|Year : 2020 | Volume
| Issue : 3 | Page : 128-133
Dental disease burden and projected financial implication of adult population of Uttarakhand, India: An observational cross-sectional multicentric study
Abhishek Kandwal1, Saba Jamil1, Sanjeeva Kumar1, Shaika Negi2, Nidhi Kundra3
1 Department of Dental Surgery, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, New Tehri, Uttarakhand, India
2 Dental Surgery, District Hospital, New Tehri, Uttarakhand, India
3 Dental Surgery, Community Health Center, Doiwala, Uttarakhand, India
|Date of Submission||05-May-2020|
|Date of Decision||02-Jun-2020|
|Date of Acceptance||06-Jul-2020|
|Date of Web Publication||08-Oct-2020|
Department of Dental Surgery, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Baksar Wala, Uttarakhand
Source of Support: None, Conflict of Interest: None
Introduction: Dental disease and oral hygiene are one of the most prevalent health problems in the world. With increasing incidence of dental caries and poor oral hygiene, the cost of oral rehabilitation significantly increases. Aim: The present study was conducted to access the burden of dental caries and oral hygiene in adults at three health care centers and the combined population. Materials and Methods: Six-hundred individuals, 200 each from three health center were enrolled. Oral hygiene index simplified (OHI-S) and decayed missed and filled teeth index (DMFT) and socioeconomic data was recorded. Approximate projected financial burden per individual was calculated for the population. Results: Nearly 94.7% of the total population has DMFT >0, while 58.7% of population had OHI-S for grade and Grade 3. Overall, financial burden per individual for the population was 2382–7716 INR. Intercenter comparison by the analysis of variance was significant P < 0.000, for DMFT and OHI-S scores. All indices were highest for center 1 followed by center 2 and center 3. Met need index was 0.46, restorative index (RI) was 25.44%, treatment 47.85% need index was and significant caries (SiC) index was 5.84. Age was statistically significant for DMFT and OHI-S (P < 0.05). Conclusion: The present study showed a very high prevalence of dental caries and SiC. Treatment needs were high, while RI and met needs were low with high projected financial burden.
Keywords: Community health, dental caries, decayed missed and filled teeth index, oral hygiene index, treatment needs
|How to cite this article:|
Kandwal A, Jamil S, Kumar S, Negi S, Kundra N. Dental disease burden and projected financial implication of adult population of Uttarakhand, India: An observational cross-sectional multicentric study. J Dent Res Rev 2020;7:128-33
|How to cite this URL:|
Kandwal A, Jamil S, Kumar S, Negi S, Kundra N. Dental disease burden and projected financial implication of adult population of Uttarakhand, India: An observational cross-sectional multicentric study. J Dent Res Rev [serial online] 2020 [cited 2020 Oct 23];7:128-33. Available from: https://www.jdrr.org/text.asp?2020/7/3/128/297523
| Introduction|| |
Approximately, 3.5 billion individuals worldwide are affected by dental and oral diseases. This high prevalence of dental diseases results in poor quality of life in such individuals causing pain, difficulty in eating and malnutrition., Prevalence of 49%–83% has been reported worldwide in the survey conducted by global oral health data bank. In India, the incidence of dental caries ranges 78%–84% incidence in for adult population.,,, There are many studies on the burden of caries in children and adolescents age group, but in an adult population, the studies are limited.,, Oral hygiene status is poor in the Asian population resulting in the higher prevalence of periodontitits., The landmark study by Green et al. on the Indian population reported 97% of population with periodontitis. Financial burden in the world has been reported to be 442 billion dollars. In India, there is no separate allocation of financial aid for oral care by the government.,, Hence, the expenses on dental ailment are borne by the individual resulting overall poor oral health care status. The present study was conducted with an aim to identify the burden of dental caries and poor oral hygiene along with its financial implication on the population at three of our health centers.
| Materials and Methods|| |
The present study was a part of oral hygiene project, it is an cross-sectional survey done on population of Utttarakhand at our three health centers for the assessment of clinical oral health parameters using oral hygiene index simplified (OHI-S) and decayed missed and filled teeth index (DMFT). The study was conducted at Dental surgery department, Himalayan institute of medical sciences (center 1), community health center Doiwala (center 2), and District hospital New Tehri (center 3). A total of 600 individuals were enrolled, 200 individuals each from these centers.
The duration of the study was from November 2019 to March 2020. A convenient sampling method was used to draw the sample form the respective centers. Sample size calculated by using standard formula with the prevalence taken at 50% and relative precision of 15%. Sample size was calculated by standard formula of n = Za/22 P Q/d2; Here “n” is number of sample, Z IS 1.96 at 0.05 P value, P is unknown prevalence as there are no previous studies so its taken as 50%. Q is P-1 and d is relative precision which is 15% (i.e., 15% of 50%). Applying the above formulae, the total number for each center was calculated to be 171. We added a 15% standard attrition and rounder it to 200 individuals from each center. P = 0.05 was considered significant at the confidence interval of 95% and 90% power. Ethical clearance was given vide letter SRHU/HIMS/ETHICS/2020/66 by our institutional ethical committee. Informed consent was taken from all individuals.
Dental consultants were trained in the calculation of oral hygiene index and DMFT. Two training session on 10 patients were done at the department of dental surgery, these patients was evaluated by all the 5 consultants and interrater variability was observed. On calculation of variability on these 10 patients, it was 0.87–0.89. Individual 18 years and above were included in the study. Patients with limited dexterity for oral care, jaw fractures in the past 6 months, or any head and neck tumor were excluded from the study.
Oral hygiene was assessed by using OHI-S by loe and silliness as per standard. Oral hygiene was classified as good, fair, and poor as per the index. To estimate the dental disease burden, DMFT index was chosen. DMFT index represents the disease burden in an individual due to dental decay. Number of decayed, missed, and filled teeth was recorded and total was done. A score of one is given for each tooth for DMFT.
Population treatment needs (TN) were calculated by dividing the total number of decayed teeth (D) with DMFT scores, and multiplying it with 100 to get result in percentage. For calculation met need index (MNI), sum of missed (M) and filled (F) were divided by DMFT scores.
Restorative index (RI) was calculated by dividing total number of filled teeth (F) with sum of decayed (D) and filled (F) teeth, and multiplying it with 100 to get results in percentage. Significant caries index (SiC) was calculated by taking the mean of highest one third DMFT scores of the population.
Further projected financial burden was calculated based on our treatment rates at respective centers. Treatment considered in this was oral prophylaxis, restorations of caries tooth, and dental prosthesis. The financial burden was calculated in INR Indian rupees. Statistical analysis was done with IBM SPSS Statistics for Windows, Version 22.0. IBM Corp., Armonk, NY. Analysis of variance (ANOVA) and Post hoc tuckey test were used to compared between three centers for OHI-S, DMFT, SiC, MNI, TN and RI. The Chi-square test was used to analyze the relation between age groups, gender, education status, and income level with DMFT and OHI-S.
| Results|| |
The dental disease burden defined for the population as DMFT >0 was 94.7%, whereas among the three centers, it ranged from 93% to 97.5%. OHI-S for Grade 2 and Grade 3 was 58.7% of population had OHI-S, amongst the three centers it ranged from 42% to 81.5%. Decayed tooth for D >0 was the highest followed by missed teeth M >0 and filled teeth F >0 [Table 1].
|Table 1: Frequency and percentage of decayed missed filled teeth index, decayed, missed filled, oral hygiene index simplified for three health center and total population|
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For the population, the average value of TN was 47.85% Met TN was 0.46, RI was 25.44% and SiC index was 5.84 for the population. Center 1 had the highest values for these indexes scores followed by center 3 and center 2 [Table 2].
|Table 2: Mean±standard deviation for various dental indicators at three health centers and total population|
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Inter center comparison by ANOVA was highly statistically significant, for DMFT OHI-S, SiC, met TN, RI and TN index. On applying tukey test for OHI-S was highly significant for all groups while DMFT was significant for all except for center 2 verses center 3 [Table 3].
|Table 3: Analysis of variance and post hoc tuckey test for various clinical parameters|
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On detail study of OHI-S for various parameter of age, gender, education level, and income status, it was observed to be statistically significant for only age on applying Chi-square test. Similarly, for DMFT, only age was statistically significantly related with P < 0.05. Highest values corresponded to third to fifth decades of life for OHI-S and DMFT values. Majority of the population was graduate or above with income in range of 20–50 thousand [Table 4] and [Table 5].
|Table 4: Comparative analysis of Oral hygiene index simplified value for Grade 2 and Grade 3 in respect to various parameters and their respective χ2 values along with significant values set at P<0.05|
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|Table 5: Comparative analysis of decayed missed filled teeth index >0), in respect to various parameters and their respective χ2 values along with significant values set at P<0.05|
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Inter center comparison for the projected approximate financial burden was highest for center 1 followed by center 3 and center 2. Financial burden was calculated by projecting cost of oral prophylaxis as 400 rupees/person, restoration as 400 rupees/tooth, removable prosthesis as 300/tooth and fixed crown and bridge as 2000 rupees/tooth according to our health center rates. All financial burden per individual for the entire population were in range of 2382–7716 INR [Table 6].
|Table 6: Approximate financial burden of dental disease per individual at three health center and total population|
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| Discussion|| |
Present study was done to find the burden of dental diseases in our three health centers. It was seen that 94.7% of population had DMFT >0, and 58.7% has OHI-S greater than and equal to Grade 2 [Table 1]. The national oral health survey of Indian population reported caries prevalence to 84%. The DMFT average score was 5.53 ± 4.74 and the SiC was high 5.84 ± 2.63 depicting a higher load of caries in the population. Between the three center, center 1 had the highest score for DMFT and SiC, followed by center 3 and center 2. The prevalence of dental caries in adult population reported by Patro et al, Kamberi et al and Kahar et al were 84.8%, 72.8% and 64.3%. respectively. The DMFT index mean ± standard deviation scores in adult population reported by Patro et al, Kamberi et al and Kahar et al were 7.9 ± 8.1, 9.16 ± 5.12 and 3.99 ± 5.7.,, While Salunke et al. reported 76.4% prevalence of dental caries with median of 12 for DMFT index.
The post hoc test was statistical significant for various index when comparison between all centers was done, except center 2 verses center 3 whre it was not significant [Table 3]. In our study the RI was 25.44% which was comparable to 26.5% reported by Olabisi et al. In an adult female Nigerian population the RI of 13.3% was reported which was much lower than our study.
It is well documented that poor oral health is associated with many systemic diseases and a hygienic oral cavity is an essential and crucial endpoint to reduce oral foci of infections. Majority of the population had fair to poor oral hygiene. OHI-S index for good oral hygiene was for only 41.3% of population. Among center, center 1 had 58% of good hygiene followed by 47.5% for center 3 and 18.5% for center 2. Taking into consideration fair and poor oral hygiene grades, 58.7% of the individuals had OHI-S with Grade 2 or Grade 3. Oral hygiene index in the adult population by Olabisi et al. was reported to be 87.5% for Grade 2 and above which was significantly higher compared to our study.
Oral status and disease burden affects the quality of life in patients. Decayed and missed teeth indicated the burden of disease in the person. Filled teeth indicate the amount of dental treatment done and the accessibility and willingness for dental care and treatment. Oral care is still considered as the secondary parameter in the evaluation of health. It has been long overlooked by patients and health professionals. Frequent and recommended biannual dental visit is essential to identify oral and dental diseases and employ preventive and therapeutic strategies in reducing its burden. The highest burden was of dental caries followed by missed teeth. Number of filled teeth was low for the population.
Age was significantly associated with DMFT and OHI-S index in our study. DMFT was significantly associated with age in other studies.,,,, The mean DMFT and OHI-S increase with the age in the population all three center and for the total population [Table 4] and [Table 5]. To best of our knowledge, there is no such study in our population about the financial and dental disease burden. On analysis, it was found that the average per person projected expenditure was ranging approximately from two to eight thousand Indian rupees [Table 6].
There was no statistically significant relation for education, income, and gender when analyzed with DMFT and OHI-S index. Various other studies have reported that increase in education reduces the caries prevalence. Furthermore, there was no association between gender and caries prevalence as contrary to other studies where gender was significantly associated with the caries.,
The present study was a cross-sectional study and hence may not be a true representation for all population. However, in determining the burden of diseases for implementation of health-related policies, these studies provide excellent information for population needs.
| Conclusion|| |
The present study showed that the population of the three health center had high caries, high SiC, and poor oral hygiene status. Met TNs index and RI were significantly low. A low RI with a high value of caries depicts poor dental health status. The economic burden on dental treatment per person was also very high. The results from the present study will be utilized to formulate cost-effective preventive dental treatment strategies for the population of these health-care centers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]