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IAPHD NEWS
Year : 2016  |  Volume : 14  |  Issue : 4  |  Page : 472-485

IAPHD Awards-2016


Date of Web Publication15-Dec-2016

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.195849

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How to cite this article:
. IAPHD Awards-2016. J Indian Assoc Public Health Dent 2016;14:472-85

How to cite this URL:
. IAPHD Awards-2016. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Jul 19];14:472-85. Available from: http://www.jiaphd.org/text.asp?2016/14/4/472/195849




  National Level Essay Competition-2016 (UG Category)-1st Prize Top


Future Perspective of Oral Health Care Delivery System In India

Merlin Sabu, AJ Institute of Dental Sciences, Mangalore

'' MEN OFTEN THINK SUBMISSION INDICATES WEAKNESS, THAT LETTING SOME ONE ELSE TAKE CHARGE BETRAYS A CHARACTER DEFICIT. BUT WE ALL SUBMIT TO STRANGERS WHO DRILL INTO OUR TEETH AS LONG AS WE CAN SEE THE PARCHMENT ON THEIR WALL WHICH READS '' DENTIST''-EDMOND MANNING.

INDIA is a vast and diverse country which is rich in its culture and heritage, a population ranging from approximately 1.2 to 1.3 billion citizens. To reach out to every nook and corner of this beautiful country is quite a difficult task that the dentists of India have been facing for the past few decades. To sustain the positive economic trajectory that India has had during the past decade and to honour the fundamental rights of all citizens to adequate oral health care, the health of all Indian people has to be given the highest priority in public policy. The creation of integrated national health system in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence based good quality health care practices to the patients. The key characteristic is to strengthen the public health system in India, to improve quality and reduce the out of pocket expenditure on health care through a well regulated integration of the private sector within the national health care system. In primary health care system oral health care should be the major component.

In recent years, the impressive development of technologies in health care has been accompanied by an increase in the demand for services due to patient and provider expectations and subsequently by rising costs. So the policy makers introduced the concept of “oral health technology system” which has been described as the” the speciality of assistance to health policymaking”.

Oral health technology assessment is a multi disciplinary activity, which methodically evaluates the effects of a technology on oral health, on the availability and distribution of resources on other aspects of oral health system performance such as equity, responsiveness, interventions applied to the system, that is policies on organizing and financing the oral health system and achievement of its ultimate goal i.e oral health gain.

The basis of health technology assessment has been compared to a bridge between the world of research and the world of decision making. The bridge is anticipated to allow the transfer of knowledge produced in scientific dental research to the decision making process. In order to achieve this, Oral Health technology Assessment is committed to the work of collecting and analysing evidence from the dental research in a reproducible way and to make it accessible and usable for decision making purposes fastidious by means of assessment reports.

The proportion of older people continues to grow worldwide, especially in developing countries. Non communicable diseases are fast becoming the leading causes of disability and mortality, and in coming decade's health and social policy-makers will face tremendous challenges posed by the rapidly changing burden of chronic diseases in old age. Chronic diseases and most oral diseases share common risk factors. Globally poor oral health amongst older people has been particularly evident in high levels of tooth loss, dental caries experience and the prevalence rate of periodontal disease, xerostomia and oral cancer. The negative impact of poor oral conditions on the quality of life of older adults is an important public health issue, which must be addressed by policy makers. The means for strengthening oral health programme implementation are available; the major challenge is therefore to translate knowledge in the action programmes for the oral health of older people. The World health organization recommends that countries adopt certain strategies for improving the oral health of the elderly. National health authorities should develop policies and measurable goals and targets for oral health. National public health system should incorporate the oral health promotion and disease prevention based on common risk factors approach. Control of oral disease and illness in older adults should be strengthened through organization of oral health services, which meet their needs. The need for care is highest among the disadvantaged, vulnerable groups in developed and developing countries. In developing countries the challenges to provision of primary oral health care are particularly high because of a shortage of dental manpower. In developed countries reorientation of oral health services towards prevention should consider oral care needs of older people.

The diversity in oral disease patterns and development trends across the countries and regions reflect distinct risk profiles and the establishment of preventive oral health care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been shown in a large number of socio epidemiological surveys. In addition to poor living conditions, the major risk factors relate to unhealthy lifestyles {i.e poor diet, nutrition and oral hygiene and use of tobacco and alcohol}, limited availability of oral health services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations {e.g diabetes or AIDS}. Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral diseases and oral health is urgently needed. In the 21st century elite people are given more preference and privilege than the poverty stricken in case of quality of treatment as well as respect, it's high time we take an initiative to change that and provide them with the best treatment and quality of service.

People always believed that “dentist is a prestidigitator who puts metal in our mouth and draws coin from our pocket but I believe that dentistry is not expensive but neglect is.'' Mahatma Gandhi once told that “the difference between what we can do and what we are capable of doing would suffice to solve most of the world's problems.'' In our call to action, we propose that India must achieve oral health care for all by 2020.


  National Level Essay Competition-2016 (UG Category)-2 nd Prize Top


Future Perspective of Oral Health Care Delivery System in India

Ms. S. Hemalatha, Sri Ramakrishna Dental College and Hospital, Coimbatore

Oral health is an integral part of general health and a fundamental right of every individual. One of the main aims of public health dentistry is comprehensive oral care delivery system focussing on the impact of oral health on the overall health of the people. However, the oral healthcare system is lacking an overarching long-term vision as to how the profession can grow in order to make a significant contribution to the improvement of health.



Barriers in Delivering Effective Oral Heathcare in India

To move towards the future, there is a need to overcome the barriers to implementation of oral healthcare. Some of them are:

  1. Barriers in affordability and accessibility
  2. Deficient manpower planning and projection
  3. Changing disease pattern affecting the workforce
  4. Systemic barriers.


Need for Oral Healthcare Delivery System Enhancement

  • Oral diseases are 4th most common disease in India
  • To reduce the impact of oral diseases on systemic conditions
  • To solve problem of inaccessibility, inequality of providing dental care to rural areas
  • To restore all the dental impairments in a community by providing curative services
  • An inter-sectoral, multidisciplinary approach to oral health promotion and prevention
  • Mapping socio-economic areas, early detection and screening of high-risk groups
  • For proper distribution of resources, regulation of private sector.



  My Prespective on the Future Top


Collaborative Approach



Role of a Dentist in a Community Setup

  • Education – informing the public and caregivers.
  • Preventive care planning.
  • Minimum Data Set Assessment – Assessment of oral and nutritional status.
  • Examination and Follow up care.


Mobile and Portable Dental Clinics



In India, people are preoccupied with learning, earning for their family while oral care takes a backseat. There is a pertinent need to provide oral healthcare to people in their place that will be beneficial to them. Portable dental services are a viable option to take the sophisticated oral health services to the doorsteps of the underserved population. This may resolve the disparity in dentist population ratio between urban and rural areas, the lack of organized dental care for underprivileged in urban slums as well as home/hospital bound patients. Though it have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the community in the absence of oral health policy and organized school dental health programs in India.

To Meet the Increasing Demands and Need for Oral Health Care

  • Advocate improved oral health literacy
  • Increase resources for education and training of the oral health care team
  • Considering and understanding the local problems, needs and resources
  • A health care workforce primed to achieve desired outcomes.


Strengthening Oral Healthcare Delivery Systems

It is an open secret that poor oral health leads to many systemic disease conditions and the oral healthcare team needs to be strengthened by involving nurses, family physicians, dieticians, pharmacists to our team that will enable us to provide a complete healthcare.

Transforming Education for Future

Presently private dental colleges are more in number whereas growth of government sectors are stunted due to inadequate funds allotted for improving dental education. Although there has been an improvement in dentist population ratio to 1: 30000 but there is a wide geographic imbalance. The rapid increase in number of dentists might increase the fear in emerging and practising dentists about their future. The Government should take steps to increase employment opportunities and grade a fixed payment scale based on their educational qualifications.

Non Profit Structure



It aligns accountability with mission of developing oral healthcare in India. It can be achieved by doing community based internship in undergraduate degree program rather than hospital based internship.

Standardisation of Treatment Cost

The cost inflation in dentistry can be controlled by making standardized treatment costs in all private clinics and governed by Government authority.

Development of Oral Health Policies

The time is right for the government to plan for Oral Health Insurance that can be included under 'State Government's Insurance Policy'. A health insurance program for children and industrial oral healthcare policies will be successful as Indian culture is more oriented towards the families and economic conditions. It would satisfy the people's demands and would be financially supportive.

Improvement in School Dental Programs

In a school setup, plan for “School Oral health Programs” is indispensable. Schools are the right place where we can emphasize for the future oral disease free society. Distribution of free fluoridated toothpastes and brushes twice or thrice a year in Government schools would be ideal.



Role of Information Technology

Information technology, mobile applications and software are the backbone of future oral healthcare delivery system in India. They can play a major role to establish patient centred care and to analyse the status, control and performance of health teams. Mobile applications in field surveys are expected to be the norm in the future.

Tele – Communication

The Indian Association of Public Health Dentistry can start with an oral health helpline services through a Toll-free number. Connectivity will lead to an integrated, co-ordinated, uninterrupted care to the needy people that will help to overcome deep-seated cultural obstacles.

Appointment of New Professionals

Measures need to be taken to appoint Professionals Complementary to Dentistry (PCD) in the new developing oral health systems. PCDs who receive proper training could diagnose and screen the most prevalent oral diseases similar to dentist. PCDs bridge the gap by providing basic treatment needs and by carrying out oral health promotion activities in rural areas.

To conclude, I firmly believe that there are ample opportunities to integrate oral health care with general health care to provide an effective and accessible oral healthcare delivery system that caters to the common man. We may fall or fail at some barriers but we will rise and move forward towards a goal of a functional and potent oral health care delivery system.

Bibliography

  1. Singh S, Shah V, Dagrus K et al. Oral Health Inequality and Barriers to Oral Healthcare in India. European Journal of Dental Therapy and Research. 2015;4:242-245.
  2. Idaho Department of Health and Welfare. Idaho Oral Health Action Plan 2015 – 2020. A Collaborative Approach to Oral Health in Idaho [internet].2015; [cited 2015 Oct 2]. Available from http://www.healthandwelfare.idaho.gov/Portals/0/Health/OralHealth/IOHA%20Strat%20Plan%20-%20FINAL-AUG%202015.pdf.
  3. Ganavadiya R, Chandrashekar B, Goel P et al. Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: A proposed model. Annals of Medical and Health Sciences and Research. 2014;4:293-304.
  4. Jain A, Bhaskar DJ, Agali C et al. Barriers to Oral Health Care Delivery System in India. Heal Talk. 2013;5:35-36.
  5. Glick M, Monteiro da Silva M, Seeberger GK, et al. FDI vision 2020: shaping the future of oral health. International Dental Journal 2012;62:278-91.



  National Level Essay Competition-2016 (UG Category)-3rd Prize Top


Future Perspective of Oral Health Care Delivery System in India

Mr. Suyash Lokras - M G M Dental College, Navi Mumbai

The future of oral health care depends on the question that “With increasing number of dental graduates every year are we getting more productive or the whole system is becoming cumbersome and difficult to manage”. Federation Dentaire Internationale had envisioned 5 chief elements for the year 2020 which included to expand the role of health professionals, improve the education, increase research and use technology and in India the twelfth five year plan of India which aims to achieve GDP of 8.2% thus by abiding to these elements and maintaining a steady growthboth can help to shape the future of oral health system both directly and indirectly.

As the heart of India lies in the rural area it is a challenge to give quality treatment to them due to various hurdles like income inequality,transportation issues, dentist availability which all leads to the 'inverse care law' given by Julian Tudor Hart (1971) stating - those who need medical care are least likely to receive it, conversely those with least need of health care tend to use health service more.It can be tackled somehow by a principle given by an Italian economist Vilfredo Pareto in 19th century which states 20% of the invested input is responsible for 80% of the results obtained.Thus if we apply the magical ratio of 80/20 and by finding and eliminating the 20% of causative factors (tobacco, poor oral hygiene habits, fluorosis) which are responsible for 80% of disease (gingivitis, periodontitis, discoloration, oral cancer) we can make a huge change even after scarcity of resources.

As we can't clap with one hand, same is the situation here thus DCI and IDA need the help of NGO's and big market driven companies like Colgate and Pepsodent to reach out till the roots of the country. There are various NGO's like 'smile train India and smile India' which are working unconditionally to help treat children with developmental defects of the face mostly Cleft lip and Cleft palate. In the future with the technological advancements and increasing connectivity more NGO's focusing on oral health of the people in the country will be mushrooming all over the country as it will be easier to teach health professionals from long distance by means of long distance (teledentistry), and visual aids.

The initiative taken by the government to make villages more accessible to electricity and water will help to accelerate the delivery system, the Indian Railways are one of the vast rail networks in the world and can be used to deliver oral healthcare needs to places which are inaccessible by road by adding a railway 'mobile dental coach'.

As Mark twain said ≴Nothing so needs reforming as other peoples habits≵, So is the case here with good oral habits being a preventive measure and if inculcated from childhood it will be less difficult to stop or revert back and should be ceased by promotion which in by adding a dental census. The most notorious of all is tobacco, according to the GATS(global adult tobacco survey) done by ministry of health and family welfare under the National Rural Health Mission done in year 2009-10 more than one-third (35%) of adults in India use tobacco in some form or the other and nearly two in five smokers (38%) and users of smokeless tobacco (35%) made an attempt to quit respective tobacco use in the past 12. month period.The promotion of cessation of tobacco products should be dynamic and ever changing as people get used to warnings and become immune, advertisement and warnings should show case different harmful effects from time to time and not just stick to one and must be present everywhere but none the less a simple ban could help in removing tobacco from the roots which due to increased awareness might happen in future.

Good oral hygiene habits which can be thought to children by using help of cartoon channels and chocolate commercials with which they can easily relate themselves with or by giving them incentives of a toy with a toothbrush or toothpaste.

Health centers are the foundation of the oral health delivery system and at primary levels play a vital role in promoting good oral health in the surrounding areas and maintaining political relations with the panchayat thus increasing the connectivity,with the major concern being the rural areas a mobile dental van should be mandatory in every health centre which would help to access even more remote places from the main village and giving them treatment by the dental auxiliaries and due to increase in unemployment the nearby village dentists should be contacted by the village head as they are more capable of communicating with the villagers than the outsiders. With the tie up of Dental companies low cost and affordable toothpaste and toothbrushes should be provided so as to replace the primitive brushing techniques of using babool and neem twigs and should be given a door to door service, all this is possible in the digital age we all are living in.

The health centers can be funded by Grameen banks or small self help groups which provide basic amenities to the rural people with seeds and fertilizers. Cooperative banks can also be approached like the farmers cooperatives, weavers cooperatives, industrial workers cooperatives, thus opening doors to dental insurance.

The day is not far when a dentist is also practicing general medicine, yes with the advent of bridge course a dentist which was just limited to the diagnosis of various systemic diseases showing oral manifestations and referring to a medical doctor will now be able to treat and save more lives and thus the public health centers can also start providing full medical care and medicines in the rural areas.

Thus concluding, and answering the question in the beginning with the potential dental manpower and the increase in connectivity, technology, promotion, and awareness among the people of India the delivery of the oral health to each and every person of the country is possible and thus lies a good future.


  National Level Essay Competition-2016 (PG Category) Top


Oral Cancer Free India-Vision 2025

Dr. Shubhi Goel, JSS Dental College, Mysore

Oral cancer and its impact: Oral cancer is the only disease perceived to be having life and death implications among all diseases, a dentist will come across in his practice barring fatal injuries. Incidence of Oral cancer is highest in India and our country contributes to one fourth of deaths that occur worldwide from the disease. We have witnessed a dramatic surge in number of deaths attributed to oral cancer over last two decades. Around 84000 deaths were reported in 1990 which increased to 1, 35000 in 2013. Almost 2,500 people die/day due to tobacco related habits of which oral cancer is the most common. Commenting on economic front, government spends approximately Rs 300 billion annually in both public and private expenditure for treatment of tobacco-related diseases which is approximately one fourth of all health spending for the nation.

Alarming challenge: Oral cancer constitutes 11.28% of all cancers in India. The tobacco use and oral cancer is estimated to account for 13% of all deaths in India by 2025. The emerging trend suggests escalating incidence among younger adults who have traditionally been at lower risk for the disease. In terms of tobacco users, India ranks second only to China. 250 million tobacco/betel quid users of India account for about 19% of the world's total 1.3 billion users. Tobacco use in school children varies from 2.7% in Himachal Pradesh to 63% in Nagaland. Nicotine contents of Indian brand tobacco products are higher than international brands. According to health ministry data, among 300 cancer centers in India, 40% are not adequately equipped with advanced cancer care equipment. 600 additional cancer care centers are required by 2020 to meet requirements.

An Overview on Existing Strategies for Cancer/Tobacco Control in India and Their Swot Analysis

The major strength of existing strategy is political will and national commitment to control tobacco. This is evident in the enactment of various legislations and comprehensive tobacco control measures to combat harmful and hazardous effects of tobacco by Government of India. The milestone legislations include Cigarettes Act (Regulation of Production, Supply and Distribution) in 1975 making it mandatory to insert statutory warning “cigarette smoking is injurious to health” on all cigarette packages, cartons and advertisements of cigarettes. It became mandatory to insert statutory warnings highlighting harmful health effects of paan masala and chewing tobacco under the Prevention of Food Adulteration Act (PFA) (Amendment) 1990. The Drugs and Cosmetics Act 1940 (Amendment) in 1992, banned use of tobacco in all dental products. Tobacco advertisement in state regulated electronic media and publications including cable television were prohibited under Cable Television Networks (Amendment) Act 2000. Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA), in 2003 makes provision to ban smoking in public places, prohibits advertisements of tobacco products, prohibits sale of tobacco products to and by minors (persons below 18 years), bans sale of tobacco products within 100 yards of all educational institutions and mandatory display of pictorial health warnings on tobacco products packages. The act also makes it mandatory to test levels of tar and nicotine content in all tobacco products. The ratification of WHO Framework Convention on Tobacco Control (WHO FCTC) by Government in 2004 that enlists key strategies for reducing demand and supply of tobacco followed by piloting of National Tobacco Control Programme (NTCP) in 2007-2008 to strengthen implementation of tobacco control provisions under COTPA and policies of tobacco control mandated under WHO FCTC reinforces the political pledge.

The lack of heavy taxation on smokeless tobacco products which makes it affordable even to school children, violations of various provisions of WHO FCTC such as surrogate advertisements of tobacco products, brand stretching and brand extension by tobacco industry, lack of effective enforcement of Cable Television Networks (Amendment) Act 2009 resulting in spurt of surrogate advertisements of paan masala in mass media are some recognized weaknesses.

The raising literacy status, mainstreaming tobacco control by integrating it into ongoing national health programs and National Rural Health Mission along with community level initiatives such as tobacco free villages and educational institutions are a few recognized opportunities to effectively implement tobacco control in the country.

Lack of affordability to care, inadequate health personnel to tackle the ever increasing disease burden, continuous tweaking of tobacco legislations by chewing tobacco industry by selling gutkha and tobacco in separate packs, lack of initiative by state governments to train enforcement officials from various departments e.g. police, food, drug, health, labor, transport, railways etc. who are authorized to enforce provisions under COTPA, resulting in failure to initiate action for violations and implementation of the law, along with many socio-cultural barriers resulting in an alarming increase in prevalence of tobacco users are regarded major threats in the existing strategies.

Key Recommendations For Strategic Control Of Tobacco Products And Oral Cancer

Taxation: Although, Indian government has raised excise duty on many tobacco products, its strict implementation is the need of hour.

Raising Awareness: The mass media, school systems, and various other social media should come together to effect behavioral change by creating awareness among younger generation which is falling prey to tobacco addiction in recent times.

Early Identification and prompt follow up: The screening programs and training of health workers at all levels to identify tobacco addicts and oral cancer cases on incentive basis can significantly improve early detection and intervention. The identified cases have to be promptly treated and followed up at designated centers.

Mainstreaming tobacco control in medical and dental education: Medical and dental graduates should be equipped with skills for tobacco control.

Intersectoral coordination: A balanced implementation of demand and supply by synergizing government policies with tobacco control initiatives by civil society and community are crucial in reducing the menace of tobacco and oral cancer in India.

Conclusion: Committed and coordinated efforts by government, private agencies, local civil societies combining regulatory, services and health education approaches can strengthen our efforts to achieve Oral cancer free India by 2025.


  CDE Programme Top


Center:Sardar Patel Postgraduate Institute of Medical and Dental Sciences, Lucknow



A CDE programme was organised by the Department of Public Health Dentistry, Sardar Patel Postgraduate Institute of Medical and Dental Sciences, Lucknow, supported by the IAPHD UP chapter on the topic, “ Tobacco Cessation- an Update” on 27th August 2016. The CDE programme was an unprecedented event which brought together 311 professionals from across Uttar Pradesh.

Dr. Bidyut Kanti Sarkar, a senior research scientist, Public Health Foundation of India was the keynote speaker who focussed on the various health effects of tobacco, mechanism of nicotine dependence, global treaty and strategy for tobacco control, WHO MPOWER package on tobacco control and the unique challenges and accomplishments of tobacco control in India. The second session focussed in detail the various evidence-based clinical and public health approaches of tobacco cessation and providing practical tips for tobacco cessation.

Co-ordinator: Dr. Basavaraj.P, Secretry IAPHD UP Chapter


  World Heart Day Celebration Top


Center: National Dental College and Hospital, Derabassi




  Hearty Congratulations Top


Dentistry 2016 Golden Tooth Award winner



Dr. Shiva Kumar M, Professor and Head, Department of Public Health Dentistry, Vivekanandha Dental College for Women, Elaiyampalayam, Tamil Nadu received Life Time Achievement Award 2016 for his services for oral health on 3rd September 2016 at Dentistry 2016, at International Dental Exhibition and Meeting organised by Indian Dentist at NIMHANS Convention Centre, Bangalore.




 

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