TPS Oral Health Final

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Final TPS Oral Health Team Presentation on July 21, 2011 in Chennai on the Concluding Day of the Trans Disciplinary Problem Solving Course: co-taught by Washington University in St. Louis and ICTPH.

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TPS Oral Health Final

  1. 1. Oral Health:Addressing Dental Diseases in Rural India Shawn Lin & Allison Mauk
  2. 2. OverviewBurden of DiseaseDeterminantsIntervention StrategiesImplementationEvaluation Plan
  3. 3. Burden of Disease
  4. 4. Dental CariesMost common non-communicable disease in theworld1Slight increase in prevalence in Tamil Nadu • 47.8% (1973)2 → 49.8% (2004)3 • Higher prevalence in rural areas3 • One survey in rural TN found a prevalence of 70.2% in 6 year-olds4
  5. 5. Prevalence of Periodontal Disease in Thanjavur Region, 20033 100Prevalence of Periodtonal Disease (%) 90 80 70 60 50 40 30 20 10 0 5 12 15 35-44 65-74 Age (years)
  6. 6. BurdenPersonal: impact on Quality of Life • Difficulty eating 5 • Severe dental disease acts as focus of infection for other organs (kidneys, heart, brain)3Population • 1,247,000 DALYs in 1998 in India 6Health System • Lack of infrastructure → difficult to assess • Inflammation a risk factor as well 7 • Significant risk factor for several systemic diseases • The birth of pre-term low-birth weight babies, coronary artery diseases, and diabetes mellitus7
  7. 7. Determinants
  8. 8. • Significant risk factor for periodontal disease andSubstance caries8,9,10 Use • Tamil Nadu: 10% of adults report using tobacco regularly3 • Expanding economy → greater access and higher Diet & preference of junk foods11Nutrition • Change in dietary patterns influences oral health
  9. 9. Fluoride • Tamil Nadu: 40% reported using fluoride toothpaste or fluoridated tooth powder3Exposure • Dentist to Population Ratio12:Access to • Urban 1:10,000 • Rural 1:250,000 Care • 72.2% of population lives in rural areas4 • In Tamil Nadu:Knowledge • 57% report using a toothbrush3& Behavior • 3.9% report brushing twice per day3
  10. 10. Intervention Strategies
  11. 11. • School-based oral health Primary promotion program • Establish comprehensiveSecondary oral health screening • Increase access to oral Tertiary health care
  12. 12. Implementation
  13. 13. Primary Prevention Strategy:School-based oral health promotion programActivities:• Administer fluoride rinse in schools• Screen oral health education video on school TVs
  14. 14. Secondary Prevention Strategy:Establish comprehensive oral health screeningActivities:• Train CHWs and RMHC staff in oral screening and education• Develop & validate non-invasive oral health screening instrument• Integrate non-invasive oral screening instrument to PISP, RRA, and Patient Visit Protocol• Implement Oral Health Screening Protocol• Perform oral health screening at schools• Add oral health education to Patient Visit Protocol
  15. 15. Secondary Prevention Strategy:Establish comprehensive oral health screeningActivities:• Train CHWs and RMHC staff in oral screening and education• Develop & validate non-invasive oral health screening instrument• Integrate non-invasive oral screening instrument to PISP, RRA, and Patient Visit Protocol• Implement Oral Health Screening Protocol• Perform oral health screening at schools• Add oral health education to Patient Visit Protocol
  16. 16. Tertiary Prevention Strategy:Increase access to careActivities:• Install dental equipment in the RMHC• Establish rotation of visiting dentists to staff bi-weekly dental clinic in RMHC
  17. 17. Evaluation
  18. 18. Formative EvaluationValidity of non-invasive oral health screeninginstrument Pretest: comprehension Validity: sensitivity & specificity
  19. 19. Process EvaluationPrimary Prevention Objectives: • Schoolchildren received 7 fluoride rinses per semester • Schoolchildren viewed video twice per semesterSecondary Prevention Objectives: • Majority of population screened for oral health • Increased visits to RMHC for follow-up comprehensive screeningTertiary Prevention Objectives: • Increased visits to RMHC for dental issues
  20. 20. Impact EvaluationObjectives • Reduction in the incidence of dental caries and periodontal disease in schoolchildren • Improved oral hygiene behavior and practices • Increased oral hygiene knowledge • Decreased prevalence of dental caries and periodontal disease
  21. 21. GoalReduction in the prevalence and incidence of dental caries andperiodontal disease in Rural India
  22. 22. AcknowledgementsICTPH StaffArun JithendraSughaVazhvu StaffFellow TPS Students
  23. 23. Contact InformationShawn Lin Allison MaukBA, MSW/MPH Candidate BA, MPH Candidateshawn.lin@wustl.edu mauk@wustl.eduGeorge Warren Brown School of Social WorkWashington University in St. LouisOne Brookings DriveSaint Louis, MO 63130
  24. 24. Thank you
  25. 25. References1Beaglehole, R., Benzian, H., Crail, J., & Mackay, J. (2009). The oral health atlas. FDI World Dental Federation. Retrieved from: http://www.oralhealthatlas.org/uniflip/index.html2Ramachandran, K., Rajan, B.P., & Shanmugam, S. (1973). Epidemiological studies of dental disorders in Tamil Nadu populations. Journal of the Indian Dental Association, 45(4), 65-70.3Bali, R.K., Aswath Narayanan, M.B., Mathur, V.B., Talwar, P.P., & Chanana, H.B. (2004). National oral health survey & fluoride mapping, 2002-2003, Tamil Nadu. Dental Council of India.4Saravanan, S., Kalyani, V., Vijayarani, M.P., Jayajodi, P., Felix, J.W.A., Arunmozhi, P., … Sampath Kumar, P. (2008). Caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, South India. Indian Journal of Dental Research, 19(3), 186-190.5Shah, N. (2005). Oral and dental diseases: causes, prevention and treatment strategies. In NMCH Background Papers – Burden of Disease in India (p.275-298). New Delhi, India. Retrieved from: http://www.whoindia.org/LinkFiles/Commision_on_Macroeconomic_and_Health_Bg_P2_Oral_and_dental_diseases.pdf6Peters, D., Yazbeck, A., Ramana, G., Sharma, R., Pritchett, L., & Wagstaff, A. (2001). Raising the sights: Better health systems for India’s poor. Washington, DC: The World Bank.7Agarwal, V., Khatri, M., Singh, G., Gupta, G., Marya, C., & Kumar, V. (2010). Prevalence of periodontal diseases in India. Journal of Oral Health & Community Dentistry, 4, 7-16.8Winn, D.M. (2001). Tobacco use and oral disease. Journal of Dental Education, 65(4), 306-312. Retrieved from: http://www.jdentaled.org9Tomar, S.L., & Winn, D.M. (1999). Chewing tobacco and dental caries among U.S. men. The Journal of the American Dental Association, 130(11), 1601-1610. Retrieved from: http://www.jada.ada.org10Tomar, S.L., & Asma, S. (2000). Smoking-attributable periodontal disease in the United States: findings from the NHANES III. Journal of Periodontology, 71(5), 743- 751.11Goldman, A.S., Yee, R., Holmgren, C.J., & Benzian, H. (2008). Global affordability of fluoride toothpaste. Globalization and Health, 4(7), 1-8. doi: 10.1186/1744-8603-4-712Tandon, S. (2004). Challenges to the oral health workforce in India. Journal of Dental Education, 68(7 Supplement), 28-33.

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