|Year : 2022 | Volume
| Issue : 2 | Page : 48-51
An overview of the oral primary preventive measures at public/community level in India
Clinical Practitioner, Daman, Gujarat, India
|Date of Submission||09-May-2022|
|Date of Acceptance||22-May-2022|
|Date of Web Publication||28-Jun-2022|
Dr. Nilima Vaghela
Clinical Practitioner, Daman, Gujarat
Source of Support: None, Conflict of Interest: None
Due importance is given to the primary level of prevention where the action is taken before the onset of the disease so that the disease exists no longer. Oral diseases are a major public health problem, and their burden is on increase in many low- and middle-income countries. Dental public health (DPH) aims to improve the oral health of the population through preventive and curative services. However, its achievements in India are being questioned probably because of lack of proficiency and skill among personnel. The present review study focuses on some of the important aspects relating to oral primary preventive measures at public/community level in India such as priority for oral health, DPH workforce and curriculum, and utilization of DPH personnel in providing primary oral health care. It was concluded that more attention should be given toward preventive oral health care by employing more number of dentists in public sector, strengthening DPH education and research, and combining oral health programs with general health-care programs.
Keywords: Dental public health, dental tourism, mobile dentistry, primary care, research
|How to cite this article:|
Vaghela N. An overview of the oral primary preventive measures at public/community level in India. Int J Prev Clin Dent Res 2022;9:48-51
|How to cite this URL:|
Vaghela N. An overview of the oral primary preventive measures at public/community level in India. Int J Prev Clin Dent Res [serial online] 2022 [cited 2022 Aug 16];9:48-51. Available from: https://www.ijpcdr.org/text.asp?2022/9/2/48/348705
| Introduction|| |
Modern medicine and dentistry is overwhelmingly reactive rather than proactive. Get sick, seek medical help. How expensive that model is! If everyone only got sick and then sought medical assistance, we could not afford the bill. It is better to prevent disease rather than to try to find cures for diseases after they occur. The reasoning here is similar to why you change the oil in your car rather than wait to fix a blown engine. In perspective of oral health, most of the Indian populace is affected with the common oral problems such as periodontal disease being 90%–95%, followed by dental caries affecting nearly 60%–80% of children, malocclusion about 30%, and oral cancer which accounts for almost 30%–35% of the total diagnosed cancer cases. However, most of the Indian studies have shown that the greatest burden of all these oral problems is on the disadvantaged and socially marginalized people., The reasons for such greater sheer magnitude of oral problems are not known, but these oral problems are known for their unique disposition of being progressive in nature leading to lack of remission or termination if left untreated, need for technically demanding, expensive and time-consuming professional treatment.,,, This necessitates for a return to primary health-care principle of focus on prevention. The application of various preventive measures could be one of the most cost-effective tools in the prevention of oral problems in enhancing the individuals and the community to lead a socially and economically productive life. However, in India, the most common approach to combat these oral problems at the population level is of curative in nature which does not appear to be cost-effective as compared to preventive approach.,,,,
| Prevention is Better than Cure|| |
The term prevention takes its origin from a Latin word “praevenire” which denotes to stop something from happening in the field concerned. Prevention has been categorized into four levels, namely primordial, primary, secondary, and tertiary levels. However, due importance is given to the primary level of prevention where the action is taken before the onset of the disease so that the disease exists no longer.,,,
| Dental Public Health Workforce|| |
The present data also show that there are a total of 5014 positions available for entering postgraduate training in dentistry in India in all the nine branches. Out of this, only 185 (3.68%) positions are available for postgraduate course in public health dentistry, which is least in all branches, whereas in a country like India where the majority of the population resides in the rural areas, there is a greater need for these specialists. However, at present, there is no policy for trained public health dentists to strictly serve the rural population.,,,
| Primary Oral Care|| |
Primary oral health care, without any barrier, is still missing across several countries across the world primarily in low- and middle-income countries such as India. The majority of the public (government) dental health-care setups are poorly equipped and understaffed, and oral health is not a priority in budgetary allocations. Not even 20% of the rural primary health-care centers (PHCs) around the country have a dentist or a dental public health (DPH) professional. The government's goal of appointing a public health dentist at every community health center (CHC) looks like a distant dream as government is struggling to ascertain CHCs and as half of the CHCs are not functional.,, The energies, talent, and precious time of public health dentists posted in PHCs and CHCs with limited dental materials are underutilized in some states. The CHC should be available for emergency care as well as dental care.
| Public Primary Prevention of Dental Caries|| |
Dental caries is a slowly progressive, irreversible microbial disease of multifactorial nature affecting the calcified tissues of the teeth, characterized by demineralization of inorganic portion and destruction of organic portion leading to cavity formation. Further, caries is proven to be sugar-dependent infectious disease of the teeth. It is one of the most prevalent chronic oral diseases which persists permanently in the form of restoration or tooth loss. This can be prevented at a public level through dental health education. It aims at altering the public's perception and their behavior toward decay-free dentition. This should provide more emphasis on sugar consumption by advising in reducing the amount and restricting frequency to no more than three times a day. Further, the public should be motivated to use fluoride-containing toothpaste and also should encourage them to use the correct method of toothbrushing for effective removal of dental plaque.,
| Fluorides in Community Oral Health|| |
The scientific basis for the use of fluoride and its safety has been accepted by numerous scientific bodies, expert groups, and government agencies.,,,,,, Hence, the benefits of fluoride can be administered at a public level through various forms such as community water fluoridation, school water fluoridation, salt fluoridation, milk fluoridation, and fluoride mouth rinse programs. Most of the studies have shown that community water fluoridation can effectively reduce caries by 50%–65%. Further, the efficacy is greatest for deciduous dentition, with a range of 30%–60% less caries in fluoridated communities. Taking this into consideration, current estimates of mean DMFT among 12–14-year-old Indian children of 2.3 will be reduced to nearly 1.1 in the future years if India avails community water fluoridation. Thus, community water fluoridation is found to be safe, most effective, efficient, economical, environmentally sound, and socially equitable public health measure to prevent dental caries and thus bringing the benefits of fluoride to whole community.
| Public Primary Prevention of Periodontal Diseases|| |
The prevalence of periodontal disease in India has been reported close to 100% and of greater severity as compared to advanced countries. Furthermore, a strong correlation between the states of oral hygiene, as determined by the plaque and calculus accumulations, has been established. Hence, the following approaches can be best adopted for Indian scenario: while there is adequate information to commence programs for the primary prevention of gum disease in India, but research is needed to better inform policies and strengthen programs. Research must also identify economic and acceptable methods by the public for utilizing the primary preventive dental services. It is also important to focus on the interventional programs toward tobacco control as it is one of the promoting factors for gum diseases. The researches must also aim periodically to evaluate the community-based programs. Further, efforts should also be made to formulate the dentifrices which are effective in controlling plaque and gingivitis. Still, there are immense researches in the microbiological aspect of periodontal disease and results of which have been demonstrated in the availability of various over-the-counter products. However, as mentioned earlier, there are problems faced by the research field in India.,,,,
| Public Primary Prevention of Oral Cancer|| |
Oral cancer is considered to be one of the ten leading cancers in the world and in India; it is one of the most common cancers and has come into view as an important public health problem. Primary prevention has been estimated to be the most cost-effective method of preventing oral cancer.,,,, Preceding studies have shown poor public awareness of oral cancer. Up to three-quarters of oral cancer could be prevented by avoiding environmental factor, notably the consumption of tobacco and excess alcohol. At a public level, educational, regulatory, or service approaches are deemed to benefit the individuals to be off from oral cancers.
| National Tobacco Program|| |
To strengthen the implementation of the tobacco control provisions under COTPA and policies of tobacco control mandated under the World Health Organization Framework Convention on Tobacco Control, the Government of India piloted the National Tobacco Control Program (NTCP) in 2007–2008. The program is under implementation in 21 out of 35 states/union territories in the country. In total, 42 districts are covered by NTCP at present. The internal monitoring of implementation of COTPA in 21 states, where the NTCP is under implementation, has revealed that only about half of the states (52%) have mechanisms for monitoring provisions under the law. On a positive note, the country has also witnessed examples of community-level initiatives for tobacco control, for example, tobacco-free villages and educational institutions being reported from many states. Steps have been taken to incorporate tobacco control in the curriculum of undergraduate medical and dental curriculum to equip medical and dental graduates with skills for tobacco control, especially tobacco cessation.,,,,,,,
| Mobile Dentistry|| |
The introduction of mobile clinics into public health dentistry dates back to 1924. They have been successfully used to provide dental treatment to schools, disabled patients, rural communities, industries, and armed forces of various countries. They may offer a viable option to address the issues of oral health-care delivery for an extensive underserved population in a developing country like India with scarce resources.
| Research on Oral Primary Preventive Measures at Public/Community Level in India|| |
Research in the field of dentistry is progressing at mightier speed worldwide. The situation of dental research in India is still in the nascent stage even though we have more than 300 dental colleges in India, which are more than any number as compared to other countries. However, the representation of India toward DPH research on the international platform is negligible. The newer opportunities in DPH research are epidemiological studies for the development of vaccines to prevent oral diseases, salivary proteomics in screening of oral cancers, epigenetics, oral health literacy, role of dentists in disaster management, and problem-based learning. Moreover, it has been suggested that there is a need for more schools of public health, DPH residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention in India.
| Conclusion|| |
The rapid growth of dental professionals has not helped the public health system as a whole. Moreover, a major imbalance exists in the distribution of public health dentists across different states in India and at the global level. DPH education programs should be implemented on a priority basis to make people aware of the dangers of self-medication. There should be inclusion of dental health programs with family welfare programs by the government like in other developed countries. Political, social, organizational (both government and nongovernmental), professional dedication and support are needed to make the oral health of this country comparable with general health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sheiham A. Oral health, general health and quality of life. Bull World Health Organ 2005;83:644.
Petersen PE, Lennon MA. Effective use of fluorides for the prevention of dental caries in the 21st
century: The WHO approach. Community Dent Oral Epidemiol 2004;32:319-21.
Newbrun E. Effectiveness of water fluoridation. J Public Health Dent 1989;49:279-89.
Truman BI, Gooch BF, Sulemana I, Gift HC, Horowitz AM, Evans CA, et al
. Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. Am J Prev Med 2002;23:21-54.
Petti S, Scully C. Oral cancer knowledge and awareness: Primary and secondary effects of an information leaflet. Oral Oncol 2007;43:408-15.
Park K. Concept of health and disease. In: Park's Text Book of Preventive and Social Medicine. 20th
ed. India: M/s Banarsidas Bhanot Publishers; 2009. p. 12-48.
Watt G. The inverse care law today. Lancet 2002;360:252-4.
David J, Astrøm AN, Wang NJ. Factors associated with traumatic dental injuries among 12-year-old schoolchildren in South India. Dent Traumatol 2009;25:500-5.
Loffredo LC, Souza JM, Freitas JA, Mossey PA. Oral clefts and vitamin supplementation. Cleft Palate Craniofac J 2001;38:76-83.
Cirino SM, Scantlebury S. Dental caries in developing countries. Preventive and restorative approaches to treatment. N Y State Dent J 1998;64:32-9.
Bowen WH. Are current models for preventive programs sufficient for the needs of tomorrow? Adv Dent Res 1995;9:77-81.
Blinkhorn AS, Davies RM. Caries prevention. A continued need worldwide. Int Dent J 1996;46:119-25.
Kay EJ, Locker D. Is dental health education effective? A systematic review of current evidence. Community Dent Oral Epidemiol 1996;24:231-5.
Miglani DC, Rajasekher A, Rao AV. Dental health education as related to prevention of dental diseases in India. J Indian Dent Assoc 1975;Spec Issue: 311-27.