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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 1  |  Page : 31-35

Care sought and normative need assessment for dental caries among rural adults in jeelugumelli mandal, Andhra Pradesh, India


1 Department of Public Health Dentistry, St. Joseph Dental College, Duggirala, Andhra Pradesh, India
2 Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
3 Department of Public Health Dentistry, Dr. Syamala Reddy Dental College, Bengaluru, Karnataka, India

Date of Submission29-May-2019
Date of Decision06-Jun-2019
Date of Acceptance11-Jan-2022
Date of Web Publication25-Feb-2022

Correspondence Address:
Chinna Babu Palli
Department of Public Health Dentistry, St. Joseph Dental College, Duggirala, Eluru, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_60_19

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  Abstract 


Introduction: Different rates of dental caries prevalence are experienced among different populations due to the influence of various demographic, political, and socioeconomic factors. Aim: To assess the prevalence of dental caries, the type of self-care remedies utilized, and normative needs assessment among rural adults residing in Jeelugumelli Mandal, West Godavari District, Andhra Pradesh, India. Materials and Methods: A cross-sectional survey was conducted among 800 adults by using a multi-stage random sampling technique in Jeelugumelli Mandal, West Godavari District, India. Data were collected using a pretested pro forma consisting of questionnaire-related demographics, traditional care, and clinical examination which was investigated by a single examiner to record caries experience (Decayed, Missing, and Filled Teeth [DMFT]) using WHO 1997 criteria. The data were analyzed using IBM SPSS Statistics, Version 20.0. Mann-Whitney U-test, Kruskal-Wallis, and Multivariate Linear Regression analysis tests were used and the level of significance was set at P ≤ 0.05. Results: Mean DMFT value of the study population was 10.29 ± 4.806 and 33.4% of the subjects had used home remedies related to plant origin. The majority of the study population required surgical need (Extractions) with a mean value of 4.23 ± 5.553 and compared with unskilled workers, unemployed workers had 2.8 units higher chances of having caries (R = 2.810 confidence interval [CI] 1.876–3.744) while it was 5.031 units lesser for professionals in having caries (R = −5.031 CI [−4.16] – [−5.901]). Conclusion: Dental caries prevalence and normative needs for dental caries were high in the adult population residing in Jeelugumelli Mandal and most of the individuals are depending on self-care procedures to relieve pain.

Keywords: Dental caries, medicine, needs assessment, rural health, traditional


How to cite this article:
Palli CB, Pachava S, Shaik PS, Ravoori S, Yaddanapalli SC, Lodagala A. Care sought and normative need assessment for dental caries among rural adults in jeelugumelli mandal, Andhra Pradesh, India. J Indian Assoc Public Health Dent 2022;20:31-5

How to cite this URL:
Palli CB, Pachava S, Shaik PS, Ravoori S, Yaddanapalli SC, Lodagala A. Care sought and normative need assessment for dental caries among rural adults in jeelugumelli mandal, Andhra Pradesh, India. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 Jul 7];20:31-5. Available from: https://www.jiaphd.org/text.asp?2022/20/1/31/338522




  Introduction Top


Different factors can influence dental caries prevalence including demographic, political, and socioeconomic factors.[1],[2],[3],[4] The common beliefs, customs, and practices related to health and disease, in turn, influence the health-seeking behavior of inaccessible rural communities. Despite remarkable worldwide progress in the field of diagnostics, curative, and preventive health, the rural people still live in isolation, in natural and unpolluted surroundings far away from civilization with their traditional values, customs, beliefs, and myth intact.[5]

Research suggests that higher rates of oral diseases occur in rural areas where a lower number of dentists are available which remains a major barrier to oral health-care access for rural village residents.[6] Facing numerous barriers to oral health care, low-income rural residents often are forced to choose alternative strategies, forgo treatment, and/or use self-care remedies for the relief of dental pain.[7] Self-care is the component of health self-management that includes behaviors undertaken to enhance health, prevent disease, limit illness or restore health, which is derived from the individual's knowledge and skills.[8] Given the large number of rural people who may seek pain relief by means other than visiting a dentist, it is important to understand the “alternative” treatment methods or self-care they utilize for pain relief.[9]

With this background, the present study was aimed to asses the prevalence of dental caries, type of self-care remedies utilized and normative needs among rural adult people residing in Jeelugumelli Mandal, West Godavari District, Andhra Pradesh, India. This study location is the border area between Andhra Pradesh and Telanga states of India.


  Materials and Methods Top


A population-based cross-sectional survey was conducted among people residing in a rural locality of a state in south India. Jeelugumelli, a rural Mandal (administrative division), was selected for analysis in the present study. It is one of the 46 manuals of the West Godavari district in the south Indian state of Andhra Pradesh and The demography of the selected mandal represents the typical rural population of southern India. A total of 800 subjects were selected by using multi-stage random sampling technique and the adult rural population of Jeelugumelli Mandal was divided into three age groups, i.e., (a) 18–27 years (b) 35–44 years (c) 65–74 years to document the age-group-wise variation in the profile of dental caries. Through multi-stage random sampling technique, 8 villages from the Jeelugumelli mandal were included in the present study. From the selected villages every alternate house was considered randomly and all the individuals present at the time of examination, falling in the specified age groups were included. The area for conducting examinations was planned and arranged for maximum efficiency and ease of operation. The subjects were allowed to sit on a chair or stool as per availability, where, sufficient natural daylight was available while avoiding discomfort from direct sunlight on either the subject or the examiner. A table to place instruments and supplies was placed within easy reach of the examiner. The recording clerk was allowed to sit close enough to the examiner so that instructions and codes could be easily heard and the examiner could see that findings were being recorded correctly.

Individuals who were non co-operative, mentally challenged, edentulous were excluded. The present study was conducted during 2017 for 4 months (June-September) and data collection was done using a specially designed pretested proforma consisting of two parts. The first part included information on demographic data and questions related to the utilization of traditional remedies. The second part included clinical examination by a single examiner who was trained and calibrated by a standard examiner to record caries experience (Decayed, Missing and Filled Teeth [DMFT]) using WHO 1997 criteria. Before the field study, the questionnaire validity was accomplished through the revision of the questionnaire by two senior experts in Public Health Dentistry and the revised questionnaire was subjected to a pilot study on 20 individuals for evaluating the psychometric properties. The intra-examiner reliability was measured by repeated examinations performed on rural adults to assess the intra-examiner agreement of caries experience, using Cohen's Kappa statistics. The intra-examiner reliability in recording the caries experience was 0.8 and 0.9, respectively.

Sample size estimation

The sample size was estimated based on the prevalence of dental caries determined through the National Oral Health Survey and Fluoride Mapping, India, 2003.[10] In that survey, the prevalence of dental caries above 18 years was 70%. As dental caries is the most prevalent disease, the least percentage of caries prevalence (50%) was taken to get the maximum sample size. Based on the prevalence the sample size was calculated using the formula

Sample size (n) = (Zα + Zβ) 2/d2

Ethical clearance and consent

Ethical clearance was obtained from the ethical committee of the SIBAR institute of dental sciences. The study protocol was later approved by the Dr. NTR University of Health Sciences (Pr. 37/IEC-SIBAR/CIR/15), Vijayawada, Andhra Pradesh, India, and voluntary written informed consent was obtained from all the individuals participating in the study before examination after discussing in detail about the purpose of the study.

Statistical procedures

The collected data were analyzed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA: IBM Corp.[11] Descriptive and inferential statistics were used to summarize the results and tests such as the Mann-Whitney U-test, Kruskal-Wallis, and Multivariate Linear Regression were used. The level of significance was set at P ≤ 0.05.


  Results Top


The mean DMFT value of the study population was 10.29 ± 4.806 and was highest among 64–75 years age group (12.79 ± 4.265) followed by 35–44 years (10.20 ± 4.284) and 18–27 years age group (6.40 ± 3.483) which is statistically significant (P ≤ 0.001). Mean DMFT values were higher among unemployed (17.25 ± 4.494), unskilled workers (11.40 ± 3.896) compared to skilled (4.54 ± 0.503), clerical/shop owner (8 ± 0.001), and professionals (5.02 ± 4.075) which is statistically significant (P ≤ 0.001) [Table 1].
Table 1: Mean Decayed, Missing and Filled Teeth scores of the study subjects according to demographic variables

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The majority of the study population required surgical need (Extractions) with a mean value of 4.23 ± 5.553 followed by prosthetic need (4.12 ± 1.337), pulp care and restorations (2.66 ± 3.349), one surface filling (2.18 ± 2.145), two surface fillings (1.29 ± 1.595). Mean surgical need (10.07 ± 4.067), and prosthetic need (9.80 ± 4.320) were higher for the 64–75 years age group [Table 2]. 33.4% of the subjects had been using home remedies related to plant origin for the treatment of dental caries and it was higher among 64–75 years age group (56%) [Graph 1]. Lack of financial support (50.8%) and decreased accessibility to the dentist (14.6%) were the two main reasons for not consulting dentists for the treatment of dental caries [Graph 2].
Table 2: Age-wise distribution of study subjects based on normative need (treatment required)

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Compared with unskilled workers unemployed workers had 2.8 units higher chances of having caries (R = 2.810 confidence interval [CI] 1.876–3.744) while it was 5.031 units lesser for professionals in having caries (R = −5.031 CI [−4.16] – [−5.901]). Compared to the 64–75 years age group, the 18–27 years age group had 7.196 units lesser chances of having caries (R = −7.196 CI [−7.780] – (−6.612]), while it was 4.164 units lesser for 35–44 years age group. Compared to the lower middle class, the upper-middle class had 11 units lesser chances of having caries (R = −11.102, CI [−12.097] – [−10.17]) while it was 5.192 units lesser for the upper-middle class [Table 3].
Table 3: Multivariate linear regression analysis between various demographic variables and decayed, missing and filled teeth scores

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  Discussion Top


Despite its known multifactorial etiology and prevention possibility, dental caries still represents the most widespread disease in the world, affecting various populations at different age groups.[12],[13] The current study was executed among rural areas of Jeelugumelli Mandal where there are various influential factors responsible for the higher prevalence of dental caries. As a result, these subjects are forced to use nontraditional providers to forgo treatment or use alternative strategies or self-remedies for the relief of dental pain.

In the present study, there was preponderance in male participation compared to females which was in accordance with Pashayev et al. The traditional patriarchal norms and limited education have relegated women to secondary status within the society could be the reason behind the less participation of females.[3],[14] Males had higher caries experience compared to females which was in contrast with the study done by Shaffer et al. Females are more concerned for esthetics and consume fewer amounts of refined sugars compared to males, which could be the reason for less caries in them in the present study.[15],[16],[17],[18]

There is an increase in mean DMFT values with an increase in the age which is in accordance with Kamberi et al. The decayed component was higher among 35–44 years age group, missing component was higher for 65–74 years, and filled component was comparatively higher for 18–27 years age group which are in accordance with Pashayev et al.[19] An increase in age directly increases the exposure to a cariogenic environment might be a reason for increased DMFT levels in the present study.[20]

Individuals suffering from dental caries do not always seek relief by visiting a dentist. For individuals who have low income who do not seek treatment from a dentist self-care plays a palliative role.[7] 79.6% of the study participants had utilized at least one type of self-care to overcome the painful experience.[21] 21.5% of Respondents more frequently reported using nonprescription medicines or over-the-counter medication for pain relief and this in-contrast with the findings of Locker D et al. where most of the participants received care from the dentist.[22] The frequent use of nonprescription medicines suggests that there is a need for a greater understanding of how rural people learn about the effectiveness and safety of nonprescription medications.

Home remedies of plant origin are used by the majority of respondents to get relief from oral pain. According to the respondents, the sap which is coming out from the barks of Jatropha Gossypifolia will relieve the teeth as well as gum pain. This finding is in agreement with a study done by S Ganesan.[23]

The plant's Jatropha curcas Linn (called “mepala” in telugu), Jatropha Gossypifolia Linn (called “chima mepala”) belonged to Euphorbiaceae family. The young stem, latex of these plants are used to get relief from teeth pain, fetid smell, mouth, and gum ulcers.[24] Along with these plants, Andrographis paniculata (green Chirayta in English language, Nelavemu in the Telugu language) is also being used by natives for relief of tooth pain which is naturally grown in Jeelugumelli environmental conditions.[21]

Regarding the normative needs of the population, the majority need extractions as a treatment option for dental caries followed by prosthetic need, pulp care, two surfaces, and one surface filling respectively. These findings are in disagreement with the study done by Maru et al., Duraiswamy et al., where there is a major need for one surface filling. The need for extractions and replacement of missing teeth are higher among the 65–74 years age group, while pulp care and restorations were higher among 35–44 years age group.[3],[25]

While the effect of sociodemographic factors on oral health and dental care-seeking behavior has been well characterized in developed countries, this is not the case in developing countries.[26] Compared to developed countries, the limited number of oral health care institutions and the less coverage of community oral health services combine to compromise access to oral health care services in India.[26] In addition, health insurance coverage is higher in urban areas compared to rural areas in India. Furthermore, medical insurance is not nationalized, and coverage is mainly provided by employers. As a result, many patients have to pay for oral health care themselves.[26] These prospects explained well the reasons for accumulated needs among elderly age groups compared to younger age groups.

Limitations

  1. The cross-sectional design of the study inherits a limitation; it does not allow the determination of a causal relationship between the variables investigated and the outcome
  2. Though a short time frame was used, recall bias was inevitable.



  Conclusion Top


The high prevalence of dental caries found in the adult population residing in Jeelugumelli mandal should be considered a relevant dental public health problem. Most of the individuals are depending on their self-care procedures to relieve pain and there is a high accumulation of normative needs in the current population.

Recommendations

  1. Additional research to explore the safety and effectiveness of plant Andrographis Paniculata which has an immense significance in treating medical conditions is recommended for its application in treating dental pain
  2. Dental doctors should be appointed in primary health centers along with medical staff to reduce the accessibility barrier in the utilization of dental services among rural residents
  3. Should work on mobile and portable dental services through a public–private partnership among inaccessible areas
  4. Additional advanced research like phytochemical analysis on self-care medicinal plants should be encouraged to rule out its safety and efficacy in treating dental diseases.


Acknowledgment

The authors wish to thank Sunil Kumar Bonu, Vishnu Kumar for their assistance in data collection and determining the analytic strategy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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