Final TPS Oral Health Team Presentation on July 21, 2011 in Chennai on the Concluding Day of the Trans Disciplinary Problem Solving Course: co-taught by Washington University in St. Louis and ICTPH.

1. Oral Health:
Addressing Dental Diseases in Rural India
Shawn Lin & Allison Mauk

2. Overview
Burden of Disease
Determinants
Intervention Strategies
Implementation
Evaluation Plan

3. Burden of Disease

4. Dental Caries
Most common non-communicable disease in the
world1
Slight increase in prevalence in Tamil Nadu
• 47.8% (1973)2 → 49.8% (2004)3
• Higher prevalence in rural areas3
• One survey in rural TN found a prevalence of
70.2% in 6 year-olds4

5. Prevalence of Periodontal Disease in Thanjavur
Region, 20033
100
Prevalence of Periodtonal Disease (%)
90
80
70
60
50
40
30
20
10
0
5 12 15 35-44 65-74
Age (years)

6. Burden
Personal: impact on Quality of Life
• Difficulty eating
5
• Severe dental disease acts as focus of infection for other organs
(kidneys, heart, brain)3
Population
• 1,247,000 DALYs in 1998 in India 6
Health System
• Lack of infrastructure → difficult to assess
• Inflammation a risk factor as well
7
• Significant risk factor for several systemic diseases
• The birth of pre-term low-birth weight babies, coronary artery
diseases, and diabetes mellitus7

7. Determinants

8. • Significant risk factor for
periodontal disease and
Substance caries8,9,10
Use • Tamil Nadu: 10% of adults
report using tobacco regularly3
• Expanding economy →
greater access and higher
Diet & preference of junk foods11
Nutrition • Change in dietary patterns
influences oral health

9. Fluoride • Tamil Nadu: 40% reported using fluoride
toothpaste or fluoridated tooth powder3
Exposure
• Dentist to Population Ratio12:
Access to • Urban 1:10,000
• Rural 1:250,000
Care • 72.2% of population lives in rural areas4
• In Tamil Nadu:
Knowledge • 57% report using a toothbrush3
& Behavior • 3.9% report brushing twice per day3

10. Intervention Strategies

11. • School-based oral health
Primary promotion program
• Establish comprehensive
Secondary oral health screening
• Increase access to oral
Tertiary health care

12. Implementation

13. Primary Prevention Strategy:
School-based oral health promotion program
Activities:
• Administer fluoride rinse in schools
• Screen oral health education video on school TVs

14. Secondary Prevention Strategy:
Establish comprehensive oral health screening
Activities:
• Train CHWs and RMHC staff in oral screening and education
• Develop & validate non-invasive oral health screening
instrument
• Integrate non-invasive oral screening instrument to PISP, RRA,
and Patient Visit Protocol
• Implement Oral Health Screening Protocol
• Perform oral health screening at schools
• Add oral health education to Patient Visit Protocol

16. Secondary Prevention Strategy:
Establish comprehensive oral health screening
Activities:
• Train CHWs and RMHC staff in oral screening and education
• Develop & validate non-invasive oral health screening
instrument
• Integrate non-invasive oral screening instrument to PISP, RRA,
and Patient Visit Protocol
• Implement Oral Health Screening Protocol
• Perform oral health screening at schools
• Add oral health education to Patient Visit Protocol

17. Tertiary Prevention Strategy:
Increase access to care
Activities:
• Install dental equipment in the RMHC
• Establish rotation of visiting dentists to staff bi-weekly dental
clinic in RMHC

18. Evaluation

19. Formative Evaluation
Validity of non-invasive oral health screening
instrument
Pretest: comprehension
Validity: sensitivity & specificity

20. Process Evaluation
Primary Prevention Objectives:
• Schoolchildren received 7 fluoride rinses per semester
• Schoolchildren viewed video twice per semester
Secondary Prevention Objectives:
• Majority of population screened for oral health
• Increased visits to RMHC for follow-up comprehensive
screening
Tertiary Prevention Objectives:
• Increased visits to RMHC for dental issues

21. Impact Evaluation
Objectives
• Reduction in the incidence of dental caries and periodontal
disease in schoolchildren
• Improved oral hygiene behavior and practices
• Increased oral hygiene knowledge
• Decreased prevalence of dental caries and periodontal disease

22. Goal
Reduction in the prevalence and
incidence of dental caries and
periodontal disease in Rural India

23. Acknowledgements
ICTPH Staff
Arun Jithendra
SughaVazhvu Staff
Fellow TPS Students

24. Contact Information
Shawn Lin Allison Mauk
BA, MSW/MPH Candidate BA, MPH Candidate
shawn.lin@wustl.edu mauk@wustl.edu
George Warren Brown School of Social Work
Washington University in St. Louis
One Brookings Drive
Saint Louis, MO 63130

25. Thank you

26. References
1Beaglehole, R., Benzian, H., Crail, J., & Mackay, J. (2009). The oral health atlas. FDI World Dental Federation. Retrieved from:
http://www.oralhealthatlas.org/uniflip/index.html
2Ramachandran, K., Rajan, B.P., & Shanmugam, S. (1973). Epidemiological studies of dental disorders in Tamil Nadu populations. Journal of the Indian Dental
Association, 45(4), 65-70.
3Bali, R.K., Aswath Narayanan, M.B., Mathur, V.B., Talwar, P.P., & Chanana, H.B. (2004). National oral health survey & fluoride mapping, 2002-2003, Tamil Nadu. Dental
Council of India.
4Saravanan, S., Kalyani, V., Vijayarani, M.P., Jayajodi, P., Felix, J.W.A., Arunmozhi, P., … Sampath Kumar, P. (2008). Caries prevalence and treatment needs of rural
school children in Chidambaram Taluk, Tamil Nadu, South India. Indian Journal of Dental Research, 19(3), 186-190.
5Shah, N. (2005). Oral and dental diseases: causes, prevention and treatment strategies. In NMCH Background Papers – Burden of Disease in India (p.275-298). New
Delhi, India. Retrieved from: http://www.whoindia.org/LinkFiles/Commision_on_Macroeconomic_and_Health_Bg_P2_Oral_and_dental_diseases.pdf
6Peters, D., Yazbeck, A., Ramana, G., Sharma, R., Pritchett, L., & Wagstaff, A. (2001). Raising the sights: Better health systems for India’s poor. Washington, DC: The
World Bank.
7Agarwal, V., Khatri, M., Singh, G., Gupta, G., Marya, C., & Kumar, V. (2010). Prevalence of periodontal diseases in India. Journal of Oral Health & Community Dentistry,
4, 7-16.
8Winn, D.M. (2001). Tobacco use and oral disease. Journal of Dental Education, 65(4), 306-312. Retrieved from: http://www.jdentaled.org
9Tomar, S.L., & Winn, D.M. (1999). Chewing tobacco and dental caries among U.S. men. The Journal of the American Dental Association, 130(11), 1601-1610.
Retrieved from: http://www.jada.ada.org
10Tomar, S.L., & Asma, S. (2000). Smoking-attributable periodontal disease in the United States: findings from the NHANES III. Journal of Periodontology, 71(5), 743-
751.
11Goldman, A.S., Yee, R., Holmgren, C.J., & Benzian, H. (2008). Global affordability of fluoride toothpaste. Globalization and Health, 4(7), 1-8.
doi: 10.1186/1744-8603-4-7
12Tandon, S. (2004). Challenges to the oral health workforce in India. Journal of Dental Education, 68(7 Supplement), 28-33.