Provisioning Oral Health and Hygiene Services to Rural Indian Populations – ICTPH’s Integrative Primary Health-care Delivery Model

By Arun Jithendra, Research Analyst – ICTPH

Oral health has been one of the neglected areas of public health with dentists primarily involved in treating oral complaints with no specific focus on preventive aspects of oral health. A National Oral Health Survey conducted by Dental Council of India in 2002-03 puts the percentage of people having experienced caries at least once in lifetime at 84.7% in the age group of 65-74 years and the Mean DMFT (Decayed, Missing, Filled Teeth) at 14.6 for the same age group. The same study points that periodontal disease (or) Gum disease is another major Oral health concern with 89.2% having Bleeding, Calculus or Pockets in the productive age group of 35-44 years. When left untreated these lead to a condition called Edentulouslness which is absence of any tooth. The study puts at 29.3% the percentage of people toothless in the age group of 65-74 years. The problem is more acute since the dentist to population ratio in India is 1:3000 (Shobha Tandon 2004).More over the problem is exacerbated by skewed presence of dentists in urban pockets. The dentist to population ratio in India in 2004 was 1:10,000 in urban areas and 1:250,000 in rural areas (Sateesh Elangovan et al 2010). More over the pricing of dental services has put it way beyond the reach of common man with dentists pointing to the capital intensive nature of the practice as the reason. A survey conducted by us in our geography revealed highly fluctuating pricing of services not just between dentists but with an individual dentist who himself sets the prices which differe from patient to patient with no standardization. These reasons are a great barrier in accessing even the available dental services.

With this background, ICTPH designed the first of its kind primary health-care integrated oral health intervention encompassing both curative and preventive aspects of Oral Health in our rural geographies. The intervention in order to be more effective was designed two pronged with one aspect being a Clinic based service delivery at our RMHC’s and other being a Community based model. The initial literature review helped us understand the pressing issues which required immediate attention. Accordingly, commonly occurring Oral health conditions (Dental Caries, Gingivitis, Aphthous ulcer, Leukoplakia, Lichen planus, Oral sub-mucous fibrosis, Oral Candidiasis, Herpetic infections, Fluorosis, Angular chelitis, Glossitis) were identified and based on resource availability, training capacity, training period, infrastructure the implementation of the intervention was divided into 2 phases. Depending on the training requirements the diseases were divided into 4 different grades with Grade I requiring 2 days of training, Grade II requiring 4 days of training, Grade III requiring 1 week of training and Grade IV requiring 2 weeks of training. The intervention was designed in such a way that it encouraged people to get treated during early stages of the disease avoiding complex treatment protocols. The most instrumental innovation, was integrating the capital intensive dental equipment requirements in to our standardized service delivery model. This led to a unique design of our dental set up by our infrastructure team. With regard to treatment of dental caries we have adapted the WHO recommended ART (Atraumatic Restorative Treatment) procedure which treats for Dental caries by preserving tooth cavity using manual equipments without much damage to the tooth cavity. We at ICTPH strongly believe that the clinic based intervention promoting early treatment coupled with community based intervention promoting prevention would in the long run ensure better Oral health status of the community in our geographies.

For the detailed ICTPH Dental Health Intervention Proposal click here

References:

Dr.Bail.R.K, Chanana, Dr.Mathur V.B, Prof.Talwar, National Oral Health Survey and Fluoride Mapping 2002-03, Dental Council of India, 2004

Mahatma Gandhi Post Graduate Institute of Dental Sciences, Atraumatic Restorative Treatment to the rural population, GOI-WHO collaborative programme, 2006-07

Poul Erik Peterson, Continuous improvement of Oral Health in 21 st century-the approach of WHO Global Oral Health Programme, World Oral Health Report, 2003

Sateesh Elangovan, Veerasathpurush Allareddy, Fiza singh, Priyank Taneja, Nadeem Karimbux et.al. Indian Dental Education in New Millenium: Challenges and Opportunities. Journal Of Dental Education 2010;74 (9 Suppl): 1011-1016.

Shobha Tandon.Challenges to Oral Health Workforce in India.Journal Of Dental Education 2004; 68 (7 Suppl): 28-33.

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