Assessment of oral health status and periodontal treatment needs among rural, semi-urban, urban, and metropolitan population of Gurgaon District, Haryana State

Abstract

Background:

Role of various etiologic factors in periodontal disease has been investigated by means of epidemiologic surveys and clinical studies. The community periodontal index of treatment needs (CPITN) provides a picture of the public health requirements in the periodontal field, which is essential for national oral health policy-making and specific interventions.

Materials and Methods:

This study was conducted on 4000 individuals among rural, semi-urban, and metro population of Gurgaon District, Haryana State, to find out the oral health status and periodontal treatment needs (TNs) using CPITN index.

Results:

An inference was drawn from the results that among 4000 participants from all the four population groups' maximum, i.e., 63.80% of individuals needed TN2 whereas 18.20% of individuals needed TN3 and 18.10% of individuals needed TN1.

Conclusion:

It can be concluded with a word of hope and a word of warning. Hope lies in the fact that the measurement of periodontal diseases by epidemiological study of this condition is improving and receiving wide spread attention. The warning lies in the varied nature of the condition which goes to make up periodontal disease and perplexing ways in which these conditions blend. In addition to dental practitioner, periodontist and public health workers must devote more time and effort toward controlling periodontal disease than they seem to be devoting at present.

INTRODUCTION

Health is a state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity.[1] Oral health is a standard of the oral and related tissues which enables an individual to eat, speak, and socialize without active disease, discomfort, or embarrassment and which contributes to general well-being. Oral health is a critical but overlooked component of overall health and well-being among children and adults.[2] Health is a fundamental right of every individual and oral health is an integral part of general health. Various factors are responsible for the maintenance of good oral health. Socioeconomic status, occupation, and education are playing a major role in the maintenance of good oral health. Access is one of the main barriers of health care delivery system which we want to overcome by primary health care.[3] Each population group comprises different individuals coming from various socioeconomic profiles, education levels, age groups, occupations, etc., thereby needing different approaches for health care. One of the strategies in public health is to identify unique population groups, study their health problems, and explore methods for health care.[4]

During the last decade, there has been an increasing prevalence of dental health problems in India. Oral diseases have attracted the researchers as early as 1941.[5] The prevalence of periodontal disease in India ranges from 90% to 95% in different population groups, only differing in severity between the various age groups.[6] Although the critical role of dental plaque in the etiology of periodontal disease is well-established, it does not explain the difference in susceptibility of given population or individuals to periodontitis. Relative role of various etiologic factors in periodontal disease have been investigated by means of epidemiologic surveys and clinical studies.[7]

The community periodontal index of treatment needs (CPITN) provides a picture of the public health requirements in the periodontal field, which is essential for national oral health policy-making and specific interventions. The CPITN index has been developed jointly by the International Dental Federation and the World Health Organization (WHO) to evaluate periodontal status and treatment needs (TNs) of population.[8]

Population group centers are classified as rural, semi-urban, urban, and metropolitan population based on the centers as available in the latest census of India (Census 2011).[9]

The population groups are classified as under:

1. Rural: Population <10,000

2. Semi-urban: 10,000 and <1 lakh

3. Urban: 1 lakh and above and <10 lakh

4. Metropolitan: 10 lakh and above.

A large number of epidemiological studies have been carried out on the prevalence of periodontal disease in the populations of various parts of India.[10] No studies have been conducted with respect to prevalence and TNs in Gurgaon District of Haryana state.

Hence, the present study was conducted to find out the oral health status and periodontal TNs among rural, semi-urban, urban, and metro population of Gurgaon District, Haryana State.

MATERIALS AND METHODS

Study design area and population

The subjects for the present study were selected at random from rural, semi-urban, urban, and metropolitan population of Gurgaon District, Haryana State. An epidemiological, cross-sectional survey was carried out on 4000 subjects of either sex. 1000 participants from each population groups were selected. Participants of age between 15 and 60 years were selected to assess their periodontal status and treatments needs.

The study groups were divided according to the population distribution as rural population, semi-urban population, urban population, and metropolitan population.

Ethical clearance to conduct the study was obtained from the Institutional Review Board or from the Ethical Committee of “SGT College of Dental Sciences and Research, Gurgaon.” A dual proforma designed to know the age, sex, socioeconomic background, methods, frequency, and duration for oral hygiene and CPITN was prepared for the study. Participants between the age of 15 and 60 years from both the sexes and who were willing to give consent were selected. Children under 14 years of age, edentulous persons, and subjects with partial dentition having two or more missing teeth were excluded from the study.

Examination procedure

A door-to-door survey was conducted with the help of auxiliary staff and personnel. The examination of the oral cavity was done by taking proper aseptic measure. The oral examination of each individual was carried out using the WHO oral health form (1997).[11,12] Each sextant was designated as healthy, when no treatment is required (Code 0 = TN0). In case of bleeding without calculus, it was recommended to improve the oral hygiene (Code 1 = TN1). If the calculus but no periodontal pocket was detected, oral hygiene instructions were provided and professional cleaning was carried out, if indicated (Code 2 = TN2). Presence of 4–5 mm pocket (Code 3 = TN2) and 6 mm or deeper (Code 4 = TN3) must need treatment by deep scaling and in these cases, root planing and more complex surgical procedures may be indicated.

Calculation of community periodontal index of treatment needs

The CPITN for a population group was calculated as follows:

Step 1: Number of charts with different code individually (i.e., 0, 1, 2, 3 and 4) were counted.

Step 2: All the individuals were given TN (i.e. TN0, TN1, TN2, and TN3) according to their codes.

Step 3: Each population group was assessed as per their TNs and their percentage prevalence was obtained.

Step 4: Intergroup assessments were also made using their percentage prevalence.

All information and data were collected by the investigator by interview technique and oral cavity examination. Only completely filled forms were considered for analysis.

Statistical analysis

Data were entered in Microsoft Excel spread sheet and analyzed using SPSS software (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. IBM Corp: Armonk, NY).

RESULTS

There was no participant in any population group with healthy periodontal tissues, so Code 0 was not assigned to anyone. Hence, in all the population groups, TN0 was not present. TN0 was not included in statistical analysis. This was in accordance with the findings by McGrath,[13] James,[14] and Anup et al.[15]

Table 1 showed the percentage prevalence of TN1, TN2, and TN3 in Group 1 (rural), Group 2 (semi-urban), Group 3 (urban), and Group 4 (metropolitan) population. In Group 1, 68.30% of population needs TN2 whereas 16.80% needs TN1 and 14.90% needs TN3. In Group 2, 56.40% of population needs TN2 whereas 23.70% needs TN3 and 19.90% needs TN1. In Group 3, 57% of individuals need TN2 whereas 24.90% needs TN3 and 18.10% needs TN1. In Group 4, 73.40% of individuals need TN2 whereas 17.50% needs TN1 and 9.10% needs TN3.

Table 1.

Percentage prevalence of treatment need 1, treatment need 2, and treatment need 3 in rural, semi-urban, urban, and metropolitan population

Results in Table 2 show that rural group population needs more TN2 when compared with semi-urban group whereas semi-urban group population needs more TN1 and TN3 when compared with rural group. There was significance present between the two groups (P < 0.001).

Table 2.

Significance of inter-group comparisons of treatment need 1, treatment need 2, and treatment need 3

Rural group population needs more TN2 when compared with urban group whereas urban group population needs more TN1 and TN3 when compared with rural group. There was significance present between the two groups (P < 0.001).

Rural group needs less TN1 and TN2 and more TN3 when compared with metropolitan group population. There was significance present between the two groups (P < 0.001).

In semi-urban group, more participants needed TN1 whereas TN2 and TN3 were needed by more participants in urban group. There was no significance between the two groups (P < 0.554). In semi-urban group, more participants needed TN1 and TN3 whereas TN2 was needed more in metropolitan population. There was significance between the two groups (P < 0.001).

Urban group population needed more TN1 and TN3 when compared with the metropolitan group population which needed more TN2. There was significance between the two groups (P < 0.001).

Hence, an inference was drawn from the results that among 4000 participants from all the four population groups' maximum, i.e. 63.80% of individuals needed TN 2 whereas 18.20% of individuals needed TN3 and 18.10% of individuals needed TN1.

DISCUSSION

In a developing country such as India which is undergoing social change, public health and primary health care should assume a place of importance. The dental health of our people is very poor. Even ordinary citizens know very little about oral and dental health. Beliefs based on ignorance, superstition, and taboos about dentistry still prevail in the minds of the people. All the population groups including rural, semi-urban, urban, and metropolitan are lacking in the maintenance of oral hygiene.

Over the past few years, CPITN index has been increasingly adopted as a procedure for classifying periodontal conditions with respect to complexity of care and personal oral health required to restore periodontal tissue to healthy conditions. The index has met its expressed purpose to provide a global standard that can be uniformly used for the measurement of TNs for use by health planners and administration. It is viewed by some as possibly the best tool currently available for measuring descriptive epidemiology of periodontal disease in diverse population. The index is simple, rapid, inexpensive, easily applied, and requires minimum equipment.

In the present study, CPITN-C probe having color coding with a black mark starting at 3.5 mm and ending at 5.5 was used, not employing a force >20 g. Ainamo et al.[11] used probe of same specification during their study way back. Morris et al.[12] used same probe during his study on the UK adult population. The periodontal status assessment criteria that were proposed in the WHO's 1997 oral health survey methods manual were used. The data were collected by a single examiner.

In the past, very few Indian and international studies have been conducted to compare the prevalence of periodontal diseases and TNs in urban and rural areas. Present study is the only study which compares the four groups of population, i.e. rural, semi-urban, urban, and metropolitan.

The results of the present study revealed that there was less need of TN1 in rural population when compared to the other three groups. These results are in accordance with the studies of Singh et al.[16] and Gupta et al.[17] Diouf et al.[18] found in his study that rural populations mostly use traditional therapy when they suffer from dental problems. All the groups needed TN2 in higher percentage as compared to TN1 and TN3. All the population groups required professional oral care. These results are in accordance with Sanjana et al.[19] Ramfjord et al.[20] who observed in their study that there is 100% prevalence of periodontal disease in India. This might be due to different lifestyle, exposure of certain risk factors such as smoking, chewing tobacco, and use of indigenous oral hygiene methods for cleaning teeth. In addition, lack of oral hygiene awareness among the rural population must have contributed to the increased risk of periodontal disease among the individuals. Lissau et al.[21] showed that how a social environment, individual behavior, and the delivery system have significant effect on the use of dental services. Syrjälä et al.[22] showed that education was not a decisive factor in determining the attitude of the people toward oral health care.

CONCLUSION

Lack of incentives for dentists to work in the rural areas is one of the major important determinants for unavailability of dentists in the rural areas. Lack of routine medical check-up can be a risk factor for routine dental care also. Dental schools organize oral health check up camps in rural areas and also inform/motivate people regarding the prevention and treatment of existing dental diseases, but it is little difficult for the population to get benefit of the facilities available in dental colleges located in nearby towns/city, because of some practical reasons such as conveyance.

On the other hand, better periodontal health in urban and metropolitan areas may be because of the more number of dentists serving in these areas. Majority of the hospitals and teaching institutions (dental colleges) are located in urban areas. Furthermore, schools located in these areas are having regular oral checkups of the students by the dentists employed/empaneled by them, thus ensuring better oral hygiene standards.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest