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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 6  |  Page : 841-842
Utilization of oral health care services among adults attending community outreach programs


Department of Public Health Dentistry, MR Ambedkar Dental College, Bangalore, India

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Date of Submission20-May-2011
Date of Decision19-Oct-2011
Date of Acceptance10-Dec-2011
Date of Web Publication3-May-2013
 

   Abstract 

Introduction: Good oral health is a mirror of overall health and well-being. Oral health is determined by diet, oral hygiene practices, and the pattern of dental visits. Poor oral health has significant social and economic consequences. Outreach programs conducted by dental schools offer an opportunity for early diagnosis and treatment, dental health education, and institution of preventive measures.
Objective: To assess the utilization of oral healthcare services among adults attending outreach programs.
Materials and Methods: This study included 246 adults aged 18-55 years attending community outreach programs in and around Bangalore. Using a questionnaire we collected data on dental visits, perceived oral health status, reasons for seeking care, and barriers in seeking care. Statistical significance was assessed using the Chi-square test.
Results: In this sample, 28% had visited the dentist in the last 12 months. Males visited dentist more frequently than females. The main reason for a dental visit was for tooth extraction (11%), followed by restorative and endodontic treatment 6%. The main barriers to utilization of dental services were high cost (22%), inability to take time off from child care duties (19.5%), and fear of the dentist or dental tools (8.5%).
Conclusion: The utilization of dental services in this population was poor. The majority of the dental visits were for treatment of acute symptoms rather than for preventive care. High cost was the main barrier to the utilization of dental services. Policies and programs should focus on these factors to decrease the burden of oral diseases and to improve quality of life among the socioeconomically disadvantaged.

Keywords: Barriers to oral health, dental visit, healthcare utilization, outreach programs

How to cite this article:
Kadaluru UG, Kempraj VM, Muddaiah P. Utilization of oral health care services among adults attending community outreach programs. Indian J Dent Res 2012;23:841-2

How to cite this URL:
Kadaluru UG, Kempraj VM, Muddaiah P. Utilization of oral health care services among adults attending community outreach programs. Indian J Dent Res [serial online] 2012 [cited 2019 Nov 17];23:841-2. Available from: http://www.ijdr.in/text.asp?2012/23/6/841/111290
Good oral health helps to ensure overall health and well-being. Poor oral health has significant social and economic consequences. In the US alone, illnesses related to oral health result in 6.1 million days of bed disability, 12.7 million days of restricted activity, and 20.5 million workdays lost each year. [1]

Orodental diseases are emerging as a major public health problem in developing countries like India. At present, in India, there are more than 267 dental schools, producing approximately 19000 dental graduates per year, and there are almost 3000 specialists available for providing dental care. Despite this, even the most basic oral health education and simple interventions for pain relief and emergency care for acute infection and trauma is unavailable to the vast majority of population, especially the rural and urban poor. In addition, the recent growth in the economy and the advances in healthcare technology have widened the gap between the rich and the poor, exacerbating the inequity in access to oral health care in particular and health care in general. Despite the deleterious consequences of untreated oral pathology, inappropriate utilization of dental services remains a major problem. [2]

Utilization of health care is a complex phenomenon and multifaceted human behavior. Various theories and conceptual models have been proposed to explain this phenomenon. The determinants of oral health care can be classified as predisposing (socio-demographic factors like age, sex, occupation, and social network), enabling (transportation, income, and information), and need (perceived health or professionally assessed illness) factors. [3]

Some studies have suggested that a lack of understanding of the benefits of good oral health and competing financial needs exacerbate oral health access disparities among the poor. [4] Parents who were less educated were more likely to postpone dental care for their child. Males and females were reported to utilize dental services equally, and utilization increased with age. Utilization was also high among the dentate elderly, with nearly three-quarters reporting that they had visited a dentist within the past year. [4],[5],[6]

Anticipation of painful dental treatment, high dental charges, long waiting times, and being too busy for a dental visit were cited as the most important barriers to seeking dental treatment. [7] Reasons other than socio-demographic factors have also been cited on occasion, for example, lack of confidence in the competence of the dentist. [8]

Community outreach programs are an essential part of public health services, helping health professionals reach the weaker sections of the society for delivery of basic oral health services. It provides an unmatched opportunity for research. With better understanding of why people use or do not use the services, the programs can be tailored to address the felt needs of the community. [9]

Studies focusing on oral health care service utilization are meager in Indian populations. Hence, we have made an attempt to assess the utilization of oral health services by adults attending community outreach programs in and around Bangalore.


   Materials and Methods Top


Study setting

To extend oral health services to the poor and needy, the Department of Public Health Dentistry, MRADC (Mathrushri Ramabhai Ambedkar Dental College and Hospital) conducts regular outreach programs with the help of various voluntary organizations. Parinaam Foundation, one such organization, in strategic partnership with Ujjivan Financial Services Ltd., a Non Banking Financial Company, provides a full range of financial services to urban and rural economically-active poor women. As part of their healthcare activities, Parinaam Foundation regularly organizes health camps (including ophthalmology, ENT, and dental camps) on Sundays for their members in and around Bangalore. Four such health camps were conducted over a 2-month period, one each in Lingarajpuram and Kodigihalli in Bangalore, Maddur taluk of Mandya district, and Ramnagar district. These health camps were the setting for this study.

In these health camps, participants receive a complete physical examination by a team of physicians. The Venkateshwara Eye Hospital provides free vision screening, while the faculty and postgraduate students from the MRADC provide free dental examinations as well as basic treatment services like extraction, permanent restorations, and oral prophylaxis, in a mobile dental unit meant for these programs. When further treatment is necessary, the patient is referred to the appropriate hospital (network hospitals for Ujjivan members or the nearest government hospital). All services are offered free of charge.

Subjects

In all, 606 Ujjivan members participated in these health camps. Of these 342 attended the camp for dental care, and 246 of them gave consent for the interview.

Data collection and survey instrument

The data regarding the utilization of dental health services were obtained using a questionnaire. Data was collected on perceived oral health status, number of visits to the dentist in the last 12 months, reasons for the visit (e.g. dental examination, tooth restoration, dental cleaning, tooth extraction, having a prosthesis made, and aching tooth or gums). The reasons for not visiting the dentist included, for example, high cost of treatment, inconvenient consulting hours, fear of the dentist/dental tools, ignorance regarding where to go, lack of transportation, language barrier, long waiting time, and inability to take time off child care duties.

Information on sociodemographic variables like age, gender, and education was also obtained for the purpose of the study.

The investigators were given a brief training on administering the questionnaire in the local language after obtaining informed consent from each participant. The questionnaire was administered by face-to-face interview. This study was approved by MRADC ethical review committee.

Statistical analysis

Statistical analysis was done using SPSS, version 19.0 (Statistical Package for Social Sciences). The independent variables were age, gender, and educational qualification, and the dependent variables were the dental visiting pattern, perceived oral health status, and perceived felt need. The quantitative values were expressed as means (± standard deviation) and qualitative values as percentages. The Chi-square test was used to detect difference in distribution of dental service utilization for age sex education and perceived oral health. The statistical significance level was fixed at P ≤ 0.05.


   Results Top


Overall, 246 adult participants were interviewed, of whom 216 (87.80%) were females. The mean age was 34.5 ± 9.66 years. A total of 28% (69/246) participants had visited the dentist in the last 12 months. Males were found to be more likely than females to visit the dentist, with 40% (12/30) of the males in this study saying that they had visited the dentist in the last 12 months. It was also observed that 52.2% (36) of participants above the age of 35 years had visited the dentist in the past 12 months compared to their younger age-group 47.8% (33). However, these differences were not statistically significant [Table 1] (P > 0.05). Level of education did not have any impact on the dental visit pattern. The main reason for a dental visit was extraction of the tooth (11%; 27 subjects) followed by restoration and endodontic treatment (6%; 15 subjects) and cleaning of teeth (3.7%; 9 subjects) [Table 1].
Table 1: Distribution of study subjects according to dental visits and reason for seeking care

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The primary reason for not seeking care was the high cost of dental treatment (22%; 54 subjects). Among the female subjects, 19.5% (48), said that they had not visited the dentist because it was difficult to take time off from child care duties [Table 2].
Table 2: Distribution of study subjects according to felt need and reasons for not seeking care

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Among the responders, 67.1% (165 participants) perceived their oral health as poor. Of those above 35 years of age, 79.5% (105) perceived their oral health as poor. As the level of education increased, fewer number of subjects perceived their oral health status as poor. The Chi-square test showed that these differences were statistically significant (P < 0.05) [Table 3].
Table 3: Distribution of study subjects according to perceived oral health

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   Discussion Top


The present study provides an excellent opportunity to understand the pattern of utilization of oral health care by people attending outreach programs.

Dental visits

The results from the study show that utilization of the dental service among adults attending outreach program was very low (28%). This is concordant with reports from China (20%) and Spain (34.3%). [3],[10] In contrast, dental service utilization is high in developed countries, with figures of 75% in the US, 61% in the Danish adult population, 47% in the UK, 56% in Finland, and 43% in Singapore. Health insurance which covers dental services in these countries can be speculated for the high utilization, which is nonexistent in India. Insurance schemes either at micro level or at macro level for oral health services for our population should be considered. [10],[11],[12],[13],[14]

The present study showed no significant difference in the pattern of dental visits between different age-groups. However, there was a tendency for increased visits in the elderly age-group, which is similar to the findings in the report from China. However, other studies have shown the opposite trend in the dental visit pattern. [15] The reasons for such trends are still not clear but it can be speculated that the elderly perceive their health status to be poor compared to younger subjects.

Since Ujjivan members are females, the percentage of female participants was high in this study. The number of dental visits of these females was less than that of males. This is because, in our population, females are largely dependent on other family members, and decisions regarding matters such as visits to the dentists are made by others. On the other hand, women in Western countries are twice as likely as men to use oral healthcare services due to the higher illness perception, higher health consciousness, and greater social role of women in the West. [8],[11]

Though previous studies have shown a positive association of education with dental visits, the present study did not show any impact of education on dental visits. It appears that awareness regarding oral health is low in our population, irrespective of the level of education. [8]

Reasons of health care utilization

The majority of the dental visits by the participants were for tooth extractions or treatment of acute symptoms. This was similar to the study done in Southern China, where the three most common treatments received in the subjects' last dental visits were fillings, extractions, and dental prosthesis. [15] The data from Western studies suggests the main reasons for oral care were dental examination (44.4%), tooth restoration (35.0%), and dental cleaning (32.1%). [8] Similarly, among Finnish adults, 43% of subjects visited the dentist for a dental examination. [12],[13]

The reasons for the poor utilization of dental services seen in this study could be: the existing preventive dental health services, both through the public and the private sector, has failed to reach this population; and the choices for health care are largely determined and conditioned by the social environment in which the individual lives and works. There is no policy or program in our country which focuses in improving the social conditions that determine this behavior. [16]

Assessment of barrier of health service utilization

This study revealed that the high cost of oral health care, and fear of dentists or dental tools were the major barriers for seeking oral health care. This was true for all age group and educational status where as time needed for child care was the major barrier for female subjects. Similar results were observed in a study from Southern China, with financial difficulty and fear of the dentist being barriers for receiving dental care. [15] In the present study, we did not examine the association between income and other dependent variables as all the study participants were from economically disadvantaged backgrounds, with monthly incomes of less than Rs. 5000.

It is important to remove the barrier of high cost of health care by conducting free health camps, which have proved to be effective in screening for diseases and for providing preventive care. A free referral can also be provided to the participants in these camps when necessary.

Perception of oral health status

This study suggests that as age increased, positive perception of oral health decreased. Also noted was that as the education level increased, the perception of good oral health increased.

Community outreach programs provide an opportunity for investigating issues among groups of people who do not utilize dental services, which should help in understanding the barriers to accessing dental care in these populations.

Limitations of the study

The measures of perceived dental care need were subjective, as they were based on the individual's conception of dental health and illness. Thus, dental health perceptions may not only depend on one's sensitivity to signs and symptoms of disease but may also be influenced by one's knowledge of dental health.

Self-reports of utilization of services has a considerable degree of inaccuracy, with a net tendency to overestimate the actual number of visits. It seems advisable to assess the validity of studies based on this measure of utilization carefully.


   Conclusion Top


Utilization of oral health care is an indicator of oral health behavior, with underlying social determinants. Since high cost is one of the main barriers to utilization of oral health care, social and economic upliftment through policies addressing the issues of sickness and rehabilitation benefits, maternity and child benefits, unemployment benefits, housing policies, healthcare facilities, and women empowerment is crucial for the successful delivery of oral health services.

 
   References Top

1.DHHS. Oral health in America: A report of the Surgeon General. [http://www.surgeongeneral.gov/library/oralhealth/] website NIH Publication no. 004713 2000.  Back to cited text no. 1
    
2.Nanda Kishor KM. Public health implications of oral health -inequity in India. J Adv Dent Res 2010;I:OnlineISSN (22294120).  Back to cited text no. 2
    
3.Pizzaro V, Ferrer M. The utilization of dental care services according to health insurance coverage in catalonia spain. Community Dent Oral Epidemiol 2009;37:78-84.  Back to cited text no. 3
    
4.Vargas CM, Ronzio CR. Disparities in Early Childhood Caries. BMC Oral Health 2006;6(Suppl 1):S3. doi:10.1186/1472-6831-6-S1-S3.  Back to cited text no. 4
    
5.Olson DG, Levy RL, Evans CA, Olson SK. Enhancement of High Risk Children's Utilization of Dental Services. Am J Public Health 1981;71:631-4.  Back to cited text no. 5
    
6.Warren JJ, Cowen HJ, Watkins CM, Hand JS. Dental caries prevalence and dental care utilization among the very old. J Am Dent Assoc 2000;131;1571-9.  Back to cited text no. 6
    
7.Bamise CT, Bada TA, Bamise FO, Ogunbodede EO. Dental Care Utilization and Satisfaction of Residential University Students. Libyan J Med 2008;3:140-3. AOP: 080601.  Back to cited text no. 7
    
8.SánchezGarcía S, de la FuenteHernández J, JuárezCedillo T, Mendoza JM. Oral health service utilization by elderly beneficiaries of the Mexican Institute of Social Security in México City. BMC Health Serv Res 2007;7:211.  Back to cited text no. 8
    
9.Vidal A, Nye N. Lessons from the community outreach partnership center program. U.S. Washington, DC: Department of Housing and Urban Development Office of Policy Development and Research; 2002.  Back to cited text no. 9
    
10.Brown LJ, Lazar V. Dental care utilization: How saturated is the patient market? J Am Dent Assoc 1999;130:573-80.  Back to cited text no. 10
    
11.Petersen PE. Dental visits and self-assessment of dental health status in the adult Danish population. Scand J Prim Health Care 1984;2:167-73.  Back to cited text no. 11
    
12.McGrath C, Bedi R, Dhawan N. Factors influencing older people's self reported use of dental services in the UK. Gerodontology 1999;16:97-102.  Back to cited text no. 12
    
13.Murtomaa H. Utilization of dental services by Finnish adults in 1971 and 1980. Acta Odontol Scand 1983;41:65-70.  Back to cited text no. 13
    
14.Lo GL. The use of dental services by adult Singaporeans. Singapore Dent J 1993;18:22-5.  Back to cited text no. 14
    
15.Lo EC, Lin HC, Wang ZJ, Wong MC, Schwarz E. Utilization of dental services in Southern China. J Dent Res 2001;80:1471. http://jdr.sagepub.com/content/80/5/1471.  Back to cited text no. 15
    
16.Watt RG. From victim blaming to upstream action: Tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol 2007;35:1-11.  Back to cited text no. 16
    

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Correspondence Address:
Umashankar Gangadhariah Kadaluru
Department of Public Health Dentistry, MR Ambedkar Dental College, Bangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.111290

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    Tables

  [Table 1], [Table 2], [Table 3]

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