Oral health need assessment

ORAL HEALTH NEED ASSESSMENT
Dr SujathaBK
MDS,PGDDM

CONTENTS
 INTRODUCTION
 DEFINITIONS
 CLASSIFICATIONS OF NEED
 REASONS TO CONDUCT NEED ASSESSMENT
 FACTORS WHICH INFLUENCE THE NEED FOR
HEALTH SERVICES

CONTENTS
 METHODS TO ASSESS THE NEED FOR ORAL HEALTH
- THEORETICAL APPROACH
- ORAL HEALTH RELATED QUALITY OF LIFE
INDICATORS
- USING INDICES
- A NEW SOCIO DENTAL APPROACH
- ORAL HEALTH NEED ASSESSMENT TOOL KIT

CONTENTS
 THE ORAL HEALTH NEED ASSESSMENT UNIT
 MODEL OF ORAL HEALTH NEED ASSESSMENT
 PUBLIC HEALTH SIGNIFICANCE
 CONCLUSIONS
 BIBLIOGRAPHY

DEFINITIONS
Health: is a state of complete physical, mental and social well-
being and not merely an absence of disease or infirmity and ability
to lead socially and economically productive life.
(WHO 1948, 1978)
Oral health : a comfortable and functional dentition that allows
individuals to continue their social role.
(Dolan 1993)

DEFINITIONS
Need : a need for medical care when an individual has an
illness or disability for which there is an effective and
acceptable treatment or cure. (Matthew 1971)
Need : ‘a state of health assessed as in need of treatment by a
medical practitioner’ (Cooper 1975)
Health need: deficiencies in health that call for preventive,
curative, control or eradication measures.
WHO 1971

CLASSIFICATIONS OF NEED
A ) In relation to health, the concept of need is divided into:
1) The need for health
2) The need for health care
Need for health: It is perceived as free from distress,
discomfort, disability, handicap and the risk of mortality and
morbidity.
Need for Health care: If needs are to be identified, then there
should be an effective intervention available to meet these needs
and improve health. “ the ability to benefit from health care”.
Wright, 1988

B) Cooper’s taxonomy of need: 1975
1) Wants: A person’s own estimation of want for health.
2) Demand: The wants of an individual demands for a
professional to meet.
3) Need: A state judged as in need by a health professional.

C) According to Bradshaw (1972)
a) Normative need
b) Felt need
c) Expressed need
d) Comparative need

a) Normative need: professional or expert defines as need in a
given situation.
National and local oral health surveys adopt this method of
need assessment.
Dental need are expressed in terms of number of people,
number of procedures, hours of work, costs.

Limitations of Normative need:
 Assessment is not objective and reliable.
(Teeling- Smith, 1973)
 Fails to provide information on the impact of disease on an
individual’s quality of life.
 Fails to consider patients health behavior and compliance.

Limitations of Normative need:
 Professional assessment of need is questioned in terms of
human or consumer rights.
 Paradoxical approach (Acheson, 1978)
Normative need – “romantic rather than humanitarian”
(Fuchs 1974)

According to Bradshaw (1972)
Felt need/want: individual’s own assessment of his or her
requirement for health care.
Expressed need/demand: a felt need translated into action,
either by use of services or request for information.
Comparative need: assessed by comparing the health needs of
similar groups of people.

Carr and Wolfe, 1979
Unmet need: is the difference between the services judged
necessary to deal with defined health problems and those
services actually being received.
“Clinical iceberg”: gap between lay person’s perception of
need and a professional’s perspective.
Need is relative to time, place and assessor
– Magi and Allander 1981.

REASONS TO CONDUCT NEED ASSESSMENT
1) To define the problem and to identify its extent and severity.
2) To obtain a profile of the community and to ascertain the
causes of the problem - helps in developing appropriate goals
and objectives in the problem solution.
3) For ethical imperative to use resources appropriately.
4) Not only involves identifying existing health problems but also
potential health problems and health promotion needs.
5) And also it evaluates the effectiveness of the program.
(White and Henderson, 1976)

FACTORS WHICH INFLUENCE THE NEED FOR HEALTH
SERVICES
1) The impact of ill health on individuals and on society,
2) The degree of disability and dysfunction that ill health
brings
3) The perceptions and attitudes of patients themselves
towards ill health and
4) The social origin of many illnesses
All these factors influence the utilization of health services,
the development of health care techniques and ultimately,
the effectiveness of treatment.

METHOD TO ASSESS THE ORAL HEALTH NEED
Theoretical approaches to assess the need for health care
a) Humanitarian approach: focuses on the burden of the
diseases. It considers need as a state of the client that creates
a requirement for care and represents a potential for service.
Donabedian, 1973
b) Realistic approach: focuses on ‘ability to benefit’
a need for medical care exists – an individual has an illness or
disability for which there is an effective treatment or cure.
Matthew’s, 1971

Oral health-related quality of life indicators:
 A multidimensional concept that captures people’s
perceptions about factors that are important in their everyday
lives (Slade, 2002)
 Self-reports problems pertaining to oral health – capturing
both the functional, social and psychological impacts of oral
disease (Gift and Redford, 1992)

Oral health-related quality of life indicators:
1) Bio psychosocial model of health: diseases are not only
influenced by the underlying pathology, but also by the
individual’s perceptions, personality and stress– Engel
1977
Health - not only in terms of survival but also in terms of
freedom from disease - ability to perform daily activities- the
happiness, social and emotional well being and quality of
life.

SEQUELAE OF A DISEASE
Disease Impairment
Discomfort
Functional
limitation
Death
Disability Handicap
Conceptual model of consequences of oral
impacts ( modified from Locker, 1988)

TERMINOLOGIES
Impairment: a loss or abnormality of mental / physical
function either present at birth or rising out of disease or
injury.
Functional limitation: restriction in function customarily
expected of the body or its component organ or system.

TERMINOLOGIES
Disability: lack of ability to carry out socially defined tasks
and roles that individuals generally are expected to do
Pope ND Tarlov, 1991
Handicap: is the disadvantage experienced by impaired and
disabled people because they do not or cannot conform to
the expectations of society or the social groups to which
they belong.

ORAL HEALTH RELATED QUALITY OF LIFE
INDICATORS

IDEAL REQUIREMENTS OF ORAL HEALTH RELATED
QUALITY OF LIFE INDICATORS
Major factors should be considered,
i) Practicality
ii) Reliability
iii) Validity
Ware et al, 1981

ORAL HEALTH RELATED QUALITY OF LIFE INDICATORS

A sample of 1755 Medicare
recipients in Los Angeles Country

A sample of 662 Brazilian
population, 35 – 44years
A consecutive sample n=270
of the Regional Government
staff of Spain.

METHOD TO ASSESS THE NEED FOR ORAL HEALTH
Applications of oral health related quality of life
indicators
- Measures the efficiency or effectiveness of health intervention
- Assesses the quality of life
- Estimates health need of a population
- Improves clinical decisions
- Helps to understand the causes and consequences of
differences in health.

METHOD TO ASSESS THE NEED FOR ORAL
HEALTH
Indices

METHOD TO ASSESS THE NEED OF PEOPLE

METHOD TO COLLECT INFORMATION/ DATA FOR NEED
ASSESSMENT
Data can be obtained by:
a) Survey questionnaire
b) Clinical examinations
c) Personal communications

PROFORMA OF ORAL HEALTH NEED ASSESSMENT
FOR POPULATION
1) General information on population:
a) Number of individuals in the population.
b) Geographic distribution of the population.
c) Rate of growth.
d) Population density and degree of urbanization.
e) Ethnic background.

FOR POPULATION
1) General information on population:
f) Diet and nutritional levels.
g) Standard of living
h) Amount and type of public services and utilities.
i) Public and private school system.
j) General health profile.
k) Pattern and distribution of dental disease.

FOR POPULATION
2) To gather epidemiological data on
a) Pattern of dental disease
b) Distribution of dental disease
The information can be collected by
a) Clinical examination
b) Patient’s dental records
c) Surveys

FOR POPULATION
3) Information on existing dental programs in the
community
a) Types of programs currently existing?
b) Orientation of those programs towards prevention,
treatment, education, research or a combination?

FOR POPULATION
3) Information on existing dental programs in the
community
c) Which organization is responsible for the planning,
implementation, and administration of the programs?
d) How successful have those organization been?
e) Community’s acceptance of that program

FOR POPULATION
4) Information about policy makers :
a) Financial leaders, Policy leaders?
b) Policy developers of the community?
c) Organizational structure of the community?
d) Attitude of community leaders towards oral health and
community dental health program?

FOR POPULATION
5) Resources :
i) Funds:
a) Source of funding at state and local level for dental care?
b) Is third party coverage available to the community?
c) Availability of federal funding through special eligibility
programs?
d) Availability of private funds through foundations/
endowments?

FOR POPULATION
5) Resources :
ii) Facilities
a) Closest medical centre?
b) Specialty services provided by the medical centre?
c) Availability of dental facilities and their location?
d) How well these facilities are used by the community?

FOR POPULATION
5) Resources :
ii) Facilities
e) Accessibility of these services?
f) Appropriateness, adequateness and efficiency of the
dental services
g) Information about operatories and dental laboratories

FOR POPULATION
5) Resources :
iii) Labor
a) Number of licensed dentists, hygienists and assistants?
b) Number of lab technicians?
c) Dental and dental auxiliary schools available?

FOR POPULATION
5) Resources :
iii) Labor
d) Community health aids available?
e) Number of school and public health nurse?
f) Number of public health hygienists, voluntary health
agencies and nutritionists available?

MODEL OF ORAL HEALTH NEEDS ASSESSMENT
Step 1
Identify partners and form advisory committee
Step 2
Conduct self-assessment to determine goals and resources
Step 3
Plan the needs assessment
 Core Optional (choose optional data elements to
supplement core)

MODEL ORAL HEALTH NEEDS ASSESSMENT
 Conduct inventory of available primary and secondary data
 Determine need for primary data collection
 Identify resources
 Select methods
 Develop work plan

MODEL ORAL HEALTH NEEDS ASSESSMENT
Step 4
 Collect data
Step 5
 Organize and
 Analyze data
Step 6
• Prioritize issues and report findings
• Utilize needs assessment for program planning, advocacy,
and education
Step 7
Evaluate need assessment

ORAL HEALTH NEED ASSESSMENT:
A NEW SOCIO-DENTAL APPROACH
Principle: need assessment is not only based on professional
judgment but also incorporating people’s perception and
propensity.
It is multifactorial approach

METHOD TO ASSESS THE NEED OF PEOPLE
Socio-dental indicators:
It measures the extent to which dental and oral disorders
disrupt normal social role functioning and bring about
major changes in behavior such as an inability to work or
attend school, or undertake parental or household duties”.
Locker 1989

ORAL HEALTH NEED ASSESSMENT: SOCIO-DENTAL
APPROACH
Elements:
i) Clinical estimates of normative need
ii) General health status
iii) Subjective perceptions – functional, psychological and
social dimensions
iv) Propensity to adopt health promoting behaviors
v) Scientific evidence of the effectiveness of treatments.

SUBJECT PERCEPTION OF NEED
It includes the assessment of
i) Perceived need for dental treatment
ii) Oral impacts and oral health- related quality of life
Assessment of dental treatment need : asking questions
through questionnaires, interviews....
Oral impact is measured through oral health related quality of
life indicators.
Eg: Oral Impact on Daily Performance

Oral Impact on Daily Performance : assesses the need for
treatment. (Aduyanon and Sheiham 1997)
Modified from WHO’s International Classification of Impairments,
Disabilities and Handicaps (1980).
It includes 3 levels:
Level 1: oral status and oral impairments, which most clinical
indices attempt to measure.

Oral Impact on Daily Performance
Level 2: ‘intermediate impacts’ refers to possible early
negative impacts caused by oral health status - pain,
discomfort, functional limitation and dissatisfaction with
appearance.
Level 3: ‘ultimate impacts’ refers to impact of these disabilities
on the ability to perform daily activities. (Disability and
handicap).

ADVANTAGES OF OIDP INDICATOR
 It focuses on the ability to perform daily activities.
 It screens for significant impacts thus eliminating the small
negative impacts on daily performance.
 More accurate to measure the behavioral impacts in terms of
performance than the feeling state dimension – policy
planning.
 Condition- Specific OIDP Allows for the impacts to be
attributed to specific oral conditions - making index suitable
for need assessment and treatment planning.

PROPENSITY FOR HEALTH PROMOTING BEHAVIOURS
 Behavioral factors are the propensity to carry out preventive
behaviors and self care and compliance with treatment
instructions.
 The comprehensive system for the assessment of oral
treatment needs includes the 4 basic behaviors –
i) Use of fluoride toothpaste (Petersson, Bratthal, 1996;
Milgrom, Reisine, 2000)
ii) Frequency of tooth brushing (Sheiham, 1997; McDonald,
Avery, 2000)

PROPENSITY FOR HEALTH PROMOTING BEHAVIOURS
iii) Sugar intake (Sheiham, 2001; WHO, 2003)
iv) Pattern of dental attendance (McDonald and Avery,
2000)
Effectiveness of treatment:
If the intervention are – unproven efficacy or doing more harm
than good – “stop starting them”
If the intervention is already introduced but no longer practiced
- “start stopping them”
(Muir Gray, 1997)

LEVELS OF ORAL TREATMENT NEED
Health need assessment – normative need assessment +
subjective perceptions + evidence from studies + propensity
of people for health promoting behavior.
It involves three levels of treatment needs measurement; and
its key factors
i) Normative need
ii) Impact - related need
iii) Propensity related need

LEVELS OF ORAL TREATMENT NEED
Dental need level Key factors
Normative need - Clinical impairments
- general health status
Impact- related need - Clinical impairments
- Perceived oral health impacts and
needs
Propensity-related need - Clinical impairments
- Perceived oral health impacts and
needs
- Behavioral propensity for treatment

MODEL OF DENTAL TREATMENT NEEDS
 Life threatening and chronic progressive oral conditions
Normative Treatment Need
Propensity – Related Need
Emergency/ life–threatening conditions
Progressive conditions
Propensity for treatment
High Propensity
Treatment Need
LOW MEDIUM HIGH
Most appropriate treatments
+ DHE / OHP
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BASIC MODEL FOR DENTAL TREATMENT NEEDS
Impairments
NO YES
Perceived Impacts Normative treatment
need
NO YES
No Intervention
Investigation,
counselling /
referral
Perceived Impacts on
Quality of Life
NO YES
DHE / OHP Impact –
related Need
Propensity for
treatment

BASIC MODEL FOR DENTAL TREATMENT NEEDS
Propensity – related Need
LOW MEDIUM HIGH
Most appropriate treatments
+ DHE /OHP
Initially Planned Treatment

Categorization of four behavioral propensities
Behavioral propensity
Propensity levels
Poor Moderate Good
Frequency of sugary
food/drink intakes per day
6 or more 4–5 0–3
Frequency of tooth brushing
per day
Not every
day
Once Twice or
more
Regular use of fluoridated
toothpaste
Did not use – Use
Dental attendance pattern Rarely Sometimes Always

ORAL HEALTH NEED ASSESSMENT TOOLKIT
 This toolkit provides primary care trusts (PCTs) with a guide to
undertaking an oral health needs assessment.
 It has been developed in the light of the experience of PCTs that
have measured and understood the needs of their population.
 It is designed to assist primary care trusts (PCTs) in designing
and carrying out oral health needs assessment in order to inform
their commissioning decisions for dental services.

A GUIDE FOR ORAL HEALTH NEED ASSESSMENT
 The Oral Health Need Assessment Unit (OHNAU): is a
centre of excellence in oral epidemiology and dental public
health research based at Queen Mary, University of London.
 The group has carried out extensive research in partnership
with General Dental Practitioners, NHS Primary Care Trusts,
Dental Public Health Consultants, Department of Health,
World Health Organization, and other health stakeholders.

The Oral Health Needs Assessment Unit (OHNAU):
 The OHNAU has staff providing specific expertise in
statistics and oral epidemiology, including innovative oral
health needs assessment and survey research design,
health services planning and management.
 Healthcare providers can obtain academic support from
OHNAU staff on a consultancy basis in developing protocols
and/or conducting high quality, innovative oral health needs
assessment.

The Oral Health Needs Assessment Unit (OHNAU):
 The OHNAU works with national (Department of Health)
and international (World Health Organization) collaborators,
providing academic support and infrastructure to carry out
surveys.
 It has a track record of conducting national and
international oral health surveys.

PUBLIC HEALTH SIGNIFICANCE
 Oral health need assessment is not merely a
professional decision.
 Patient need should be considered into the method
of assessment.
 Every oral need assessment should be patient
centered.

PUBLIC HEALTH SIGNIFICANCE
 People should be given equal importance in
deciding what he /she wants.
 Assessment by this method not only fulfils patients
requirements but also helps to spend minimal
resources for the problem.

CONCLUSIONS
 With in a constantly changing world, oral health need
assessment is the core part of planning dental services
and treatment.
 Needs are assessed effectively and efficiently in order to
reduce the burden of illness, disability and handicap.
 Appropriately assessed population need improves
estimates of resources, rational allocation of dental
services, and efficient dental care expenditure.

CONCLUSIONS
 Assessment of needs should include clinical, social and
psychological dimensions except for life threatening oral
conditions like malignancy, chronic conditions which are
progressive.
 Dental practitioners should be able to assess individual
patient needs, based not only on normative assessment
but on perceived needs and impacts, to make suitable
treatment plans and obtain the best treatment outcomes.

BIBLIOGRAPHY
 Cynthia Pine. Community oral health. 2nd ed. p.no.59-
81:Germany:Quintessence publishing 2007.
 Dally B, Watt RG, Batchelor P, Treasure ET. Essential
Dental Public Health. p.no.299-313:New Delhi: Oxford
University Press; 2002.
 George M Gluck, Warren M Morganstein. Jong’s
community dental health. 5th ed. p.no. 329-351:New
Delhi:Mosby;2003.

BIBLIOGRAPHY
 Oral Health Needs. Barts and the London university of
Dentistry Centenary. Oct.1911 –Oct.2011.
http://www.dentistry.qmul.ac.uk/research/Population%20Bas
ed%20Patient%20Studies/Oral%20Needs%20Assessment/in
dex.html. Accessed on 01/10/2011.
 Gherunpong S, Tsakos G, Sheiham A. A sociodental
approach to assessing dental needs of children:concept
and models. International Journal of Paediatric
Dentistry. 2006;16:81–88.

BIBLIOGRAPHY
 Oral Health. Dental Epidemiology Programmes. 2008.
 Shamsher Diu. Oral Health Needs. Consultant Dental
Public Health. Barking and Dagenham PCT 2007.
 World Health Organization. Oral Health Surveys; Basic
methods: Oral health unit 4th ed. New Delhi: A.I.T.B.S;
1987.

BIBLIOGRAPHY
 Leaol A, Sheiham A. Relation between Clinical
Dental Status and Subjective Impacts on Daily
Living. J Dent Res 74(7) 1995.
 Martín JM et al. Validation the Oral Health Impact
Profile (OHIP-14sp) for adults in Spain. Med Oral
Patol Or Oral Cir Bucal. 2009 Jan 1;14 (1):E44-50.

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