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Untreated Dental Caries Among Primary School Children and Dental Services Availability in Jawadhu Hills and Polur, Thiruvannamalai District, Tamil Nadu

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Untreated Dental Caries Among Primary School Children and Dental Services Availability in Jawadhu Hills and Polur, Thiruvannamalai District, Tamil Nadu UNTREATED DENTAL CARIES AMONG PRIMARY SCHOOL CHILDREN AND DENTAL SERVICES AVAILABILITY IN JAWADHU HILLS AND POLUR, THIRUVANNAMALAI DISTRICT, TAMIL NADU Dr. SUSEENDAR KK Dissertation submitted in partial fulfilment of the Requirement for the award of Master of Public Health ACHUTHA MENON CENTRE FOR HEALTH SCIENCE STUDIES SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES AND TECHNOLOGY, TRIVANDRUM Thiruvananthapuram, Kerala. India – 695011 OCTOBER 2016 i Special thanks to Dr. K. Kolandaswamy, The Director of Public Health & Preventive Medicine, Chennai Thiru. Annamalai, Directorate of Public Health & Preventive Medicine, Chennai Ms R. Meena The Deputy Director of Health Services, Thiruvannamalai Thiru. Rajendran, The District Elementary Education Officer, Thiruvannamalai Ms Chandrika, The Assistant Elementary Education Officer, Polur Thiru Govindaraj, The Assistant Elementary Education Officer, Jawadhu Hills School Head Masters and Teachers, Polur and Jawadhu Hills Block Medical Officers Polur and Jawadhu Hills Medical Officers and staffs of Primary Health Centres, Polur and Jawadhu Hills Primary School Children, Polur and Jawadhu Hills ii Acknowledgements I sincerely thank all my teachers, class mates, friends and family who made my journey of undertaking a master programme in public health possible. It gives me immense pleasure to write this section. I take it as an opportunity to thank everyone who in one way or another, helped me in completing this piece of my course work. I first, thank my Guide Dr. Biju Soman, Additional professor, AMCHSS, SCTIMST, for helping me find where my interest and strength lies. If it is not for his enduring patience in handling a student like me it would not have been possible to finish this task. He had always kept his doors open for us to interact even out of office hours. It was a great learning experience for the past one year under him. I thank Dr. Srinivasan K, Additional professor for guiding and coordinating the batch of MPH 2015 for the past two years, especially during this whole process of dissertation. I thank Dr. KR Thankappan and Dr Mala Ramanathan who provided us an impetus to begin this dissertation thesis by making us understand what research is and how a student researcher should view it. I thank Dr. V Raman Kutty who inspired us in many ways. He always stood front in critiquing every step of student‟s dissertation work. It helped us review our own progress. His teachings of Epidemiology laid the foundation for us to build this work further. I thank Dr. P Sankara Sarma, for reviewing the methodology drafted for this study; his teaching approach to new students of biostatistics helped us learn the basic and relevant skills necessary for doing this study. I thank Dr. TK Sundari Ravindran, for having instilled in us „social thinking‟ in every opportunity she had. It made me believe strongly that health is social and both are inseparable. This in many ways influenced me to conduct a research among the disadvantaged population. I thank Dr. Ravi Prasad Varma and Ms Jissa VT for reviewing the tools developed for this study. Those valuable inputs had helped in shaping the tool. Their suggestions had been incorporated. I thank Dr. Manju Nair for her comprehensible way of teaching „Gender and health‟ for us. It made us understand why sex and gender matter in public health research. I thank Dr Neethu Suresh, PhD scholar, AMCHSS for her support and continued interest she showed in this dissertation work I thank my friends Dr Dasarathan and Dr Raja, Dental practitioners for their timely help during the course of this study. I thank my friend and senior Dr Tijo George who had always remained a source of moral support all these two years both personally and professionally. It helped me in keeping myself composed in this journey. I thank Dr Donald M Paul, Dr Sahane Vikram Kundlik and Dr Lalchhanhima Ralte for their contributions and support throughout the process of doing this thesis. iii DECLARATION I hereby declare that this dissertation titled “Untreated dental caries among primary school children and dental services availability in Jawadhu hills and Polur, Thiruvannamalai district, Tamil Nadu” is the Bonafide record of my original research. It has not been submitted to any other university or institution for the award of any degree or diploma. Information derived from the published or unpublished work of others has been duly acknowledged in the text. Dr. Suseendar KK Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Thiruvananthapuram, Kerala. India -695011 October, 2016 iv CERTIFICATE Certified that the dissertation titled “Untreated dental caries among primary school children and dental services availability in Jawadhu hills and Polur, Thiruvannamalai district, Tamil Nadu” is a record of the research work undertaken by Dr. Suseendar KK, in partial fulfilment of the requirements for the award of the degree of “Master of Public Health” under my guidance and supervision. Guide: Dr. Biju Soman Additional Professor Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Thiruvananthapuram, Kerala. India -695011 October, 2016 v CONTENTS Section No Title Page No List of tables viii List of abbreviations ix Abstract x Chapter 1- Introduction 1 1.1 Background 1 1.1.1 Prioritizing oral health 1 1.1.2 Public health approach for dental caries 1 1.1.3 Basic package of oral care (BPOC) 2 1.1.4 Integrating oral health care at primary health practice 2 1.2 Literature review 3 1.2.1 Current concepts of dental caries 3 1.2.2 Epidemiology of dental caries 4 1.2.3 Economic impact of dental caries 8 1.2.4 Oral health inequalities 9 1.2.5 Dental technology 9 1.2.6 Dental services 10 1.2.7 Recommendations and guidelines for dental services at PHC 10 1.3 Rationale for the study 12 1.4 Study objectives 14 Chapter 2- Methodology 15 2.1 Study design 15 2.2 Study setting 15 2.3 Study population 16 2.4 Sample size and sampling method 18 2.5 Sample selection procedure 19 2.6 Data collection 20 2.7 Variables used in the survey 22 2.8 Ethical considerations 24 2.9 Data management 25 Chapter 3- Results 27 3.1 Untreated caries among primary school children 27 3.1.1 Description of sample characteristics 27 3.1.2 Socioeconomic characteristics of the sample 28 3.1.3 Number and percentage of children by dentition 29 3.1.4 Prevalence of untreated caries in primary teeth 30 3.1.5 Prevalence of untreated caries in permanent teeth 31 vi CONTENTS Section No Title Page No Chapter 3- Results 3.1.6 Self report of dental health 32 3.1.7 Dental hygiene habits 33 3.1.8 Frequency of eating snacks 35 3.1.9 Results of bivariate analysis 36 3.2 Dental services availability at primary health centres 40 3.2.1 General features of primary health centres 40 3.2.2 Provision of dental services 42 3.2.3 Basic infrastructure of primary health centres 43 3.2.4 Specialist dental services at upgraded PHC of Jawadhu hills 44 3.2.5 Staff position at primary health centres 45 Chapter 4- Discussion 48 4.1 Untreated dental caries among primary school children 48 4.2 Dental services availability in primary health centres 51 4.2.1 Dental service provision 52 4.2.2 Access to referral dental services 53 4.2.3 Integration of dental services at primary health care practice 53 4.3 Strengths 54 4.4 Limitations 54 4.5 Conclusion 55 References 56 Annexure 1 Institutional Ethics Committee approval 2 Interview schedule 3 Clinical assessment form 4 Dental services availability checklist 5 Information sheet for parents 6 Parental consent form 7 Information sheet for chid 8 Child assent form 9 Information sheet for PHC staff 10 PHC staff consent form 11 Information sheet for parents (Tamil) 12 Parental consent form (Tamil) 13 Information sheet for chid (Tamil) 14 Child assent form (Tamil) 15 Permission from the Directorate of Public Health & Preventive Medicine, Chennai 16 Copy of Permission from office of District Elementary Education Officer , Thiruvannamali District, Tamil Nadu vii List of tables Table No Title Page No 1.1 Global DMFT for 12 years old-trends 5 1.2 Age standardized prevalence rates of untreated caries in 6 deciduous teeth in 1990 and 2010 1.3 Age standardized prevalence rate of untreated caries in 6 permanent teeth in 1990 and 2010 1.4 Prevalence of dental caries among tribal, suburban and urban 7 regions of Thiruchengode and Erode, Tamil Nadu 1.5 List of recommendations for oral health care at PHC by working 11 group on disease burden, 2011 1.6 Jobs and responsibilities for Accredited Social Health Activist 11 1.7 Guidelines for oral health services at PHC 12 2.1 List of variables used in the interview schedule 22 2.2 Indices used for measuring caries and caries experience 22 2.3 Codes the dentition status -primary and permanent teeth 23 2.4 Indicators for dental services availability 23 3.1 Basic characteristics of sample 27 3.2 Socioeconomic characteristics of the sample 29 3.3 Number and percentage of children by dentition 29 3.4 Caries prevalence in primary and permanent teeth 30 3.5 Mean of decayed, missing, filled and dmft teeth-Primary 30 dentition 3.6 Mean of Decayed, Missing, Filled and DMFT score of 31 permanent teeth 3.7 Self report of dental health 31 3.7a Self report of dental health 32 3.8 Dental hygiene habits 34 3.9 Frequency of eating snacks 35 3.10 Caries of primary teeth by geographical location 36 3.11 Caries of primary teeth by sex and age groups 37 3.12 Caries of primary teeth
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