Effect of family cohesion on oral health predictors in children and adolescents: A systematic review

OBJECTIVE

The family environment influences oral health conditions and the utilization of dental services. The emotional link between the family members and the degree to which they are resilient and close to each other is represented as family cohesion and adaptability. This systematic review critically appraises and synthesizes existing evidence on the effect of family cohesion on oral health predictors in children and adolescents.

METHODS

The protocol was registered in PROSPERO (CRD42023453608). Databases such as PubMed, Embase, and Scopus were electronically searched in September 2023. No restriction of time frame was allowed. Risk of bias was assessed using the Agency for Healthcare Research and Quality tool.

RESULTS

Initially, 272 records were identified from PubMed (133), Embase (122) and Scopus (10) databases and other sources, finally leading to 12 cross-sectional studies to be included. Eleven studies were carried out in Brazil and one in USA. Only one study reported moderate risk, whereas the others all reported low risk of bias. The studies were carried out from 2013-2023. The frequency of dental visits, oral health literacy, and self-perceived need for dental treatment were reported to be higher in families with the better cohesive ties. An inconsistent direct association was reported between dental caries and family cohesion.

CONCLUSIONS

Family dynamics are important in shaping oral health behaviors and outcomes during a pivotal phase of development. Further exploration through longitudinal studies in this field can elucidate causal pathways and potential moderators.

Sign language based educational interventions vs. other educational interventions to improve the oral health of hearing-impaired individuals: A systematic review and meta-analysis

OBJECTIVE

Individuals with special needs requiring special care are more vulnerable to oral health problems. Sign language is a communication medium and language of instruction for individuals with hearing impairments. The purpose of this systematic review and meta-analysis was to assess the effectiveness of sign language-based educational interventions compared to other educational interventions in improving the oral health of hearing-impaired individuals.

METHODS

PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials databases were searched without any restriction on the publication date. Analytical and experimental studies that evaluated and compared the effectiveness of sign language with other educational intervention groups such as videos, posters etc were included.

RESULTS

Initially, 5568 records were identified. Three relevant publications from India were eligible and included in the systematic review and meta-analysis. Differences were reported in favour of sign language over other interventions concerning plaque status, gingival health, and oral hygiene status.

CONCLUSION

Sign language-based interventions were found to be effective. However, further studies in different locations and populations are required to support their effectiveness.

Posting and Transfer: the experiences of public sector doctors in two Indian states

Posting and Transfer (PT) refers to deployment of the health workforce in ways that ensure appropriate numbers and distribution. Although PT is a crucial aspect of health workforce governance, it remains under-researched from the viewpoint of implementation, health workforce and governance. The aim of this paper is to examine public sector doctors' experience of their initial postings, in the context of local policy from two Indian states. We carried out a review search for policy documentation. A total 61 in-depth interviews were conducted in both states with 33 doctors, as subjects of the study. There were 28 key informant (KI) interviews of health administrators and other policy actors to understand their perspectives of PT policies and implementation. Thematic analysis was used to analyse data. Job histories were constructed from the doctors' interviews to track their experience with the PT system, and analysed using location, duration and postings. Despite search for state policy for PT, we were unable to identify any policy documentation. However, participants referred to PT practices that suggested expectations of what the poliy meant to them. These expectations were corroborated by KI, and the job histories and interview data enabled the authors to construct a series of norms, interpreted as evidence of implied policy. The main norms identified relate to service need, native place, request, gender and posting duration. The norm related to state need had strong face validity, while other norms based on request, gender and duration were less consistent in application. In the absence of documented policies, the construction of norms from the qualitative data proved useful to examine the dynamics of health workers' interactions with the initial PT systems This construction of norms provides a methodological innovation allowing health policy and systems researchers to compensate for the absence of documented policy in exploring PT functions.

Job Satisfaction Among Public Sector Doctors and Nurses in India

In most countries, the efforts to attract and retain health workers have been focused on extrinsic measures of motivation, with very less focus on a better understanding of job satisfaction—an important intrinsic factor and construct. The main aim of this study was to assess job satisfaction, its seven dimensions, and motivation among health service providers (doctors and nurses) employed within the public sector in India. The study was conducted in three districts representing two states in India. The study participants represent the doctors and nurses from public health and service delivery centres. Data were collected from a total of 307 healthcare providers (152 doctors and 157 nurses).

‘Measure job satisfaction’ tool was adapted that contained 41 items capturing seven dimensions of job satisfaction on a five-point Likert scale with a higher score indicating a higher level of job satisfaction and vice versa. In addition, one single statement was used to assess motivation.

Average scores were calculated for each of the seven dimensions of job satisfaction, motivation and for overall job satisfaction. Parametric tests such as t-test and analysis of variance (ANOVA) were used for comparisons of job satisfaction scores according to the place of work, years of work experience, appointment type and health professional categories. The statistical analysis was carried out using SPSS version 22.0. Exploratory factor analysis was carried out to assess the relationship between job satisfaction and motivation and regression analysis of motivation was carried to assess predictors of job satisfaction, demographic and work-related factors’ effect on motivation.

The average scores for most of the dimensions of job satisfaction were low for both doctors and nurses with the lowest scores reported for the dimensions of ‘professional support’ and ‘personal satisfaction’ while the highest score reported for ‘satisfaction with pay’. Significant results in the difference of mean scores were found for all seven dimensions of job satisfaction except for ‘prospects’ at different levels of place of work, ‘standard of care’ at different levels of length of service and ‘training’ for different levels of types of appointment. The mean scores of motivation were found to be significantly different for different levels of place of work and also between the doctors and nurses. The regression analysis of motivation on various predictors of job satisfaction suggests that personal satisfaction and satisfaction in prospect were highly significant while other variables such as gender and place of posting were marginally significant. Understanding of job satisfaction can provide useful insights to both extrinsic as well as intrinsic aspects of work motivation, which arguably is the most critical area of health systems research that could potentially feed into streamlined and improved health workforce management policies aimed at addressing the shortage and retention of the health workforce.

Is Malocclusion Associated with Dental Caries among Children and Adolescents in the Permanent dentition? A Systematic Review

OBJECTIVE

To determine the association between malocclusion and the severity of dental caries among children and adolescents in the permanent dentition.

METHOD

A search was conducted in Medline, Cochrane databases, Google scholar, Scopus and Web of Science through October 2020 for studies of malocclusion and dental caries among children and adolescents using the Dental Aesthetic Index (DAI) and the Decayed, Missing, Filled Teeth (DMFT) index. Quality was evaluated using the Newcastle-Ottawa tool for cross-sectional studies. Data were extracted using the Cochrane Collaboration guidelines. Meta-analysis used the Cochrane Program Review Manager Version 5. A random effects model was used to assess the association among different categories of malocclusion with dental caries. GRADE analysis assessed the certainty of evidence.

RESULTS

Five studies met the inclusion criteria. Handicapping malocclusion was significantly associated with higher mean DMFT scores (Mean difference: 1.03, 95% CI, 0.61, 1.44). Participants with severe malocclusion had higher mean DMFT when compared to subjects with normal occlusion (0.32, 95% CI, 0.13, 0.51). Definite malocclusion was also associated with higher mean DMFT scores (Mean difference: 0.19, 95% CI, 0.03, -0.35).

CONCLUSION

Malocclusion is associated with dental caries in the permanent dentition. DMFT scores and the strength of the association increased with severity of malocclusion. Low to moderate certainty of evidence was observed for association between handicapping, severe, and definite malocclusion with dental caries.

Role stress among auxiliary nurses midwives in Gujarat, India

Background

Understanding Role Stress is important as health service providers, especially nurses experience high levels of Role Stress which is linked to burnout, poor quality of care and high turnover. The current study explicates the concept of Role Stress and assesses the Role Stress experienced by the Auxiliary Nurse Midwives (ANMs) working with rural government health centres from Gujarat, India.

Methods

The study included 84 ANMs working with government health centres from one district in India. A structured instrument with established reliability and validity was used to measure 10 dimensions of Role Stress namely: Inter-role distance, role stagnation, role expectation conflict, role erosion: role overload, role isolation, personal inadequacy, self-role distance, role ambiguity and resource inadequacy. The study instrument was based on 5 point Likert rating scale that contained 50 unidirectional negative statements, 5 for each dimension. Kolmogorov-Smirnov and Shapiro-Wilk test were carried out to assess if the data were normally distributed. Cronbach’s alpha test was carried out to assess reliability of the instrument. The study data was analyzed using descriptive statistics mainly using mean scores with higher scores indicating higher Role Stress and vice versa. The data was analyzed using SPSS version 19.

Results

Kolmogorov-Smirnov and Shapiro-Wilk test indicated that the data were normally distributed. Cronbach’s alpha test indicated values of 0.852 suggesting high reliability of the tool. The highest Role Stress among ANMs was experienced for resource inadequacy. Role overload, role stagnation and inter-role distance were among the other important role stressors for ANMs. The study results suggests that ANMs frequently feel that: they do not have adequate amount of resources, facilities and financial support from the high levels authorities; people have too many expectations from their roles and as result they are overloaded with work and have very limited opportunities for future growth.

Conclusion

The current study has the potential to provide a useful and a comprehensive framework to understand the Role Stress among the health service providers that could be further useful in designing interventions specifically aimed at reducing Role Stress in order to prevent burnout thereby addressing the productivity and retention.

Opening the black box of transfer systems in public sector health services in a Western state in India

Background

Limited research on Posting and Transfer (P&T) policies and systems in the public sector health services and the reluctance for an open debate on the issue makes P&T as a black box. Limited research on P&T in India suggests that P&T policies and systems are either non-existent, weak, poorly implemented or characterized by corruption. Hence the current study aimed at opening the “black box” of P&T systems in public sector health services in India by assessing the implementation gaps between P&T policies and their actual implementation.

Methods

This was a qualitative study carried out in Department of Health, in a Western State in India. To understand the extant P&T policies, a systems map was first developed with the help of document review and Key Informant (KI) Interviews. Next systems audit was carried out to assess the actual implementation of transfer policies by interviewing Medical Officers (MOs), the group mainly affected by the P&T policies. Job histories were constructed from the interviews to understand transfer processes like frequencies of transfers and to assess if transfer rules were adhered. The analysis is based on a synthesis of document review, 19 in-depth interviews with MOs working with state health department and five in-depth interviews with Key Informants (KIs). Framework analysis approach was used to analyze data using NVIVO.

Results

The state has a generic transfer guideline applicable to all government officers but there is no specific transfer policy or guideline for government health personnel. The generic transfer guidelines are weakly implemented indicating a significant gap between policy and actual implementation. The formal transfer guidelines are undermined by a parallel system in which desirable posts are attained, retained or sometimes given up by the use of political connections and money. MOs’ experiences of transfers were marked by perceptions of unfairness and irregularities reflected through interviews as well as the job histories.

Discussion

The generic transfer rules and ambiguity in how transfers are treated may explain the discrepancy between policy and implementation leading to systems abuse. This discrepancy could have negative influence on MOs’ morale which could in turn affect distribution of MOs. Where possible, ambiguity in the rules should be avoided and a greater transparency on implementation of the transfer rules is needed. However, it may not be possible to make any significant improvements to P&T policies and how they are implemented until the external pressure that creates parallel systems is greatly reduced in translating HR policy into HR practice.

Conclusions

Effective P&T policies and implementation may have important implications for organizational performance and may help to improve Human Resource (HR) policy and HR expertise. Also there is a greater need for transparency on implementation of the rules. However, it may not be possible to make any significant improvements to P&T policies and how they are implemented until the external pressure that creates parallel systems is greatly reduced.

Issues and challenges in recruitment for government doctors in Gujarat, India

BACKGROUND

India faces a critical shortage of government doctors in rural and underserved areas. Several measures have been introduced to address the shortage, but significant problems still remain. The main aim of the current research was to understand the existing recruitment-related policies and systems in place for government doctors in Gujarat and to identify issues that prevent effective recruitment of doctors that could have implications for doctors' shortage in the state. The research also aims to fill the knowledge gap in the existing literature on why recruitment in civil services is an important HR function to address the shortage of doctors.

METHODS

The study aimed at identifying the existing recruitment policies and practices for government Medical Officers (MOs) from Gujarat state in India. The analysis is based on document review to understand the existing policies, 19 in-depth interviews with MOs to understand the systems in place for recruitment of MOs, construction of job histories from interviews to understand various nuances in the recruitment system and five interviews with Key Informants to understand recruitment policies and their actual implementation. Thematic framework approach was used to analyse qualitative data using NVivo.

RESULTS

While the state has general recruitment guidelines called the Recruitment Rules (RRs), these rules are very wide-ranging and fragmented. The MOs were neither briefed about them nor received copies of the rules at any time during the service suggesting that RRs were not transparent. The recruitment system was considered to be slow and very sporadic having possible implications for attraction and retention of MOs. The study results indicate several other system inefficiencies such as a long time taken by the health department to provide salary benefits and service regularization that has a negative effect over MOs' motivation. The study also found unequal opportunities presented to different categories of MOs in relation to job security, salary benefits and in recognizing their previous work experience leaving MOs unclear about their future thereby influencing the attraction and retention of MOs to government jobs negatively.

CONCLUSIONS

If long-term solutions are to be sought, the health department needs to have an effective recruitment system in place with the aim to (1) address the slow and sporadic nature of the recruitment system (that is likely to attract more doctors and prevent loss of any doctors during recruitment) and (2) address the job insecurity issue that MOs have which also influences their other employment benefits such as salary, pension and recognition for the years of service they have given to the health department. Addressing these issues can improve motivation among doctors and prevent loss of doctors through voluntary turnover leading to better retention.

Initial posting-a critical stage in the employment cycle: lessons from the experience of government doctors in Gujarat, India

BACKGROUND

With the critical shortage of government doctors serving in rural health centers in India, understanding the initial posting policies, processes, and practices become important from a retention point of view. The initial posting is a very critical stage of an employment cycle and could play an important role in influencing the key human resource for health outcomes such as turnover and performance. The current study aimed at exploring a rather unknown phenomenon of the initial posting-related processes, practices, and perceptions of Medical Officers working with the Public Health Department in Gujarat, India.

METHODS

This was an exploratory study carried out in the state of Gujarat, India, that used qualitative methods first to document the extant initial posting policy with the help of document review and five Key Informant interviews; next, 19 in-depth interviews were carried out with Medical Officers to assess implementation of policies as well as processes and systems related to the initial posting of Medical Officers. A thematic framework approach was used to analyze qualitative data using NVIVO.

RESULTS

The results indicate that there is no formal published or written initial posting policy in the state, and in the absence of a written and formal policy, the overall posting systems were perceived to be arbitrary by the study respondents. In the absence of any policy, the state has some unwritten informal practices such as posting the Medical Officers at their native places. Although this practice reflects a concern towards the Medical Officer's needs, such practices are not consistently applied indicating some inequity and possible implications over Medical Officers' retention and motivation.

CONCLUSIONS

Initial posting is a critical aspect of an employment cycle, and the perceptions and experiences of MOs regarding the processes and practices involved in their initial posting can be crucial in influencing their performance and turnover rates. If long-term solutions are to be sought in addressing the availability and distribution of Medical Officers in the state, then there is a need to have clearly laid down initial posting-related policies that reflect the equity and consideration towards Medical Officers in placement-related matters.

Is the Annual Confidential Report system effective? A study of the government appraisal system in Gujarat, India

BACKGROUND

Effective performance appraisal systems can not only motivate employees to improve performance but also be important for the performance of organizations. However, the appraisal systems in civil services called the Annual Confidential Report (ACR) systems can be ineffective and do not contribute to employees' learning and development. With this background, the current study aimed at understanding the ACR system and assessing its effectiveness. The research aims to contribute in filling the knowledge gap in the existing literature on the need as to why the ACR system in civil services is an important human resource management (HRM) function.

METHODS

The analysis is based on policy review to understand the extant appraisal-related rules and policies. Nineteen in-depth interviews with medical officers (MOs) working with the government health department of Gujarat, India, were conducted. The main objective of the research was to assess the effectiveness of the actual appraisal system called or referred to as the ACR as perceived by MOs. Thematic framework approach was used to analyze qualitative data using NVIVO 9. Themes were built around five features of an effective appraisal system, i.e., purpose, source, feedback quality, link of the ACR system with other human resource functions, and administrative effectiveness.

RESULTS

The five features of the effective appraisal system studied in the current research (purpose, source, feedback quality, link of ACR system with other HRM functions, and administrative effectiveness) indicate that the overall appraisal system is ineffective. The overall appraisal system was perceived to be subjective and one directional in character by the study respondents. Furthermore, respondents perceived the appraisal system to be a ritual and where MOs hardly got to know about their performance, especially good performance. Hence, the feedback loop, an important feature for an effective appraisal system, was absent. The overall ACR system functions in isolation with no link to other HRM functions such as training and counselling, and a weak link with salary administration and promotion.

CONCLUSIONS

Addressing the five features or domains of an effective appraisal system can lead to improved perceived fairness MOs have on the current appraisal system which may further influence the satisfaction and motivation positively. Improved motivation and satisfaction with the appraisal system can influence two important human resource for health-related outcomes, i.e., performance and retention.

Developing a tool to assess motivation among health service providers working with public health system in India

BACKGROUND

Addressing the shortage of health service providers (doctors and nurses) in rural health centres remains a huge challenge. The lack of motivation of health service providers to serve in rural areas is one of the major reasons for such shortage. While many studies have aimed at analysing the reasons for low motivation, hardly any studies in India have focused on developing valid and reliable tools to measure motivation among health service providers. Hence, the objective of the study was to test and develop a valid and reliable instrument to assess the motivation of health service providers working with the public health system in India and the extent to which the motivation factors included in the study motivate health service providers to perform better at work.

METHODS

The present study adapted an already developed tool on motivation. The reliability and validity of the tool were established using different methods. The first stage of the tool development involved content development and assessment where, after a detailed literature review, a predeveloped tool with 19 items was adapted. However, in light of the literature review and pilot test, the same tool was modified to suit the local context by adding 7 additional items so that the final modified tool comprised of 26 items. A correlation matrix was applied to check the pattern of relationships among the items. The total sample size for the study was 154 health service providers from one Western state in India. To understand the sampling adequacy, the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's test of sphericity were applied and finally factor analysis was carried out to calculate the eigenvalues and to understand the relative impact of factors affecting motivation.

RESULTS

A correlation matrix value of 0.017 was obtained narrating multi-co-linearity among the observations. Based on initial factor analysis, 8 out of 26 study factors were excluded from the study components with a cutoff range of less than 0.6. Running the factor analysis again suggested the inclusion of 18 items which were subsequently labelled under the following heads: transparency, goals, security, convenience, benefits, encouragement, adequacy of earnings and further growth and power.

CONCLUSIONS

There is a great need to develop instruments aimed at assessing the motivation of health service providers. The instrument used in the study has good psychometric properties and may serve as a useful tool to assess motivation among healthcare providers.

A Study of Organizational Values in Government Run Primary Health Centres in India

Background:

Organizational Culture (OC) (with focus on core organizational values) has been a much neglected area for research in Government Health sector in India. The present study aimed at assessing the OC with the sole focus on the organizational values at the Government run Primary Health Centres (PHCs) in India.

Methods:

The study participants included 124 healthcare providers and other health staff from 24 government run PHCs in India. Instrument called OCTAPACE (Openness, Confrontation, Trust, Authenticity, Praoaction, Autonomy, Confrontation and Experimentation) was used for data collection. It consists of 40 items that measured eight different organizational values: Openness; Confrontation; Trust; Authenticity; Praoaction; Autonomy; Confrontation and Experimentation. The assessment of organizational values was based on ratings provided by respondents on the 40 items.

Results:

The study results indicate that Openness was the most important perceived organizational value followed by Confrontation and Trust while Autonomy and Collaboration were the least appreciated and practiced values. The study found statistically significant higher mean scores for the values of Authenticity and Collaboration for the group having more work experience. In addition, the study results also show statistically significant higher mean scores for Openness, Confrontation, Trust, Authenticity, Proactiveness and Experimentation values for paramedical and other staff in comparison to mean scores of Medical officers.

Conclusion:

More research is needed in the area of OC with focus on values. The overall culture in PHCs can be further improved by encouraging free sharing of ideas and expression of feelings and thoughts. More importantly, employees of health centres should be given more autonomy and freedom to take decisions in their work to improve the OC.

What Motivates Government Doctors in India to Perform Better in their Job?

Objectives:

Addressing the issue of poor motivation of Medical Officers (MOs) to join and continue service in rural India is a major challenge faced by the health system. The present study aimed at assessing the driving factors of motivation for MOs working with rural government health centres in India. The study also aimed at finding out the differences in the preferred factors of motivation based on various job-related aspects of the respondents.

Methods:

The study participants included MOs from Gujarat, India. The study asked the participants to rank 20 factors of motivation (10 intrinsic and 10 extrinsic motivation factors) important for them to continue in their current job. The factors for the study were selected using Herzberg’s two factor theory of motivation and the data was collected with the help of an instrument that has an established reliability and validity. Distribution of ranks of different motivating factors was studied using average ranks assigned by respondents based on different job-related aspects. Average scores were also calculated to see whether the respondents are motivated more by extrinsic factors or by intrinsic factors.

Results:

The results indicate that ‘job security’ was the most preferred factor of motivation followed by ‘adequate salary’ while, the least preferred factor for motivation was ‘local political interference’. Adequate salary and job security also emerged as the two most important motivation factors for all the three groups of respondents based on number of years of work experience. For Ad hoc MOs, ‘adequate salary’ and ‘interesting work’ were the most important motivation factors while for bonded category of MOs, ‘adequate salary’ and ‘opportunities for promotion’ were the two most important factors for motivation.

Conclusion:

The current study concludes that MOs motivation to continue with the current job is driven both by extrinsic and intrinsic factors. Hence, the health departments and systems need to pay close attention to devising strategies that address both the extrinsic as well as intrinsic factors. However, according to study findings, more attention needs to be paid to providing Job security and better salaries and monetary benefits to MOs. The study results may be useful to health departments and systems to design management strategies that are based on motivational needs of MOs to improve their attraction and retention.

Beyond job security and money: driving factors of motivation for government doctors in India

BACKGROUND

Despite many efforts from government to address the shortage of medical officers (MOs) in rural areas, rural health centres continue to suffer from severe shortage of MOs. Lack of motivation to join and continue service in rural areas is a major reason for such shortage. In the present study, we aimed to assess and rank the driving factors of motivation important for in-service MOs in their current job.

METHODS

The study participants included ninety two in-service government MOs from three states in India. The study participants were required to rank 14 factors of motivation important for them in their current job. The factors for the study were selected using Herzberg's two-factor theory of motivation and the data were collected using an instrument that has an established reliability and validity. Test of Kendall's coefficient of concordance (W) was carried out to assess the agreement in ranks assigned by participants to various motivation factors. Next, we studied the distributions of ranks of different motivating factors using standard descriptive statistics and box plots, which gave us interesting insights into the strength of agreement of the MOs in assigning ranks to various factors. And finally to assess whether MOs are more intrinsically motivated or extrinsically motivated, we used Kolmogorov-Smirnov test.

RESULTS

The (W) test indicated statistically significant (P < 0.01) agreement of the participants in assigning ranks. The Kolmogorov-Smirnov test indicated that from policy perspectives, MOs place significantly more motivational importance to intrinsic factors than to extrinsic factors. The study results indicate that job security was the most important factor related to motivation, closely followed by interesting work and respect and recognition. Among the top five preferred factors, three were intrinsic factors indicating a great importance given by MOs to factors beyond money and job security.

CONCLUSION

To address the issue of motivation, the health departments need to pay close attention to devising management strategies that address not only extrinsic but also intrinsic factors of motivation. The study results may be useful to understand the complicated issue of work motivation and can give some useful insights to design comprehensive management strategies that are based on motivational needs of MOs.

Malocclusion and orthodontic treatment need measured by the dental aesthetic index and its association with dental caries in Indian schoolchildren

OBJECTIVE

To assess prevalence of malocclusion and orthodontic treatment needs among 12 year old Indians using the Dental Aesthetic Index, and to find its association with dental caries.

METHOD

927 schoolchildren were randomly selected and their DAI and dentition status scores were recorded as per 1997 World Health Organization criteria. Clinical exams were carried out by one trained and calibrated examiner. The Chi-square test, Z-test and Spearman's correlation test were carried out.

RESULTS

Mean DAI score was 19.2 (sd 6.8). Differences were found between male and female DAI scores (Z < or = 0.05). 82% of children had DAI scores < 26 with no or minor malocclusion requiring no or little treatment, 3.2% had DAI scores 31-35 with severe malocclusion requiring highly desirable treatment and 1.8% DAI scores > 35 with handicapping malocclusion requiring mandatory treatment. A mean DMFT of 1.15 (sd 1.62) was recorded. Severe and handicapping malocclusions were associated with dental caries.

CONCLUSIONS

The distribution of DAI scores among Indian schoolchildren differs from that reported in other populations. Positive correlation was found between severe and handicapping malocclusion with dental caries.