|Year : 2017 | Volume
| Issue : 3 | Page : 63-66
Dental care utilization pattern and barriers encountered toward seeking oral health care services among the residents of Nimbut Village, Maharashtra, India
Saurabh P Kakade1, Sahana Hegde-Shetiya2, Ravi V Shirahatti2, Deepti Agrawal2, Amit Mahuli2, Simpy Mittal-Mahuli2
1 Department of Public Health Dentistry, Bharti Vidyapeeth Dental College, Pune, Maharashtra, India
2 Department of Public Health Dentistry, Dr D Y Patil Vidyapeeth, Dental College and Hospital, Pune, Maharashtra, India
|Date of Web Publication||11-Jan-2018|
Saurabh P Kakade
Department of Public Health Dentistry, Bharti Vidyapeeth Dental College, Pune, Maharashtra, Pune - 411 018, Maharashtra
Source of Support: None, Conflict of Interest: None
Objectives: The objectives of the present study have been conducted to evaluate the dental care utilization pattern and barriers encountered toward seeking oral healthcare services. Materials and Methods: A community-based cross-sectional study was conducted using a structured interview using the investigator's guide to assess felt needs, utilization, and barriers. Using systematic random sampling technique recruitment of 625 (125 participants per ward of each WHO age group) was done. Results: It was observed that only 52.8% had ever been to a dentist in the past 1 year, and maximum visits were by 65–74-year-olds. The oral healthcare need was majorly met by visiting a private dental practitioner (27.4%) and through outreach programs (23.8%). About 43.5% of participants responded that receiving of oral healthcare was “important only when in pain.” About 66.9% participants felt “cost” was the main barrier restricting them to visit dentist. About 17.11% participants felt that having oral healthcare facility in primary health centers would have helped them. Conclusions: There is an urgent need to increase awareness and utilization of oral healthcare services through mass education and preventive programs.
Keywords: Health services, India, needs and demand, oral health
|How to cite this article:|
Kakade SP, Hegde-Shetiya S, Shirahatti RV, Agrawal D, Mahuli A, Mittal-Mahuli S. Dental care utilization pattern and barriers encountered toward seeking oral health care services among the residents of Nimbut Village, Maharashtra, India. J Dent Res Rev 2017;4:63-6
|How to cite this URL:|
Kakade SP, Hegde-Shetiya S, Shirahatti RV, Agrawal D, Mahuli A, Mittal-Mahuli S. Dental care utilization pattern and barriers encountered toward seeking oral health care services among the residents of Nimbut Village, Maharashtra, India. J Dent Res Rev [serial online] 2017 [cited 2018 Apr 25];4:63-6. Available from: http://www.jdrr.org/text.asp?2017/4/3/63/223055
| Introduction|| |
A wide spectrum of oral health services exists in many urban and very few rural areas in India. These services range from rudimentary and sporadic in rural areas to sophisticated and state-of-the-art in the urban areas. Basic priorities, felt needs, and demands of rural people far largely differ from the urban Indian population.
Translating a dental felt need into demand is governed by factors such as accessibility, utilization, and barriers toward seeking oral healthcare services. Every individual dreams of well-being and a healthy life. Healthy individuals are the most precious assets any country can have. Health is the privilege every citizen should enjoy whether rich or poor. However, the poor in developing countries are less likely than the rich to receive effective healthcare. With regard the poor, accessibility to care can be determined by a “supply side” and a “demand side”. “Supply side” where good quality and effective healthcare may not be offered and even if it is offered the purchasing power may be inadequate, while on a “demand side,” individuals may not utilize services from which they could benefit because of their barriers to seek care. Solving the access problem requires tackling both demand and supply-side issues. Maldistribution of oral healthcare personnel has led to an inability to cope with increasing levels of oral diseases and demands for treatment.
Nimbut is a small village with population of 5670 (as per 2001 census) on the bank of river Nira, in Baramati taluka of Maharashtra. It has only one subcenter with no dentists posted in it. There are no dental clinics in the village to provide oral healthcare; however, sporadically, in the recent years, oral checkup camps have been organized in this place. The nearest private dental clinics for the villagers are 5 km away. In an attempt to obtain baseline oral health data of the villagers of Nimbut, the present study has been conducted to evaluate the dental care utilization pattern and barriers encountered toward seeking oral healthcare services.
| Materials and Methods|| |
A community-based cross-sectional survey was conducted. Before commencing the study, scientific and ethical approval was taken from the Institutional Ethics 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. Twenty-five individuals from each age/age group (5, 12, 15, 35–44, and 65–74 years) were selected using stratified cluster sampling from each of the five wards yielding a total sample of 625 (125 participants per ward). Using systematic random sampling technique, every 5th house was considered for recruitment of the participants.
Before beginning the study, informed consent was obtained from participants. The intent of the study was explained in local language (Marathi) to the participants. All the individuals fulfilling the inclusion criteria, such as permanent resident of Nimbut village, falling in the WHO age/age group, who were cooperative and were willing to participate in this study were included.
Data collection was done by an interview using the structured validated set of questions to assess utilization pattern and barriers encountered toward seeking oral healthcare services.
The investigator's guide contained questions on demographic details and personal habits. There were two questions on dental care utilization and seven questions on barriers. All questions were close-ended. Frequency and percentage distribution of participants' responses were calculated based on responses obtained using Microsoft office excel 2007.
| Results|| |
The participants majorly comprised of children (60%) in 5, 12, and 15 years. The adult population was mainly housewives (14.24%), farmers (11.84%), laborers (7%), and 13.92% others.
Oral hygiene practices
All the participants had a habit of cleaning their teeth, however, practicing it only once daily. About 84.48% use toothbrush and toothpaste on daily basis to clean and maintain their oral hygiene. The use of toothbrush and toothpaste was more common among children (5, 12, 15 years) while adults preferred to use finger. In addition, use of herbal stick was also prevalent. “Mishri,” a form of smokeless tobacco generally used to clean the teeth, was being used very frequently (4–5 times) on daily basis by the women.
High use of smokeless tobacco (20.96%) was noticed in the age-groups 35–44 years and 65–74 years as compared to smoking form (5.44%). The popular type of chew tobacco (smokeless), especially in men was “gutka” and “pan masala.” Nearly 10.4% of the participants had habit of drinking alcohol.
It was observed that only 52.8% had ever been to a dentist in the past 1 year, and maximum visits were by 65–74 year-olds and minimum by the 5-year-old. The oral healthcare need was majorly met by visiting a private dental practitioner (27.4%) and through outreach programs (23.8%). About 43.5% participants responded that receiving oral healthcare was “important only when in pain” and about 42.7% participants responded that oral health care was “somewhat important” to them. The reasons for visiting a dentist are given in [Figure 1].
|Figure 1: Distribution of total participants based on the utilization of dental services|
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Almost all the participants (96.5%) were aware of the nearest dental clinic, and 89% respondents said that the dental clinic was accessible. About 59.7% participants responded that they would seek oral healthcare if provided to them free of cost. Two hundred and five participants visited the dental clinic and from those who were referred for advance treatment, only 18.63% had gone to get the treatment done. At the dental clinic, about 67%, 47.31%, and 45.85% participants were provided primary oral care in the form of “scaling,” “restorations,” and “extraction,” respectively.
About 56.42% participants had felt “good” on visiting the dentist and 47.85% responded that their chief complaint was taken care of on undergoing the treatment. About 56.42% participants recommended that the treatment cost in private clinics should be less and about 24.9% participants recommended having oral healthcare facility in the primary health centers.
Barriers to seek care
Following are the reasons for not seeking oral healthcare [Figure 2]. “Cost of treatment” and “fear” were the two major reasons reported by 368 participants who did not seek the oral treatment. While other reasons that constrained participants from seeking oral healthcare were “no time for oral healthcare needs,” “home remedies,” beliefs, “wastage of time at the dental office,” and “did not feel like.”
|Figure 2: Distribution of total participants based on the barriers restricting visit to a dentist|
Click here to view
| Discussion|| |
The major concern in this study was to investigate the utilization patterns and barriers to seek oral care which actually would reflect the attitude and practices of the villagers.
The use of indigenous method of oral hygiene was prevalent among the adult population of the village. It can be said that the person's religion might influence their oral hygiene and personal habits and practices. In addition, the use of herbal stick, neem stick, and datun is more likely among the elderly, in rural areas of India,, while affordability of toothpaste and toothbrush in rural parts of India is questionable.
The use of smokeless form of tobacco was highest in the age groups 35–44 and 65–74 years as compared to smoke form of tobacco. This practice peculiar to rural India has been reported earlier.,, In addition, use of mishri as a dentifrice is also prevalent in several parts of rural India, especially in Maharashtra, and the same has been noticed in other study.
It is evident from the observations of this study that oral healthcare-seeking behavior was very poor. The visit to the dentist was seen mostly among elderly (65–74 year olds) and minimum visits seen by 5-year-old which is very less as compared to the study conducted by Punitha and Sivaprakasam. There is lack of oral health awareness, which affects oral health perception, behavior, and practices among all age groups. The participants showed more interest in dental treatment than the preventive services. However, in this study, the dental attendance was far better than in the study by Kakatkar et al. conducted in Udaipur. This may be due to the fact that the older age group had more number of missing teeth component which may lead to problems in chewing food. It was also found that in the very young age group “fear” and “cost” barred them from visiting a dentist.
The study results point to the need to create awareness regarding good oral health and utilization of oral health services.,,, Scarce resources have been the main barrier in developing countries like India to start with preventive public oral health services. Second, the dentists tend to practice curative treatment than the preventive regimen. Dentists have to be posted at primary health centers and subcenters in India and initiate the practice of primary preventive services.
To improve the regular dental attendance, the barriers have to be controlled by appropriate education and intervention. The results support the idea that to motivate people successfully, one not only has to give them information but also has to coordinate with village panchayat, the village health guides, and the local nongovernmental organization, in dealing with various reasons of the people which restrict their behavior and performance toward improving their oral health.
| Conclusions|| |
The present study was undertaken to analyze utilization and barriers to oral healthcare services. There appears to be lack of knowledge in relation to oral health awareness, which reflects in dental visits, perception, behavior, and practices of oral health. Oral health program planning and intensive measures for implementation are like a dream of India being a “super power” by 2020. To conclude, the study emphasizes on the attempt needed from all sections of bodies controlling orodental issues and policies in India; be it, the legislative, administrative, or the judiciary. There lies an urge to increase awareness and utilization of oral healthcare services through mass education and preventive programs. However, it is totally unrealistic as economically India spends hardly on health and oral health is far behind in the mindset of program planners.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bali RK, Damle SG, Maglikar SD, Yethwar RR, Mathur VB, Talwar PP, et al
. National Oral Health Survey & Fluoride Mapping 2002-2003, Maharashtra, Dental Council Of India, New Delhi; 2004.
Roberts-Thomson KF, Stewart JF. Access to dental care by young South Australian adults. Aust Dent J 2003;48:169-74.
O'Donnell O. Access to health care in developing countries: Breaking down demand side barriers. Cad Saude Publica 2007;23:2820-34.
World Health Organisation. Design of a basic oral health survey. In: Oral Health Survey: Basic Methods. 4th
ed. Geneva: World Health Organisation; 1997. p. 7-8.
Ahuja NK, Parmar R. Demographics and current scenario with respect to dentists, dental institutions and dental practices in India. Indian J Dent Sci 2011:3:8-11.
Tandon S. Challenges to the oral health workforce in India. J Dent Educ 2004;68:28-33.
Goldman AS, Yee R, Holmgren CJ, Benzian H. Global affordability of fluoride toothpaste. Global Health 2008;4:7.
Vellappally S, Jacob V, Smejkalová J, Shriharsha P, Kumar V, Fiala Z, et al.
Tobacco habits and oral health status in selected Indian population. Cent Eur J Public Health 2008; 16:77-84.
Shimkhada R, Peabody JW. Tobacco control in India. Bull World Health Organ 2003;81:48-52.
Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology 2003;8:419-31.
Punitha VC, Sivaprakasam P. Oral hygiene status, knowledge, attitude and practices among rural children of Kanchipuram district. Ind J Multidiscip Dent 2011;1:115-9.
Kakatkar G, Bhat N, Nagarajappa R, Prasad V, Sharda A, Asawa K, et al.
Barriers to the utilization of dental services in Udaipur, India. J Dent (Tehran) 2011;8:81-9.
Nanda Kishor KM. Public health implications of oral health-inequity in India. J Adv Dent Res 2010;1:1.
[Figure 1], [Figure 2]