tps oral health final

Oral Health:

Addressing Dental Diseases in Rural India

Shawn Lin & Allison Mauk

Overview

Burden of Disease

Determinants

Intervention Strategies

Implementation

Evaluation Plan

Burden of Disease

Dental Caries

Most common non-communicable disease in the

world1

Slight increase in prevalence in Tamil Nadu

• 47.8% (1973)2 → 49.8% (2004)3

• Higher prevalence in rural areas3

• One survey in rural TN found a prevalence of

70.2% in 6 year-olds4

0

10

20

30

40

50

60

70

80

90

100

5 12 15 35-44 65-74

Pre

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f P

eriodto

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ise

ase (

%)

Age (years)

Prevalence of Periodontal Disease in ThanjavurRegion, 20033

Burden

Personal: impact on Quality of Life

• Difficulty eating5

• Severe dental disease acts as focus of infection for other organs

(kidneys, heart, brain)3

Population

• 1,247,000 DALYs in 1998 in India6

Health System

• Lack of infrastructure → difficult to assess

• Inflammation a risk factor as well7

• Significant risk factor for several systemic diseases

• The birth of pre-term low-birth weight babies, coronary artery

diseases, and diabetes mellitus7

Determinants

• Significant risk factor for periodontal disease and caries8,9,10

• Tamil Nadu: 10% of adults report using tobacco regularly3

Substance Use

• Expanding economy → greater access and higher preference of junk foods11

• Change in dietary patterns influences oral health

Diet & Nutrition

• Tamil Nadu: 40% reported using fluoride toothpaste or fluoridated tooth powder3

Fluoride Exposure

• Dentist to Population Ratio12:

• Urban 1:10,000

• Rural 1:250,000

• 72.2% of population lives in rural areas4

Access to Care

• In Tamil Nadu:

• 57% report using a toothbrush3

• 3.9% report brushing twice per day3

Knowledge & Behavior

Intervention Strategies

•School-based oral health promotion programPrimary

•Establish comprehensive oral health screeningSecondary

• Increase access to oral health careTertiary

Implementation

Primary Prevention Strategy:

School-based oral health promotion program

Activities:

• Administer fluoride rinse in schools

• Screen oral health education video on school TVs

Secondary Prevention Strategy:

Establish comprehensive oral health screening

Activities:

• Train CHWs and RMHC staff in oral screening and education

• Develop & validate non-invasive oral health screening

instrument

• Integrate non-invasive oral screening instrument to PISP, RRA,

and Patient Visit Protocol

• Implement Oral Health Screening Protocol

• Perform oral health screening at schools

• Add oral health education to Patient Visit Protocol

Secondary Prevention Strategy:

Establish comprehensive oral health screening

Activities:

• Train CHWs and RMHC staff in oral screening and education

• Develop & validate non-invasive oral health screening

instrument

• Integrate non-invasive oral screening instrument to PISP, RRA,

and Patient Visit Protocol

• Implement Oral Health Screening Protocol

• Perform oral health screening at schools

• Add oral health education to Patient Visit Protocol

Tertiary Prevention Strategy:

Increase access to care

Activities:

• Install dental equipment in the RMHC

• Establish rotation of visiting dentists to staff bi-weekly dental

clinic in RMHC

Evaluation

Formative Evaluation

Validity of non-invasive oral health screening

instrument

Pretest: comprehension

Validity: sensitivity & specificity

Process Evaluation

Primary Prevention Objectives:

• Schoolchildren received 7 fluoride rinses per semester

• Schoolchildren viewed video twice per semester

Secondary Prevention Objectives:

• Majority of population screened for oral health

• Increased visits to RMHC for follow-up comprehensive

screening

Tertiary Prevention Objectives:

• Increased visits to RMHC for dental issues

Impact Evaluation

Objectives

• Reduction in the incidence of dental caries and periodontal

disease in schoolchildren

• Improved oral hygiene behavior and practices

• Increased oral hygiene knowledge

• Decreased prevalence of dental caries and periodontal disease

Goal

Reduction in the prevalence and

incidence of dental caries and

periodontal disease in Rural India

Acknowledgements

ICTPH Staff

Arun Jithendra

SughaVazhvu Staff

Fellow TPS Students

Contact Information

Shawn LinBA, MSW/MPH Candidate

shawn.lin@wustl.edu

Allison MaukBA, MPH Candidate

mauk@wustl.edu

George Warren Brown School of Social Work

Washington University in St. Louis

One Brookings Drive

Saint Louis, MO 63130

Thank you

References1Beaglehole, R., Benzian, H., Crail, J., & Mackay, J. (2009). The oral health atlas. FDI World Dental Federation. Retrieved from:

http://www.oralhealthatlas.org/uniflip/index.html

2Ramachandran, K., Rajan, B.P., & Shanmugam, S. (1973). Epidemiological studies of dental disorders in Tamil Nadu populations. Journal of the Indian Dental

Association, 45(4), 65-70.

3Bali, R.K., Aswath Narayanan, M.B., Mathur, V.B., Talwar, P.P., & Chanana, H.B. (2004). National oral health survey & fluoride mapping, 2002-2003, Tamil Nadu. Dental

Council of India.

4Saravanan, S., Kalyani, V., Vijayarani, M.P., Jayajodi, P., Felix, J.W.A., Arunmozhi, P., … Sampath Kumar, P. (2008). Caries prevalence and treatment needs of rural

school children in Chidambaram Taluk, Tamil Nadu, South India. Indian Journal of Dental Research, 19(3), 186-190.

5Shah, N. (2005). Oral and dental diseases: causes, prevention and treatment strategies. In NMCH Background Papers – Burden of Disease in India (p.275-298). New

Delhi, India. Retrieved from: http://www.whoindia.org/LinkFiles/Commision_on_Macroeconomic_and_Health_Bg_P2_Oral_and_dental_diseases.pdf

6Peters, D., Yazbeck, A., Ramana, G., Sharma, R., Pritchett, L., & Wagstaff, A. (2001). Raising the sights: Better health systems for India’s poor. Washington, DC: The

World Bank.

7Agarwal, V., Khatri, M., Singh, G., Gupta, G., Marya, C., & Kumar, V. (2010). Prevalence of periodontal diseases in India. Journal of Oral Health & Community Dentistry,

4, 7-16.

8Winn, D.M. (2001). Tobacco use and oral disease. Journal of Dental Education, 65(4), 306-312. Retrieved from: http://www.jdentaled.org

9Tomar, S.L., & Winn, D.M. (1999). Chewing tobacco and dental caries among U.S. men. The Journal of the American Dental Association, 130(11), 1601-1610.

Retrieved from: http://www.jada.ada.org

10Tomar, S.L., & Asma, S. (2000). Smoking-attributable periodontal disease in the United States: findings from the NHANES III. Journal of Periodontology, 71(5), 743-

751.

11Goldman, A.S., Yee, R., Holmgren, C.J., & Benzian, H. (2008). Global affordability of fluoride toothpaste. Globalization and Health, 4(7), 1-8.

doi: 10.1186/1744-8603-4-7

12Tandon, S. (2004). Challenges to the oral health workforce in India. Journal of Dental Education, 68(7 Supplement), 28-33.