|Year : 2014 | Volume
| Issue : 2 | Page : 124-128
Assessment of self-perceived and normative dental needs among teaching faculty of Visveswarapura Group of Institutions: A cross-sectional study
Verma Shikha, R Rekha, G Radha, SK Pallavi
Department of Public Health Dentistry, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||6-Sep-2014|
Department of Public Health Dentistry, V. S. Dental College and Hospital, K. R. Road, V. V Puram, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: The purpose of this cross-sectional study was to assess and compare self-perceived and normative dental needs among teaching faculty of Visveswarapura Group of Institutions, Bangalore, India. Materials and Methods: The study population included 217 teaching faculty from four Visveswarapura Group of Institutions namely Arts and Commerce, Law, Science College and Engineering College. The study population was subjected to a self-administered closed-ended questionnaire inquiring about their socioeconomic status, Oral health status and treatment needs. Clinical examinations, employing WHO dentition status and community periodontal index were performed to determine normative status and needs. Perceived and normative assessments were compared for sensitivity, specificity, positive and negative predictive values using Kappa statistics. Results: The degree of agreement (κ values) and sensitivity was seen in filled teeth (0.839, 80%), missing teeth (0.696, 85.2%), and mobile teeth (0.57, 55.6%). However, the disagreement was seen with all other questions with average κ = 0.20. Regarding overall proportions, a large discrepancy was found between self-perceived and normative needs for both dental and periodontal health status. Conclusion: Self-assessment questionnaires were of low value in evaluating oral health status and treatment needs compared with clinical examination.
Keywords: Normative needs, oral health, self-perceived needs, teaching faculty
|How to cite this article:|
Shikha V, Rekha R, Radha G, Pallavi S K. Assessment of self-perceived and normative dental needs among teaching faculty of Visveswarapura Group of Institutions: A cross-sectional study. J Indian Assoc Public Health Dent 2014;12:124-8
| Introduction|| |
In recent years, much attention has been focused on measuring the severity, and prevalence of dental caries and periodontal diseases as these are the two foremost oral pathologies and affect all populations throughout the life span.  In determining the health, various forms of assessment are possible, the data may be obtained from a clinical study, screening with or without an interview study or a self-administered questionnaire and a combination of methods. Information of treatment needs can be used to evaluate outcomes of care by measuring the reduction of the need, to prioritize services according to the impact of the need, and to plan services to best meet need. 
Most commonly used type of need assessment in oral health care planning and evaluation is "normative/professionally defined need" because it seems to be relevant to the disease-oriented or biomedical model, which is believed to identify diseases without depending on the subjective perception of the patient. However, clinical examinations are time-consuming, require special clinical facilities, expensive, invasive, require calibrated examiners, and are a resource demanding.
As research funds are limited, the use of "interviews and questionnaires/self-perceived assessment" has become more common method for collecting diagnostic data and performing oral health surveys. ,,, Perceptions of need for dental care play a key role as to whether people in general will seek dental care and that lack of need perceptions constitutes an important barrier for utilization of heath care services.
Gilbert et al. have reported that need perceptions correlate, however, weakly with professionally determined need assessments based on clinical examination suggesting that people place importance on oral symptoms and functional impacts from oral diseases when evaluating their need for dental care services. , According to Astrψm and Kida relying on normative methods such as clinical diagnosis alone, without integrating the psychosocial dimensions of dental health, seriously overestimates the need for dental care. Thus, a normative measure of dental care need estimated by converting clinical measures alone would probably yield a result that is too high to be met. ,
In the majority of studies, change has been assessed by means of clinical indicators of disease, but little attention has yet been paid to change in self-perceptions regarding dental health status. Hence, the present study was undertaken with the aim to assess self-perceived and normative dental needs among teaching faculty of Visveswarapura Group of Institutions.
| Materials and Methods|| |
A cross-sectional study was conducted among teaching faculty of Visveswarapura Group of Institutions namely Visveswarapuram College of Science, Visveswarapuram College of Law, Visveswarapuram College of Arts and Commerce, and Bangalore Institute of Technology. Sample size was estimated using the data from the previous studies where sensitivity of oral health status for self-perceived versus clinically diagnosed was found to be 28%.  Thus, in the present study taking absolute precision as 6% and confidence interval as 95%, the final sample of 217 was obtained. The study was conducted from April 2013 to June 2013 till the desired sample size was achieved.
Ethical approval was obtained from Institutional Ethical Committee. Prior permission was obtained from principals of the selected four colleges for conducting this study. The purpose of the study was explained to all participants, and participation was voluntary. Informed consent was obtained from the participants, and they were informed that the study would consist of them answering a questionnaire and then having a dental examination.
Self-perceived needs assessment
Each participant was asked to answer a closed-ended, pretested self-administered questionnaire  consisting of 12 questions on a three-point Likert scale (yes/no/don't know). The questionnaire distributed was in English language.
For assessing socioeconomic status, the necessary information regarding education, occupation, family income, and the number of family members were obtained and divided accordingly from class I to class V, using Modified Family Income Group of the Kuppuswamy's socioeconomic status scale. It was calculated using the formula:
Current income group = Original family income groups of Kuppuswamy (1976) × current consumer price index (CPI) × 0.0735 (multiplication factor); where CPI = 226 (April 2013).
Normative needs assessment
The type III clinical examination was then carried out in the college premises with good day light illumination by a single trained examiner. The examiner was blinded to the questionnaire filled by the teaching faculty. The normative needs were assessed using a part of WHO oral health assessment Form that is, for recording dental caries, dentition status and treatment needs were used; for measuring periodontal status, community periodontal index and loss of attachment were used. Prosthetic status and prosthetic needs were also assessed during the examination. Mobility was elicited with the help of a blunt end of 2-mouth mirrors and was recorded under the following codes: Code 1: No mobility present, Code 2: Mobility elicited.
The data were entered into the computer database and analysed using the Statistical Package, SPSS version 20 software package, Bangalore , India. The normative needs assessed through clinical examination and self-perceived needs via questionnaire were compared for sensitivity, specificity, positive predictive value (PPV), and negative predictive value. In all above test, P < 0.05 was accepted as indicating statistical significance with confidence intervals 95%.
| Results|| |
Out of the total 217 study subjects, 121 (55.8%) were males, and 96 (44.2%) were females with a mean age of 46 years. 14 (6.5%) participants belonged to 15-30 years age group, 146 (67.3%) participants were between 31 and 45 years and 57 (26.3%) participants were between 46 and 60 years of age. The response rate was found to be 100%. Based on Kuppuswamy's socioeconomic status, 211 study subjects belonged to upper middle class II and only 6 belonged to upper class I.
Self-perceived need status
Among 217 subjects, 169 (77.4%) people perceived the need for regular dental visit. 29% reported having decayed teeth, 26.9% reported filled teeth, and 29.5% reported that they got teeth extracted from a Dentist. The problem of bleeding gums and swollen gums was perceived by 19.8% and 5.5% subjects respectively. 5.1% reported having teeth mobility and 6.9% perceived to have gingival recession. 14.3% people reported that they were wearing prosthesis (removable/fixed) [Table 1].
Overall 145 (66.8%) people felt the need of some form of dental treatment. Among these, 79.3% of the total subjects felt the need of restorations, 30% felt the need for getting extractions and 7.4% felt the need of getting artificial teeth [Table 1]. Both females and males had almost equal perceived needs (P = 0.361).
Normative need status
On clinical examination, it was found that mean dynamical mean field theory for males was 5 and for females was 4 but the difference between both sex was not statistically significant (P = 0.205). Restorations were required by 70.5% and extractions by 33.6% subjects. Pulpal treatment was required by 20 (9.2%) subjects, treatments like Orthodontic treatment/Periodontal surgeries were required by 5% of the total subjects [Figure 1]. 84.9% had CPI score of 0-2 and 33% had CPI scores of 3-4. Loss of attachment score 0 was found in 88% of the subjects, score1 in 7.8% and score 2 in only 3.68% of the subjects.
|Figure 1: Gender wise distribution of normative treatment needs for the subjects|
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Self-perceived and normative needs status
On clinical examination, 81.5% had dental caries, but only 29% reported them. Thus, for dental caries the specificity was low, and agreement was poor between normative and perceived needs (κ = 0.105). Good agreement (κ = 0.696) was seen regarding presence or absence of missing teeth. On clinical examination, prosthesis was seen in 17.9% subjects and 14.3% subjects perceived the presence of the prosthesis [Table 2] and [Figure 2].
|Table 2: Agreement of normative and perceived need for dentition and prosthetic status measures |
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|Figure 2: Comparison of normative and self-perceived need assessment for dentition and prosthetic status measures|
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The perceived need for gingival inflammation and gingival bleeding was 5.5% and 19.8% respectively however, on clinical examination it was found to be15.2% and 8.3%, respectively. Poor agreement was found for periodontal status except for teeth mobility, in which agreement was found to be moderate (K = 0.571) [Table 3]. Calculus was found in 72.3% subjects on clinical examination, but it was perceived only by 32.3% subjects. On clinical examination overall treatment needs were found to be 86.9%, but only 66.8% perceived the need of treatment [Table 4].
|Table 3: Agreement of normative and perceived need for periodontal status measures |
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Only 6.5% of the subjects perceived that their food intake was reduced due to oral pathology, whereas in reality food intake was altered in 46% of the subjects due to the problem in teeth. Thus, the percentages of self-assessed and clinically diagnosed oral health status showed marked discrepancy between the two values showing that self-perceived needs were a poor indicator of the oral health status.
| Discussion|| |
The present cross-sectional study was conducted to assess and compare normative and self-perceived dental needs among teaching faculty. Out of the total 217 subjects, more number of males (55.8%) participated in the study, which is in accordance to studies done by Balappanavar et al.  and Bernabe et al. Based on Kuppuswamy's socioeconomic status, 211 study subjects belonged to upper middle class II and only 6 belonged to upper class I so the comparison was not possible. In contrast, a study done by Balappanavar et al.  showed that upper middle class had higher perceived needs when compared to other classes.
In the present study, perceived oral health status was found to be of high specificity exception being dental caries for which sensitivity was high, but specificity was low. This finding is in contrast to a study done by Robinson et al.  Additionally, good agreement was found for filled and missing teeth, gingival bleeding and mobility [Table 3]. All these findings are in accordance with the studies done by Palmqvist et al.  and Balappanavar et al.  These authors found low sensitivity and high specificity values among treatment needs as compared to the disease condition. This may be due to the fact that people are unaware of the disease until diagnosed or treated, though they are aware of the presence of treatment.
In the present study, prosthesis was seen in 17.9% subjects on clinical examination, but subjects perceived it as 14.3%. In contrast, a study done by Balappanavar et al.  showed that PPV was 100% that is, among 100% of subjects who perceived having prosthesis were all confirmed by clinical examination.
Most of the patients were unaware of the presence of bleeding gums, that is, a marked disparity between self-assessed and clinically diagnosed bleeding gums was seen. This finding is in agreement with the studies by Nagarajan and Pushpanjali,  Tervonen and Knuuttila  and Kallio et al.  However contrasting results were found by Gilbert et al. and Buhlin et al., which showed that self-reported bleeding gums had a good validity. , The present study is also in agreement with the study by Gilbert and Nuttall,  which showed a low sensitivity for self-assessed swelling of gums.
Self-assessment of recession showed low sensitivity that is in agreement with studies by Nagarajan and Pushpanjali  and Pitiphat et al.  Self-assessment of loose teeth showed good sensitivity that is in agreement to the study of Nagarajan and Pushpanjali,  Gilbert Nuttall,  Glavind and Attström,  which means patients were able to perceive periodontitis as the severity increased and irreversible changes set in. Significant differences were not reported between normative and self-perceived needs among the two sex (P > 0.05) for any of the above parameters recorded.
As majority of people in the present study belonged to high socioeconomic strata, the results cannot be generalized to the whole population and further research is required in this field.
| Conclusion|| |
The comparison performed in the present study suggests that the perception of health is at a higher level whereas perception of disease is much lower. Overall, the results of the study showed marked disparity between the self-assessed and clinically diagnosed oral health status stressing on the urgent need for patient education and motivation for the maintenance of oral health. Additional research is required to assess how these and other cultural factors might affect oral health status and treatment needs.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]