the oral health treatment of the population, and it involves individuals from all WHO age groups. Through this study, we can strongly recommend that there is a need for primary public oral health measure to be made available to one who really needs it and that is in the rural parts of India. Oral health program planning and intensive measures for implementation are must especially for rural India. CONCLUSION This study was undertaken to analyze oral health status and normative treatment needs of residents of Nimbut village, Pune, Maharashtra, India. In the elderly, loss of teeth was evident. For most of the participants, cost of treatment was not affordable, dental fear, and fear of pain of injections existed. Preventive and promotive care would decrease oral disease burden of rural India. The lack of awareness and motivation of having good oral health for which public oral health education, prevention, and promotion activities will be needed to secure and dream of healthy smiling and bright Indians. REFERENCES 1. Stokes E, Ashcroft A, Platt MJ. Determining liverpool adolescents beliefs and attitudes in relation to oral health. Health Educ Res 26;21: Nanda Kishor KM. Public health implications of oral healt Inequity in India. J Adv Dent Res 21;1: Bali RK, Damle SG, Maglikar SD, Yethwar RR, Mathur VB, Talwar PP, et al. National Oral Health Survey & Fluoride Mapping 22-23, Maharashtra. New Delhi: Dental Council of India; World Health Organization. Oral Health Survey-Basic Methods. 4 th ed. Geneva: WHO; Ahuja NK, Parmar R. Demographics and current scenario with respect to dentists, dental institutions and dental practices in India. Indian J Dent Sci 211;2: Tandon S. Challenges to the oral health workforce in India. J Dent Educ 24;68: Goldman AS, Yee R, Holmgren CJ, Benzian H. Global affordability of fluoride toothpaste. Global Health 28;4:7. 8. Vellappally S, Jacob V, Smejkalová J, Shriharsha P, Kumar V, Fiala Z. Tobacco habits and oral health status in selected Indian population. Cent Eur J Public Health 28;16: Shimkhada R, Peabody JW. Tobacco control in India. Bull World Health Organ 23;81: Ramya K, Prasad KV, Niveditha H. Public oral primary preventive measures: An Indian perspective. J Int Oral Health 211;3: Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology 23;8: Dongre A, Deshmukh P, Murali N, Garg B. Tobacco consumption among adolescents in rural Wardha: Where and how tobacco control should focus its attention? Indian J Cancer 28;45: Agarwal V, Khatri M, Singh G, Gupta G, Marya CM, Kumar V. Prevalence of periodontal diseases in India. J Oral Health Community Dent 21;4: Lal S, Paul D, Pankaj D, Vikas D, Vashisht B. National oral health care programme (NOHCP) implementation strategies. Indian J Community Med 24;29: Jacob PS. Periodontitis in India and Bangladesh. Need for a population based approach in epidemiological surveys. A literature review. Bangladesh J Med Sci 21;9: Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: Exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health 27;7: Goel P, Singh K, Kaur A, Verma M. Oral healthcare for elderly: Identifying the needs and feasible strategies for service provision. Indian J Dent Res 26;17: