Abstract
Introduction: There is a growing need for inter-professional education (IPE) to reduce the burden of oral diseases and address oral health disparities. Professional websites associated with inter-professional education can serve as a reliable source of information about oral health. Hence, the study was conducted to determine the prevalence of oral health content on non-dental health professional associations' websites in India.
Methods: Eighty-nine organizations were selected from five types of health professional associations. Six dental search terms were used on searchable websites. The keywords were dental, oral, dentistry, mouth, teeth, and fluoride. Websites were assessed for any oral health content.
Results: Only four websites (4.5%) had any oral health content, and all four were physician-related.
Conclusion: The study highlights the limited and inconsistent oral health content on non-dental professional association websites. Improving the availability, accuracy, and comprehensiveness of oral health information on these platforms is crucial to enhancing oral health literacy and promoting better oral health outcomes.
Keywords: allied health personnel, india, interprofessional education, oral health, physicians
Introduction
Oral health serves as a vital indicator of general health, well-being, and quality of life [1]. Molecular and immunology-based evidence establishes a connection between oral diseases and other systemic non-communicable diseases (NCDs) due to their shared major risk factors [2,3]. Meta-analytic estimates reveal a strong association between oral disorders and 28 NCDs, encompassing conditions such as obesity, asthma, inflammatory bowel disease, gastric Helicobacter pylori infection, cancer, diabetes mellitus, cardiovascular disease, neurodegenerative conditions, rheumatic diseases, and neurodegenerative problems [4]. Despite being preventable, oral diseases impose a significant health burden [1]. Integration of oral health into medical care has enhanced the quality of life, particularly for patients with chronic diseases [5].
According to the World Health Organisation's (WHO) Framework for Action on Inter-Professional Education and Collaborative Practice (2010), "Inter-professional education occurs when two or more professionals learn about, from, and with each other to enable effective collaboration and improve health outcomes" [6]. Inter-professional education (IPE) offers numerous benefits, including decreased patient costs, reduced length of stay, improved quality of patient care, and minimised medical errors [7].
Given the current global healthcare trends, there is an increasing need for inter-professional education and inter-professional practice to coordinate care for individuals with chronic medical conditions. As part of their accreditation criteria, many health professional education programmes have incorporated IPE, including oral health, into their curricula. This integration aims to foster the qualities and abilities necessary for effective collaborative practices [8].
The cumulative use of the internet has led people to rely on online sources for health information [9]. However, the quality and accuracy of the information found on websites are subject to debate, often resulting in misperceptions and incorrect information [9]. Non-dental health professionals, such as physicians, nurses, pharmacists, and other allied health professionals, play a crucial role as sources of health information for the public. However, their oral health knowledge may be limited, and they may not have received formal training in this area. Non-dental health professionals can significantly promote oral health and prevent oral diseases by providing accurate and reliable information to their patients.
The means by which non-dental healthcare practitioners acquire knowledge about oral health remains unclear [10]. A literature search revealed that continuing education opportunities regarding oral health for non-dental healthcare providers have proven challenging [11]. Professional websites associated with inter-professional education can serve as a reliable source of information about oral health.
In order to effectively improve the health and quality of life of each patient, healthcare systems require well-trained specialists who can collaborate inter-professionally [12]. Integrating oral care and expanding the roles of healthcare providers can help reduce the burden of oral diseases and address oral health disparities [13]. A desirable goal is to enhance the availability of accurate and user-friendly information about oral health through various channels and across professions. The websites of professional associations are more accessible and recognisable to their members compared to those of dentistry organisations.
A literature review demonstrates the presence of oral health content on non-dental professional association websites in developed countries like the USA [10]. However, literature regarding the availability of oral health content on non-dental professional association websites in India is lacking. Consequently, this study aims to evaluate the oral health-related information present on the websites of non-dental professional organisations in India.
Materials and methods
The list of organisations was initially identified by identifying the key terms relevant to non-dental professional organisation websites. The search was conducted by utilising the search engine "Google." The websites listed in the search results were reviewed, and their contents were explored to confirm their relevance to the study. A list of appropriate organisations was finalised based on the evaluation and cross-referencing with the official sources.
Data extraction
Data were extracted from the selected websites using a standardised data extraction form that includes the organisation's name, organisation website, presence of an oral health-related webpage, authored oral health article(s), and links to oral health resources on other sites.
Dental terms such as dental, oral, dentistry, mouth, teeth, and fluoride were used to search for oral health content. These lay terms were chosen to reflect general information on oral diseases rather than specific oral conditions.
The websites were searched between October 2022 and December 2022. Two investigators pilot-tested the data extraction tool and reviewed several websites together to standardise the data collection protocol. The collected data were entered into an Excel spreadsheet (Microsoft® Corp., Redmond, WA). In the statistical analysis, frequency distributions were created based on the types of professional disciplines, and the oral health content was presented descriptively.
Results
The study identified a broad range of non-dental professional organisations where oral health-related content could potentially be found. The majority of these were physician-related, covering a wide spectrum of medical specialities, from the Indian Medical Association to the Urological Society of India. Additionally, allied health-related organisations, nursing councils, pharmacy and public health organisations were included in the search. A list of non-dental healthcare professional websites searched for oral health content is presented in Table 1.
Table 1. List of non-dental health care professional websites searched for oral health content.
| S. no. | Type | Name of the association |
| 1 | Physician related | Indian Medical Association |
| 2 | Physician related | Homoeopathic Medical Association of India |
| 3 | Physician related | Unani Medical Association |
| 4 | Physician related | Ayurveda Medical Association of India |
| 5 | Physician related | Indian Psychiatric Society |
| 6 | Physician related | Indian Association of Clinical Psychologists |
| 7 | Physician related | Dermatopathology Society of India |
| 8 | Physician related | Indian Dietetic Association |
| 9 | Physician related | Nutrition Society of India |
| 10 | Physician related | Association of Plastic Surgeons of India |
| 11 | Physician related | All India Cosmetologists and Beauticians Association |
| 12 | Physician related | Indian Society of Critical Care Medicine |
| 13 | Physician related | Paediatric Association of India |
| 14 | Physician related | Indian Academy of Paediatrics |
| 15 | Physician related | Indian Society of Human Genetics |
| 16 | Physician related | Indian Academy of Medical Genetics |
| 17 | Physician related | Geriatric Society of India |
| 18 | Physician related | Indian Academy of Geriatrics |
| 19 | Physician related | Indian Association for Geriatric Mental Health |
| 20 | Physician related | The Association of Physicians of India |
| 21 | Physician related | Indian Association of Clinical Medicine |
| 22 | Physician related | Society of Indian Radiographers |
| 23 | Physician related | Indian Radiological and Imaging Association |
| 24 | Physician related | Association of Microbiologists of India |
| 25 | Physician related | Indian Association of Medical Microbiologists |
| 26 | Physician related | The Federation of Obstetric and Gynecological Societies of India |
| 27 | Physician related | All India Ophthalmological Society |
| 28 | Physician related | Indian Neuro-Ophthalmology Society |
| 29 | Physician related | Paediatric Orthopaedic Society of India |
| 30 | Physician related | Indian Association of Paediatric Surgeons |
| 31 | Physician related | The Association of Surgeons of India |
| 32 | Physician related | Indian Association of Physical Medicine and Rehabilitation |
| 33 | Physician related | Indian Association of Aesthetic Plastic Surgeons |
| 34 | Physician related | Indian Rheumatology Association |
| 35 | Physician related | Paediatric Rheumatology Society |
| 36 | Physician related | Clinical Robotic Surgery Association |
| 37 | Physician related | Indian Society of Anaesthesiologists |
| 38 | Physician related | Indian Society of Blood Transfusion and Immunohematology |
| 39 | Physician related | Cardiological Society of India |
| 40 | Physician related | Indian Association of Clinical Cardiologists |
| 41 | Physician related | Indian Society of Otology |
| 42 | Physician related | The Association of Otolaryngologists of India |
| 43 | Physician related | Association of Emergency Physicians of India |
| 44 | Physician related | Indian Society of Electro cardiology |
| 45 | Physician related | Endocrine Society of India |
| 46 | Physician related | Academy of Family Physicians of India |
| 47 | Physician related | Indian Society of Gastroenterology |
| 48 | Physician related | Indian Association of Gastrointestinal Endo surgeons |
| 49 | Physician related | Association of Gynaecologic Oncologists of India |
| 50 | Physician related | Society for Heart Failure and Transplantation |
| 51 | Physician related | Indian National Association for the Study of the Liver |
| 52 | Physician related | Clinical Infectious Diseases Society |
| 53 | Physician related | National Integrated Medical Association |
| 54 | Physician related | Indian Association of Functional Medicine |
| 55 | Physician related | Indian Society of Oncology |
| 56 | Physician related | Indian Society of Clinical Oncology |
| 57 | Physician related | Association of Nuclear Medicine Physicians of India |
| 58 | Physician related | Indian Academy of Neurology |
| 59 | Physician related | Neurological Society of India |
| 60 | Physician related | Neuro Spinal Surgeons Association |
| 61 | Physician related | Indian Society of Nephrology |
| 62 | Physician related | Vascular Society of India |
| 63 | Physician related | Urological Society of India |
| 64 | Physician related | Indian Society for Assisted Reproduction |
| 65 | Physician related | Indian Fertility Society |
| 66 | Physician related | Indian Society for the Study of Reproduction & Fertility |
| 67 | Physician related | Indian Association of Respiratory Care |
| 68 | Physician related | The Indian Association for Bronchology |
| 69 | Physician related | Indian Society for Study of Lung Cancer |
| 70 | Physician related | Indian Association of Pathologists and Microbiologists |
| 71 | Physician related | Molecular Pathology Association of India |
| 72 | Physician related | Indian Orthopaedic Association |
| 73 | Allied health related | Central Council of Physiotherapy |
| 74 | Allied health related | All India Council of Physical Therapy |
| 75 | Allied health related | Optometry Council of India |
| 76 | Allied health related | Indian Speech Language and Hearing Association |
| 77 | Allied health related | All India Association of Anesthesia and operation theatre technologist |
| 78 | Allied health related | Council for Allied and Healthcare Professionals |
| 79 | Pharmacy related | Pharmacy Council of India |
| 80 | Pharmacy related | Indian Pharmaceutical Association |
| 81 | Nursing | Indian Nursing Council |
| 82 | Nursing | Indian Paramedical Council |
| 83 | Nursing | Paramedical Council of India |
| 84 | Nursing | All India Nursing and Paramedical Council |
| 85 | Nursing | Council of Paramedical science of India |
| 86 | Nursing | All India Paramedical Council |
| 87 | Public health | Public Health Foundation of India |
| 88 | Public health | Indian Public Health Association |
| 89 | Public health | All Institute of Hygiene and Public Health |
The study surveyed a total of 89 websites from various non-dental professional organizations. The majority of these organisations were physician-related, comprising 80.9% (72 organisations). Allied health and nursing-related organisations each comprised 6.7% (6 organisations each), while pharmacy-related organisations accounted for 2.3% (2 organisations). Public health-related organisations constituted 3.4% (3 organisations). The distribution of websites viewed by type of discipline is presented in Table 2.
Table 2. Distribution of non-dental professional organizations by type of discipline.
| Organization characteristic | All websites (n= 89) | |
| Number | % | |
| Physician related | 72 | 80.9 |
| Allied health-related | 6 | 6.7 |
| Nursing related | 6 | 6.7 |
| Pharmacy related | 2 | 2.3 |
| Public health-related | 3 | 3.4 |
| Total | 89 | 100 |
The analysis revealed that oral health content was only on physician-related professional websites, and it primarily focused on treatment rather than preventing oral diseases. For example, the Indian Medical Association included discussions on phasing out dental amalgam and mercury instruments, as well as keynote addresses to dental students. The Association of Plastic Surgeons of India provided information on oral maxillofacial reconstructive surgery. The Indian Academy of Paediatrics included standard treatment guidelines for oral thrush, while the Indian Association of Respiratory Care highlighted interdisciplinary care during COVID-19, involving dental and allied healthcare professionals. Table 3 provides an overview of the oral health content found on non-dental health professional websites and the search terms used to locate the content.
Table 3. Contents of oral health in non-dental health professional websites.
| S. No. | Association | Oral health content | Search term |
| 1. | Indian Medical Association [14] | Minutes of the meeting phasing out of dental amalgam and Mercury BP instruments and thermometer on 25th February 2016 keynote address to dental students speech for dental students | Dental |
| 2. | Association of Plastic Surgeons of India | Oral maxillofacial reconstructive surgery https://apsi.in/reconstructive-surgery.php?rsid=1 [15] | Oral |
| 3. | Indian Academy of Paediatrics | Standard treatment guidelines for oral thrush https://iapindia.org/pdf/Ch-084-Oral-Thrush.pdf [16] | Oral |
| 4. | Indian Association of Respiratory Care | Conference proceeding: The national voice of the vibrant respiratory therapy community will be heard at the 5th session of the thematic resource dissemination conference on 29th Sep 2021 at 05.00 pm IST. "Managing interdisciplinary care during COVID-19: dental and allied healthcare professionals’ perspective” don’t miss it!! | Dental |
Discussion
All medical professionals need access to oral health information since integrating dental health and overall health has emerged as a crucial strategy for enhancing patient and public health [17]. However, many non-dental organisations have little or no information about oral health, and the necessary emphasis on adding oral health information is lacking among non-dental health professionals.
The relevance of interdisciplinary training aligns with Lamster and Eaves' call for increased interprofessional cooperation, emphasising respect for all health disciplines, enhancing awareness of each profession's role, fostering more effective communication, and maximising safety, efficiency, and effectiveness [18]. Currently, there are limited opportunities for interprofessional training. Therefore, improving the oral health content on non-dental professional association websites is crucial to enhancing oral health literacy among non-dental health professionals.
A lack of oral health information in many non-dental organisations suggests that most of the organisations are in the pre-contemplation stage of the transtheoretical theory of behaviour change, unaware of oral health's importance to their patients and profession. Identifying these organisations allows us to move them to the contemplation and preparation stages by introducing oral health information and providing relevant messaging or links [10].
Several strategies can be implemented to address the limitations identified in this study: (a) providing training to non-dental professionals to enhance their knowledge through webinars, workshops, etc.; (b) creating awareness among the public about the availability of oral health information on non-dental professional association websites; (c) collaboration between dental and non-dental professionals to develop and regularly update oral health content.
For example, the Indian Society of Oncology could add relevant information on "cancer treatment and oral health." Chemotherapy and radiation therapy (RT) hinder the growth of new cells and disrupt the healthy balance of bacteria in the mouth. Oro-dental changes resulting from RT are caused by multiple factors, including direct damage to both hard and soft tissues, damage to salivary glands, difficulty in maintaining oral hygiene due to mucositis-induced pain and trismus, leading to radiation caries (RC), periodontal breakdown, and osteoradionecrosis (ORN) [19]. The lack of healthcare facilities with a dedicated multidisciplinary team, coordination issues among team members due to the absence of established oral care protocols, and the time required to address all existing and potential oral sources of infection before RT have always been sources of distress for treating oncologists and dental teams [20]. The availability of a time-bound protocol and/or a sequence of oral treatment strategies aimed at achieving satisfactory oral health pre-RT on associated websites can help reduce oral complications following cancer treatment.
The Indian Dietetic Association website could include "Good oral health and nutrition." Diet and nutrition have a mutual correlation with oral health [21]. Food and nutrition are impacted by oral tissues, while oral health impacts the nutrients consumed [22]. Sugar consumption has been linked to a higher risk of developing dental caries. Regular consumption of acidic foods and drinks should be avoided to prevent erosive tooth damage [23]. An interdisciplinary team of dentists, general practitioners, nurses, and dieticians must collaborate to ensure that patients are well-informed about the connection between good nutrition and oral health [24].
The Federation of Obstetric and Gynaecological Societies of India could add oral health information relevant to pregnant women, such as the association between periodontitis and poor pregnancy outcomes, including preterm birth and low birth weight [25]. Considering that poor dental health during pregnancy can negatively impact the health of both the mother and the unborn child, oral health should be seen as a crucial component of prenatal care [26].
Incorporating oral health information into non-dental health professional platforms is vital for promoting a more integrated approach to healthcare, ensuring that professionals across disciplines recognise the connection between oral and systemic health. By enhancing the visibility of oral health on these websites, we can improve overall health outcomes, encourage interdisciplinary collaboration, and promote a more holistic approach to patient care. Addressing this gap is a necessary step toward fostering interprofessional education and cooperation in the healthcare sector, ultimately benefiting both professionals and patients alike.
Limitations
The reviewed websites might not represent all non-dental health professional websites, as they may primarily include larger or more well-known organizations. The results might have varied if alternative search terms, such as 'hygienist' or the names of specific oral conditions, had been used.
Conclusions
The findings of this study highlight the limited and inconsistent oral health content on non-dental professional association websites in India. Improving the availability, accuracy, and comprehensiveness of oral health information on these platforms is crucial to enhancing oral health literacy and promoting better oral health outcomes among the population. Collaborations between dental professionals and non-dental professional associations and regular monitoring and updating of the content can contribute to achieving this goal. Future research can explore the impact of these improvements on the general public's oral health knowledge, attitudes, and behaviours.
Disclosures
Human subjects: All authors have confirmed that this study did not involve human participants or tissue.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.
Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.
Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Author Contributions
Concept and design: Anju James, Chandrashekar Janakiram
Acquisition, analysis, or interpretation of data: Anju James, Chandrashekar Janakiram, Vaishnav Vinodkumar, Anand Suresh, Vijay S. Kumar
Drafting of the manuscript: Anju James, Chandrashekar Janakiram
Critical review of the manuscript for important intellectual content: Anju James, Chandrashekar Janakiram, Vaishnav Vinodkumar, Anand Suresh, Vijay S. Kumar
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