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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 58-62

Perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services at peripheral medical centre: Poonjeri, Mamallapuram, India


1 Department of Public Health Dentistry, Asan Memorial Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Public Health Dentistry, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India

Date of Web Publication11-Jan-2018

Correspondence Address:
Prabhu Subramani
No. 1, Big Street, Tirukazhukundram, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_60_17

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  Abstract 

Introduction: Dental care utilization is limited, and teeth are often left untreated or extracted in India. Several barriers exist for the utilization of dental services. The present study was undertaken to assess the oral healthcare needs, utilization pattern of oral healthcare services, and barriers to utilization of oral healthcare services among the outpatients of Peripheral Medical Centre, Poonjeri, Mamallapuram, India. Materials and Methods: Simple random sampling was conducted among outpatients and their attenders reporting to the health centre; demographic profile of the patients were recorded followed by interviewer-administered questionnaire for recording the self-perceived dental needs and barriers in utilizing dental care services followed by Type II clinical examination to assess normative dental treatment needs. Results: N =282 study participants participated in the present study; majority of the study participants were from upper lower class and lower middle class. Among the study subjects n = 124 (44%) have not accessed any dentist, n = 112 (39.7%) had visited dentist for toothache. Common reason cited as Self – perceived barriers for dental care are n = 184 (65.2%) – 'Unaware of the dental problems' and n = 118 (41.8%) 'Fear of dental treatment'. Logistic regression showed that significant difference was seen in gender, socioeconomic status, and barriers to dental care (P < 0.05) in influencing the utilization pattern of dental care. Conclusion: Perceived and normative dental needs were high among the study population due to problem-oriented care, and it is influenced by various barriers such as unawareness of dental problems, fear, cost, accessibility, and time.

Keywords: Barriers, dental care, utilization and needs


How to cite this article:
Subramani P, Nagappan N. Perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services at peripheral medical centre: Poonjeri, Mamallapuram, India. J Dent Res Rev 2017;4:58-62

How to cite this URL:
Subramani P, Nagappan N. Perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services at peripheral medical centre: Poonjeri, Mamallapuram, India. J Dent Res Rev [serial online] 2017 [cited 2018 Apr 25];4:58-62. Available from: http://www.jdrr.org/text.asp?2017/4/3/58/223054


  Introduction Top


Oral health is an integral part of general health.[1] Epidemiological studies have shown high prevalence of dental diseases such as dental caries, periodontitis, and oral cancer is growing in many low- and middle-income countries.[2] Use of dental services is more discretionary than use of either physician or hospital services because oral conditions are not life-threatening.[3] Dental service use can be defined by the following parameters: (1) annual number of dental visits per person, (2) proportion of persons visiting a dentist within a year, (3) reported first dental visit within a series of visits, (4) lack of dental visits within a specific period of time, (5) aggregated expenditures for dental visits, and (6) routine versus emergency care.[4] Preventive dental visits help in the early detection and treatment of oral diseases. However, the provision of preventive dental care for adults depends on each patient's initiatives in utilizing dental care.[5]

In many developing countries, dental care utilization is limited, and teeth are often left untreated or extracted.[6] Although dentists recommend regular dental visits, many people fail to comply with this due to several barriers that exist for the utilization of dental services. The barriers for seeking dental services have been classified by the FDI as related to the following: (a) individuals themselves (such as the lack of perceived need, anxiety or fear, financial considerations, and lack of access), (b) dental profession (inappropriate workforce resources, uneven geographical distribution, training inappropriate to changing needs and demands and insufficient sensitivity to patient's attitudes and needs), and (c) society (insufficient public support of attitudes conducive to health, inadequate healthcare facilities, inadequate oral health workforce planning, and insufficient support for research).[7]

Poonjeri village is located in the vicinity of UNESCO World Heritage Centre, Mamallapuram yet the dental care services are very meager. Considering the need for improvement in oral health among the inhabitants of the village, the present study was undertaken to assess the oral healthcare needs, utilization pattern of oral healthcare services, and barriers to utilization of oral healthcare services among the outpatients reporting to Peripheral Medical Centre, Poonjeri, Mamallapuram, India.


  Materials and Methods Top


A cross-sectional descriptive study employing simple random sampling was conducted among the outpatients reporting to Peripheral Medical Centre located at Poonjeri, Mamallapuram. The population of the village as per 2011 census is 2586, the village has 687 houses, sample size was calculated using OpenEpi statistical software,[8] sample size for the study is n = 217, based on the prevalence of dental problems in the study conducted by Bommireddy et al.[1] Residents of the village who are aged between 18 and 70 years and willing to participate in the present study were included. Residents who are having severe medical problems and who could not co-operate for oral examination were excluded.

Before the start of the study, approval is obtained from Chettinad Dental College and Research Institute and approval from the village president is obtained. Survey instrument consists of interviewer-administered questionnaire to assess sociodemographic data, perceived oral healthcare needs, utilization of dental care services, and barriers to utilization of dental care services followed by clinical examination to assess the normative oral healthcare needs among the study population.

Type II oral examination is performed by the team of three examiners who were calibrated before field survey in the Department of Public Health Dentistry, Chettinad Dental College and Research Institute. Interexaminer reliability was determined using Kappa Statistics (κ – 0.87).

Statistical analysis was performed with SPSS version 21; descriptive data are recorded. Logistic regression analysis was used to assess the factors assessing utilization of dental care services among the study population.


  Results Top


A cross-sectional descriptive study employing simple random sampling was conducted among the outpatients and their attenders reporting to Rural Health Centre of Chettinad Dental College and Research Institute located at Poonjeri, Mamallapuram.

[Figure 1] depicts the distribution of study participants according to gender; among n = 282 study participants, n = 128 (45.4%) were males and n = 154 (54.6%) were females.
Figure 1: Distribution of study participants according to gender

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[Figure 2] depicts the distribution of study participants according to their socioeconomic status; among n = 282 study participants, n = 16 (5.7%) were from upper class, n = 38 (13.5) were from upper middle class, n = 68 (24.1%) were from lower middle class, n = 140 (49.6%) were from upper lower class, and n = 20 (7.1%) were from lower class. Majority of the study participants were from upper lower class and lower middle class, respectively. Among the study participants, n = 158 (56%) had history of dental visit and n = 124 (44%) have not accessed any dentist.
Figure 2: Distribution of study participants according to socioeconomic status

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[Figure 3] depicts the cause for the previous dental visit; among the study participants, n = 112 (39.7%) of the study participants had visited dentist for toothache followed by n = 30 (10.6%) of the study participants visited dentist for cavities in their teeth, none of them had visited a dentist for malposed teeth.
Figure 3: Distribution of study participants according to reason for previous dental visit

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[Figure 4] depicts the treatment undergone by the study participants during their previous dental visit, n = 88 (31.2%) of the study participants had undergone extraction of teeth, followed by n = 32 (11.34%) participants had undergone restoration and endodontic treatment and n = 34 (12%) study participants had undergone scaling and complex periodontal treatment.
Figure 4: Distribution of study participants according to history of dental treatment

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[Figure 5] depicts the barriers perceived by the study participants to receive dental care; n = 184 (65.2%) of the study participants were unaware of the dental problems followed by n = 118 (41.8%) of the participants had fear of dental treatment were perceived to be a common barrier to receive dental care among the population studied.
Figure 5: Distribution of study participants according to self-perceived barriers in receiving dental care

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[Figure 6] depicts the self-perceived dental treatment needs among the study population, n = 143 (50.7%) study participants required treatment for their toothache followed by cavities n = 50 (17.7%), bad breath/bleeding gums/stains n = 46 (16.3%), tooth hypersensitivity n = 42 (14.8%), and replacement of teeth n = 36 (12.7%), respectively.
Figure 6: Self-perceived dental treatment needs among the study participants

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[Figure 7] depicts the normative dental treatment needs among the study population, n = 228 (80.9%) study participants need scaling and complex periodontal treatment, n = 172 (61%) study participants require prosthesis, n = 154 (54.6%) participants require restoration or endodontic treatment of their teeth, n = 130 (46.1%) participants require extraction of teeth, n = 6 (2.1%) participants required orthodontic treatment, and only n = 2 (0.7%) participants required no dental treatment.
Figure 7: Normative dental treatment needs among the study participants

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[Table 1] depicts the influence of various factors on utilization of dental care services; among the study participants, significant difference was seen in gender, socioeconomic status, and barriers to dental care (P < 0.05).
Table 1: Factors influencing utilization of dental care services among the study participants

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  Discussion Top


Utilization is not just the willingness of people to seek care but the actual attendance at the site of delivery of healthcare services to receive care.[1] The present study was conducted among outpatients and their attendees reporting to peripheral medical centre located at Poonjeri, Mamallapuram, to assess their perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services.

Upper lower socioeconomic status of the people constituted the major portion of the study population (49.6%) similar to the study conducted by Bommireddy et al.[1] Upper lower class refers to “the group which needs to become the objective of major educational efforts regarding dental care and this is primarily because they are most accessible to these attempts and offer the best possibilities of behavioral and attitudinal changes.” Attitude of people from upper lower socioeconomic status was characterized by limited education; skilled or semiskilled laborers prefer to get treated from a hospital than from an individual practitioner.[9]

In the present study, n = 124 (44%) of the study participants had no history of dental visit; this status is attributed to the negligence in oral healthcare; there is no large scale community based dental health education programmes and people tend to visit dental setup only in cases of emergencies and not for preventive dental care needs.[10] Patients with history of dental visit had mainly visited them for toothache (39.7%) similar to the studies conducted by Cohen et al.[11] and Al-Shammari et al.[5] Dental pain adversely affects the quality of life, normal functioning, and daily living of people, and most dental visits are aimed at immediate relief of pain.

Patients often present them to the dentist when overt symptoms such as pain appear, rather than earlier, i.e. a problem-oriented visit rather than a prevention-oriented care, and the most common dental treatment undergone during previous dental visit was tooth extraction; among n = 88 (31.2%) the study participants, the results are in par with the study conducted by Devaraj and Eswar.[12]

Dental attendance pattern among the people who visited the dentist also showed that the people do not believe in regular dental visits and their attitude toward prevention of dental diseases is low and dental care is perceived to be useful only when there is a need but not as an integral part of general health and well-being. However, the least cited reason for avoiding dental care among the study population was “Don't think dental treatment is important;” the results are in contrast to the study conducted by Devaraj and Eswar.[11]

Most frequently cited reason for avoiding dental visit was “Unawareness regarding dental problems,” the results are in accordance to the study conducted by Poudyal et al.[8] This finding shows that inability of the study population to recognize the need for dental treatment in one's self acts as a barrier to utilization of dental services. People seek healthcare services only when they believe that they need health professional assistance otherwise the condition will be worsened.[13]

“Fear of dental treatment” is presumed to be a huge barrier to undergo dental treatment as the study participants were mostly “Unaware of the dental problems,” the results of the present study was comparatively higher than the studies conducted by Brukiene et al.[14] and Quteish Taani;[15] the difference is attributed to availability of essential dental healthcare services to general population in those countries.

“Lack of time” and “Inaccessibility to dental care” are considerate barriers among the study population as most of the study participants were daily wages, visit to the dentist might lose them a whole or part of their earnings for the day leading to low dental attendance among the study population, and the results are similar to the studies conducted by Jaafar et al.[16] and Devaraj and Eswar.[11]

“Toothache” was the most common self-perceived dental treatment need among the study population which would have been a primary motive to avail dental care by the study population; however, due to the self-perceived barriers stated above, only few of the study participants with toothache (27%) utilized dental care; others waited for the symptom to subside on its own or home remedies such as placing cloves or taken over-the-counter medications to get relieved of pain; the results are similar to the study conducted by Bommireddy et al.[1]

“Normative” dental needs among the study population showed that the periodontal health status of the study population is worse and 80.9% of the study participants needed periodontal intervention, similar to the study conducted by Sekhon et al.[17] among rural adult population in Karnataka, India. Addressing toothache was the most common self-perceived dental treatment need among the study population and 54.6% of the study participants required restoration or endodontic treatment and 46% of the study participants required extraction of teeth, similar to the study conducted by Singh et al.[18] in Bhopal, India.

The present study was a hospital-based study; hence, the samples included patients with dental or general health problems and their attenders; the results of the study can be generalized only to that limited geographic area. Further studies are required to relate the relationship between oral health knowledge, attitude, practices, and their impact on dental health needs among the study population.

Regression analysis showed that “Utilization of dental care” is influenced by the self-perceived barriers among the study population and the cause of previous dental treatment which was “Unawareness of the dental problem,” “Fear of dental Treatment,” and “Tooth Ache,” respectively. To promote oral health of the study population and improve dental attendance pattern which was “problem-oriented,” appropriate education measures should be taken with emphasis on the importance of regular dental care, discuss barriers in dental care, and promote attitudinal changes toward positive health-seeking behavior.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bommireddy VS, Pachava S, Ravoori S, Sanikommu S, Talluri D, Vinnakota NR, et al. Socio-economic status, needs, and utilization of dental services among rural adults in a primary health center area in Southern India. J Int Oral Health 2014;6:56-60.  Back to cited text no. 1
    
2.
Petersen PE. Global policy for improvement of oral health in the 21st century – Implications to oral health research of World Health Assembly 2007, World Health Organization. Community Dent Oral Epidemiol 2009;37:1-8.  Back to cited text no. 2
    
3.
Schuurs AH, Duivenvoorden HJ, Thoden van Velzen SK, Verhage F. Differentiating regular from irregular dental attenders of either sex by linear discriminant analysis. Community Dent Oral Epidemiol 1983;11:43-9.  Back to cited text no. 3
    
4.
Holm-Pedersen P, Vigild M, Nitschke I, Berkey DB. Dental care for aging populations in Denmark, Sweden, Norway, United Kingdom, and Germany. J Dent Educ 2005;69:987-97.  Back to cited text no. 4
    
5.
Al-Shammari KF, Al-Ansari JM, Al-Khabbaz AK, Honkala S. Barriers to seeking preventive dental care by Kuwaiti adults. Med Princ Pract 2007;16:413-9.  Back to cited text no. 5
    
6.
Poudyal S, Rao A, Shenoy R, Priya H. Utilization of dental services in a field practice area in Mangalore, Karnataka. Indian J Community Med 2010;35:424-5.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Cohen LK. Converting unmet need for care to effective demand. Int Dent J 1987;37:114-6.  Back to cited text no. 7
    
8.
Sample Size Estimation Using OpenEpi Statistical Software. Available from: http://www.openepi.com/SampleSize/SSPropor.htm. [Last accessed on 2017 May 10].  Back to cited text no. 8
    
9.
Peter S. Essentials of Public Health Dentistry. 5th ed. New Delhi: Arya Medi Publishing House Pvt. Ltd.; 2015. p. 182-3.  Back to cited text no. 9
    
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Arora SA, Jayna A, Sharma A, Atri M. Socio-demographic factors influencing preventive dental behaviours in an adult dentate population: A questionnaire based survey. Indian J Dent Adv 2011;3:483-91.  Back to cited text no. 10
    
11.
Cohen LA, Bonito AJ, Eicheldinger C, Manski RJ, Macek MD, Edwards RR, et al. Behavioral and socioeconomic correlates of dental problem experience and patterns of health care-seeking. J Am Dent Assoc 2011;142:137-49.  Back to cited text no. 11
    
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Devaraj C, Eswar P. Reasons for use and non-use of dental services among people visiting a dental college hospital in India: A descriptive cross-sectional study. Eur J Dent 2012;6:422-7.  Back to cited text no. 12
    
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Kiyak HA, Reichmuth M. Barriers to and enablers of older adults' use of dental services. J Dent Educ 2005;69:975-86.  Back to cited text no. 13
    
14.
Brukiene V, Aleksejuniene J, Balciuniene I. Is dental treatment experience related to dental anxiety? A cross-sectional study in Lithuanian adolescents. Stomatologija 2006;8:108-15.  Back to cited text no. 14
    
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Quteish Taani DS. Dental anxiety and regularity of dental attendance in younger adults. J Oral Rehabil 2002;29:604-8.  Back to cited text no. 15
    
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Jaafar N, Jalalluddin RL, Razak IA, Esa R. Investigation of delay in utilization of government dental services in Malaysia. Community Dent Oral Epidemiol 1992;20:144-7.  Back to cited text no. 16
    
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Sekhon TS, Grewal S, Gambhir RS. Periodontal health status and treatment needs of the rural population of India: A cross-sectional study. J Nat Sci Biol Med 2015;6:111-5.  Back to cited text no. 17
    
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Singh A, Bhambal A, Saxena S, Tiwari V, Tiwari U. Assessment of dentition status and treatment needs of police personnel in Bhopal city, Central India. Int J Med Sci Public Health 2015;4:829-34.  Back to cited text no. 18
    


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