|Year : 2014 | Volume
| Issue : 4 | Page : 218-222
Oral health care availability in health centers of Mangalore taluk, India
Arun K Simon, Ashwini Rao, Gururaghavendran Rajesh, Ramya Shenoy, Mithun B Pai
Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
|Date of Submission||11-Dec-2013|
|Date of Acceptance||24-Mar-2014|
|Date of Web Publication||15-Oct-2014|
Dr. Ashwini Rao
Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Light House Hill Road, Mangalore-575 001, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Community-oriented oral health programs are seldom found in India. When primary health care systems were in the 1980s, dentistry was not adequately included. This has left oral health far behind other health services. Objectives: To find the availability of dental professionals, infrastructure, equipment, and treatments provided in health centers of Mangalore taluk. Materials and Methods: A cross-sectional study was conducted among medical officers and dentists working in all the health centers of Mangalore taluk, using an interview schedule, the oral health care availability inventory (ORAI). Results: Among 23 health centers of Mangalore taluk, dental services were available at six health centers (26%) [two community health centers (CHCs) and four primary health centers (PHCs)]. Mouth mirrors, dental explorers, and extraction instruments were available at six health centers [two CHCs (100%) and four PHCs (19%)]. No health centers provided orthodontic tooth corrections, removal of impacted teeth, oral biopsies, and fabrication of removable dentures. Conclusions: Availability of dental services was limited in the health centers, and a vast majority of the rural population in Mangalore taluk did not have access to dental care.
Keywords: Dental health services, dentists supply and distribution, health centers, rural health services
|How to cite this article:|
Simon AK, Rao A, Rajesh G, Shenoy R, Pai MB. Oral health care availability in health centers of Mangalore taluk, India. Indian J Community Med 2014;39:218-22
|How to cite this URL:|
Simon AK, Rao A, Rajesh G, Shenoy R, Pai MB. Oral health care availability in health centers of Mangalore taluk, India. Indian J Community Med [serial online] 2014 [cited 2019 Oct 15];39:218-22. Available from: http://www.ijcm.org.in/text.asp?2014/39/4/218/143023
| Introduction|| |
India has one of the fastest growing economies in the world and the country's growth averaged 8.5% annually from 2005 to 2010. This growth, combined with an energetic democracy and active foreign policy, has helped expand India's influence regionally and globally. India being a part of 'the BRICS' countries (Brazil, Russia, India, China, and South Africa) has declared its commitment to collaboration on common health challenges and to support other countries in their efforts to promote health for all. 
The thrust for India's development is its 1210.2 million population, which is almost equal to the combined population of USA, Indonesia, Brazil, Pakistan, Bangladesh, and Japan put together. India is divided into 28 states and seven union territories with 640 districts, 5,924 subdistricts (tehsils/taluks), 7,935 towns, and more than 6,40,867 villages.  The seeds for the delivery of oral care through health centers were sown as early as 1946, through the recommendations of Bhore Committee.  People with the greatest healthcare needs often receive the least adequate healthcare. This phenomenon, the "inverse care law," has implications for healthcare and outcomes for vulnerable populations. 
The World Health Organization (WHO) recommends a dentist to population ratio of 1:7500.  In India, the dentist to population ratio, which was 1:300,000 in the 1960s, stands at 1:10,000 in 2011. However, in rural India, there is only one dentist for 2.5 lakh population.  The major missing link is the lack of implementation of the primary health care approach. Although, dental care is a part of primary health care in India, dental care services are available in few states at the primary health care level.  As on March 2011, there were 23,887 primary health centers (PHCs) and 4,809 community health centers (CHCs) functioning in the country. 
Oral diseases are the most common of the chronic diseases, but there are few efficient dental care systems to cope with these problems, and where there are, the cost is beyond most people's means.  Dentistry faces a crisis regarding accessibility of its services to all. In many developing countries like India, oral health services are offered by dentists, who practice in the cities and treat the affluent parts of the urban population. It is often difficult for the poor urban and the rural population to get access to emergency care. 
Dearth of literature in this area led us to initiate this study with the objective of finding out the availability of dental professionals, infrastructure, and equipment as well as dental treatment provided in the health centers in Mangalore taluk, India.
| Materials and Methods|| |
Demographic details of Mangalore taluk (as per 2011 census)
It is a taluk (subdistrict) located on the western coast of Dakshina Kannada district in the state of Karnataka, India. Mangalore is the administrative headquarters of the taluk. Mangalore taluk is spread over an area of 834 km 2 . The total population was 9,89,856 among which males were 4,88,875 (49.39%) and females were 5,00,981 (50.61%). Urban population was 7,80,278 (78.83%), whereas the rural population was 2,09,578 (21.17%). 
This was a cross-sectional study conducted among the medical officers and dentists working in all the health centers in Mangalore taluk, India. Permission to conduct the study was obtained from the district health officer of Dakshina Kannada district. Ethical clearance was obtained from the Institutional Ethics Committee [Protocol No: 12030]. Participants gave written informed consent.
Medical officers and dentists working in all the health centers were interviewed using the oral health care availability inventory (ORAI), which was in English language and which was specially designed for this study. The interview schedule was pretested for reliability and validity. It consisted of 35 items divided into three sections. The first seven items are about availability of dental professionals, whereas the next 13 items are about dental infrastructure and equipment, whereas the last 15 items are about oral health services provided.
Data collection was carried out over a period of two months during March 2013 to April 2013. The inclusion criteria for the study were the medical officers and dentists who are presently working in these health centers, who were willing to give informed consent. The medical officers and dentists who were presently working in the health centers were administered the interview schedule by the principal investigator at the respective health centers. The response rate was 100% and general information such as designation and qualification, name of the village, type of health center, and population covered was obtained. Once the interview schedule was completed, the principal investigator visually verified the presence of dental personnel and of equipment at the health center.
The data were coded and analyzed using the Statistical Package for the Social Sciences (SPSS, version 15.0; SPSS Inc., Chicago, IL, USA). Basic descriptive statistics were done and results tabulated.
| Results|| |
There were a total of 23 health centers present in Mangalore taluk, of which 21 were PHCs and two were CHCs. Of the 21 PHCs, dental services were being provided in only four PHCs (19%), whereas both the CHCs provided dental services.
Availability of dental professionals
The two CHCs had government-appointed dentists, and dental services were provided the whole day and every day in these centers. However, the four PHCs did not have any government-appointed dentists but were managed by dentists from the private colleges in and around the area. The dental services in the PHCs were only limited to the forenoons and were not on a daily basis. Dental services were provided once a week in the three PHCs, and in one PHC dental services were provided only once a month. The number of patients visiting the centers ranged between 10 to 25 patients per day in these six health centers.
Dental infrastructure and equipment
Both the CHCs had one dental chair each, installed by the government, out of which one was hydraulically operated and the other was of the electromechanical type. One of the CHCs had only mouth mirrors, dental explorers, and extraction instruments, whereas the other CHC had mouth mirrors, dental explorers, extraction instruments, scaling instruments, restorative instruments, endodontic instruments, dental materials, and a dental X-ray machine. None of the CHCs had an amalgamator and none of them had orthodontic and prosthodontic instruments.
Among the four PHCs where dental services were being provided by private institutions, only one PHC had two electromechanical dental chairs installed by the private dental college. No dental chairs were installed by the government. Among the four PHCs providing dental treatment, all of them had mouth mirrors, dental explorers, scaling instruments, restorative instruments, extraction instruments, and dental materials. Two PHCs had amalgamators too, all provided by private institutions. However, none of the PHCs had dental X-ray machines, endodontic, prosthodontic, and orthodontic instruments [Table 1].
Oral health services provided
Only dental checkup and simple extractions were available at one CHC, whereas dental checkup, simple extractions, oral prophylaxis, and silver amalgam restorations were available at the other CHC and at all the four PHCs. Composite restorations and endodontic treatments were provided only at one CHC. Oral health records were maintained in both the CHCs but not in the PHCs. Oral health education and checkup of school children was provided at one CHC and two PHCs.
None of the six health centers provided orthodontic tooth corrections, removal of impacted teeth, oral biopsies, and fabrication of dentures. No health center provided home visits for oral health checkup and oral health education. However, all the six centers had provisions for referral of complicated dental treatments to the nearest Dental College or to the Dental Wing of the nearby Government Hospital [Table 2].
| Discussion|| |
Oral health promotion and checkup and appropriate referral on identification is an essential requirement at the PHCs, whereas in the CHCs it is imperative to have a unit consisting of dental chair and sets of dental equipment for examination, extraction, and management of dental problems. Health assistants are required to carry out educational activities regarding dental care. ,
The Indian Public Health Standards (IPHS) Guidelines for health centers issued by the Government of India states that in a PHC it is mandatory to conduct school dental checkup along with medical checkup by doctors at every PHC who will visit one school per week based on the report submitted by the health workers.  In a CHC, the IPHS Guidelines state that it is essential to provide dental health education services and dental care, including fillings, root canal treatment, and extraction of routine and emergency cases. 
This study noted that all the health centers that provided dental services possessed basic equipment for identification of common oral diseases and for carrying out dental extractions and restorations, but preventive programs were not the focal point of the services provided. Oral health care with emphasis on preventive and promotive aspects needs to be provided at the health centers. This should include early identification of oral precancer/cancer, oral health education, tobacco cessation counseling, and topical fluoride applications.
Presently, dental care has not been included under the "Assured Services" to be provided in CHCs under IPHS. A mention has been made of "optional" dental clinic in the outpatient department. There is a need for setting of IPHS standards for compulsory oral health care provision at CHCs. 
At the health center, either specially trained dental hygienist or staff nurse may deliver simple preventive, interceptive, and curative oral health services like oral health education, pain relief, ART (atraumatic restorative treatment), early diagnosis of oral cancer, and referral for patients with HIV/AIDS (human immunodeficiency virus infection/acquired immunodeficiency syndrome)-related oral lesions.  There is also a need to strengthen the existing health centers and formulation of IPHS, defining personnel, equipment, and management standards for oral health care provision.
In this study, the number of patients visiting the dental outpatient department was between 10 to 25 patients per day, which was similar to the findings of the study done at government dispensaries in Chandigarh, India.  Dentists require a significant time to complete the oral examination and to perform treatments. For this adequate support staff strength is required, which were lacking as per recommended guidelines of the Working Group on Disease Burden (communicable and noncommunicable diseases) for the formulation of the 12 th Five Year Plan. 
None of the health centers were equipped with prosthodontic and orthodontic instruments. This can be attributed to lack of specialists, materials, instruments, and a dental laboratory with support staff. Again these findings were comparable with the study done in Chandigarh, India where complete denture facility was found nowhere in the government dental clinics. 
The Working Group on Disease Burden (communicable and noncommunicable diseases) for the formulation of the 12 th Five Year Plan felt that there is a need to provide routine and emergency care in dental surgery at CHC level. This would include oral health education and school health education program as an outreach activity.  Findings of this study convey that no health center provided home visits for oral health checkup and oral health education. Although the school health education program was carried out only by one CHC and two PHCs, it was not a routine outreach activity.
The compartmentalization involved in viewing the mouth separately from the rest of the body must cease, as it has been well established that oral health affects general health, causing considerable pain and suffering, altering of food habits, speech, and the quality of life and well-being.  An uncoordinated approach leads to duplication of efforts. The common risk factor approach provides the justification for an integrated role for ASHA (accredited social health activists) who are available at the health centers for oral and general health education. Community health workers can also be trained to conduct comprehensive oral cavity screening during their visit to the individual homes in the area covered by the health centers. Studies have shown that screenings of different conditions performed by community health workers have high validity. , This would not only help in identifying people with dental needs, but the health worker can also motivate them to visit the health center to avail dental services.
Lack of incentives for the dentists to work in the rural areas is one of the major important determinants for availability of dentists in the rural areas.  Promotion of public private partnerships (PPPs) can be encouraged in the provision of prosthodontic and orthodontic treatment at these centers, and dental education needs to focus on the rural health issue. The need of the hour is to engage dentists from private colleges to provide dental treatment services at the health centers.
| Conclusion|| |
The availability of dentists and dental services at health centers in Mangalore taluk was alarmingly low. Accordingly, dentists were available only at six health centers (26%), and the availability of dental equipment and dental services were also not streamlined. A coordinated effort to integrate government and private sectors is a definite beginning toward meeting the goal of improving oral health in rural India.
| References|| |
Fiscella K, Shin P. The inverse care law: Implications for healthcare of vulnerable populations. J Ambul Care Manag 2005;28:304-12.
Thomas S. Plenty and scarcity. Br Dent J 2013;214:4.
Ahuja NK, Parmar R. Demographics and current scenario with respect to dentists, dental institutions and dental practices in India. Ind J Dent Sci 2011;3:8-11.
Verma H, Aggarwal AK, Rattan V, Mohanty U. Access to public dental care facilities in Chandigarh. Indian J Dent Res 2012;23:121.
Sheiham A. Oral health, general health and quality of life. Bull World Health Organ 2005;83:644.
Tandon S. Challenges to the oral health workforce in India. J Dent Educ 2004;68:28-33.
Darmstadt GL, Baqui AH, Choi Y, Bari S, Rahman SM, Mannan I, et al
. Bangladesh Projahnmo-2 (Mirzapur) Study Group. Validation of community health workers′ assessment of neonatal illness in rural Bangladesh. Bull World Health Organ 2009;87:12-9.
Mathew B, Sankaranarayanan R, Sunilkumar KB, Kuruvila B, Pisani P, Nair MK. Reproducibility and validity of oral visual inspection by trained health workers in the detection or oral precancer and cancer. Br J Cancer 1997;76:390-4.
Allison RA, Manski RJ. The supply of dentists and access to care in rural Kansas. J Rural Health 2007;23:198-206.
[Table 1], [Table 2]