| Abstract|| |
Objective: The aged are prone to biological, social, and psychological problems, especially those residing in the rural areas. The rural aging population in contrast to their urban counterparts is illiterate, poor, and ignorant; cumulative is the fact that the youth are leaving rural areas for money and better opportunity to urban areas. An educational and motivational program to increase prosthodontic awareness was therefore undertaken and it was studied whether this translated into an increased demand for prosthodontic services.
Materials and Methods: The study area consisted of a group of six villages collectively known as "Sarora" situated in Lucknow, Uttar Pradesh, India. The study population was divided on the basis of age, sex, education, and economic status and comparisons were made in between these groups. Interview and clinical examination were the tools of the study. Data were collected before and after the educational program and was subjected to statistical analysis.
Results: The educational program led to more subjects adopting tooth brushing and neem twig chewing as a method of oral hygiene maintenance. The prosthodontic need fulfillment increased from 3.5% before the program to 13.6% after education and motivation.
Conclusion: It was concluded that mobile dental clinics, dental camps, and prosthodontic outreach programs could be solutions to spread awareness and disseminate treatment.
Keywords: Geriatrics, oral health educational programs, outreach programs, prosthodontic awareness, prosthodontic need
|How to cite this article:|
Parlani S, Tripathi A, Singh SV. Increasing the prosthodontic awareness of an aging Indian rural population. Indian J Dent Res 2011;22:367-70
Rural areas present a bleak picture in contrast to the urban areas as the residents are mostly illiterate, and ignorance and myths prevail widely. The standard of living and economic status is low and no importance was given to women's education and liberation. When we consider the aging population, to the existing problems are added disease and lack of mobility. Dental treatment is therefore obviously neglected till tooth loss is the final result. 
|How to cite this URL:|
Parlani S, Tripathi A, Singh SV. Increasing the prosthodontic awareness of an aging Indian rural population. Indian J Dent Res [serial online] 2011 [cited 2013 May 21];22:367-70. Available from: http://www.ijdr.in/text.asp?2011/22/3/367/87054
Dentists too are responsible for this state as for the same population ratio, there are 10 times more dentists in cities than in villages in India.  Literacy and development programs are directed toward the youth who, do not find ample opportunities in the villages and hence migrate to urban areas leaving the old to their woes.
A prosthodontic awareness and motivational program was therefore undertaken to help the aged and to change their attitude toward dental care and treatment. 
| Materials and Methods|| |
The present study was conducted in a group of six villages in the district of Lucknow, Uttar Pradesh., India, collectively known as Sarora. The total population of Sarora was 5800 (Census 2001), with land cultivation or agricultural labor being chief occupations of the population (79%), illiteracy was 65% and majority of residents came below poverty line.
A total of 445 people of Sarora were aged 50 years or above, 227 of whom were interviewed and examined clinically, the remaining either refused to be interviewed, were away at the time of interview, or were too ill to be interviewed. The format of the interview was based on the available literature and was pretested. Close-ended multiple choice questions were put to the subject to facilitate data processing and avoid ambiguity.
The awareness program was carried after the preliminary interview and examination and attempted to motivate the study population to adopt measures preventing tooth loss, while stressing the importance of replacement of lost teeth. Twenty lectures with the help of visual aids including posters and models were held at weekly intervals at previously allocated locations and time in the villages to cover all the study area. A time span of 6 months was decided to study the effects, if any, of the program after which 212 out of the 227 subjects could participate in the interview and clinically examination.
Name, age, sex, educational status, and monthly income of the subjects were recorded and the subjects were divided into groups on the basis of
Age: group A 1 - 50-54 years, group A 2 - 55-64 years, and group A 3 - 65 years and above.
Sex: group M - males and group F - females.
Educational status: group E 0 - illiterate, group E 1 - educated, but to or below primary level, group E 2 - educated above primary level.
Monthly income: group I 0 - no source of income, group I 1 - income less than Rs. 1000/- per month, group I 2 - income Rs. 1000/- or more per month.
Both before and after the awareness program it was determined whether the subject felt handicapped due to loss of teeth, whether the prosthodontic need had been fulfilled, if the need had not been fulfilled the reasons for nonfulfillment were determined. Subjects visit, if any, to the dentist were noted, with the purpose of the visit along with the oral hygiene measure adopted by the population and prevalent dental myths if any. The data were then subjected to standard statistical tests such as mean, standard deviation, t-test, chi-square test, and P values.
| Results|| |
Pre- and post-program data were analyzed and are shown in [Table 1], [Table 2], [Table 3], [Table 4], [Table 5] and [Table 6]. There was a 5.1% increase in subjects using tooth brush and 19.8% increase in datoon or neem twig chewing after the program [Table 1]. After 6 months of program there was a 26.2% increase in subjects who considered tooth loss disadvantageous [Table 2] and 10.1% increase in prosthodontic need fulfillment [Table 3].
After the completion of motivational program subjects stating unawareness and disinterest as reasons for unfulfillment of prosthodontic need decreased significantly by 13.1-8.7%, respectively [Table 4]. Comparing existing dental myths in the study population also yielded a significant decrease after the program [Table 5].
|Table 2: Comparison of percentage of subjects considering tooth loss disadvantageous in the study population|
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|Table 3: Comparison of prosthodontic need fulfillment in the study population|
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|Table 4: Comparison of reasons for nonfulfillment of prosthodontic need in the study population|
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| Discussion|| |
On comparing pre- and post-program oral hygiene methods in the study population [Table 1], there was a 5.1% increase in subjects using tooth brush and 19.8% increase in datoon or neem twig chewing. This change was highly significant. Redmond et al.  also reported an improvement in oral hygiene after conducting an dental education program for 12 months. The more significant increase in " datoon" chewing over tooth brushing could be due to 55.2% of the aged population having no source of income and 32.1% having monthly income of less than Rs. 1000.
On studying the perceived prosthodontic need fulfillment [Table 3] in the study population, there was a 10.1% increase in prosthodontic need fulfillment, 6 months after the program completion, which was highly significant. Marino et al.  evaluated the impact of a community-based oral health promotion program on the use of dental services and oral health knowledge and found improved self-reported oral hygiene practices and use of dental services posttest. Petersen and Nortov  also found a reduction in unmet need after a dental public health program.
There was a 26.2% (highly significant) increase in subjects who considered tooth loss disadvantageous, 6 months after the program [Table 2]. Tuominen  said that the need by professional criteria was always higher than the felt need. Brodeurs, Demers et al.  found that while 96.4% of the subjects needed treatment, only 58.2% said that they had problems. After educating the study population, they were better able to relate functional and esthetic disturbances to the loss of teeth leading to higher disadvantage perception. Majority of subjects felt difficulty in mastication to be the main disadvantage. Shah, Prakash, and Sunderam  also reported 60% of the elderly subjects as dissatisfied with their mastication function after the loss of teeth.
After the completion of motivational program subjects stating unawareness and disinterest as reasons for unfulfillment of prosthodontic need decreased significantly by 13.1-8.7%, respectively [Table 4]. The most common reason for unfulfilled prosthodontic need after the program was financial constraints. Tuominen  also found financial constraints to be a main cause. Disinterest was the second important reason, the justifications for which varied from the opinion that old age was the sole reason of tooth loss to a generalized disillusionment with their environment/family. Tennstedt et al.  reported disinterest as the most common reason for nonutilization of prosthodontic treatment in New England. The other reasons cited were unavailability/inaccessibility of services and systemic disease.
Comparing existing dental myths in the study population also yielded a significant decrease after the program [Table 5]. The most common myth was "tooth loss is an extension of old age" in the rural population. It is reported that certain cultures view loss of teeth solely as an extension of the ageing process. Other myths which prevailed in the study population included eating tobacco prevents caries, dental diseases can be cured by medicines alone, tooth extraction leads to loss of vision and oral prophylaxis causes loosening of teeth.
There was a 10.1% highly significant increase [Table 6] in subjects who went to a dentist for prosthodontic need fulfillment with a 22.1% decrease in subjects never having visited a dentist before and after the program. Wardh et al.  reported that the studied group established more contacts with dentist after an education program. Leake et al.  studied the factors influencing the pattern of dental services received by older adults in Canada and reported that dental care patterns were influenced by dental status, area of residence and visiting behavior.
| Conclusion|| |
Preventive dental care is almost nonexistent in rural India. Shah in 2004  observed that for the same population ratio, there are 10 times more dentists in cities than in villages in India. She also stated that the primary health centers which are the basic unit of health care in rural areas do not have provisions for dental care. It is essential that to combat oral diseases a preventive approach, with a focus on health education and promotion, should be given prime importance.
Initiatives should be aimed not only on the prevention but also on the curative aspects of oral health. Mobile dental clinics, dental camps, and prosthodontic outreach programs are possible solutions to change attitudes, spread awareness, and extend treatment.
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Department of Prosthodontics and Dental Material Sciences, Faculty of Dental Sciences, Chatrapati Sahuji Maharaj Medical University, Lucknow, Uttar Pradesh
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]