Oral health in india

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AIIMS - All India Institute of Medical Sciences, New Delhi
DCI - Dental Council of India
DGHS - Directorate General Health Services
dmft - Decayed, Missing and Filled Primary Teeth
DMFT - Decayed, Missing and Filled Permanent Teeth
MOHFW - Ministry of Health and Family Welfare
SEARO - South East Asian Regional Office of WHO
WHO - World Health Organization
WHO-India - WHO- Country Representative Office for India
1. Abbreviations and Acronyms

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2. Foreword
Oral diseases are one of the most common of non communicable diseases
affecting varied population. It is an important public health problem owing to
the prevalence, socio-economical aspect, expensive treatment & lack of
awareness. As per the report of the National Commission on Macroeconomics
& Health, Ministry of Health & Family Welfare, Government of India, the
prevalence of dental caries in all age group has been found to be 50%,
periodontal diseases (relatively severe) in the 15+ age group is 45%,
malocclusion in the age group of 9-14 years is 32.50%, Fluorosis in all age
groups is quoted 5.50% and that of oral cancer in the age group of 35+ is
0.03%. The determinants of oral diseases are often the same as for many other
non-communicable diseases & accordingly there is a great urgency to
incorporate oral health into general health. Good oral health becomes especially
important in consideration tot he children & elderly in order to enjoy good
quality life.
“Oral Health in India : A report of the multi centric study” is a timely publication
& one of its kinds, which gives an insight in to the various oral health problems
across the seven centers, representing different areas of this country. It was
since long felt that a standarized report of this kind representing the oral
disease burden from different geographical locations was required to have an
idea about the prevalence & knowledge, attitude & practice of people regarding
oral health. The striking feature of this survey is its uniformity as regards to
male/female subject size & urban/rural presentation. Efforts of the principal
investigators & their team deserve accolades as the survey was conducted from
all walks of life, varied age groups & under constraints because of natural
calamities faced many centers.
The report is an output of the collective work undertaken from Directorate
General of Health Services, World Health Organization & All India Institute of
Medical Sciences. I hope that the contents of this report would be useful to the
health professionals, researchers & policy makers.
Dr. R. K. Srivastava
Director General of Health Services
Ministry of Health & Family Welfare,
Government of India

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3. Preface
Epidemiological data on any disease serve very useful purpose - it helps in
understanding the prevalence of disease in a given community, age and gender
preference/bias, various causative/ modifying factors, and finally in strategic
planning to curtail and prevent the diseases. WHO recommends that oral health
survey be conducted regularly at 5 years interval to understand the effectiveness
of oral health care service being provided and modifications, if any that need
to be made.
Oral and dental disease data are very complex to record, analyze and interpret
due to several reasons. There are two dentitions –primary and permanent and
the intervening period of mixed dentition, in which both primary and permanent
teeth are present. Dental caries recording is done differently in primary and
permanent teeth and hence difficult to record during mixed dentition stage.
Also, dental diseases like caries and periodontal diseases have age related
prevalence pattern. Hence WHO has defined index ages, at which dentition
status should be recorded, so that it is uniform all over the world and
comparisons can be made.
Caries experience is recorded as DMFT in its simplest form, which include not
only decayed teeth (primary, recurrent or root caries) but also filled teeth and
missing teeth due to caries. It is the most commonly used index, since it
records not only the present but also the past caries experience and hence
gives the total caries experience of an. individual/community
The most difficult for examination and recording as well as analysis is the
periodontal diseases. Several indices have been recommended such as plaque
index, calculus index, gingival bleeding index, periodontal pockets of different
pocket depth recording, attachment loss etc. Ideally the recording is to be
charted for all the teeth on 4 sides of each tooth, the buccal, lingual, mesial
and distal proximal surfaces, which becomes extremely difficult in a community-
based path finder survey. Hence to simplify, mouth is divided into 6 sextants
and index teeth such as two central incisors and 2 molars on either side of
arch are taken for recording of periodontal disease. Even in its simplest form,
it is difficult to record, since inter-operator variation (subjective bias) is difficult
to eliminate.
Keeping all the above goals of oral health survey, a national pathfinder survey,

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covering one district in 7 states across India was planned and undertaken by
GOI-WHO India. The CDER at AIIMS was identified for training of regional
coordinators in uniform sampling methods of subjects in urban and rural areas
in the 4 index age groups, 12,15, 35-44 and 65-74 years, for recording of
Oral Health data and Oral Health behavior in a uniform manner using Basic
Oral Health Survey and questionnaire designed by WHO-HQ.
Thereafter, the complete monitoring of the project, i.e. sample selection,
calibration of examiners, collection and recording of oral health information
and oral health behavior questionnaire, and data entry in the statistical software
SPSS by the coordinators in the 7 states was done by WHO India office. The
CDER and Department of Biostatistics at AIIMS was given the responsibility to
analyze the data and prepare the present report.
The data from all the Centers was received as soft copies in SPSS software.
During scrutiny of the records every efforts were made to streamline the data
to transfer the same from SPSS software to STATA to obtain the find output.
We are thankful to all those who have contributed & helped in any way to bring
this report in its final shape.
Naseem Shah
Jagdish Kaur

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I. Teams for multi centric oral health survey
Arunachal Pradesh
A. Dr. C. L. Sah
Principal Investigator
State Dental cell, Directorate of Health Services
Naharlagun- 791550, Arunachal Pradesh
B. Dr. Gekar Loyi
Project Field Officer
C. Dr. Joram Nisha
Delhi
A. Dr. Pravesh Mehra
Assistant Professor, Department of Dental Surgery
Lady Hardinge Medical College, Delhi
B. Dr. Anukul Biswas
Orissa
A. Prof. P. C. Das
Former Vice Principal, Dental Wing
S.C.B. Medical College, Cuttack – 753007, Orissa
B. Dr. P. K. Sahoo
Co-Investigator
C. Dr. Hemamalini Rath
4. Contributors

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Maharashtra
A. Prof. S. G. Damle
Dean, Nair Hospital Dental College
Dr. A. L. Nair Road, Mumbai – 8, Maharashtra
B. Dr. Amita Tikoo
Puducherry
A. Dr. Shyam Singh
Mahatma Gandhi Postgraduate Institute of Dental Sciences
Government of Puducherry Institution, Puducherry - 605006
B. Dr. C. G. Ajithkrishnan
Co-Investigator
C. Dr. G. California
Rajasthan
A. Dr. Usha Rani Narain
Principal, Government Dental College
Jaipur
B. Dr. Pooja Narain
C. Dr. Sameer
Uttar Pradesh
A. Prof. Suresh Chandra
Former Dean, King Georges Dental University
Lucknow, Uttar Pradesh

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B. Dr. Jitendra Rao
C. Dr. Mohd. Abrar alam
II. Directorate General of Health services
(Central coordination & monitoring)
A. Prof. P. H. Ananthanarayanan
Deputy Director General
B. Dr. Mrs. Jagdish Kaur
Chief Medical Officer & Program Officer (Oral Health)
C. Dr. Kumar Rajan
National Consultant (Oral Health)
D. Prof. Sanjay Shrivastava
Former Assistant Director General (Medical Education)
& Program Officer (Oral Health)
III. World Health Organization
WHO HQ Geneva
Prof. Poul Erik Petersen
Chief (Oral Health),
WHO India (Country Office)
A. Dr. Cherian Varghese
Cluster Focal Point
Non Communicable Diseases & Mental Health
B. Dr. Kumar Rajan
National Consultant (Oral Health)
C. Dr. Kavita Venkataraman
National Consultant (NMH)

xiv
IV. All India Institute of Medical Sciences
A. Prof. Naseem Shah
Chief, Center for Dental Education & Research
B. Prof. R. M. Pandey
Dept. of Biosattistics
C. Dr. Ritu Duggal
Addl. Prof. Center for Dental Education & Research
D. Dr. Vijay Prakash Mathur
Asst. Prof. Center for Dental Education & Research
E. Prof. Hari Parkash
Former Chief, Centre for Dental Education & Research
F. Prof. K. R. Sundaram
Former Head of the Department
Department of Biostatistics
G. Dr. Rajbir Singh
Dept. of Biostatistics

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5. INTRODUCTION
India is the largest democracy in the world covering 1/7th
of the area of the
world. The Health care in India is still under various stages of development
with vast differences between regions and states. There are vast differences
between the oral health care services available at village level and metropolitan
cities. The health care planners have started thinking about reorganization of
health care services delivery and primary prevention through “National Rural
Health Mission”. Since independence, India never had oral health status data
based on uniform assessment criteria and it was a great problem in making
assessment of the need of services etc. for the policymakers.
India is a country of diverse ethnic groups, geographic character, culture,
religion and languages (there are 16 official languages). Its total landmass is
2,973,190 sq. km (slightly more than 1/3rd
the size of US) on which it supports
the population of 1,049,700,118 people, 1/6th
of the world population and the
second largest population, after China. It has 29 states and 6 union territories.
Oral health is an integral part of general health. Oral Health status has a direct
impact on general health and conversely, general health influences oral health.
Though oral and dental diseases are rarely life threatening, they do impact the
quality of life. Dental diseases are expensive to treat but simple to prevent. In
addition, dental problems can cause severe pain, loss of man days and morbidity.
In India, dental care scenario is unique. At present there are more than 267
dental schools, producing approximately 19,000 dental graduates/year and
almost 3000 specialists. There dental schools offer excellent tertiary care, in a
cost-effective manner. It is becoming a favored tourist destination for oro-
dental treatment of international standards including. On the other hand,
even the most basic oral health education and simple interventions like pain
relief and emergency care for acute infection and trauma are not available to
the vast majority of population, especially in rural area.
There are several reasons for this contradiction, the main being
1. Geographic variations
2. Uneven dentist: population ratio

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3. Poor specialist: generalist ratio
4. Poor dentist :auxiliary ratio
5. Low priority given to oral health
Health of any population depends on two major factors:
1. Healthcare delivery system
2. Socio-demographic profile of its population which includes socio-economic
status, literacy rate, human development index and health indicators such
as maternal and infant mortality rate ( MMR and IMR), life expectancy at
birth etc.
Healthcare delivery system in India
The health care delivery is based on the principal of providing “health for all”
through primary health care approach, which is the foundation of rural health
care system. An integrated network of sub-centers, primary health centers,
community health centers, district hospitals and multi specialty tertiary care
hospitals provide different level of care to the population as shown in the
diagram below.
Medical/ Dental Colleges and Tertiary care centres
District Hospitals
Community Health Centre
Primary Health Centre
Sub-centre

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Socio-demographic profile of the population
India stands at 126th
rank amongst world nations as far as Human development
index is concerned. The HDI provides a composite measure of three dimensions
of human development: living a long and healthy life (measured by life
expectancy), being educated (measured by adult literacy and enrolment at the
primary, secondary and tertiary level) and having a decent standard of living
(measured by purchasing power parity, PPP, income).
Human development index
Human development index (HDI) value, 2004 0.611
Life expectancy at birth (years) (HDI), 2004 63.6
Adult literacy rate (% ages 15 and older) (HDI), 2004 61.0
Combined gross enrolment ratio for primary, secondary and
tertiary schools (%), 2004 62.0
GDP per capita (PPP US$) (HDI), 2004 3,139
Life expectancy index 0.64
Education index 0.61
GDP index 0.58
GDP per capita (PPP US$) rank minus HDI rank - 9
The HDI for India is 0.611, which gives India a rank of 126th out of 177 countries.
Background
Under the Government of India and World Health Organization collaborative
program on oral health, a Multicentric oral health survey was envisaged in the
year 2004, in order to have a baseline data of the oral diseases burden and
associated risk profile of the population for four index age group i.e 12, 15,
35-44 and 65-74 years. This survey was conducted in seven different
geographical locations in India i.e. Arunachal Pradesh, Delhi, Maharashtra,
Puducherry, Rajasthan, Orissa and Uttar Pradesh covering 3200 no. of samples
from each site, thus surveying a total of 22400 people in rural and urban areas
of selected districts.

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The WHO oral health assessment form, questionnaire for children and adult
and soft wares for data entry were provided by the WHO-Head Quarters. Center
for Dental Education and Research, All India Institute of Medical Sciences in
consultation with Department of Biostatistics, Directorate General of Health
services and WHO –India were involved in sample size determination,
methodology planning, providing training to the Principal Investigators and
their team of different centers.
In the training workshop conducted at AIIMS it was decided to record only
extra oral conditions, denture status, dentition status, periodontal status,
mucosal conditions and fluorosis apart from demographic data etc. In order to
find out the feasibility of usage of the oral health assessment form 2004 as
such for the survey, preliminary exercises were done at AIIMS and it was found
that periodontal indices, specially, bleeding and pocket measurement for all
the teeth was taking a long time and it could become very difficult for the field
investigators to record bleeding and pockets. It was finally decided to record
bleeding and pocket on 10 index teeth, two each for the posterior sextants
and one each for the anterior sextants in consultation with WHO-HQ. It was
also decided to have only four index age groups for the present survey. In
order to study the determinants of oral diseases, a questionnaire (designed by
WHO-HQ) was used. A detailed list of the equipments and instruments required
for completion of the survey was drawn and provided to WHO-India Country
office for early procurement and dissemination to all the participating centers.
Mechanism of the monitoring, submission of the review reports and time lines
for completion of the complete work was explained to the Principal Investigators
in due course of time and necessary instruments; equipments and desktop
computers and peripherals were provided. Directorate General of Health Services
and WHO-India (Country Office) was involved in monitoring and mid term review
meetings were conducted at Directorate to know the exact status of the survey
work at each center.
There were few constraints experienced during the survey at different centers
like floods in Mumbai, landslides in Arunachal Pradesh, tsunami affecting
Puducherry etc, but the survey at different centers finished almost in time.
The data thus acquired from different centers along with the brief report was
submitted to the Directorate General of Health Services and after due

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consultation from the WHO-India (country office) and CDER, AIIMS, the same
was provided to CDER, AIIMS for data analysis and report preparation of the
Multicentric study.
Objectives
The objectives for the multi-centric oral health survey were as follows.
1. To study the magnitude of various oro-dental problems at seven
representative centres in India namely – Delhi, Mumbai (Maharashtra),
Cuttack (Orissa), Puducherry, Jaipur (Rajasthan), Luchnow (Uttar Pradesh)
and Arunachal Pradesh in the index age groups of 12, 15, 35-44 and 65-
74 years. The clinical examination included,
a. Extra Oral Examination and Denture wearing
b. Dentition Status
c. Community Periodontal Index and Loss of attachment
d. Oral mucosa
e. Enamel Fluorosis
2. To evaluate the Knowledge, Attitude and Practice (KAP) regarding oral health
in the same population.
3. To recommend the best and the most feasible method of oral health
promotion in the country to control the oro-dental problems.

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6. Scope of the survey
The plan for the survey included the study of oral health behaviour, practices
and status of the population in the seven districts of different states, selected
from different corners of the country, to provide representative data for the
country. However, since the variation in geography, culture and eating habits
differ significantly among various states, the results from the study can not be
extrapolated to whole country. Further, the selection of a district within a state
was also “selection for operating convenience”, therefore the district may not
be true representative of the state. It also aimed to study the gaps in oral
disease burden and health care provision. The final goal was to recommend
policy framework to reduce the oral disease burden and improve oral health of
the people in this subcontinent.
For the above objectives, 4 index age groups as recommended by WHO (12,15,
35-44 and 65-74 yrs age groups) equally distributed in urban and rural area
and further equally distributed among male and female were selected. The
modified WHO Oral Health Survey Proforma 2004 and Modified Questionnaires
on Oral Health for children and adult population by WHO-HQ, Geneva were
used, for carrying out this survey.
There are few high ground water fluoride belts in the country and no
consideration was given while selecting the site. For ex. Fluorosis was reported
only from Delhi and Lucknow where as Rajasthan which is known to have high
fluoride zones, were completely free of fluorosis.
The questionnaire or the assessment form did not have provision of recording
the socio-economic status of the population, therefore it is anticipated that
the report will not have any component on oral health disparities in different
economic groups.
Oral health survey did not record tooth tissue loss due to attrition, abrasion,
erosion and abfraction, gingival recession, dental trauma etc. and TMD since
all these parameters would have taken a long time in examination of subjects.
However, in spite of these lacunae, the result of the study helps to understand
prevalence and severity of various oral diseases, their correlation with dietary
practices, oral hygiene methods, literacy level of parents and adult individuals
and to give the recommendations for oral health prevention and promotion
strategies.

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Organization of the survey
Sample Size Calculation
As described by WHO, four age groups viz., 12 years, 15 years, 35-44 years
and 65-74 years were identified as index age groups representative of
permanent dentition, adult dentition and geriatric dentition. The sample was
equally divided between both the genders and urban and rural location. The
required minimum sample size for the study was computed based on the lowest
prevalence rate which has been reported in literature as that for dental caries
in children of 12 years of age, it is 35%. (This prevalence was taken as an
average of isolated studies reported in the literature).
Required minimum sample size = (n) = 4Xp (100-p)
L²
Where ‘p’ is the prevalence rate and L is the allowable error (20% of p). This
formula applied for achieving 95% confidence Interval.
Therefore - n = 4X35X65 = approx.200.
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Since separate estimates of the prevalence rate of various dental disease was
required for the each of the four age groups equally distributed in males and
females both in urban and rural areas, the total sample size calculated to be
covered in each centre was;
4 (age groups) x 2 (sex) x 2 (urban/rural) = 16 x 200 = 3200
The distribution of the sample in each of the eight sub groups in urban/rural
areas is indicated in the following table:
Age groups Sex Number of Total in Total in urban/
subjects age group rural cluster
12 years Male 200 400 1600
Female 200
15 years Male 200 400
Female 200
35-44 years Male 200 400
Female 200
65-74 years Male 200 400
Female 200

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Sampling Procedures
Selection of states and sites
It was initially planned to include one site in each of the geographical regions
of the country, but later due to some reasons, two more sites for selected for
data collection on oral health. One institution in each of the states was selected
for the task. The states were Arunachal Pradesh, Delhi, Maharashtra, Orissa,
Puducherry, Rajasthan and Utter Pradesh. Except Arunachal Pradesh and Delhi,
one dental institution in each of the states were invited to participate in the
data collection. However, Department of Health, Govt of Arunachal Pradesh
and a Medical College in Delhi was invited. The institutions were given freedom
to choose one administrative unit (District) of the state based on their
convenience but having both urban and rural population.
Sampling Unit
House hold (HH) was taken as the sampling unit in the study. All the eligible
persons in the adult and geriatric age groups (35-44 and 65-74 years) from
the house hold were be included in the study whereas the sample of children
and adolescent age group (12 and 15 years) were selected from schools as
described subsequently. However if any non school going child was found in
the selected household, that child was also included in the study. Multistage
sampling was applied for the selection of urban and rural areas.
Part I - Adult and Geriatric Age Groups
The first stage of selection in each centre was the District. Keeping in view the
various aspects like expertise and facilities available, the District which is closest
to the study centre was selected for the study. (This was left for the operational
convenience of the investigators).
The second stage comprised of selecting Sub-districts (if any) from the already
selected District. One of them was selected using the random method (lottery).
In case the District was not divided into Sub-districts then direct next step for
selection of rural and urban localities was undertaken.
In the third stage for the urban area, a complete list of cities and towns was
obtained and four town areas were selected randomly by lottery method. Further
list of wards in each of the selected towns was obtained. However, for rural
areas, directly fourth stage was followed.

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In the fourth stage, one ward was selected from the list of wards of each
selected town by lottery method. Similarly in the rural area, a list of all villages
was obtained from the already selected district and four villages were selected
randomly by using lottery method. In case a district already selected was not
having enough rural population (village), a nearby district having village was
randomly selected.
In the fifth stage from each selected ward / village, a total of 400 households
were selected for surveying the adult and geriatric age group. The selection of
400 household was allocated proportionately from each of the four selected
wards (for urban area) or villages (for rural area).
In order to cover the selected number of households, the investigators went to
one of the prominent places in the selected area (either ward or village) like
market, temple, church etc. and then one direction was selected by random
method and all the households in that direction were covered till the total
number is not completed. In case the total number was not completed in that
direction, the investigators went to another prominent location and again chose
the direction randomly.
From each of the selected villages in blocks of HH, the adult and geriatric age
group only was covered. If more than one person was identified in the HH out
of these two age groups in males and females, all of them were examined for
the survey. Once the required sample size was reached in both adult and
geriatric age groups, the data collection was stopped.
Part – II Children and Adolescent Age Groups
Sample of 12 and 15 years age groups were studied through school based
survey. If non-school going children in these age groups were identified in
these HH, they were also included in the study.
Selection of Schools - For school survey, all the secondary schools located in
the selected villages and wards were listed. Separate lists were prepared for
Govt. and Private secondary schools. Out of this, one Govt. and one Private
school were selected randomly for each of the selected villages and wards.
Selection of Classes - The required age groups (12 and 15 years in males and
females) for this survey were mostly studying in 7th
and 10th
class, however it
was instructed to examine all children in the age range of 12±1 years and

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15±1 years studying in these classes . In case the said classes had more than
one section, random selection method (lottery) was used to further select the
section to be examined. Once a section or a class was selected for the survey,
all the children studying in that section or class were included in the study.
In case there were no private schools, two Govt. schools were selected. Similarly,
if there were separate schools for boys and girls, one boys school and one girls
school were selected.
The total samples for these two age groups were as follows:
4 (Govt. schools) + 4 (Private schools) x 2 (age groups) x 50 (assumed number
of children boys section) = 800.
Similarly 800 children were covered in rural area making total 1600.
Each of the seven regional centers was instructed to plan similar sampling
methodology based on the guidelines for carrying out Multi Centric Oral Health
Survey. Further, they were also asked to submit the sampling details to WHO –
India and AIIMS and take the clearance before proceeding for the data collection.
As a sign of good gesture, the investigators were asked to offer oral health
examination and advice on oral hygiene to other members of the selected
households also. Similarly they were also asked to give oral health instructions
in the schools visited.
Sampling tools
1. WHO Oral Health Assessment form (1997) as modified by WHO- HQ in year
2004 was used to assess the oral health status of the population. Following
components were covered in this form:
• Survey Identification and General Information
• Extra Oral Examination and Denture wearing
• Dentition status and Dental Caries
• Periodontal status and Loss of attachment
• Oral mucosa
• Enamel Fluorosis

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2. Apart from this, KAP questionnaire designed for children and adults (WHO
2004) were also used to assess the Knowledge, Attitudes and Practices
being followed in respect of oral health by the selected subjects.
The data collection was performed by field investigators at different centres
using the WHO Oral Health Assessment Form (2004) and specially designed
questionnaires for adults and children. They were asked to taken informed
consent before beginning the work on printed consent form. The data was
entered into computer using SPSS Data Entry Builder and SPSS Data Entry Station
provided by WHO-HQ, Geneva at all seven sites. The soft copy of data was then
submitted to the WHO-India.
Collection and Storage of Survey forms and Questionnaire
The surveying teams were instructed to keep the oral health assessment forms
and questionnaires together for same ID number. Then the forms were to be
arranged in serial number and stacked together in bundles of 50 or 100, label
the bundles with ID numbers, cluster and date of recording and keep them
ready for data entry. They were also instructed to do the data entry on same
day or within 2-3 days so that if any discrepancy was found, it could be corrected
easily.
Data Assembly and Analysis
The centre investigators from all seven centers submitted the data in SPSS
format to WHO-India office. The copies of the data on CDs from all seven
centers were finally submitted to AIIMS for processing and analysis.
Inspection, Scrutiny and clarifications
The data received at AIIMS was inspected for completion and it was found that
the data was not complete from many centers with regard to continuity of the
numbers, problems in copying the data and missing ID’s. Accordingly centres
were contacted and asked for the complete data. Finally the data was received
from all the centres and arranged for analysis. The centres were asked for re-
sending the data only when entry for one or more stack of 50 or 100 was
missing. Individual incomplete entries were excluded from the analysis in order
to keep the data away from individual data entry bias.

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Duplication, Out of Range and Missing value analysis
After carefully arranging the data in SPSS, it was converted into Strata 9.0
format for further analysis. The data from individual centres were subjected to
duplication and missing value analysis. It was found to be satisfactory with
almost all the centres.
Finally out of range test was applied to the data to find out errors in data entry.
The amount of ‘out of range’ entries were found to be negligible and it was
decided to discard individual entries with out of range data and not to include
them while analyzing the overall data. Since the number of such entries was
small, it was thought that it will not have any impact on final analysis.
Relational Checks
The data was then subjected to relational checks to find out any discrepancy in
the data due to data entry mistakes. It was decided to exclude wrong entries
wherever the answers were mutually exclusive. However, if some relational
discrepancy was found, that particular ID was excluded from analysis of that
parameter.
Data Preparation
The data thus arranged was then finally prepared in terms of recoding for
sextants in periodontal indices, calculation of d, m, f, D, M and F etc.
Data Analysis
The data was then subjected to analysis using specially developed software in
STATA 9.0. The software was initially cross checked for small group of data
manually and on verification of finding, the software was used on whole data.
The data was subjected to analysis for all 7 centers and all four age groups
separately. The data thus obtained was then compiled in form of tables MS
Word (MS Office XP Home) for further use.
Cross tabulations and analysis of correlations, associations
In order to find out correlations between various factors, cross tables were
prepared for selected parameters and appropriate correlation tests were applied
to find out the associations, correlations and goodness of fit.

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Report writing
The data thus generated was them assembled and various in house discussions
were conducted to write the salient features of the data thus obtained. The
data was then presented before the investigators of different centres and
representatives from Dte. GHS and WHO-India. During presentation several
issues were discussed and clarifications were obtained from various centres.
Finally, the report compilation and writing started in October 2006.

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7. Results
A. An overview
Dental caries
12 yrs. The lowest prevalence of dental caries was found in Orissa (23%) whereas
the highest in Puducherry (71.5%). A range of 45-50% caries prevalence was
observed at all other centers. When average DMFT in only caries affected children
was considered, Puducherry had the highest score of 3.8 and Orissa had the
lowest score of 2.0. In all other states, the score ranged between 2.3 to 2.6.
15 yrs. An exceptionally high prevalence of dental caries 83.4% was recorded
at Puducherry and the lowest at Orissa (24.3%). A range of 50-55% prevalence
was noted at the remaining centers. Puducherry also had an exceptionally high
average DMFT score of 4.9 and Orissa had the lowest DMFT score of 2.4. All
other states the score ranged between 2.7 to 3.1.
35-44 yrs. A high caries prevalence of 83-86% was recorded in Delhi,
Maharashtra and Uttar Pradesh, whereas in this group, Puducherry had
comparatively lower prevalence of 73.3%. Arunachal and Rajasthan had an
average of 64% prevalence. Again, the lowest prevalence was found in Orissa
(48%). The highest DMFT score recorded was 8.8 in Arunachal Pradesh, followed
by Maharashtra (5.4), Delhi (5.3) and Puducherry (5.2) and Uttar Pradesh (5.1).

16
65-74 yrs. Highest prevalence of dental caries was recorded at 95% in Uttar
Pradesh. Maharashtra and Arunachal Pradesh recorded 83 and 81% prevalence
respectively. Rest all centers had an average of 52% prevalence. Uttar Pradesh
also had the highest average DMFT score of 15.5 followed by Arunachal Pradesh
at 6.04, Puducherry at 5.3 Delhi at 4.4. In Rajasthan and Orissa average DMFT
score was 2.4 and 2.9 respectively.
Gingival Bleeding
12 yrs. Highest prevalence of gingival bleeding was reported from Orissa (70%)
and the next highest from Delhi (61%). The lowest score was from Arunachal
Pradesh (10%). The average gingival bleeding score from other centers ranged
between 35-45%.
15 yrs. The lowest score recorded was 5% from Arunachal Pradesh. Orissa and
Maharshtra recorded an average score of 59%. Rest of the centers had an
average score ranging between 35-50%.
35-44 yrs. Orissa recorded bleeding score of 100% which was very surprising.
Maharashtra and Puducherry had the high score of 88 and 86%. Delhi, Rajasthan
and Uttar Pradesh had the score of 78, 76 and 64% respectively. Only Arunachal
Pradesh recorded a lower score of 15%
65-74 yrs: The gingival bleeding score in this group was slightly lower but the
trend of prevalence was the same as that found in 35-44 yrs. age group. The

17
highest score was observed in Orissa followed by Maharashtra, Puducherry,
Delhi, Rajasthan and Uttar Pradesh. The lowest score was in Arunachal Pradesh.
The general trend in all the age groups and all the centers was higher bleeding
scores in rural than urban population and higher score in women compared to
men (with few exceptions)
Loss of Attachment
35 -44 yrs: Attachment loss of >3mm was highest in Maharashtra (78%)
followed by Orissa 68% and Delhi 46%. The rest of the centers had the prevalence
ranging between 15-33%
65-74 yrs: The prevalence of Loss of attachment was significantly higher in
this age group compared to 35-44 yrs. group. The highest prevalence was
recorded from Maharashtra (96%), followed by Orissa (90%), Delhi (85.5%),
Rajasthan (75%), Uttar Pradesh (68%) and Puducherry (55%). Arunachal Pradesh
recorded the lowest prevalence of 20%.
The general trend for loss of attachment observed was that it was higher in
rural than in urban population and was higher in males compared to females.
But in geriatric age group, loss of attachment was found in higher percentage
of females.
Fluorosis

18
Evidence of dental fluorosis was highest in 12 and 15 year age groups and
decreased in the adult and geriatric age groups. Delhi recorded highest
prevalence of 36, 32, 17 and 20% in the four age groups (in ascending order).
Next was Rajasthan with prevalence of 14.3, 16.9, 3.8, 1.2% in the four age
groups. Orissa had Fluorosis prevalence of 9% in 12 and 15 yrs. age group.
Maharashtra and Uttar Pradesh had 3-5% prevalence Puducherry had the lowest
prevalence 1.5-2% Fluorosis. Arunachal Pradesh had no evidence of dental
Fluorosis in all age groups of the studied population.
However, all the above prevalence recorded was only very mild-mild with only
a few cases having moderate Fluorosis.
Oral Mucosal Lesion (OML)
The prevalence of OML in studied population in all the states exept Orissa was
very low. Orissa reported 7.3% of cases showing the lesion, mainly in the form
of Orissa also had highest percentage of tobacco chewers, i.e. 35 and 49% in
35-44 and 65-74 yrs. age groups respectively, when compared to data from
other states. However, tobacco smoking habits reported from Orissa in both
adult group population was not the highest. Smoking tobacco practice was
highest in Puducherry (38.7%) in 35-44 yrs age group and in Delhi (47.7%) in
65-74 yrs group. The lack of correlation of OML with smoking tobacco habits
is difficult to explain. Since the tobacco use was self –reported and oral findings
were by direct clinical examination, it is possible that one of these was not
accurately reported.
When oral health seeking behavior and brushing frequency was considered, it
was found that oral health seeking behavior in Puducherry as well as in Orissa
Traumatic ulcer Apthous ulcer ANUG

19
was the poorest in 35-44 yrs group; i.e. 81 and 66.6% respectively. It was
found that the entire studied population in 35-44 yrs. age group in Puducherry
did brush their teeth daily followed by Arunachal Pradesh (87.2%) and Orissa
(75%). The same trend was also found in 65-74 yrs group, where 86% in
Puducherry and 74.8% in Aurnachal Pradesh and 69.3% in Orissa did practice
daily brushing. Poor oral hygiene maintenance is known to be one of the
cofactors in causation of oral mucosal lesions, being the major etiological factors
in dental caries and periodontal diseases.
Therefore in states like Orissa, Arunachal Pradesh and Puducherry, more than
the direct impact of environmental factors like eating frequent sweets other
and faulty dietary practices and tobacco use lack of oral health awareness, low
oral health perception, poor oral health seeking behavior were found to be
major causes for oral health problem. In these states creating oral health
awareness through aggressive oral health campaigns should be the foremost
strategy of curtailing oral diseases. The thrust of Oral Health education should
be proper Oral Health maintainence by regular and frequent brushing of teeth
tongue cleaning and gum massage. For orissa, prevention and stoppage of
tobacco chewing should be given due emphasis, as tobacco chewing practice
as well as oral mucosal lesions are widely prevalent in adult population of
Orissa.
Edentulousness and Denture wear

20
Arunachal Pradesh - Edentulousness
The complete edentulousness was seen in a total of 16% of the population in
the geriatric age group. The rural group and males in general had higher
edentulism than urban population and females. There were no subjects wear-
ing complete denture signifying the lack of dental health care in the state.
Delhi
Complete edentulousness in adult population was 19 and 18% in urban and
rural population. Though the difference in prevalence of complete
edentulousness was insignificant, the difference between denture wear in rural
and urban population was striking; 12% of urban vs. 7.6% of rural elderly
population were having complete dentures. Denture wear was higher in males
than females (11.2 vs. 8.3%).
Maharashtra
Complete edentulousness was found in only 2.5% of the total adult population
studied. In urban adults, edentulousness was found in 4.1% but denture wear
was found in only < half the edentulous persons i.e. 1.9%. In rural adults,
complete edentulousness was found in only 0.9% and denture wear was in
0.1%.
Pudc
Surprisingly, both the total edentulousness and denture wear was very low i.e.
1.3 and 0.2% in the adult population between the age groups of 35-74 years.
All denture wearers were (only 3 persons) in urban area and none in rural area.
Orissa
Of the 2.7% totally eduentulous persons, only 0.8% were wearing complete
dentures High percentage of urban population were edentulous and they also
had higher denture wear than rural population (1.9 vs 0.4 and 1.1 vs 0.5%
respectively). Though edentulousness was higher in women, denture wear
was higher in males ( i.e. 2.3% women and 1.6% men were edentulous, while
1.4% men had complete dentures and only 0.3% women were wearing the
dentures.

21
Rajasthan
Only one person (0.1%) was recorded as having complete dentures of the total
35 (2.2%) completely edentulous subjects, highlighting the abysmal state of
health care seeking/ provision of health care in the studied area.
Uttar Pradesh
Complete edentulousness was 10% of which only 1/4th
(2.6%) were denture
wearers. Edentulousness was higher in rural area but denture wear was higher
in urban area (11.6 vs 8.5 and 3.4 vs 1.9% respectively).
Complete edentulousness in all the centers recorded was very low in elderly
age group of 65-74 except in Delhi (18.5%). In Uttar Pradesh, 10% of elderly
were found to be edentulous. In rest of the centers, the average percentage of
edentulousness was only 1.9, ranging between 1- 2.7% Considering such low
reported edentulousness level, it was not surprising to find no denture wear in
Aurnachal Pradesh and Rajasthan and a meager 2.5% in Puducherry. In Uttar
Pradesh, denture wear was 26.2% of edentulous elderly, in Maharashtra it was
40% and the highest of 52 % was found in Orissa and Delhi. (Though the
percentage denture wear appeared high in Orissa., the actual number of denture
wearers was small, i.e. only 13 of the total 25 edentulous persons were wearing
dentures.)

22
B. Site specific reports
7.1 Arunachal Pradesh – District Papum Pare
Indicators
Total Population 1,097,968
Population - Male 579,941
Population - Female 518,027
Sex-ratio 893
Total Literacy Rate 54.3%
Literacy Rate – Male 63.8%
Literacy Rate - Female 43.5%
As per 2001 Census
Sample Area (Papum Pare)
Rural Urban
1 Dikmukh Itanagar Township
(Chimpu)
2 Sagalee Ganga
3 Balijan Naharlagun
Township
(Naharlagun)
4 Kimin Nirjuli

23
Introduction
The state of Arunachal Pradesh is situated in the north east end of the country
with sharing of international borders with China, Bhutan and Myanmar. The
population of the state is more than one million and male: female ratio is
5.7:5.3. The literacy rate is about 54.7 % and Gender inequality is more than
the country average, i.e. 893 females for 1000 males. The people mainly
belong to three types of tribals and village system is the main administrative
hub for the state.
There are 3 general hospitals and 11 District hospitals in the state. The overall
health facilities are poor with very few sub divisions having specialists. The
numbers of dental surgeons in Government services are only forty eight. The
majority of the dental surgeons are posted in district hospitals and very few
are in Community Health Centers.
The Profile of Papum Pare District
The Papum Pare district is one of the 16 districts of the state with its Head
Quarter at Yupia. It has an area of 2,875 Sq. Km. with a population of 1,
21,750. The Principal inhabitants of the district are Nyishi tribe. By virtue of
being the capital complex of the state, this district portrays a cosmopolitan
character where all the major tribes of the state constitute the tribal community
of the state, reflecting their socio-cultural oneness.
The socio-demographic status of the district is as follows:
INDICATORS RATE
Population – Total 121750
Population – Male 64122
Population – Female 57628
Decadal growth rate (1991-2001) % + 67.21
Sex ratio (No. of females/1000 males) 899
Population Density/Sq. Km 35
0-6 Years Population – (% of Total Population) 16.55
0-6 Years Population – Male 50.57
0-6 Years Population – Female 49.42
Literacy rate – Total 70.89
Literacy rate – Male 79.00
Literacy rate – Female 61.72

24
Health and Family Welfare Service in the Papum Pare district is managed by
one district Medical Officer (DMO) who is the district Health authority. One
General Hospital in the district is under the control of the Chief Medical Officer
where different specialties are available including dentistry.
State Directorate of Health and Family Welfare control the District Medical
Officers/ Chief Medical Officers (DMOs/ CMOs) who is assisted by district level
Programme Officer in implementation of various National Health Programmes.
Dental Health facility of the district
a) General Hospital - 4 Dental Surgeons.
b) Community Health Centre - 4 Dental Surgeons.
c) Primary Health Centre - NIL
d) Sub-Centre - NIL
Profile of Study Population
Occupation
35-44 years Group In this group, 38.4 % were non-skilled workers, 26.8%
were housewives, 34.3 % were skilled workers and 26.8% were professional/
skilled workers/businessmen. Non-skilled workers in rural population were
more than double of those in the urban area. (43.4 vs. 15.2 % respectively.)Men
comprised the majority of skilled workforce as compared to women. (56.3
vs.12.1% respectively)
65-74 years Group In this group, 41.2 % were non-skilled workers, 25.4%
were house wives and 32.7 % were professional/ skilled workers. The non-
skilled workers were higher in rural than urban (61.9 vs. 21.7%) and more men
were skilled professionals than women (50.5 vs. 13.9%)
Educational level
Parents of 12 years old-Almost half of the parents/guardians did not respond
to this query (46.2%). of Parents having less than primary level education
comprised 12.% and less than secondary level to graduation level comprised
21.8% . It was observed that higher education level was more in urban than
rural (45.3 vs. 24.7), but surprisingly more in women than in men. (42.1 vs.
29.1)

25
Parents of 15 years old-In this group 23-46 % were non-respondents, 21%
had primary level education, 51.9% had less than secondary level and 25.4%
had up to graduation level education. Education level was higher in urban
than in rural persons (39.5 vs. 13.4 %) and more in men than women (26.9
vs.14.0 %)
35-44 years-Only 9.4% of this group had less than primary level education.
85.7% were educated with the up to less than secondary level and 4.8% had
higher secondary to graduate level education. Lower educational status was
more in urban than in rural persons (56.6 vs. 3.3%). People with higher level
were also more in urban than in rural groups (6.6 vs.3%). More than secondary
special and more than primary level were higher in rural than urban (93.7 vs.
77.9%)
65-74 years-In this group, 24.7% had less than primary level, 68.6% had
secondary special level and only 6.8% had education higher than secondary
special to graduation level. In this age group, not a single woman had higher
education.
Results of Children (12 and 15 years)
Oral Health Perception
Status of teeth and gums
The various categories were
summarized into three groups: good,
average and poor
12 years - Of the studied population
57% respondents rated health of
there gums and teeth as average,
21% as good, and 22% rated it as
poor. It was seen that there were no
significant differences between the
urban: rural and male: female
populations
15 years - In this age group 17% of the male and female respondents of both
the populations rated the health of their gums and teeth as good, whereas 64%
of them rated it as average and 20% rated it as poor. It was seen that there

26
were no significant differences between the urban: rural and male: female
populations
Oral discomfort / pain
12 years - Of the studied population 50% respondents of both the sexes reported
an occasional toothache, whereas 50% had no complain in past one year.
15 years - This group also showed the same pattern as the younger age
group.
Oral Health Seeking Behaviour
Reason for the last visit to the dentist
12 years - Out of the studied population, 73% of the respondents never visited
a dentist (63% urban vs. 85% rural).,22% visited 1-3 times and 3% visited e•4
times. Male and female population followed the same pattern.
15 years - The same pattern were observed as in the age group of 12 years
Reasons for visiting a dentist in past 12 months
12 years - Out of the studied population, 69% respondents in urban: rural and
male: female population visited the dentist with the complaint of pain, whereas
31% of them visited for routine dental check up.
15 years - In this age group, 66% respondents in urban: rural and male: female
population visited the dentist with the complaint of pain, whereas 34% of them
visited for routine dental check up
Oral Health Practices
Frequency of teeth cleaning
62% of respondents in both 12 and 15 years age group irrespective of urban:
rural and male: female were cleaning their teeth once a day and 30% of the
respondents, twice daily.
Use of toothpaste with or without fluoride
12 years - Out of the studied population, 56% of the respondents were using
fluoridated toothpaste, and only 2% were not using tooth paste. It was seen

27
that there were no significant differences between the urban: rural and male:
female populations
15 years - In this age group, 64% of the respondents were using fluoridated
tooth paste, and 3% were not using tooth paste. It was seen that there were no
significant differences between the urban: rural and male: female populations.
Dietary Habits
12 and 15 year old children
Bakery products were consumed once or more than once a day by 41% and 29
% and candies by 27% and 24% by 12 and 15 year old children respectively.
Fresh fruit consumption was relatively low: only 20% and 39% of 12 and 15
years consumed fresh fruits. An average of 29% of both the age groups was
chewing gums. The girls were using more colas and beverages then boys among
the 15 year olds. However, there were no significant differences in the eating
habits between urban and rural population in both the age groups.
Tobacco Habits
Smoking Cigarettes, Cigar /Bidi etc.
12 years - Of the studied population, only 21 respondents responded, out of
which 4 smoke occasionally and 15 smoked regularly. It was observed that
more of the males were smoking than the females (11 vs.4). There were no
significant differences between urban: rural population.
15 years - In this age group, 69 respondents responded, out of which 13
smoke occasionally, whereas 42 regularly. It was observed that more of the
males were smoking than the females (40 vs.15), and more rural than the
urban (40 vs.15).
Chewing tobacco
12 years - Only 119 respondents responded, out of which 66 chewed tobacco
occasionally, whereas 54 chewed regularly. It was observed that more of the
males were chewing tobacco than the females (76 vs. 40). There were no
significant differences between urban: rural population.
15 years - In this age group, 135 respondents responded, out of which 89
chewed tobacco occasionally, whereas 46 chewed regularly. It was observed

28
that more of the males were chewing tobacco than the females (85 vs.50).
There were no significant differences between urban: rural population.
Oral Health Perception – Adult population (35-44 years and 65-74
years)
Number of natural teeth present
35 - 44 years - Of the studied population 98% of the respondents have reported
having more than 20 natural teeth It was seen that there were no marked
differences between the urban: rural and male: female populations.
65 – 74 years - In this age group 84% of the respondents have reported having
more than 20 natural teeth, there were no marked difference between urban
:rural and male: female populations.
35 - 44 years - Of the studied population, 7% respondents experienced frequent
pain in their teeth and gums, It was observed that the urban population
complained of pain more then the rural (8% vs. 3%), whereas there were no
significant difference between male and female population (6% and 6%
respectively).
65 – 74 years - In this age group, 27% respondents experienced frequent pain
in their teeth and gums, there were no marked difference between urban :rural
and male: female populations.
Use of removable prosthesis
35-44 years - Of the studied population, 36% respondents were using a partial
denture, there were no marked difference between urban: rural and male: female
populations
65-74 years - In this age group, 19% of the respondents were using a partial
denture, there were no marked difference between urban: rural and male: female
populations.
The various categories were summarized into three groups: good, average and
poor

29
35-44 years - Out of the studied population, 88% of the respondents rated the
health of their gums and teeth as average, 4% as excellent and another 8% as
poor. It was seen that there were no marked differences between the urban:
rural and male: female populations.
65 – 74 years - In this age group, 69% of the respondents rated the health of
their gums and teeth as average, 1% as good and another 30% as poor. It was
seen that there were no marked differences between the urban: rural and male:
female populations.
35 - 44 years - In this age group, 87% respondents cleaned their teeth once a
day. 5% respondents did not clean their teeth daily. It was seen that there
were no marked differences between the urban: rural and male: female
populations
65-74 years - In this age group, 75% respondents cleaned their teeth once a
day. 4% respondents were not brushing daily. It was seen that there were
no marked differences between the urban: rural and male: female
populations
Methods of teeth cleaning
35 – 44 years - Of the studied population, 97% of the respondents were using
the tooth brush to clean their teeth. Only 5% of the respondents were using
charcoal and Miswak to clean their teeth. It was seen that there were no marked
65 – 74 years - In this age group, approx. 92% of the respondents of both the
sexes in urban and rural areas were using the tooth brush to clean their teeth.
It was also seen that a significant number of the respondents were using charcoal
and Miswak to clean their teeth (4%), It was seen that there were no marked
Use of tooth paste with or without fluoride
35 – 44 years - Of the studied population 4% of the respondents used fluoridated
tooth paste, whereas 2% respondents did not use tooth paste at all. It was seen

30
that there were no differences between the urban: rural and male: female
populations
65-74 years - Of the studied population 14% of the respondents used
fluoridated tooth paste, whereas 2% respondents did not use tooth paste at all.
It was seen that there were no differences between the urban: rural and male:
female populations
35-44 years – Almost half of the respondents had never received any dental
care. 21% of the respondents had seen a dentist more than five years ago and
another 21% had visited a dentist more than 2 years ago. 7% had visited a
dentist more than one year ago and 3% of the respondents had visited a dentist
in the past one year. Among those who had never received any dental care it
was surprising to find that the urban respondents were almost twice the rural
(58% vs. 38%) and males were more than double the % of women respondents.
65-74 years – Again in this age group 34% of the respondents had never received
any dental care. 15% had visited a dentist more than 5 years ago. 24% had
visited more than 2 years ago, 19% had visited more than one year ago and 8%
had visited a dentist in the past one year. The difference between the urban,
rural and male female as regards to visit in the past one year was significant
(11 Vs. 4 and 10 Vs. 5 % respectively).
Last visit to a Dentist
35-44 years – Almost half of the respondents had never received any dental
care. 21% of the respondents had seen a dentist more than five years ago and
another 21% had visited a dentist more than 2 years ago. Ten percent of the
respondents had visited a dentist in the past one year. Among those who had
never received any dental care it was surprising to find that the urban
respondents were almost twice the rural (58% vs 38%). Similarly, the number of
males who visited a dental health facility was more than double the number
female respondents (68% vs 32%).
65-74 years – Again in this age group, 34% of the respondents had never
received any dental care. 15% had visited a dentist more than 5 years ago, 24%
had visited more than 2 years ago, 27% had visited a dentist in the past one

31
year. The difference between the urban, rural and male, female as regards to
visit in the past one year was significant (11% Vs 4 % and 10% Vs 5 % respectively).
Dietary Habits
35-44 years and 65- 74 years
Among the adult and geriatric age groups, the use of bakery product was not
popular and only 40% of 35-44 year olds and 20% of the 65-74 year olds were
found to be having habit of using bakery foods daily. Once or more than once
use of candies and sweets was reported by 90% and 86% of the respondents in
adult and geriatric age group respectively. About 58% of the adults and 47% of
the geriatric population used colas and beverages once of more times a day. In
general females were using more colas and beverages etc. than males in both
age groups. But there were no significant differences in other dietary habits
among males, females and urban: rural population in both age groups.
Tobacco Habits
Smoking cigarettes, cigars/ bidies
35-44 years - Of the studied population, 53% respondents were occasional
smokers whereas 6% were regular smokers.
65-74 years - In this age group, 50% respondents were occasional smokers
whereas 19% were regular smokers
Chewing tobacco
35-44 years - Of the studied population, 4% were occasional tobacco chewers
whereas 6% were regular chewers. There were no significant differences between
urban: rural population.
65-74 years - In this age group, 3.3% were occasional tobacco chewers whereas
18% were regular chewers. There were no significant differences between urban:
rural population.
Oral Health Status of the Population
Extra oral lesions –No abnormality was recorded in any of the age groups.
Oral mucosal conditions – Nothing significant was reported in any of the age
groups

32
Denture wear- Overall, denture wear was found to be very low. Only one each
from urban and rural person in 35-44 age group were wearing partial denture.
None had complete denture. But surprising finding was that none were found
to have complete denture even in 65-74 age group, though a small %, i.e. 1.3%
of this group had partial denture.
Dentition status
12 years Decayed teeth were found in 43.6% and missing teeth in 3.9%, but
the filled teeth were found only in one child, i.e. 0.1%. Though the difference
between urban and rural was small, caries and missing teeth were more in
girls than boys (47 vs. 39% and 4.2 vs. 3.4% respectively) Overall, caries
experience in this group was 44.4% and 9.4% had more than 4 DMFT.
15 years- Decayed teeth were found in 45.6%, missing teeth in 7.3% and filled
teeth in only 1.2%. Caries was more prevalent in urban children and more in
girls (48 vs. 43.4 and 52.3 vs. 38% ) More % of boys had filled teeth compared
to girls (6 vs. 3) but the total % of children with filled teeth was only 1.2%.
Overall, 48.5% of examined children had caries experience and 16.6% had more
than4DMFT which was almost double compared to 12 years age group (16.6
vs. 9.4%).
35-44 years Fifty % of this group had carious teeth, 35% had few missing teeth
and only 1.4% had filled teeth, indicating a huge caries burden and negligible
care. Urban: rural as well as male: female differences were significant (54 vs.
44% and 44 vs.54 % respectively) More urban subjects had missing teeth than
rural (40 vs. 30%) and there was no sex difference. Filled teeth were found
more in urban than rural and in women compared to men(2.2 vs. 0.5 and 0.7
vs. 2%). In this age group,more than 62% of the examined persons had
experienced caries and 29.7 % had more than 4 DMFT.
65-74 years - There was significant increase in % of decayed and missing
teeth in this group compared to 35-44 years group. Decayed teeth were found
in 63.7%, missing teeth in 58%, while filled teeth in only 0.2%. Rural elderly
had higher % of decayed teeth compared to urban (68.8 vs. 58.8%) with no sex
difference. Missing teeth were more in men compared to women without any
difference between the urban: rural population. In this age group, persons
with caries experience were very high, i.e. 80.7% and even the % of persons
with more than 4 DMFT was 59%.

33
Average DMFT score for different age groups
12 years old The DMFT score was 2.4. The U:R as well as male: female difference
in DMFT score was small, i.e. 2.5 vs. 2.2 and 2.2 vs. 2.5
15 years At this age an increase in DMFT score was found. It became 3.02.
Though there was a small difference in urban: rural DMFT score (3.14 vs. 2.90),
male: female difference was significant (2.7 vs. 3.3).
35-44 years –The DMFT score in this group was alarmingly high at 8.84. The
difference between urban: rural as well as male: female was significant (8.62
vs. 9.17 and 8.42 vs. 9.16 respectively) The high score could probably be
explained by higher missing component in this age group.
65-74 years –The DMFT score in this age group decreased compared to 35-44
years age group, which was 7.48. Also, there was no significant difference
between urban: rural and male: female population (7.58 vs. 7.38 and 7.34 vs.
7.63).
Periodontal Status
12 years Bleeding gums were found in 10% of children, more in urban than
rural and more in boys compared to girls (11 vs. 9.8 and 14 vs. 7.6%
respectively). Lack of care and attention towards hygiene in boys compared to
girls could reflect carefree attitude in this age group boys.
15 years- With maturity, bleeding score decreased to 4.8%. Again the same
trend was observed, more in boys than in girls (7.5 vs. 2) . However, in this
group, bleeding was higher in rural compared to urban children (5.4 vs. 3.9)
35-44 years Majority of subjects, i.e. 85.2% of those examined, had healthy
periodontium. Shallow pocket and bleeding was recorded in approx. 15 and
20% respectively and only 2.6% had deep pockets. The only striking finding
was that deep pockets were recorded only in rural population.
65-74 years All healthy sextants were found in 87.7%, bleeding and shallow
pocket in approx. 12 and 18% and deep pocket in only 0.6%, all in rural men.
Probably, with advancing age, gingival recession is more marked and hence,
prevalence of pockets is decreased.

34
Loss of Attachment
35-44 years Normal attachment level was found in 83.7%. Attachment loss of
4-5 mm was recorded in 3.3%. Attachment loss in rural population was 3 times
higher than in urban ( 22.7 vs. 9%) with very small difference between male:
female, higher in males than females (17.6 vs. 14.1% )
65-74 years –Normal attachment level was found in 78%. Total % of persons
showing more than6mm attachment loss was only 0.6%, which can again be
explained by the fact that with increased gingival recession, pocket formation
is reduced and hence loss of attachment recorded is less than that found in the
35-44 years age group.
Fluorosis
The entire studied population in all age groups and in both, urban and rural
areas had no evidence of dental fluorosis.
SUMMARY
The state of Arunachal Pradesh is located on the north east border of the
country with low population density and below national average socio- economic
status of the population. The district Papumpare has been selected keeping in
mind the operation ease of conducting the survey. This district has mixed
population mainly comprised of three different tribal of Arunachal Pradesh.
The Dental caries prevalence was found to be higher (60-80%) in adults as
compared to the children (45-48%). The average DMF score was about 1- 1.5
in children and 2.6 in adults. The geriatric population had higher score in the
range of 6 and 7 because of more edentulousness in the these groups. There
were less than 1% filled teeth in the entire population due to poor oral health
care services in the state and lack of awareness. No case of dental fluorosis
was reported in the population, therefore it is difficult to mention about the
fluoride rich zone in the NE region. Surprisingly the gingival bleeding was
quite low in all age groups and possible region for the same may frequent
usage of betel nut and quid among the whole spectrum of population. Similar
trends were also seen in loss of attachment and adult and geriatric group had
only 16 and 20% prevalence respectively. The tobacco smoking habits were
seen in 6% adults and 17.5% of geriatric population. The chewing tobacco
habits were reported in 6-7% of the children and 17% of geriatric population,

35
however, there are no cases reported for oral pre cancer and cancerous
conditions.
The eating habits of the population was found to be having highly skewed
towards sweet intake and in adults about 70-80% were found to be having
regular use of sweet eatables. The use of cola and beverages were relatively
low in the population. Poor and very poor self perception of oral health was
reported by about 30% of geriatric population indicating complete negligence
about oral health care in the elderly. The proportions of population who have
never visited as dental operatory were 50-70% high in almost all age groups.
Overall it seems that the prevalence of gingival problems is low in the population
but it requires steps in the direction of dental caries prevention and oral hygiene
maintenance. The oral health services require augmentation specially in the
prosthodontic and restorative aspect.

36
Site specific reports
7.2 Delhi – District South West
Indicators (South West)
Population - Male 7,607,234
Population - Female 6,243,273
Sex-ratio 821
As per 2001 Census
Sample Area (South West)
Rural Urban
1 Surera Chhawala Ward No. 55
2 Gomen DMC (U) Ward No. 17
Hera Ward No. 54
3 Ujwa Roshan Ward No. 49
Pura
4 Jaffarpur
Kalan

37
Introduction
Delhi, a state in itself, has New Delhi as the capital of India. It has a unique
position among the various geographical units in which India is divided. Its
small area (1483 sq. K.M.) borders the states of Haryana and Uttar Pradesh.
Delhi’s population was 4.1 million in 1971 and increased to 13.4 million in
2001. The annual number of migrants is more than its natural increase. It is
often referred to as “Mini India”, as people from all the States and Union
Territories are represented here. Delhi comprises of people from almost all
religions and castes, however the tribal population is nil. The average size of a
household is 5.3.
The gender ratio of Delhi stands at 821 which is significantly lower then National
average of 927. The birth rate of Delhi is 23.58 and death rate is 5.93 only.
The infant mortality rate is 23.19 per 1000 live births.
Medical Facilities
The medical facilities in the state are being provided by various agencies like,
Municipal Council of Delhi, New Delhi Municipal Council, Central Govt. Health
Services, Govt. of NCT of Delhi, Indian Army (Army Dental Corps), Central Health
Services., Railways and other statutory bodies etc.
There are a total of 563 hospitals in Delhi with 30,267 beds. There are 937
dispensaries and only 8 PHCs in Delhi, since it has very small rural population.
The Bed: Population Ratio (Per Thousand) is 2.22 only.
The Dental facilities in Delhi are basically part of each of the agencies mentioned
for medical services. The dental care services are not well organized and there
is lack of infrastructure and materials in these facilities. There are two dental
teaching institutions within the state. It is estimated that there are about 119
dental surgeons in Govt. organizations in Delhi apart from the two teaching
institutions for population of about 14 million.
Profile of the study population
Occupation
35-44 years Of the studied population, 43.4% were housewives, 4.2% were
professionals/ businessman/skilled workers, whereas only 6.7% were non-
skilled workers and 7.5% were in local occupation. Skilled workers were almost

38
double in urban than in rural areas (54.7 vs. 29.1%) and majority were men
(73.5 vs. 10.6%).
In 65-74 age group, 23.6% were not working, 47.8% were housewives, 15.6%
were non-skilled workers and only 13% were skilled professionals.
Educational level
35-44 years Only 17.5% had more than primary level education,.35% had
less or till secondary level and a high 47.4% had education up to graduation
level.
65-74 years As high as 54.% had more than primary level education, 27.4%
had up to or higher than secondary level, while only 9.5% had graduate level
education.
poor
12 years
Of the studied population, 61% of the total respondents rated the health of
their teeth and gums as average, 25% as good and 14% ranked it as poor. It
was seen that there were no significant differences between the urban: rural
and male: female populations.
15 years
In this age group, 70% of the total respondents rated the health of their teeth
and gums as average, 9% as good and 11% ranked it as poor. It was seen that
there were no marked differences between the urban: rural and male: female
populations.

39
Oral Health Seeking Behavior
12 years
Of the total respondents, 47% of the respondents of both the sexes reported
toothache occasionally, whereas 44% had no complaint. It was seen that there
were no marked differences between the urban: rural and male: female
populations.
15 years
Same pattern were reported as in the 12 years age group.
Frequency of visiting a dentist in past 12 months
12 years
Of the population, 74% respondents never visited the dentist, approx. 24% of
the male and female respondents of both urban and rural populations visited
dentist 1-3 times and only 2% of the population visited dentist e”4 times during
the past 12 months. There were no differences between urban: rural and male:
female population.
15 years
In this age group majority of the population (76%) had never visited a dentist,
a small proportion (20%) of population had visited a dental health facility once
or more times in last 12 months. There were no differences between urban:
rural and male: female population with reference to reason for last visit.
Reason for the last visit to the dentist
12 years
The numbers of respondents for this question were only 19.3% of 12 year old
children. Of the respondents, 48%, had visited the dental service provider due
to complain of pain while the rest visited for other reasons including routine
check up. The proportion of urban children availing oral care services for pain
were more then rural children (53% Vs. 43%).
There were no significant differences among male and female group.

40
15 years
Only 16-5% of the children responded to this question. In this age group, 42%
of the respondents of both the sexes in the urban and rural area had visited a
dentist in last 12 months with the complain of pain, It was seen that complaint
of pain were more in the rural population (52.63%) then in the urban (35%),
and more in males (49%) then in females (39%), whereas 50% respondents
visited the dentist for other reasons including routine check up.
Methods and Frequency of teeth cleaning
12 years
Of the studied population, 95% of the respondents used tooth brush to clean
their teeth. Out of 4% of the population using charcoal/chew sticks or Miswak,
majority were males (60%).
Of the studied population, 68% of the respondents cleaned their teeth at least
once a day and 15% twice a day. It was observed that 72.32% of urban and
63.41% of the rural respondents cleaned their teeth once a day. There was a
marked difference between urban and rural respondents who cleaned their
teeth twice or more times/ day (21.70% Vs. 7.77%), and more females cleaned
their teeth twice than the males (17.5 Vs. 12%).
15 years
In this age group, 95% of the respondents cleaned their teeth with tooth brush.
Out of 5% of the population was using charcoal/chew sticks or Miswak, majority
were males (65%) as compared to female (35%) respondents.
There were no significant differences between urban and rural respondents.
The children in 15 year old age group were having little better brushing habits.
The proportion of children brushing once a day were about 75% while those
brushing twice or more times a day were about 14%. There were marginal
differences in brushing frequencies of male and female children. Whereas,
20% of urban were brushing twice daily as compared to only 8% rural children.

41
12 years
Only 25% of children in this age group responded to this question. Of these,
85% used fluoridated tooth paste.
15 years
This particular question was replied by only 20% of children among 15 year
olds. Of these, 75% reported use of Fluoridated toothpaste. It was also observed
that 9% of rural respondents did not use toothpaste at all as compared to only
2% among urban respondents.
Dietary Habits
12 and 15 year old children
Bakery products were consumed once or more than once a day by only one
fifth (20%) and candies by about one fourth (24%) of schoolchildren in 12 and
15 year old age groups. Fresh fruit consumption was relatively low: only 36%
and 39% of 12 and 15 years consumed fresh fruits. Regular use of colas and
beverages was reported by only 17% among 12 year and 25% among 15 year
old children. There were no significant differences in the eating habits between
male: female and urban: rural population in both the age groups.
Tobacco habits
Smoking cigarettes, cigars or pipe
12 years
Only 4 children in this age group admitted smoking habit. Out of these, 3
smoked occasionally and 1 smoked regularly. It was observed that more of the
boys (3) were smoking than the girls (1). There was no significant difference
between urban: rural population.
15 years
In this age group, only 16 children responded positive, out of which 10 smoked
occasionally, whereas 6 children reported regular smoking. It was observed
that most of the smokers were males (15). There was no significant difference
between urban: rural population.

42
Chewing tobacco or snuff
12 years
Of the studied population, only 2 urban boys accepted tobacco chewing habit
on occasional basis.
15 years
In this age group, only 6 children responded, of which 3 chewed tobacco
occasionally and 3 chewed regularly. It was observed that more boys (5) than
girls (1) and more rural (4) than urban (2) children were chewing tobacco.
Number of natural teeth present
35 - 44 years
Only 3% of the studied population had less than20 natural teeth. There were
only minor differences between urban: rural and male: female population.
65 – 74 years
Out In this age group, 28% respondents of both sexes and populations had
more then 20 natural teeth present, 36% respondents had 10-19 natural teeth,
whereas 37% of the respondents had no natural teeth. There were no marked
differences in the %s of male: female and urban: rural populations.
35 - 44 years
Of the studied population, 44% of the respondents reported toothache
occasionally, whereas remaining 56% never complained of toothache. There
were no marked differences in the male: female and urban: rural populations
65 – 74 years
Respondents showed the same pattern as 35 – 44 age groups.

43
Use of removable prosthesis
35-44 years
Of the studied population, 8% respondents were using partial dentures, and
1% were using upper and/or lowers complete dentures. It was observed that
the prosthesis were more common with the urban (70%) then the rural (30%)
population.
65-74 years
In this age group, 8% respondents were using partial dentures, and 20% were
using upper and/or lowers complete dentures. It was observed that the partial
prosthesis were more common with the urban (80%) than the rural (20%)
population. Same pattern was observed with complete prosthesis 70% Urban
vs. 30% Rural.
poor
35-44 years
Of the studied population, majority of the respondents of both the sexes and
populations rated health of their gums and teeth as average (75%), 2.24% as
good and 21% rated them as poor. There was no significant difference between
urban: rural and male: female respondents.
65 – 74 years
In this age group, 43% rated the health of their gums as average, 55% as poor
and only 3.52% respondents rated as good. There were no significant differences
between urban: rural and male: female respondents.
35 - 44 years
Of the studied population, 70% of the total respondents clean their teeth once
a day, whereas 31% urban, 11% rural, 16% males, and 26% of female respondents

44
clean their teeth two or more times a day. It was observed that out of 1%
population not cleaning their teeth, majority were the rural (85%) as compared
to urban (15%) respondents.
65-74 years
In this age group, 45% respondents clean there teeth once a day, whereas 9%
respondents clean their teeth two or more times a day. It was observed that
30% population was not cleaning their teeth. There were no significant
differences between urban: rural and male: female respondents.
Methods of teeth cleaning
35 – 44 years
Of the studied population, majority of the respondents clean their teeth with a
tooth brush 91%, and out of 9% population using charcoal, chew sticks or
Miswak, 8% were urban, 40% rural, 32% males and 20% females.
65 – 74 years
In this age group,38% of the respondents clean their teeth with a tooth brush,
and out of 8% population using charcoal, chew sticks or Miswak ,11% were
urban, 46% rural, 30% males and 13% females.
35 – 44 years
Of the studied population, 60% of the respondents use fluoride tooth paste; It
was observed that fluoride tooth paste were used extensively in the urban
population (74%) then in the rural (34%). 20% of the total respondents did not
use tooth paste at all, It was seen that 84% rural respondents were not using
tooth paste as compared to the 14% urban respondents.
65-74 years
In this age group, 8% of the respondents use fluoride tooth paste; It was observed
that fluoride tooth paste were used extensively in the urban population (84%)
then in the rural (16%). 80% of the total respondents did not use tooth paste at
all and there were no significant differences between urban: rural and male:
female respondents.

45
Last visit to a Dentist
35-44 years
29% of the respondents had never received any dental care. 13% of the
respondents had seen a dentist more than five years ago and another 15% had
visited a dentist more than 2 years ago. 16% had visited a dentist more than
one year ago and 26% of the respondents had visited a dentist in the past one
year. There was no significant difference between Male: Female and Urban:
Rural population.
65-74 years
In this age group, 13% of the respondents had never received any dental care.
25% had visited a dentist more than 5 years ago, 15% had visited more than 2
years ago, 15% had visited more than one year ago and 24% had visited a
dentist in the past one year. Among those who had never received any dental
care it was seen that the rural respondents were almost five times the urban
(46%) vs. 8% ). There was no significant sex difference.
Dietary Habits
35-44 years and 65- 74 years
Among the adult and geriatric age groups, the use of bakery product was not
popular and only 23% of 35-44 year olds and 12% of the 65-74 year olds were
found to be having habit of using it daily. Once or more than once use of
candies and sweets was reported by only 10% and 4% of the respondents in
adult and geriatric age group. About 27% of the adults and 8% of the geriatric
population used colas and beverages once of more times a day. There were no
significant differences in dietary habits among males, females and urban: rural
population in both age groups.
Tobacco Habits
Smoking cigarettes, cigars or pipe
35-44 years
In this age group, about one third of the studied population reported their
smoking habits, Most of them (31%) were regular smokers while only 2% reported

46
to be occasional smokers. Only 10% of the urban adults reported regular
smoking as compared to 17% of rural adults. However, majority of reported
regular smokers were males (36% Vs 1.7%)
65-74 years
In this age group, Bidi, Cigarettes etc. smoking habit was reported by about
13-18% of the respondents as regular users, however a little proportion (1-
2%) reported occasional smoking habit. Rural population had more regular
smokers (17-30%) than urban (10-12%) and significantly more males (23-30%)
had regular and occasional smoking habits than females (0.2%).
Chewing tobacco or snuff
35-44 years
Of the studied population, only 4% reported regular tobacco chewing habits as
compared to smoking. There were 1% occasional tobacco chewers and 4% regular
users. There were no significant differences between urban: rural population.
65-74 years
In this age group, only 2% of the people accepted having regular tobacco chewing
habits. There were no significant differences between urban: rural population.
Oral Health Status
Extra oral appearance
12 years One fourth of the studied population had enlarged head and neck
lymph nodes, which was a very significant finding. Either the children had
chronic systemic illnesses such as viral or bacterial infection or tubercular
infection, apart from any occasional dental cause.
Even in the 15 years age group, enlarged lymph nodes were reported in 19.8%
of population.
In 35-44 years group, only 4% exhibited some or the other extra oral lesion in
the form of ulcers, swelling or enlarged lymph nodes. Even in 64-74 years
group, there were minor lesions. Hence extra oral lesions, particularly enlarged
cervical lymph nodes, were the most predominant finding in 12 and 15 years
as compared to adult age population.

47
Oral Mucosal Conditions
12 years Oral mucosal ulceration was found in 4%, abscess in 1%, other
conditions in 2.6%. of the studied population
15 years No abnormal findings were reported in this age group.
35-44 years 12% of the group had some form of oral mucosal disorders. 3%
had leukoplakia 2.4% had ulcers, 1.6% had ANUG and another 3% had other
condition probably in the form of oral submucous fibrosis or melanoplakia/
erythroplakia etc.
65-74years In this group, almost 17% had mucosal lesions. Leukoplakia was
found in 4% ulcerations in 4.5% abscesses in 1% but other lesion constituted
the highest of 5.4%
With increasing age, it was noticed that prevalence of mucosal lesions increased,
which could be due to cumulative effect of years of neglect, adverse oral habits,
hygiene practices and tobacco use.
Denture wear
In 35-44 years age group, only 6.6% were wearing partial dentures and 0.7%
were wearing complete denture.
65-74 years In this group, 19% were wearing complete dentures and 7% were
wearing partial dentures. Similarly, men were more than double the number
of women denture wearers. However, there were double the number of denture
wearers in urban compared to rural area.
Periodontal Status
12 years In 61% of children, bleeding gums was recorded which was
predominantly in rural than urban children (79 vs. 42 %)
15 years Bleeding gums was recorded in 59%, again much higher prevalence in
rural children compared to urban was noted (72.6 vs. 45%).
35-44 years Bleeding gums were present in 70%, shallow pockets in 34% and
deep pockets in 1% of the examined population. However, the urban: rural
difference was not very significant.

48
65-74 years: Bleeding was present in 57.7% and shallow and deep pockets in
only 1.7% of the examined population.. With advancing age, probably, with
gingival recession and alveolar bone loss occurring simultaneously, periodontal
pockets does not manifest as compared to younger persons.
Loss of attachments
35-44 years Loss of attachment of 4-5mm was recorded in 6.3% and more
than6 mm in another 1.3%. It was seen in more rural than urban adults (9.8 vs.
5.7).
65-74 years: About 14 % of the subjects could be evaluated for loss of
attachment in this age group, out of which about 4% had loss of attachment to
a clinical significant level.
Fluorosis
Questionable to very mild fluorosis was reported in 44.8, 43,5, 81.9 and 25.5%
in the four index age groups in ascending order. In was observed that 16% of
12 and 15 years age group had mild to moderate fluorosis, which decreased
to 4.2% and 2.2% in 35-44 and 65-44 years age group respectively. Severe
fluorosis was not observed except in 4 individuals (0.2%) in the 12 years age
group.
Probably, with advancing age, due to abrasion and attrition of teeth and extrinsic
stains of tea, coffee tobacco and betel quid etc. effect of fluorosis was less
noticeable. Other reason could be loss of teeth.
Summary
Being the commercial capital of the country, Delhi has the highest number of
migrated population due to urbanization and growth, there are literally no
rural areas left. However, for sampling purposes the term rural area has been
used but in fact it is a peri urban area. The south west district of Delhi is a
mixed population having urbanized colonies and villages which have been
included into the National Capital.
The perception about own oral health was found to be good in more than 70%
of the population. Dental Caries prevalence was about 50 % among children
and 60-70% in the adult and geriatric age groups. The usage of sweet eatables
and cola, beverages etc. was not much different in urban and rural population.

49
The proportion of population brushing their teeth at least once a day was quite
high (70-80%). The average DMFT scores were higher in rural areas as compared
to urban population. The proportion of population who have never availed
dental services were about 70-80% in children, 30 % in adults and inly 12% in
geriatric age groups. As expected the rural population has higher prevalence
of Dental Fluorosis. Although there were little differences in usage of sweets
and beverages and brushing frequency, the difference in prevalence of gingival
bleeding was very high in rural as compared to urban population indicating
poor oral hygiene.
In adults, the prevalence of gingival bleeding was reported to be very high in
both 35-44 and 65-74 years population. The loss of attachment was found to
be >3 mm in over 50% of the population. These findings are very well in
accordance with dental caries prevalence, since gingival bleeding is considered
as a parameter for cumulated oral hygiene performance.
The use of tobacco in smokeless form was found to be less prevalent (3-5 %)
than smoking which was found in 32% of the adults and 47% of geriatric
population. The combined prevalence of leukoplakia, lichen planus and
malignant conditions was 0.8% in this population out of which most of the
subjects were rural males. This finding definitely proves the need of tobacco
control interventions in the area.
Overall the geriatric population had poorer oral health indicators as compared
to all other age groups. The level of edentulism was higher in this age group
4.6% however only 0.6% had received complete dentures.
The overall dental caries prevalence has shown increasing trend with increasing
age except in the geriatric population which may be attributed to tooth loss
among them. In brief, the site requires increase in awareness about oral hygiene
practices, use of sugar and beverages and edentulism. The oral health care
services need improvement and penetration upto the masses.

50
Site specific reports
7.3 Maharashtra – District Mumbai and Thane
Indicators (Maharashtra)
Population - Male 50,400,596
Population - Female 46,478,031
Sex-ratio 922
As per 2001 Census
Sample Sample Area
Area (Mumbai City)
(Thane)
Rural Urban
1 Bolinj Tardeo Ward No. 417
2 Wagholi Santacruz (E) Ward No. 1048
3 Gas Chunabhatti Ward No. 1977
4 Naigaon Mulund Ward No. 2486

51
Introduction
Maharashtra state is one of the bigger state of the country and extends about
308 thousand sq. km. Located in the north centre of Peninsular India, with a
command of the Arabian Sea through its port of Mumbai. The state area, barring
the extreme eastern Vidarbha region, parts of Kolhapur and Sindhudurg, is
practically co-terminous with the Deccan Traps. The total population is about
96 million. The literacy rate is 76.9% and the gender ratio is 922 females per
1000 males. The urban population is about 42.4%. There are 35 districts and
353 sub divisions in the state.
In contrast to the agrarian economy that characterizes India, Maharashtra stands
out, with the highest level of urbanization of all Indian states. The mountainous
topography and soil are not as suitable for intensive agriculture as the plains
of North India; therefore, the proportion of the urban population (38.69 per
cent) contrasts starkly with the national average (25.7 per cent). The state has
one metropolitan city, two mini-metropolises and many large towns. Mumbai
is the state capital, with a population of approximately 9.926 million people.
The other large cities are Pune, Nasik, Nagpur, Aurangabad and Kolhapur.
There are 1028 general hospitals, 2058 dispensaries and 93 beds per 100,000
population. The birth rate is 19.9/1000, death rate is 7.2/1000 and Infant
mortality rate is 42 per thousand live berths.
The Dental health care is being looked after the Health Ministry in whole state
except Mumbai where the health services are under Mumbai Municipal
Corporation. All the District hospitals (35) have a post of Dental Surgeons but
the Community Health centres and Primary health centres do not have dental
facilities in the state. The City of Mumbai has several hospitals under the
Municipal Corporation and most of the hospitals have a post of dental surgeons.
There are in all approximately 53 dental surgeons employed under Municipal
Corporation. Apart from this, Municipal Corporation also runs a Dental Teaching
College and Hospital – Nair Hospital Dental College – where around 50 dental
staff are working. There are 28 Dental teaching institutions in the state including
five Govt. Dental Colleges which supports dental health care services.
The Demographic Profile of Mumbai and Thane District
Mumbai
Mumbai is the commercial capital of the country with highest number of
immigrants.

52
The Health and Family welfare is being looked after by Municipal Corporation
of Mumbai. The Public Health Department is mainly responsible for preventive
healthcare and Municipal Hospitals are responsible for health care services.
The health services are performed by the staff in the words, etc., under the
supervision and guidance of the Executive Health Officer, the Deputy Executive
Health Officer, 4 Zonal Assistant Health Officers and the Epidemiologist.
For the efficient discharge of these functions, Greater Bombay has been divided
into Wards which, have been grouped into six zone as follows. Each zone is in
charge of each of four Assistant Health Officers. There are in all 24 wards,
each ward being in charges of a Medical Officer of Health. The Medical Officers
work under the directions of their Zonal Asstt. Health Officer. This district has
5 dental teaching institutions with 100 admissions each and most of these
also run post graduate courses in various disciplines of Dentistry.
Thane
Thane district ranks second in the state in respect of its Population size as per
the Census of 2001. Population of the Thane district, according to the 2001
Census is 81,31,849 and is distributed over fifteen tahsils. The rate of increase
of population in Thane district during the decade 1991-2001 was 54.92 %
which is probably due to large scale migration of people from outside the
district in search of employment to Thane and Mumbai. The population growth
rate is 2.42 times more than that of state in 1991-2001. The sex ratio per
1,000 males is 857. The % of urban population in the district is 72.58 and that
of rural population 27.42 as per 2001 Census.
Thane district has one Dental college.
Public Health Facilities
Hospitals 28
Dispensaries 43
Primary health Centres (PHC) 122

53
Profile of the Study Population
Occupation
35-44 years
42.9% were housewives, 29.7% were skilled workers or professionals (urban
54.7 vs. rural 29.1% ). Women constituted only 7.7%. Non-skilled workers
constituted 5.7 % and the rest were house wives (84.6%)
65-74 years
In this age group, only 28% of elderly were not working, 43% were house wives,
9.2% were professionals/ skilled workers and 8.4% were non-skilled workers.
The difference between men and women’s occupational status was very
significant; only 4.1% women were skilled workers against 14.2% men.
Educational level
Parents of 12 and 15 years age group. About 15% of parents had low education
(unfinished primary school), 35% had more than or up to secondary level
education and only 16% were graduates or above.
35-44 years
22% in this group had less than primary level education, 28% more than or up
to secondary level and only 18% were graduates or above. Surprisingly, there
was not much difference between urban and rural population, but the literacy
level was comparatively low in women.
65-74 years
In the elderly population, 54% were below primary level, 13% were more than
or up to secondary level and only 8.5% were graduates or above. Educational
status was significantly low in rural than urban (77.5 vs. 30.9% below primary
level) and higher in men than in women (only 39.3% of men vs. 69% of women
had more than primary level education)

54
12 years
11.3% urban and 27.1% rural respondents rated health of there gums and
teeth as excellent or very good, 78.8% urban and 60.4% of the rural respondents
as good or average and 9.3% urban and 12.5% rural respondents rated their
own oral health as poor or very poor. 21% males and 16.7% females respondents
rated health of there gums and teeth as excellent or very good, 69.2% males
and 71.4% females as good or average and 9.8% males and 11.8% females
respondents rated them as poor or very poor.
15 years
17.5% urban and 24.4% rural respondents rated health of there gums and
teeth as excellent or very good, 72.5% urban and 68.7% rural as good or
average and 17.9% urban and 6.9% rural respondents rated them as poor or
very poor.
21.9% males and 19.9% females respondents rated health of there gums and
teeth as excellent or very good, 70.3% males and 71% females as good or
average and 7.9% males and 9% females rated them as poor or very poor. Most
of the respondents in both the age groups rated the health of teeth and gums
as Good or Average,
Whether experienced pain in teeth/mouth during past one year
12 years
About 46% of the respondents in 12 year old age group never experienced
toothache, however 41.6% urban and 53% of the rural respondent reported of
tooth ache occasionally. Among these, 47.9% boys and 52.4% girls reported of
having occasional tooth ache.
15 years
There are about 56% of the respondents in 15 year old age group who never
had pain in teeth. However, 38 had experiences it occasionally or rarely. Only
5% of the children had complain of regular toothache. The distribution was
marginally higher in urban population and in boys. 50 % of the respondents of
both the sexes and in both the populations reported of tooth ache and/or
discomfort during past 12 months.

55
Visit to Dentist in past one Year
12 years Only 22.5% urban and 20.3% of the rural respondents visited dentist
during last 12 months, whereas 73.6% urban and 76.8% of rural respondents
never visited a dental health facility.
15 years A total of 23.4% urban and 11.6% rural respondents visited dentist
during last 12 months, whereas 72.7% urban and 84% of the rural respondents
did not visit dentist in last 12 months.
It was observed that in both the sexes and in both rural as well as urban
population, most of the respondents (Approx. 76%), did not visit a dentist in
past one year.
In spite of 50 % of the respondents of both the sexes and in both the populations
reporting of tooth ache and/or discomfort during past 12 months, it was seen
that, there were no regular visits to the trained dentist.
Reason of your last visit to the dentist
12 years Only 23.5 % of the children in this age group replied to this question.
Out of which 85% urban and 88.6% of the rural respondents visited dentist
with the complaint of pain in teeth or gums in last 12 months, whereas 15%
urban and 11.3% rural respondents visited dentist for other reasons including
check up during the last 12 months. The girls were found to have more visits
(90%) to a dental care provider for pain than boys (84%).
15 years
This question was replied by only 20% of the children in this age group. More
than 80% of the respondents have utilized Dental Health services for pain in
teeth. The other reasons for visit were only 15% (urban) and 20% in rural
population.
Approximately 86% of the respondents in both the populations and sexes,
visited the dentist when in pain. It was observed that irrespective of 50 % of the
population having dental related problems, the visits to the dentist for regular
check ups was minimal (Approx 11% overall).

56
Oral Health Behavior
12 years
About 60% of the children in this age group reported to be brushing their teeth
once daily and rest were brushing twice a day. The frequency of brushing was
nearly equal among rural urban and male female population.
15 years
About 99% of the children in 15 year age group were found to be having brushing
frequency once or twice a day. Urban females were having twice daily brushing
habits than their rural counterparts. Out of total respondents 56% had once
daily brushing habit while 44% had twice daily brushing routine. Approx. 97%
of the total respondents cleaned there teeth at least once a day, though the
number of respondents cleaning their teeth twice a day was also very significant
in both the populations (Approx. 40%) and more so in females (48%).
Use of tooth paste containing fluoride
12 years
Only 10% of the children could reply to this question since most of the people
in India are not aware of fluoride content of the toothpaste and neither they
give attention towards components of a toothpaste. Of the respondents, more
children from rural background (25 out of 31) reported use of fluoridated
tooth paste then urban children (15 out of 50). The number of boys (24 out of
43) reported use of fluoridated toothpaste was higher as compared to the girls
(16 out of 38).
15 years
The 15 year old children were also not very aware of the fluoride content in the
toothpaste and only 9.5% of the children responded to this question. A total of
46 children out of 76 respondents reported fluoridated toothpaste use.
The use of fluoridated tooth paste was more in the rural population than in the
urban. It was surprising to that a approx. 40% of the respondents were not
using toothpaste at all.

Oral health in india

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