Addressing oral health disparities, inequity in access and workforce issues in a developing country

Risk factors and associated pathway for rural and urban unmet dental prosthetic needs among older adults in Central India

AIM

This study was undertaken to evaluate the risk factors and associated pathways for unmet dental prosthetic needs among older adult population in Central India.

METHODS

A total of 11,145 randomly selected older adults participated in the study; 4613 from urban region and 6532 form rural region. Oral examinations were conducted at individual households for recording dental caries, periodontal disease, prosthetic status and needs. Structural Equation Modelling (SEM) was used to examine relationship between a set of exogenous variables and unmet dental prosthetic needs with variables that remained significant in the adjusted multilevel logistic model. Path coefficients were calculated for all variables with 95% confidence interval. Goodness of fit of the model was assessed by several indices.

RESULTS

A total of 8433 (75.7%) participants had never visited a dentist and 9139 (82%) had unmet dental prosthetic needs. Dental caries was observed among 3207 (69.5%) and 4644 (71.1%) study participants from urban and rural regions respectively (p < .05). Low utilization of dental services was associated with high dental prosthetic needs in upper arch and lower arch (PC = -0.05, 0.001) and DMFT was associated with lower utilization of dental services (PC = -0.09, 0.001). DMFT was also associated with age, annual income, level of education, paternal education, type of family, tobacco consumption and CPI score in the hypothesized model. The fit indices used indicated that the model was adequate.

CONCLUSIONS

Dental prosthetic needs in the proposed pathway model was associated with low utilization of dental services, dental caries, periodontal disease and other socio-demographic factors.

The global distribution of special needs dentistry across dental school curricula

INTRODUCTION

Special needs dentistry (SND) is an emerging dental specialty, with ongoing developments in education and clinical practice focused towards the tailored management of individuals with special needs (SN). Patients with SN have a higher prevalence of oral diseases and unmet dental needs compared to the general population. Although inadequate training and experience in managing patients with SN has been highlighted as a significant barrier to accessing care, there is limited data about the extent of SND teaching at the entry-to-practice or higher levels.

METHODS

This work is the first to map SND curricula globally, across 180 countries and 1265 dental schools.

RESULTS

Although 74.62% of dental schools were found in developing economies, the distribution of programs that reported SND in their courses was highly skewed towards developed countries. In terms of advanced degrees, beyond basic entry-to-practice training, the USA delivered 60% of the SND programs, followed by Canada (15.56%), UK (13.33%), and Australia (8.89%). The term SND appeared in 33.95% of entry-to-practice level program curricula and was less commonly used in transitioning economies. Only 112 SND-specialized practitioners enter the workforce globally each year from developed economies, and all but three advanced degrees are found in G7 countries.

CONCLUSION

By exploring the impact of economic status on its distribution, this paper highlighted the lack of SND representation in dental curricula, especially amongst programs in transitioning or developing economies. Education of both general dentists and specialists is critical as a collaborative effort is needed to manage the growing population of patients with SN.

Learning on the country: Motivating dental students to attend a rural placement

PURPOSE/OBJECTIVES

This research aimed to identify factors that affect dental students' attitudes toward participation in rural clinical outplacements (RCOP) in Australia, and to suggest strategies that will increase students' desire to attend RCOP in the future.

METHODS

Dental students from the nine dental schools in Australia were invited to an online survey on their willingness to participate in an RCOP and the factors that influence this willingness. These factors were grouped into themes of education, personal and health, social, financial, and information-related.

RESULTS

The study had an estimated response rate of 10% with 202 responses. More than two-thirds (68%) of students were willing to participate in an RCOP. Students who grew up in a rural area were significantly more likely to be willing to attend an RCOP, compared to those from urban settings. Attitudes toward the anticipated educational experience of RCOP were positive, while factors related to finances and pre-existing information were of concern to students. Educational, personal/health-related, and social factors had significant impacts on participants' willingness to attend RCOP.

CONCLUSION

Overall, despite students holding negative opinions on certain social and financial factors, their positive attitudes toward other factors outweighed these. Universities should aim to further promote the educational benefits of RCOP to improve students' attitudes prior to attending RCOP. In-depth qualitative analysis is required to explore students' concerns regarding RCOP and longitudinal research is warranted to monitor students' attitudes toward RCOP and rural work over time.

Utilization of dental health services and its associated factors among adult population in Ernakulam district, Kerala, India: A mixed-method analysis

Background

There exists a high burden of oral diseases. Yet, the utilization of oral health care remains low. Understanding how, when, and why/why not individuals utilize dental healthcare resources is essential for planning health services and developing policies as it reflects the population's oral health needs, helps allocate resources efficiently, and formulate policies that are tailored to address their needs.

Objectives

To assess the utilization of dental health services and its associated factors along with barriers and facilitators among adults residing in Ernakulam district, Kerala, using the Anderson healthcare model for healthcare utilization.

Methods

A mixed-method study was conducted among adults aged 18 years and above in urban and rural wards of Ernakulam district using the cluster sampling method. Univariate and multivariate analysis were used for the quantitative part, and thematic analysis was used for the qualitative aspect. The total sample size was 544.

Results

The dental healthcare utilization was 15.4 ± 2.9 % among the study participants. Age and education were associated with dental healthcare utilization. The level of education, pain, and self-consciousness of oral diseases were independent predictors. Barriers identified were negative attitudes, financial restraints, and difficulty in access, while facilitators were trust in service providers, availability of services, and a positive attitude.

Conclusion

Utilization was poor despite the perceived need for oral health care. This was affected by several personal and system-level facilitators and barriers.

Oral health community engagement programs for rural communities: A scoping review

This scoping review aims to identify the available literature on oral health community engagement programs that have been developed to guide oral health care in rural communities and to summarize their outcomes. This review was conducted using the 5-stage scoping review framework outlined by Arksey and O'Malley. We conducted a literature search with defined eligibility criteria through electronic databases such as Science Direct, PubMed, ProQuest, Scopus, EBSCOhost, and Wiley Online; other well-established online scientific health and dental organizations such as the WHO, the Fédération Dentaire Internationale of the World Dental Federation, the American Dental Association, and the South African Dental Association; and grey literature spanning the time interval from January 2012 to August 2023. The charted data were classified, analysed, and reported using descriptive and thematic analyses. A total of 19 records were included in the final review. These records were classified into four categories of interventions: community-based, school-based, integrated dental-based, and non-dental volunteer oral health programs. The findings imply that there is a growing appreciation for the significance of qualitative data in enhancing oral healthcare interventions and outcomes. Furthermore, the study showed that oral health strategies were successful in shaping the understanding and perception of oral health among children and mothers/caregivers, and in improving the oral health and quality of life of edentulous older adults and children living in rural communities.

Psychometric Properties of the Oral Health Values Scale and Cultural Adaptation in the Indian Population

AIM

The Oral Health Values Scale is a multidimensional instrument that identifies and measures a person's values related to oral health. This scale has been validated in American respondents. This study aims to evaluate the adaptability and validity of the Oral Health Values Scale in the Hindi language (H-OHVS).

METHODOLOGY

A total of 240 adults participated in the study that was carried out from July to November 2022. An offline one-to-one survey was carried out to collect data by an investigator blinded to the study protocol. The translation and testing of the OHVS were carried out based on the cross-cultural adaptation guidelines of the American Academy of Orthopedic Surgeons (AAOS) Evidence-Based Medicine Committee. The content validity was assessed by an expert panel. Construct validity was analyzed through Exploratory Factor Analysis (EFA), utilizing principal component analysis with varimax rotation. The internal consistency of the Hindi version of OHVS was evaluated using Cronbach's alpha.

RESULTS

 The results showed that H-OHVS had an Item-level Construct Validity Index (I-CVI) ranging from 0.82 to 1.00. Two components, compliance and hesitance, were formed on H-OHVS accounting for 63.91% of the cumulative variance. The resulting model fit indices on confirmatory factor analysis presented an adequate fit to the data. The overall Cronbach's alpha coefficient for H-OHVS (α = 0.868) presents excellent internal consistency.

CONCLUSIONS

The study findings provide a certain degree of evidence in favor of this scale and establish the Oral Health Values Scale (OHVS) as a psychometrically sound measure.

A scoping review exploring oral health inequalities in India: a call for action to reform policy, practice and research

INTRODUCTION

Reduction in health inequalities and providing universal access to health care have been identified as two important global milestones by the World Health Organization for countries to achieve by 2030. Therefore, recognizing the magnitude of oral health inequalities in India has become a pressing priority to improve access to dental care within the country. This scoping review was conducted with the aim of reviewing, collating and analysing the current knowledge base on oral health inequalities in India.

METHODOLOGY

The scoping review followed Arksey and O'Malley's approach, and reporting was performed in accordance with the PRISMA-ScR guidelines. A systematic search was conducted on Scopus, PubMed, Web of Science, and EMBASE to identify literature addressing one or more dimensions of oral health inequalities in India, published in English between January 2002 and April 2022. The data were charted, and qualitative analysis was performed to derive themes, highlighting the key concepts emerging from this review.

RESULTS

In accordance with the eligibility criteria, a total of 71 articles retrieved through database search and backward citation search were included in this scoping review. The major themes ranged from individual to diverse sociodemographic factors acting as barriers to and facilitators of access to dental care. Deficiencies in human resources for oral health, along with a wide diversity in dental service provision and dental education were other major themes contributing to inequality. Subsequently, this has resulted in recommendations on restructuring the dental workforce and their development and modifications in oral health care policies and practices. The qualitative synthesis demonstrates the intertwined nature of the multiple factors that influence the goal of achieving an affordable, accessible, extensive and inclusive oral healthcare system in India.

CONCLUSIONS

This comprehensive review provides a broad perspective on oral health inequalities in India, providing valuable insights for both researchers and policymakers in this area and guiding their efforts towards achieving universal oral health coverage in the Indian context.

The Effect of Structured Education Training Program on Oral Health Awareness Among School-Going Children of Central India: A Cross-Sectional Study

Background

In order to curb the ever-increasing load of diseases related to the oral cavity, there is a call for generating organized school-based oral health education and training programs. It is proposed that there will be an emphasis on the primary care of oral health of school-going children proven, which is often neglected. This will be beneficial for the early detection, intervention and thus prevention of further debilitating conditions of the pathologies pertaining to the oral cavity with the assistance of the structured program suggested in this article.

Aim

The aim of the study was the evaluation of oral health programs for oral health awareness and knowledge among school-going children in the Central India region.

Settings and design

This is a cross-sectional study with measurements before and after the implementation of the oral care program. 

Materials and methods

This cross-sectional study, approved by the Institutional Ethical Committee, Datta Meghe Institute of Medical Sciences, Wardha, has been done according to the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) checklist. A study based on certain questions was carried out amongst the school-going children of Central India, especially the Vidarbha region. A total of 250 school-going children were enrolled in the study. A survey based on a questionnaire was carried out among the study participants in the age group of 12-16 years of age, which consisted of questions pertaining to knowledge of oral health and hygiene maintenance. The program consisted of presentation slides, role-plays, and demonstrations for inculcating the knowledge.

Result

A total of 200 study participants responded to the questionnaire. Overall, the baseline mean score of knowledge with scale was 2.80 ± 1.73 SD, which after the intervention was observed to be 10.70 ± 0.54 SD, which showed an increase. There was an aptly 60.4% increase in test scores related to oral health after the specific oral health inculcation program based on questionnaire execution which was statistically significant (p<0.001).

Conclusion

A properly constructed school children-based oral health education and training program induces better results in the oral health-related comprehension of students.

Oral health inequality among Indonesian workers in South Korea: role of health insurance and discrimination factors

Background

The health of migrant workers is becoming an important public health issue. Although there are an increasing number of migrant workers in Korea, the health status in migrant populations remains unknown. The aims of this study were (1) to evaluate the association between income and self-rated oral health (SROH), and (2) to assess the role of health insurance and self-perceived discrimination in the association between income and SROH among Indonesian migrant workers in Korea.

Methods

Information about self-reported income, SROH, coverage/utilization of health insurance (HI), living difficulties related to oral health (LDROH), oral health literacy (OHL), and discrimination were obtained from Indonesian migrant workers in Korea (n = 248). The main explanatory variable was income, and SROH was an outcome variable. Logistic regression analyses were performed controlling for age, gender, HI, LDROH, OHL, and discrimination. The paths from income to SROH were analyzed using the Partial Least Square-Structural Equation Model (PLS-SEM).

Results

Among Indonesian migrant workers, the lower income group had the highest probability of a poor SROH compared to the higher income group. The variables showing a high explanatory power were discrimination among the low income group and HI among the middle income group. In PLS-SEM, the variables such as HI, LDROH, OHL, and discrimination contributed 11% to explaining the association between income and SROH.

Conclusion

A monotonic gradient was revealed among migrant workers according to the association between income and SROH. Discrimination and HI contributed to oral health inequalities.

Teledentistry awareness, its usefulness, and challenges among dental professionals in Pakistan and Saudi Arabia

Objectives

This study aims to describe the perception of dental professionals in Pakistan and Saudi Arabia (SA) towards the practice of teledentistry, its usefulness and challenges.

Methods

A cross-sectional study was carried out among 190 dentists from January 2021 to April 2021. The participants were included in the study using snowball sampling method. A 26-item adopted questionnaire was distributed using different social media channels. Chi-square test was used for analysis.

Results

Out of 190 participants, 46.3% were from Pakistan and 53.7% were from SA. The majority of participants in both countries agreed that teledentistry would enhance guidelines and advice (74.2%), improve peer-to-peer interaction (79.5%) and make patient's referrals more efficient (75.8%). For the usefulness, most participants agree that it is economical for the patients (61.1%), improves communication (74.7%), helps in educating the patients (86.3%), avoid unnecessary travel (76.8%), helps monitoring (71.6%), and benefits patients in remote areas (74.7%); however, more Pakistani participants perceived that time spent with the patient would increase compared to SA participants (p < 0.001) and a higher proportion of SA participants believe that it helps in communication and monitoring of patients (p < 0.001) than Pakistani participants. Regarding the challenges in the use of teledentistry, few participants think that it violates the patient's privacy (22.6%) or is difficult to use (14.7%) or have distrust towards the teledentistry equipment (24.2%).

Conclusion

The results indicated a high awareness and a positive attitude towards teledentistry, and its adaptation in their dental practice in both countries. However, limited infrastructure, set-up cost, and information technology (IT) literacy are the main challenges in integrating teledentistry which can be overcome by strategic government initiatives, policies, and programs.

Oral Health Related Quality of Life and its Association with Dental Caries of Preschool Children in Urban and Rural Areas of India

Background: In early childhood due to dental neglect, children suffer from multiple decayed teeth and experience pain, interfering with their daily activities. This study aimed to assess Oral Health Related Quality of Life (OHRQoL) of preschool children in urban and rural Bangalore, and to correlate it with their dental caries status. Study design: Oral health examination of 1545 preschool children, aged 3 to 5 years were selected from urban and rural Bangalore. The parents answered the Oral Health-Related Early Childhood Quality of Life OH-ECQOL proforma on OHRQoL of their children. Results: The mean OHRQoL of urban preschool children was 17.86 and was significantly different from 20.42 of rural preschool children. (p<0.001). The mean deft score was 2.60±2.26 in rural preschool children and it was significantly higher than 1.92±2.05 seen in urban preschool children (p< 0.001). A significant correlation was seen between dental caries (deft) and OHRQoL in urban preschool children (p=0.04). Their OHRQoL was significantly associated with the 'decayed' component.(p=0.03) Multiple regression analysis showed OHRQoL to be significantly associated with dental caries. Conclusion: OHRQoL among preschool children living in urban Bangalore was found to be better than those in rural Bangalore.

Validation of an Indian (Kannada) translation of the Family Impact Scale questionnaire and the impact of malocclusion on the families of adolescent school children

OBJECTIVES

The objectives of this study were to validate an Indian translation of the Family Impact Scale (FIS) questionnaire and assess the impact of malocclusion on the families of adolescent school children between 12 and 15 years old across socio-economic strata (SES).

MATERIALS AND METHODS

The sample consisted of 768 school children aged between 12 and 15 years from randomly selected schools in Udupi district. The FIS and informed consent forms were sent through the children to be completed by their parents. Information was collected on socio-demographic details, past dental visit in the last year, type of school and SES. Clinical examination for malocclusion using the Dental Aesthetic Index was conducted by a single trained and calibrated examiner.

RESULTS

The prevalence of malocclusion was 59.9%. The intra-class correlation for the total FIS score of 0.95 and Cronbach's alpha value of 0.88 demonstrated internal consistency. There was a significant difference in the overall and subscale scores of FIS between parents of children with and without malocclusion (P < 0.001). Parents of children who had malocclusion had significantly higher FIS scores across all SES (P < 0.001). Parents of children with malocclusion had 1.86 (P < 0.001, 95% CI = 1.60-2.17) times higher FIS scores than parents of children without malocclusion after adjusting for age, gender, SES, and past dental visits in the last year.

CONCLUSION

The psychometric properties of the FIS were found satisfactory for assessing the effect of a child's oral condition on his/her family. Malocclusion in children had a significant negative influence on the family impact scores.

Oral mucosal disorder-A demographic study

Introduction:

Oral mucosal disorder (OMD) has the potential disorder than any other oral disorder. It is found in the all over would. In our country India, is also more prone area of oral mucosal disorder. People more affected in male, low educated, low socioeconomic. Areca nut consumption is more so oral mucosal disorder is more reported, this survey was undertaken in darbhanga and is surrounding to determine the demographic data of oral mucosal disorder and to identify their association with various factors.

Materials and Methods:

A total of 5620 patients of Oral mucosal disorder attending the dental outpatient clinic of the Department of Oral Medicine and Radiology in dental college and department of dentistry in darbhanga medical college over a period of 36 months were selected for the study. A detailed case history and clinical examination was done in visible light. Study was done on the basis of age group, gender, socioeconomic habit duration, frequency of habit, and type of habit.

Statistical Analysis Used:

Simple t-test analysis was performed.

Results:

Of the 5620 cases of OMD studied, 75.01% cases were male. 49.09% were low socioeconomic people, 36.12% graduate educated, 47.29% smokeless habit and frequency of habit more than two time 57.12%. Oral mucosal disorder.

Conclusion:

Younger populations have relatively a higher percentage of oral mucosal lesions than would older populations. Habits, like smoking and smokeless, which further increase with age, can also increase the incidence of oral mucosal disorder Prevalence of habits was more in males than females.

Comparative analysis between developmental and inflammatory odontogenic cysts: retrospective study and literature review

PURPOSE

To assess epidemiological, clinical, and radiographic characteristics of odontogenic cysts (OCs) in a South Brazilian sample and to compare the results with international literature.

METHODS

For the main study purposes, biopsy and histopathological records were retrospectively analyzed from December 2006 to December 2018, OC cases were selected, and data about clinical characteristics were evaluated. Further, a literature review was performed for similar studies.

RESULTS

In the main study, the prevalence of OCs was 11.26% (n = 406), the majority of patients was male (56.73%), and the mean age was 39 ± 17.33 years. Radicular cyst was the most common OC (46.06%), followed by the odontogenic keratocyst (15.02%), dentigerous cyst (14.04%), and paradental cyst (13.55%). Inflammatory OCs were more prevalent in the maxilla (54.84%) and developmental cysts in the mandible (69.92%) (p < 0.05). Individuals with inflammatory OCs were usually older (41.0 ± 15.34 years) than the ones with developmental OC (28.0 ± 19.68 years) (p < 0.05). Regarding the literature review, 22 articles were included. Analysis of pooled data showed that global prevalence of OCs was 11.62% (95%CI = 9.97-13.37), from which radicular cyst was the most common (54.26%; 95%CI = 49.30-59.18), followed by dentigerous cyst (22.94%; 95%CI = 19.22-26.89) and odontogenic keratocyst (11.99%; 95%CI = 8.88-15.49). Furthermore, studies from Asia (72.40%; 95%CI = 70.30-74.40) and South America (68.48%; 95%CI = 64.07-72.72) presented the highest frequencies of inflammatory OCs.

CONCLUSION

The main study showed that the prevalence of OCs was 11.26%, which corroborates with international literature. Considering geographic variability of OC distribution, public health authorities and researchers could use these data for the development of focused prevention interventions, especially with regard to inflammatory OCs.

University-based initiatives towards better access to oral health care for rural and remote populations: A scoping review

This scoping review maps a wide array of literature to identify academic programs that have been developed to enhance oral health care for rural and remote populations and to provide an overview of their outcomes. Arksey and O'Malley's 5-stage scoping review framework has steered this review. We conducted a literature search with defined eligibility criteria through electronic databases, websites of academic records, professional and rural oral health care organizations as well as grey literature spanning the time interval from the late 1960s to May 2017. The charted data was classified, analyzed and reported using a thematic approach. A total of 72 citations (67 publications and seven websites) were selected for the final review. The review identified 62 universities with program initiatives towards improving access to oral health care in rural and remote communities. These initiatives were classified into three categories: training and education of dental and allied health students and professionals, education and training of rural and remote community members and oral health care services. The programs were successful in terms of dental students' positive perception about rural practice and their enhanced competencies, students' increased adoption of rural practices, non-dental health care providers' improved oral health knowledge and self-efficacy, rural oral health and oral health services' improvement, as well as cost-effectiveness compared to other strategies. The results of our review suggest that these innovative programs were effective in improving access to oral health care in rural and remote regions and may serve as models for other academic institutions that have not yet implemented such programs.

Dental treatment needs using a sociodental approach among south Indian youths: a cross-sectional study

AIM

The aim of this study was to compare the normative dental needs and sociodental needs in a sample of 18-21-year-old students in Davangere city in South India.

METHOD

This cross-sectional survey was conducted on a sample of 250 students aged 18-21 years. Data was collected using a self-administered questionnaire and clinical examination. The normative needs were assessed by different indices. The impact of oral diseases on their quality of life was assessed using the standard Oral Impact on Daily Performance (OIDP) scale and propensity-related needs (PRNs) were assessed using three standard questions.

RESULTS

About 85.6% of the subjects fulfilled the criteria for professionally judged normative treatment need. Among them, 42% of the subjects were suffering from emergency/progressive oral conditions and the remaining 43.6% subjects were suffering from non-progressive oral conditions. In turn, a total of 28.4% of the subjects with non-progressive oral conditions fulfilled the criteria of impact-related treatment need. Finally, only 1.2% had sociodental needs (high PRNs).

CONCLUSIONS

A substantial reduction in treatment needs were found with the sociodental approach among youths in India. The considerable proportion of the children with impact-related need (IRN) did not have a high behavioral propensity, hence potentially needing alternative interventions and programs.

Factors determining access to oral health services among children aged less than 12 years in Peru

Background: Understanding problems of access to oral health services requires knowledge of factors that determine access. This study aimed to evaluate factors that determine access to oral health services among children aged <12 years in Peru between 2014 and 2015. Methods: We performed a secondary data analysis of 71,614 Peruvian children aged <12 years and their caregivers. Data were obtained from the Survey on Demography and Family Health 2014-2015 (Encuesta Demográfica y de Salud Familiar - ENDES). Children's access to oral health services within the previous 6 months was used as the dependent variable (i.e. Yes/No), and the Andersen and col model was used to select independent variables. Predisposing (e.g., language spoken by  tutor or guardian, wealth level, caregivers' educational level, area of residence, natural region of residence, age, and sex) and enabling factors (e.g. type of health insurance) were considered. Descriptive statistics were calculated, and multivariate analysis was performed using generalized linear models (Poisson family). Results: Of all the children, 51% were males, 56% were aged <5 years, and 62.6% lived in urban areas. The most common type of health insurance was Integral Health Insurance (57.8%), and most respondents were in the first quintile of wealth (31.6%). Regarding caregivers, the most common educational level was high school (43.02%) and the most frequently spoken language was Spanish (88.4%). Univariate analysis revealed that all variables, except sex and primary educational level, were statistically significant. After adjustment, sex, area of residence, and language were insignificant, whereas the remaining variables were statistically significant. Conclusions: Wealth index, caregivers' education level, natural region of residence, age, and type of health insurance are factors that determine access to oral health services among children aged <12 years in Peru. These factors should be considered when devising strategies to mitigate against inequities in access to oral health services.

Exploratory scoping of the literature on factors that influence oral health workforce planning and management in developing countries

OBJECTIVES

The purpose of this study was to scope the literature that exists about factors influencing oral health workforce planning and management in developing countries (DCs).

METHODS

The Arksey and O'Malley method for conducting a scoping review was used. A replicable search strategy was applied, using three databases. Factors influencing oral health workforce planning and management in DCs identified in the eligible articles were charted.

FINDINGS

Four thousand citations were identified; 41 papers were included for review. Most included papers were situational analyses. Factors identified were as follows: lack of data, focus on the restorative rather than preventive care in practitioner education, recent increase in number of dental schools (mostly private) and dentistry students, privatization of dental care services which has little impact on care maldistribution, and debates about skill mix and scope of practice. Oral health workforce management in the eligible studies has a bias towards dentist-led systems. Due to a lack of country-specific oral health related data in developing or least developed countries (LDCs), oral health workforce planning often relies on data and modelling from other countries.

DISCUSSION AND CONCLUSION

Approaches to oral health workforce management and planning in developing or LDCs are often characterized by approaches to increase numbers of dentists, thus not ameliorating maldistribution of service accessibility. Governments appear to be reducing support for public and preventative oral healthcare, favouring growth in privatized dental services. Changes to professional education are necessary to trigger a paradigm shift to the preventive approach and to improve relationships between different oral healthcare provider roles. This needs to be premised on greater appreciation of preventive care in health systems and funding models.

APPRAISAL OF ACCESS TO DENTAL SERVICES IN SOUTH EAST OF IRAN USING FIVE AS MODEL

BACKGROUND

Access to dental services not only refers to utilization but also to the extent by which the utilization is judged according to professional norms. This study aimed to study the access to dental services using the Five As model.

METHODS

This cross sectional study was conducted in southeast of Iran. A sample of 400 subjects participated in the study according to a multistage sampling method. A questionnaire was used for data collection. Data were analyzed using independent T test, ANOVA and multivariate linear regression models by means of SPSS V.20 software.

FINDINGS

Affordability, availability, accessibility, accommodation and acceptability mean scores were 58.2±12.2, 53.9±12.9, 59.4±15.7, 60.2±8.6, 70±11.5 and 60.3±7.4 respectively. According to multivariate linear regression models, there was significant associations between affordability and age, education level, having basic insurance and family income. Moreover, total accessibility was significantly correlated with education and monthly family income.

CONCLUSION

This study showed that access to dental services was at the moderate level among the studied population. It also revealed that age, basic insurance coverage, family income and level of education, are determinants of this accessibility.

Need for Oral Health Policy in India

Dental diseases are a significant public health menace having a substantial impact on the quality of life which in turn affects the daily performance and general life satisfaction. There is a vast difference in health status including the oral health between urban and rural population of India and in other developing countries. The existing situation demands the formulation and implementation of National Oral Health Policy in India in order to expand the oral health care to make it more affordable, and reachable. An extensive literature search was conducted using various search engines in order to include relevant information in the review. Number of keywords and their combinations were used in order to extract appropriate data. Finally 24 out of 35 articles were selected upon detailed reading. The present paper focusses on some of the important subjects that can be considered while formulation of a National Oral Health Policy for the benefits of both the dental profession and community as a whole. There is a need of dental health planners and policy makers that have relevant qualifications and training in public health dentistry to understand the unique needs and resources for the development of an effective oral health policy. Professional dental organizations can also support government programs to provide basic oral health needs of extensive underserved population of this country.

The current status of dental graduates in India

The dental profession is a noble profession. It takes years of devotion towards the subject of dentistry to get the graduate degree of Bachelor of Dental Surgery. However, even after such painstaking efforts the current situation of dental graduates in India is grave. There are a lot of issues that are the main cause for this problem. The dental graduates are in a state of crisis due to lack of support from the Government. If this situation continues it will lead to a negative effect on the integrity of the dental profession, and highly trained dental manpower of the country will go in vain.

Addressing inequalities in oral health in India: need for skill mix in the dental workforce

Dentistry has always been an under-resourced profession. There are three main issues that dentistry is facing in the modern era. Firstly, how to rectify the widely acknowledged geographical imbalance in the demand and supply of dental personnel, secondly, how to provide access to primary dental care to maximum number of people, and thirdly, how to achieve both of these aims within the financial restraints imposed by the central and state governments. The trends of oral diseases have changed significantly in the last 20 years. The two of the most common oral diseases that affect a majority of the population worldwide, namely dental caries and periodontitis, have been proved to be entirely preventable. Even for life-threatening oral diseases like oral cancer, the best possible available treatment is prevention. There is a growing consensus that appropriate skill mix can prove very beneficial in providing these preventive dental care services to the public and aid in achieving the goal of universal oral health coverage. Professions complementary to dentistry (PCD) have been found to be effective in reducing inequalities in oral health, improving access and spreading the messages of health promotion across entire spectrum of socio-economic hierarchy in various studies conducted globally. This commentary provides a review of the effectiveness of skill mix in dentistry and a reflection on how this can be beneficial in achieving universal oral health care in India.

Periodontal health status and treatment needs of the rural population of India: A cross-sectional study

Background:

Periodontal disease is of public health concern and hence data on its prevalence rate are necessary. We have documented the prevalence pattern of periodontal disease in a rural population of Belgaum district, India, and identify the optimal treatment needs (TNs).

Materials and Methods:

A cross-sectional study was carried on 1680 dentate adult subjects, examined from 12 villages in Belgaum district, Karnataka, India for prevalence of periodontal status and their TNs (using Community Periodontal Index for Treatment Needs [CPITN]).

Results:

Increase in CPITN score positively correlated with age. Only 4.3% (13) of subjects in the age-group of 20-29 had a CPITN score of 4 indicative of pockets of 6 mm or more when compared to 26% (91) of subjects in the age-group of 45-60 years. 92% (569) of the subjects in the age-group of 30-44 were having a TN score 2 whereas only 5.3% (33) of subjects were having a TN score 0 in the same age-group. Significantly higher need for treatment was observed in males, smokers and subjects using finger and tooth powder. Surprisingly diet of the subjects did not influence TNs.

Conclusion:

Increased prevalence of periodontal diseases and TNs was observed. There is a need for initiating adequate awareness regarding oral hygiene, specifically primary prevention could help in reducing the prevalence of periodontal disease.

Addressing geriatric oral health concerns through national oral health policy in India

There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world's elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries.