Bharathi Purohit

Oral health status and treatment needs of children attending special schools in South India: a comparative study

The aim of this study was to assess and compare oral health status and treatment needs of children with special healthcare needs (SHCN) between the ages of 5 and 15, with a matched group of healthy children, in Udupi District of South India. A cross-sectional study of 265 children with SHCN was compared to 310 healthy children to assess differences in periodontal status, dentition status, treatment needs, and dentofacial anomalies using the WHO criteria. Chi-square, t-test, and Z-tests were performed to compare different variables. p ≤ 0.05 was considered statistically significant. A significantly higher prevalence of caries (89.1%), malocclusion, and poorer periodontal status was observed among children with SHCN compared to the healthy control group. Improving the oral health of these children will require maintaining good oral hygiene practices, which can be achieved with appropriate target-based oral health approaches.

Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health

Even though dentistry was not a specialized branch of Ayurveda, it is included in its Shalakya Tantra (system of surgery). Problems such as deformities of the oral cavity, plaques and infections were managed in ancient India. Traditional medicine can treat various infectious and chronic conditions. Research has shown that all kinds of chewing sticks described in ancient Ayurveda texts have medicinal and anti-cariogenic properties. Its oil pulling (Kaval, Gandush) practice is claimed to cure about 30 systemic diseases. Amla (Emblic myrobalan), is a general rebuilder of oral health. Bilberry fruit (Vaccinium myrtillus) and hawthorn berry (Crateagus oxycanthus) stabilize collagen, strengthening the gum tissue. Liquorice root (Glycyrrhiza glabral) promotes anti-cavity action, reduces plaque, and has an antibacterial effect. Use of safe, quality products and practices should be ensured based on available evidence if traditional medicine is to be acknowledged as part of primary health care. Scientific validations of the Ayurveda dental health practices could justify their incorporation into modern dental care. Publicity of these techniques using appropriate media would benefit the general population by giving more confidence in the ancient practices, thus preventing tooth decay and loss.

Addressing oral health disparities, inequity in access and workforce issues in a developing country

The health sector challenges in India like those in other low and middle income countries are formidable. India has almost one-third of the worlds dental schools. However, provisions of oral health-care services are few in rural parts of India where the majority of the Indian population resides. Disparities exist between the oral health status in urban and rural areas. The present unequal system of mainly private practice directed towards a minority of the population and based on reparative services needs to be modified. National oral health policy needs to be implemented as a priority, with an emphasis on strengthening dental care services under public health facilities. A fast-changing demographic profile and its implications needs to be considered while planning for the future oral health-care workforce. Current oral health status in developing countries, including India, is a result of government public health policies, not lack of dentists. The aim of the article is to discuss pertinent issues relating to oral health disparities, equity in health-care access, dental workforce planning and quality concerns pertaining to the present-day dental education and practices in India, which have implications for other developing countries.

Oral health status of 12-year-old children with disabilities and controls in Southern India

Background: This study explores the association of disabilities and oral health. The aim of the study was to compare and assess oral health status of 12-year-old children with disabilities with healthy controls in Karnataka, Southern India. Methods: A total of 191 schoolchildren with disabilities were examined from 12-year age group. For comparison, 203 healthy children were randomly selected from other government schools. Clinical data were collected on periodontal status, dental caries, treatment needs and dental malocclusion using WHO criteria. A chi-squared test was used to compare between categorical variables. Linear and logistic regression analysis was performed to determine the importance of the factors associated with caries status. Results: Significant differences were noted in the frequency of sugar consumption between subjects with disabilities and their healthy controls. Subjects with disabilities had significantly higher CPI (community periodontal index) scores than their healthy counterparts (p<0.001). Dental caries was present in 89.8% children from special schools as compared with 58.6% from the control group. Mean DMFT (decayed, missing, filled teeth) values for special school children and healthy controls were 2.52 ± 2.61 and 0.61 ± 1.12, respectively. Higher prevalence of malocclusion was seen in subjects with special healthcare needs, with 66.4% having definite malocclusion and 17.4% of controls having malocclusion (p<0.001). The mean values for treatment needs were higher in subjects with disabilities. Regression analysis showed that, type of school, male gender, low frequency of brushing, increased frequency of sugar consumption between meals and dental malocclusion were significantly related to dental caries. Conclusion: Poor oral health of children with disabilities as compared with their healthy controls in terms of periodontal status, dentition status, treatment needs, and dentofacial anomalies was found in our study, which confirms a need for preventive treatment for these children.

Street Children as a Public Health Fiasco

Street children are a common problem of developing countries. Global efforts for the preservation of child rights and the protection from child labor are becoming a first priority of every nation. Health concerns of street children have become a major public health problem in developing countries. “Street children” is a term used to refer to children who live on the streets of a city. They are deprived of family care and protection. Most children on the streets are between the ages of about five and seventeen years old. Because of unemployment, increasing rural–urban migration, attraction of city life, and a lack of political will, India is home to the world’s largest population of street children, estimated around18 million. According to the estimates of the Asian Development Bank, about 25 million children are living on the streets in Asia.

Oral health status of 5-year-old Aborigine children compared with similar aged marginalised group in south western India.

OBJECTIVE   To compare and assess oral health status of 5-year-old Aborigine children with similar aged, marginalised children in coastal region of south western India. MATERIALS AND METHODS   A total of 418 Aborigine children were invited to participate in the study and a total of 428, 5-year-olds were selected randomly for comparison from other government schools to form the other marginalised group. The WHO (1997) proforma was used for clinical examinations. Chi Square test was used to compare between categorical variables. Mann-Whitney U-test was used for comparison between the two groups for quantitative variables. Logistic and linear regression analysis was performed to determine the importance of the factors associated with caries status. Odds ratio was calculated for all variables with 95% confidence intervals. P≤0.05 was considered as statistically significant. RESULTS   Dental fluorosis was present in 50 (11.9%) Aborigine children, whereas in the other marginalised group 7 (1.6%) children had dental fluorosis (P≤0.001). Untreated dental caries was 76.3% for the Aborigine children and 70.3% in the comparison group. Mean dmft values in the two groups were 4.13±3.90 and 3.58±3.60, respectively (P>0.01). High frequency of between-meal sugar consumption was related to dental caries (OR =1.20; P=0.001). Utilisation of dental care and dental fluorosis were inversely related to dental caries (OR=1.16; P=0.001 and OR=1.91; P=0.001). CONCLUSION   The study revealed poor oral health status among both the marginalised groups. Significant differences were noted between the two groups with respect to oral hygiene practices, dietary habits, and dental utilisation pattern. Schools for tribal children, male gender, low frequency of cleaning teeth and higher in between-meal sugar consumption were significantly related to dental caries.

Public Health Impacts of Global Warming and Climate Change

Global warming means the rise in the average temperature of Earth’s atmosphere and oceans as well as its projected continuation. The greenhouse effect is the process by which absorption and emission of infrared radiation by gases in the atmosphere warm a planet’s lower atmosphere and surface. Since the early twentieth century, Earth’s mean surface temperature has increased by about 0.8◦C (1.4◦F), with about two-thirds of the increase occurring since 1980. The major greenhouse gases are water vapor, CO2, CH4, and ozone. Water vapor contributes for 36–70 percent of the greenhouse effect, whereas CO2, CH4 and ozone accounts for 9–26 percent, 4–9 percent, and 3–7 percent of the green house effect, respectively. Human activity, since the Industrial Revolution, has increased the amount of greenhouse gases in the atmosphere; concentrations of CO2 and methane have increased by 36 percent and 148 percent, respectively, since 1750.

Utilization of teledentistry as a tool to screen for dental caries among 12‐year‐old school children in a rural region of India

OBJECTIVE The study aims to assess the reliability of video-graphic method as a tool to screen the dental caries among 12-year-old school children in a rural region of India. METHODS A total of 139 school children participated in the study. Visual tactile examinations were conducted using the Decayed, Missing, and Filled Teeth (DMFT) index. Simultaneously, standardized video recording of the oral cavity was performed. Sensitivity and specificity values were calculated for video-graphic assessment of dental caries. Bland-Altman plot was used to assess agreement between the two methods of caries assessment. Likelihood ratio (LR) and receiver-operating characteristic (ROC) curve were used to assess the predictive accuracy of the video-graphic method. RESULTS Mean DMFT for the study population was 2.47 ± 2.01 and 2.46 ± 1.91 by visual tactile and video-graphic assessment (P = 0.76; > 0.05). Sensitivity and specificity values of 0.86 and 0.58 were established for video-graphic assessment. A fair degree of agreement was noted between the two methods with Intraclass correlation coefficient (ICC) value of 0.56. LR for video-graphic assessment was 2.05. Bland-Altman plot confirmed the level of agreement between the two assessment methods. The area under curve was 0.69 (CI 0.57, 0.80, P = 0.001). CONCLUSION Teledentistry examination is comparable to clinical examination when screening for dental caries among school children. This study provides evidence that teledentistry may be used as an alternative screening tool for assessment of dental caries and is viable for remote consultation and treatment planning. Teledentistry offers to change the dynamics of dental care delivery and may effectively bridge the rural-urban oral health divide.Objective The study aims to assess the reliability of video-graphic method as a tool to screen the dental caries among 12-year-old school children in a rural region of India. Methods A total of 139 school children participated in the study. Visual tactile examinations were conducted using the Decayed, Missing, and Filled Teeth (DMFT) index. Simultaneously, standardized video recording of the oral cavity was performed. Sensitivity and specificity values were calculated for video-graphic assessment of dental caries. Bland–Altman plot was used to assess agreement between the two methods of caries assessment. Likelihood ratio (LR) and receiver-operating characteristic (ROC) curve were used to assess the predictive accuracy of the video-graphic method. Results Mean DMFT for the study population was 2.47 ± 2.01 and 2.46 ± 1.91 by visual tactile and video-graphic assessment (P = 0.76; > 0.05). Sensitivity and specificity values of 0.86 and 0.58 were established for video-graphic assessment. A fair degree of agreement was noted between the two methods with Intraclass correlation coefficient (ICC) value of 0.56. LR for video-graphic assessment was 2.05. Bland–Altman plot confirmed the level of agreement between the two assessment methods. The area under curve was 0.69 (CI 0.57, 0.80, P = 0.001). Conclusion Teledentistry examination is comparable to clinical examination when screening for dental caries among school children. This study provides evidence that teledentistry may be used as an alternative screening tool for assessment of dental caries and is viable for remote consultation and treatment planning. Teledentistry offers to change the dynamics of dental care delivery and may effectively bridge the rural–urban oral health divide.

Addressing Geriatric Oral Health Concerns through National Oral Health Policy in India

There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the worlds elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries.

Efficacy of pre-procedural rinsing in reducing aerosol contamination during dental procedures:

Our objective was to determine the efficacy of pre-procedural rinsing with chlorhexidine in reducing bacterial aerosol contamination during use of ultrasonic scaler and high speed air turbine handpiece. Twenty patients, ten each for the two groups who were found to satisfy the inclusion criteria were selected for the study. Four predesignated locations of the dental clinic were chosen to be evaluated for each patient using blood agar plates. Aerosols were collected during treatment procedures for control and experimental quadrants. Results showed that a regimen of 30-seconds pre-procedural rinsing with 0.12% chlorhexidine gluconate before dental procedures consistently reduced colony-forming units than without rinsing due to the ability of antiseptic mouthwash to inhibit microbial growth. There was more aerosol contamination during scaling procedures than during the use of a high speed air turbine handpiece. The conclusion is that chlorhexidine is an effective primary measure in reducing aerosol cross-contamination when using dental devices in a dental set up.