|Year : 2021 | Volume
| Issue : 2 | Page : 86-89
Community-based preventive and oral health promotion programs in early diagnosis of oral disease: A cross-sectional study
Amanpreet Kaur Bhangu1, Ramandeep Singh Gambhir2, Latika Nirola3
1 Department of Orthodontics, Dr. B Smiles (Dental Surgery), Wappingers Falls, NY, USA
2 Department of Public Health Dentistry, Rayat and Bahra Dental College and Hospital, Mohali, Punjab, India
3 Department of Social and Preventive Medicine, New Final Year, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
|Date of Submission||05-Dec-2020|
|Date of Acceptance||05-Jan-2021|
|Date of Web Publication||16-Jul-2021|
Ramandeep Singh Gambhir
Department of Public Health Dentistry, Rayat and Bahra Dental College and Hospital, Mohali - 140 103, Punjab
Source of Support: None, Conflict of Interest: None
Background: It is very important to identify common oral health problems, particularly in rural areas, and counsel the patients screened for a particular oral disease for early treatment to prevent the progression of oral disease. The present study was conducted among the adult population and school students residing in rural areas to identify any oral disease at the earliest. Materials and Methods: A descriptive cross-sectional study was conducted among schoolchildren and adults residing in rural areas. Seventeen villages were selected on the basis of cluster sampling methodology. A total of 1892 individuals constituted the final sample size after making necessary exclusions. Statistical calculations were done using Chi-square test. Results: A number of school students were 1230 and 662 were adults. A number of male patients having pit and fissure caries were comparatively more as compared to females (45% and 36%, respectively). Periodontal disease and oral precancerous lesions were more prevalent in the 46–60-year age group. There was a statistically significant association between gender and pit and fissure caries in schoolchildren (P = 0.027). Conclusion: It is concluded from the present study that screening camps play a pivotal role in diagnosing a dental disease at the earliest and thus halting its progression.
Keywords: Caries, oral disease, periodontal disease, screening, students
|How to cite this article:|
Bhangu AK, Gambhir RS, Nirola L. Community-based preventive and oral health promotion programs in early diagnosis of oral disease: A cross-sectional study. J Dent Res Rev 2021;8:86-9
|How to cite this URL:|
Bhangu AK, Gambhir RS, Nirola L. Community-based preventive and oral health promotion programs in early diagnosis of oral disease: A cross-sectional study. J Dent Res Rev [serial online] 2021 [cited 2021 Aug 1];8:86-9. Available from: https://www.jdrr.org/text.asp?2021/8/2/86/321536
| Introduction|| |
Oral diseases remain hidden till they cause some disabilities to perform daily functions. Early detection of oral diseases prevents unnecessary damage to the oral tissues which can be managed by minimal invasive treatment. No perceived need and having no serious dental problems were among the two most commonly cited reasons for not having seen a dentist for at least 3 years according to another study. Among patients who had visited a dentist within 3 years, the most commonly received treatments were restorations, extractions, and dental prostheses.
India, a developing country, faces numerous hurdles in delivering oral care to the needy population. Dental caries prevalence in 5–12-year-old Indian schoolchildren was 55.5% in 1940, 68% in the 1960s, and jumped to 89% in the following years. Children constitute more than 40% of the Indian rural population and therefore are most vulnerable to dental diseases as they cannot avail dental facilities due to inaccessibility, financial constraints, and scarcity of public dental health-care services in rural parts of the country. A study was conducted among 227 individuals aged 50 years or above in a rural part of India. An educational and motivational program to increase people's awareness was organized and evaluation was done before and after the program. Certain myths that prevailed in the population were reported by the study like tooth loss is an extension of old age, dental caries can be prevented by eating tobacco, medicines alone can cure oral diseases, loss of vision can occur due to tooth extraction, and oral prophylaxis causes loosening of teeth. These myths proved to be a hurdle in utilization of dental services prevailed in the population.
Moreover, majority of the studies on community-based oral health and preventive programs have been conducted on South Indian population, and very few studies engaged northern, western, and north-eastern population. Therefore, the present study was conducted among schoolchildren and adult population residing in a particular area so that any oral abnormality can be diagnosed at the earliest.
| Materials and Methods|| |
Ethical clearance was obtained from concerned authorities (health and school authorities) prior to the start of the study. Informed consent was obtained from the individuals for their willingness to participate in the study. Participation in the study was voluntary, and identification information was not collected from the study participants. Consent from the parents was taken in case of schoolchildren.
Study population and study sample
A descriptive cross-sectional study was conducted among schoolchildren and adults residing in rural areas around the dental clinic (Amloh, Punjab, India). Schoolchildren were assessed in school dental camps by a dental team consisting of three examiners. Adult population comprised patients (35–60 years old) who visited the dental clinic for their treatment for 2 months. There are 16 government primary schools in the block and a total number of 1572 schoolchildren in the age group of 5–12 years. All the schoolchildren in the age group of 5–12 years studying in 16 government primary schools of the block were recruited for the study. It comprised approximately 12%–13% of the total population of the block. The literacy rate in the age group of 5–12 years is more than 95%, and majority of the children study in government schools of the area. Hence, the study population was the true representative of the population. Each school was visited a maximum number of 2 days in a week or less till all children were examined. If it required more than 2 days, then remaining children were covered in subsequent week. Seventeen villages were selected on the basis of cluster sampling methodology. Using the systematic random sampling methodology, a total of 1892 individuals (after applying the formula for sample size calculation) were selected as the final sample. School students and adults comprised 1230 and 662 individuals, respectively. Individuals who were systemically ill and unwilling to participate were excluded from the study.
Oral health examination
All the examiners were calibrated in the dental clinic for conducting the oral health examination among school students and adult population. School students were assessed on three parameters: pit and fissure caries, caries involving pulp, and students who required orthodontic consultation. The presence of any precancerous oral lesions formed the basis for oral health examination among adults.
Data obtained were entered in an MS Excel spreadsheet and analyzed using Statistical Package for Social Sciences (SPSS) software (version 19, IL, Chicago, USA). Categorical variables were compared using the Chi-square test. A level of P ≤ 0.05 was considered statistically significant. The accuracy of data entry was checked by re-entering 10% of the data, and the consistency of the data was compared.
| Results|| |
A total of 1892 individuals were included in the present study. The distribution of study participants according to gender is depicted in [Table 1]. Majority of the participants comprised males in both the categories (58.5% of the school students and 68% of the adult population) as compared to females.
|Table 1: Distribution of study participants (school students and adults) according to gender|
Click here to view
Oral findings in school students
[Figure 1] depicts the type of oral finding present in school students gender-wise. A number of male patients having pit and fissure caries were comparatively more as compared to females (45% and 36%, respectively). Deep caries involving pulp was present in 15% of the total participants, out of which 9% (110) were male. Only 26% (319) of the participants required orthodontic consultation, out of which only 7% (86) were female.
|Figure 1: Gender-wise distribution of school students accordingly with their oral finding|
Click here to view
Oral findings in adults
[Figure 2] depicts the major oral findings in adults accordingly with two age groups. Gingivitis was reported in 24% (159) of the adult population belonging to the age group of 35–45 years. However, periodontal disease and precancerous lesions were reported among more number of participants belonging to the age group of 46–60 years (49% and 2.5%, respectively). Surprisingly, 50% (317) of the adults were unaware regarding the presence of precancerous lesions in their oral cavity.
|Figure 2: Distribution of oral findings in adults according to their age groups|
Click here to view
Association of findings
When gender of the school students was compared with their oral findings, there was a statistically significant association between gender and patients having pit and fissure caries (P = 0.027). Similarly, there was a significant association of age group of adults with periodontal disease (P = 0.034) and presence of precancerous lesions (P = 0.014) [Table 2].
|Table 2: Association of findings among the study participants with sociodemographic characteristics|
Click here to view
| Discussion|| |
It has been proven that early diagnosis and appropriate treatment can prevent worsening of the oral diseases. It is evident from this study as well that if a disease is diagnosed at an early stage, its prognosis will be better as 50% of the adults in our study were not aware regarding the presence of oral precancerous lesions. Inadequate knowledge regarding oral health in rural areas and unawareness of the different types of oral diseases is one of the key factors for progression of diseases. A study conducted in the United States showed that illnesses related to oral health resulted in 6.1 million days of bed disability, 12.7 million days of restricted activity, and loss of 20.5 million workdays each year. Therefore, it is very important to emphasis on prevention of these diseases.
A study on interventions promoting child health provides evidence that professional preventive oral care can reduce dental caries in children. The prevalence of pit and fissure caries was seen more among males as compared to female school students in the present study. This finding is in congruence to the findings of some other studies conducted in some other parts of India. However, the findings of another study oppose this finding. Therefore, the study stresses the importance of application of pit and fissure sealants on vulnerable occlusal surfaces, and prior to the application, the more viable they are.
Correction of malocclusion by timely orthodontic treatment can prevent the exaggeration of the psychological as well as functional abnormalities of the oral cavity. A definitive need for orthodontic treatment was found among 26% of the school students in the present study. Almost similar results were reported in another study conducted among schoolchildren in Udaipur city, India.
Dental caries is still a major public health problem in many developing countries like India. In the present study, dental pulp was found to be involved in 15% of the school students which is more as compared to a study conducted in some other parts of India. This can be because of lack of public awareness, motivation, and devoid resources for dental treatment.
According to the National Oral Health Survey and Fluoride Mapping, the prevalence rate for periodontal disease nationwide for 35–44-year age group was 89.2%. The prevalence of periodontal disease among the adult population in the present study was less (81%) as compared to the findings of another study conducted in Moradabad, India.
Oral ranks among the top three types of cancer prevalent in the country and therefore is a major public health concern. Early diagnosis of oropharyngeal cancer can greatly increase the 5-year survival rates from 50% to more than 80%. The results of the present study show that the overall prevalence of precancerous lesions in the adult population in our study was 3.5% and the findings were significantly associated with age. This is low as compared to a study conducted in the state of Kerala, India (4.4%). Regular oral health screening and awareness programs can detect these types of lesions at an early stage to prevent them from converting into oral cancer.
Oral health is not given a high priority and dental caries is left untreated with people seeking dental treatment only when they have unbearable pain that often results in extraction of the concerned tooth. Community oral health programs not only help in early detection of caries but also help in educating people about oral diseases so that these can be prevented in the future.
The present study had some limitations also. Due to time and workforce constraints, some valuable information such as oral hygiene practices (toothbrushing, flossing, etc., in case of school students), consumption of alcohol, and tobacco use by adults were not included in the study. Furthermore, details about different types of precancerous lesions are not included in the study. This could have impacted the results of the study to some extents. Moreover, the study was conducted in a small rural setup situated in and around the dental clinic. Therefore, the results of the study should be interpreted with caution. Similar studies engaging a larger sample and including other valuable information should be conducted in the future.
| Conclusion|| |
It is concluded from the present study that screening camps play a pivotal role in diagnosing a dental disease at the earliest and thus halting its progression. Therefore, regular oral health screening camps should be organized by government and nongovernment organizations especially in rural areas for uplifting the oral health of the community.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Steele TO, Meyers A. Early detection of premalignant lesions and oral cancer. Otolaryngol Clin North Am 2011;44:221-9, vii.
Lo EC, Lin HC, Wang ZJ, Wong MC, Schwarz E. Utilisation of dental services in Southern China. J Dent Res 2001;80:1471-4.
Hiremath A, Murugaboopathy V, Ankola AV, Hebbal M, Mohandoss S, Pastay P. Prevalence of dental caries among primary school children of India – A cross-sectional study. J Clin Diagn Res 2016;10:ZC47-50.
Dhar V, Jain A, van Dyke TE, Kohli A. Prevalence of dental caries and treatment needs in the school-going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent 2007;25:119-21.
] [Full text]
Gambhir RS, Sohi RK, Nanda T, Sawhney GS, Setia S. Impact of school based oral health education programmes in India: A systematic review. J Clin Diagn Res 2013;7:3107-10.
Parlani S, Tripathi A, Singh SV. Increasing the prosthodontic awareness of an aging Indian rural population. Indian J Dent Res 2011;22:367-70.
] [Full text]
Bhat M, Bhat S, Brondani M, Mejia GC, Pradhan A, Roberts-Thomson K, et al
. Prevalence, extent, and severity of oral health impacts among adults in rural Karnataka, India. JDR Clin Trans Res 2021;6:242-50.
Satcher D, Nottingham JH. Revisiting oral health in America: A report of the surgeon general. Am J Public Health 2017;107:S32-3.
de Silva AM, Hegde S, Akudo Nwagbara B, Calache H, Gussy MG, Nasser M, et al
. Community-based population-level interventions for promoting child oral health. Cochrane Database Syst Rev 2016;9:CD009837.
Pandiyan I, Raj SS, Balasubramaniam A. Association between gender and prevalence of pit and fissure caries among patients visiting private dental college – A retrospective study. Int J Res Pharm Sci 2020;11:568-73.
Doméjean S, Banerjee A, Featherstone JDB. Caries risk/susceptibility assessment: Its value in minimum intervention oral healthcare. Br Dent J 2017;223:191-7.
Vishnoi P, Shyagali TR, Bhayya DP. Prevalence of need of orthodontic treatment in 7-16-year-old school children in Udaipur City, India. Turk J Orthod 2017;30:73-7.
Shyam R, Manjunath BC, Kumar A, Narang R, Goyal A, Piplani A. Assessment of dental caries spectrum among 11 to 14-year-old school going children in India. J Clin Diagn Res 2017;11:ZC78-81.
Bali RK, Mathur VB, Talwar PP, Chanana HB. National Oral Health Survey and Fluoride Mapping; 2002-2003. India, New Delhi: Dental Council of India; 2004.
Batra M, Tangade P, Gupta D. Assessment of periodontal health among the rural population of Moradabad, India. J Indian Assoc Public Health Dent 2014;12:28-32. [Full text]
Mangalath U, Aslam SA, Abdul Khadar AH, Francis PG, Mikacha MS, Kalathingal JH. Recent trends in prevention of oral cancer. J Int Soc Prev Community Dent 2014;4:S131-8.
Silverman S Jr., Kerr AR, Epstein JB. Oral and pharyngeal cancer control and early detection. J Cancer Educ 2010;25:279-81.
George B, Sebastian ST, Soman RR, Mulamoottil VM, Johny MK. Prevalence of precancerous lesions in an adult population. Indian J Dent Res 2019;30:500-5.
] [Full text]
[Figure 1], [Figure 2]
[Table 1], [Table 2]