tps oral health final
DESCRIPTION
Final TPS Oral Health Team Presentation on July 21, 2011 in Chennai on the Concluding Day of the Trans Disciplinary Problem Solving Course: co-taught by Washington University in St. Louis and ICTPH.TRANSCRIPT
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
vale
nce o
f P
eriodto
nalD
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
Allison MaukBA, MPH Candidate
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.
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Delhi, India. Retrieved from: http://www.whoindia.org/LinkFiles/Commision_on_Macroeconomic_and_Health_Bg_P2_Oral_and_dental_diseases.pdf
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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,
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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.