1. EPIDEMIOLOGY OF DENTAL CARIES IN INDIA
BY
Dr. Naseemoon Shaik
III rd year PG
Department of Pedodontics and preventive dentistry
2. Content
• Introduction
• Background demographic features of India
• Dental problems and treatment practices
• Dental caries status and treatment need
• EPIDEMIOLOGY OF DC
• National Oral Health Policy
• Karnataka
• Studies
• Conclusion
• Reference
3. Epidemiology Definition
“The branch of medical science which deals with the
treatment of epidemics.”
-Parkin 1873
“The study of the distribution and determinants of the
disease frequency in man.”
-Mac Mahon 1960
4. Epidemiology can be defined as the study of the distribution
and determinants of health related states or events in
specified population and the application of this study to
control the health problems.”
-John Last 1988
Epidemiology is the study of the distribution and
determinants of health-related states or events (including
disease), and the application of this study to the control
of diseases and other health problems.
5. Aim of Epidemiology?
• To describe size and distribution of the disease
problem in human populations.
• To provide the data essential for the planning,
implementation and evaluation of health services for
the disease and for the setting up of priorities among
those services
• To identify etiological factors in the pathogenesis of
disease
Text book of essentials of preventive and community dentistry: soban peter :4th edition
7. Incidence
Incidence can be defined as the number of new cases of a specific
disease occurring in a defined population during a specified period of
time.
Number of new cases of a specific disease
during a given time period.
Incidence = -------------------------------------------------------------X 1000
The population at risk
Types :
Episode incidence
Cumulative incidence
8. Uses of Incidence Rates
1. Taking action to control the disease
2. Clues to research into etiology and pathogenesis
3. Study of distribution of diseases
4. Evaluating the efficacy of preventive and
therapeutic measures
9. Prevalence
The term ‘disease prevalence’ is used to indicate all
current cases (both old and new) existing in a given
population at a given point in time, or over a period of
time’.
Prevalence is of two types:
Point prevalence
Period prevalence
10. Total number of all current cases (old & new) of a
specific disease at a given point in time
• Point prevalence = ------------------------------------------------------------- X 100
Estimated total population at the same point in time
Total number of existing cases of a specific disease
during a given period of time interval
• Period prevalence = --------------------------------------------------------- X 100
Estimated mid-interval population at risk
13. Rate
A rate is a measure of the frequency with which an event
occurs in a defined population in a defined time
Number of events (deaths or disease) in a specified period
RATE = ---------------------------------------------------------------------------
Population at risk of experiencing the event or disease
14. Ratio
The value obtained by dividing one quantity by another: the male
to female
Numerator not part of the denominator
The number of school children with dental caries at a certain time
Ratio = ------------------------------------------------------------------------------------
The number of school children with gingivitis at a certain time
15. Proportion
Numerator is always part of the denominator.
Proportion=
The number of school children with dental caries at a certain time
--------------------------------------------------------------------------------- x 100
The total number of children in the school at the same time
16.
17.
18. • There are 7 continents and 195 countries in the world today.
19. • Asia is Earth's largest and most populous continent, located
primarily in the eastern and Northen-Hemispheres.
20. • Located in the continent of Asia, India covers 2,973,193
square kilometers of land and 314,070 square kilometers of
water, making it the 7th largest nation in the world with a
total area of 3,287,263 square kilometers.
21. INDIA
India being a country with diverse socio-economic, life style, and dietary characteristics.
22. • It is the 2nd most populated country
in the world
• A/c to 2011 census the population
is 1.2 billion.
• A/c to the 2017 revision of the
World Population Prospects*, the
population stood at 1,3 billion.*
*worlds population prospects :The 2017 revision. ESA.UN.org (custom data acquired via website). United Nations
Department of Economic and Social Affairs, Population Division. Retrieved 10 September 201
28. Climate
• Based on the Köppen system, India
hosts six major climatic subtypes,
ranging from arid desert in the
west, alpine tundra and glaciers in
the north, and humid tropical
regions supporting rainforests in
the southwest and the island
territories.
• The nation has four seasons: winter
(January–February), summer
(March–May), a monsoon (rainy)
season (June–September) and a
post-monsoon period (October–
December)
29. • India is predominantly rural covering about 69% of the
population.
• India accommodates 17.5% of the world’s population, 44%
of its population being in the productive age -2014
30. rice was the staple food of 70 percent
Andhra Pradesh
Assam,
Goa
Jammu and Kashmir
Karnataka
Kerala
Orissa and
Tamil Nadu
31. 80 percent wheat as their staple food
Chandigarh,
Delhi
Gujarat
Haryana
Madhya Pradesh
Punjab
Uttar Pradesh
32. • Nature of food :
• vegetarians and non vegetarian across the country were 59
percent and 41 percent
33. Change in the food habits
• in 1961 the average Indian had a daily calorie intake of 2,010.
Their daily diet consisted of 43% grains (378g), 23% produce
(199g), 12% dairy & eggs (108g), 12% sugar and fat (108g),
2% meat (17g) and 8% as other (68g).
• In 2011 the average Indian had a daily calories intake
of 2,458. Their daily diet consisted of 34% produce (450g),
32% grains (416g), 18% eggs and dairy (235g), 10% sugar and
fat (129g), 2% meat (29g) and 4% as other (58g).
34. • So, what does it all mean?
• The above statistics show that the average Indian is
consuming more calories than they did 50 years ago. India’s
consumption of eggs, dairy and plant produce has increased
more than two-fold in this time. Whilst the average Indian
diet remains primarily vegetarian, the consumption of meat
and animal-based products has also increased. Furthermore,
the consumption of grains has decreased whilst the average
daily sugar and fat intake has also increased.
35. • More recently, the influence of Western products and eating
habits has increased significantly as well as the modernization
and industrialization of food production processes. Particularly in
metropolitan areas and among younger generations, however,
this tradition is slowly changing. Many processed and
convenience foods such as pickles and papads are now easily
available as well as the popularisation of Western foods such as
pizzas, burgers and fries. All such factors are playing their part in
bumping up the national average of fat and sugar.
36. Sugars
• The typical Indian diet consists of foods that are rich in carbohydrates, such
as white rice, potato, white bread, and sugary snacks and beverages.
• One of the most worrisome carbohydrates that we have begun to consume
more than we should is sugar.
• Even though sweet or starchy carbohydrates provide energy to the body,
excessive consumption can lead to various diet-related problems such as
cardiac trouble, obesity, diabetes, tooth decay, metabolic disorders,
nutritional deficiencies and even cancer.
• Over the last five decades, sugar consumption in India has risen from five per
cent of the global production to 13 per cent. India has become the world’s
biggest sugar consumer today, consuming one-third more sugar than the
entire E.U. and 60 per cent more than China.
37. Dental caries
• It is defined as a microbial disease of the calcified tissues of the
teeth characterized by the dimeneralization of inorganic portion
and dissolution of the organic portion of the tooth.”
- Shafer, Hine & Levy
38. Caries in Prehistoric Man 3000-750 BC
• Dental caries may be considered as a disease of modern
civilization, since prehistoric man rarely suffered from this
form of teeth destruction.
39. Anthropologic studies of Von Lenhossek revealed that the dolichocephalic skulls of
men from preneolithic periods (12,000BC) did not exhibit dental caries, but
brachycephalic skulls of the neolithic period (12,000-30,000 BC) contained carious
teeth
NEOLITHIC AGE NEANDERTHAL PERIOD
40. • Over decades, health in India is gaining less importance and
oral health, the least.
• Oral diseases remained still a public health problem for
developed countries and a burden for developing countries
like India especially among the rural population.
• These dental problems are initially painless but become
chronic and self-destructive later, thus leading to gradual
tooth loss.
• The dental caries has a crippling effect on the functional
components of oral cavity that leads to malnutrition because
of incapacity to chew any coarse food available to them.
Unfortunately, this is still not considered a public health
problem and thus no action is taken to correct it
41. Dental workforce
• The dental education came to light for the first time in India in
1920 when the first dental college was opened in 1920.
• Presently, India is ahead in the world with 301 dental colleges,
25 270 BDS and 5014 MDS positions.
Jaiswal, A. K., Srinivas, P. and Suresh, S. (2014), Dental manpower in India: changing trends since 1920. Int Dent J, 64: 213–
218. doi:10.1111/idj.12111
42. •The dentist to population ratio has markedly improved from 1960s when it was
1:301,000
•Dentist to population ratio of 1:10 271 which is less than that recommended by WHO
for rising nations (1:7500).
•The rural dentist to population can roughly be estimated as 1:30,000. This contrasts
with an urban dentist to population ratio of approximately 1:4,000
43.
44. Primary Oral Healthcare
• Not even 20% of the rural PHCs around the country have a dentist.
• The proposed plan of placing no less than a single dental graduate
per PHC to cover 30 000 populations is a practicable goal.
• However, appointing a dental specialist at every community health
centre (CHC) looks like a distant dream as government is struggling
to ascertain CHC’s basic infrastructure and as half of the CHCs are
not functional.
• The CHC should be available for emergency care as well as dental
care.
45. EPIDEMIOLOGY OF DENTAL CARIES IN INDIA
PART- 2
BY
Dr. Naseemoon Shaik
III rd year PG
Department of Pedodontics and preventive dentistry
46. EPIDEMIOLOGYOFDC in india
• Earliest reference of study of D.C. Prevalence, can be traced back
to 1939 when Day and Taylor reported low prev. of D.C. in
children of Kangra valley (part of Northern Punjab – pre
independent)
• 1940 Day and Tandon carried out investigations in another group
of children in Punjab and observed amount of Dental C. present
in Indian children was less as compared to American children.
• 1941 K.L. Shourie conducted a multicentric epidemiological
Investigation for the first time in India .
47. • In India over the last 5 decades a number of point prevalence
studies on dental caries and periodontal diseases have been
conducted.
• A fact emerges from these studies that dental caries has been
constantly increasing both in prevalence and severity over
the last three decades.
• In the years 1940 - 1950 , its prevalence reported has been
40 to 50 percent with an average number of Decayed,
Missing, Filled Teeth (DMFT) in an individual.
EPIDEMIOLOGYOFDC in india
48. STUDIES 1940 -1960
AUTHOUR –
YEAR
Year Place DC PREVALENCE
%
dmft DMFT
SHOURIE KL 1941 DELHI and
central india
58% 5.1
SHOURIE KL 1947 Ajmir (Rural) 21.3 1.63
KOKILA 1951 Gujrath 69%
THAPAR 1953 Moga –
punjab urban
59.11 8.75
CHAWLA &
CHOWDARY
1957 Lucknow 55.95 10.31
49. STUDIES FROM 1960-1980
AUTHOUR Year Place Age group n DC PREVALENCE
%
dmft DMFT
Vacherr,B.R 1962 Amritsar 49.50 9.02
SHOURIE KL 1964 South
India
44.5%
MALVIYA 1967 50.7%
GILL &
PRASAD
1968 Ru .
lucknow
48.0%
NANDA ** 1972 24%
Dutta ** 1972 2.40
Tiwari &
chawla
1977 Chandigar
h
6-16 1517 86.76% 3.42
S. Chandra&
chawla
1979 Lucknow 6.60
A . Tewari&
Chawla
1979 Chandigar
h
72%
50. STUDIES 1980 - 2000
AUTHOUR Year Place AGE GROUP Number
of
subjects
(n)
DC
PREVALE
NCE %
dmft DMFT
Rao N.G et
al
1980 Udaipur 5- 10 yrs 500 5-10 M:3.31
Females:3.2
1.70
1.95
Damle
&Tewari
1982 Haryana –
rural
79.48% 2.50
1982 survey Orissa 28.6%
SAIMBI 1983 Lucknow 3-12 yrs 657 60.4%
Chopra 1983 Amrithsir 6-14 yrs 1500 63.27% 0.62 1.04
Singh S et
al
1985 Fardikot Primaryschool
children
2915 30.63%
51. AUTHOUR Year Place AGE GROUP
(n)
DC PREVALENCE
%
dmft DMFT
Nagaraja Rao 1985 Mysore 5-9(84), 10-
14(327)
5-9: 46%
10-14: 48%
0.72
0.15
0.27
1.07
A.A. Khan ** 1986 60-65%
Gauba K,
Tewari,chawla
1986 Ludhiana 7-17 years
N=1516
7 yrs :61.96 13
yrs :87.95
3.87
Borle et al 1990 Wardha 4-20 yrs
n=1240 ,
6.9%
Rahamathulla 1992 Madras 6,12 , 15
n=1121
6yr: 1.79
12yrs:1.02
15 yrs:1.15
Gaikwad R.S 1993 5-14yrs
n=1995
51.12%
Rao SP 1993 ** 1993 22.8%
Bhowate RR ** 1994 53.50%
Dolwani R et al 1995 Nasik N=8864 64%
**Joyson Moses, et al, Prevalence Of Dental Caries, Socio-Economic Status And Treatment Needs Among School Children.
52. AUTHOUR YEAR Place AGE GROUP
Number of
sub
DC
PREVALENCE
%
dmft DMFT
Chakrobarty M 1997 57.47%
Rodrigues JS 1998 Bhiwandi 12-15 yrs
n=1126
56.93% 1.25
Retnakumari N 1999 Kerala 68.5% 2.73
Mascarenhas A K 1999 Goa 12 yrs
n=1189
81.2%
Gopinath V K et
al
1999 Maduuravoyal -TN 3-6yr,9-12 yrs
n=415
58% M :1.36
F : 1.17
M :1.21
F :1.10
Kurakosi S 1999 57%
Rao S 1999 Moodbidri -kA 5& 12
n=2902
76.9% 2.73 2.06
Singh A.A 1999 Haryana -rural 12-16 yrs
n=1019
39.4% 1.03
Chawla et al., 1999 Chandigarh 5-6, 12 & 15 6.06 1.38
Goel et al 2000 Puttur –KA 5-6,12-13 5-6:81.25% 4.86 1.87
53. Multi centric epi-
investigation
Investigation Years Place Point -- DMFT DMFT
North Shourie K.L. 1941 Delhi and Central
India
58.7 - 5.1%
South Shourie K.L. 1942 Madras 54.07 - 5.2%
North Shourie K.L. No:
6866, age 5-17 yr
1947 Ajmer (rural) 21.53 - 1.63
North Vacher B.R. 1952 Amritsar (Punjab)
–Urban
49.50 - 9.02
North Chawla and
Chaudhary
1957 Moga (Punjab)
Urban
59.11 8.75
West Sehgal, Usha 1960 Lucknow 55.95 - 10.31
South Miglani and Sharma 1963 Bombay 83.53 - 6.45
East Dutta A. 1965 Calcutta 48.2 2.4
South Ramchandran and
Rajan
1973 Madras 66.2-U
47.77-R
5.8
7.8
North Tewari and Chawla 1977 Chandigarh 81.60 3.93
East Mishra F.M. 1979 Orrisa 60.4 11.73
South Nagraja Rao 1980 Karnataka 90.1 4.77
North Damle and Tewari 1982 Hariyana -R 79.48 2.50
North Gawba, Tewari,
Chawla
1986 Ludhiana (R)
Punjab F-0.3,
0.5ppm
87.5 (DMFT + dmft
av-4.4)
West Subnata Shankar 1992 Dum Dum (W. 5.97
56. • An attempt was made to summarize these studies so as to draw a
clear picture of the trends of dental caries in India.
• For this purpose, the country was divided into four regional
zones: North, West, South and East because these regions vary in
their cultural and dietary traditions.
• The epidemiological data will be summarized in two sections.
• 1) Total number of studies carried out in each region with the
prevalence of dental caries among the index age groups of 5-6
years and 15 years and
• 2) The trends of dental caries in a few cities, where studies using
standardized recording criteria (WHO) in the index age groups of
5-6 years and 15 years, over a period of time, are available
Prevalence of dental caries in India – and its trends
Dr. Chawla H.S (Guest editorial ISPPD Dec. 2002)
57. Prevalence of dental caries in India – and its trends
Dr. Chawla H.S (Guest editorial ISPPD Dec. 2002)
North Zone:
No of studies: 23
5-6 YRS: (15 STUDIES):
15-16 YRS:(13 STUDIES ):
Low to very low
East zone:
No.of studies:4
5-6 YRS: (2 STUDIES):
15-16 YRS:(2 STUDIES ):
West bengal,Orissa, Bihar
Decrease in the caries
prevalence rate
West Zone:
5-6yrs: once Mumbai and
Indore in 1985
15 years:
Caries decline
1985(4.7) 1998(1.99)
South zone:
No.of studies:16
KA(8),TN(4),KL(3),AP(1)
5-6 YRS: (9 STUDIES):
CARIES PREVALENCE
LOW TO VERY LOW
15-16 YRS:(5 STUDIES )
CARIES PREVALENCE:
VERY LOW
North East zone:
Caries prevalence in
Meghalaya, Manipur,
Nagaland was low in
15-16ysr,
Assam, Sikkim was moderate.
5-6 yrs: all these states has high
except Sikkim
58. The caries prevalence in India though declined in some parts, has,
by and large, remained stated in most parts ofthe country and
is mainly in the low to very low range.
59.
60. National Oral Health Policy
• Oral health policy in India, formulated way back, is a
miserable picture even today.
• In 1984, national workshops were organized in Bombay on
oral health targets for India and in the year 1986, oral health
policy was conscripted by Indian Dental Association (IDA).
• Based on the recommendation of IDA, 2 more national
workshops were organized, one at Delhi in 1991 and the
other at Mysore after 3 years.*
*Kothia NR, Bommireddy VS, Devaki T, et al. Assessment of the status of national oral health policy in India.
Int J Health Policy Manag. 2015;4(9):575–581. doi:10.15171/ijhpm.2015.137
61. • Through the input of these 2 workshops, national oral health
policy has been developed by Dental Council of India (DCI).
• It is the same time when World Health Organization (WHO)
had given importance to dental health by selecting the
theme “Oral Health for Healthy life” for global health for the
year 1994.
62. • In continuum of this, the core committee appointed by Ministry of
Health and Family Welfare, GoI accepted in principle national oral
health policy as a component of NHP and moved a 10 point
resolution in its fourth conference in the year 1995.
• After 3 years, National Oral Health Care Program (NOHCP), a
project of Directorate General Of Health Services (DGHS) and
Ministry of Health and Family Welfare was initiated and launched
on a pilot basis.
63. • Later the Department of Oral and Maxillofacial Surgery, All India
Institute of Medical Sciences (AIIMS) was given the charge to execute it.
• NOHCP initiated as a “Pilot Project” in 5 states (Delhi, Punjab,
Maharashtra, Kerala, and North Eastern states) in the process of
achieving the goals of national oral health policy.
• Single district from each above-mentioned were selected to trial the
strategies generated through 2 national and 4 regional workshops held
in collaboration with AIIMS, New Delhi, in different areas of the
country.
64. The survey, initiated in 2002, aimed at knowing the ground situation to help
decision-makers formulate policies and programmes to improve the oral
health of the people.
objectives :
(1).awareness and knowledge of people about oral health problems;
(2) current status of oral health problems in the community;
(3) practices people adopt for both prevention and treatment of their oral and
dental problems; and
(4) levels of fluoride in their drinking water across the country.
• The project was reviewed by the National Institute of Health and Family
Welfare in 2004.
65. Sample selection
• Each state was divided into a few homogeneous regions, comprising of a
number of districts, on the basis of agro-climatic factors.
• A three-stage sampling design
The first stage was the random selection of a district from a region.
The second was selection of 15 villages with probability proportional to size (pps) of the
village, and,
finally, selection of 14 households randomly from each selected village.
• In the case of the urban sample of 105 households from a homogeneous region,
eight blocks/wards were randomly selected from the selected district. From these eight
blocks, 15 wards or census enumeration blocks (CEBs) were randomly selected (each CEB
has almost equal population). In the next stage, 7 households were selected from each
CEB. Again, 105 subjects from each age group (5, 12, 15, 35-44 and 65-74) were to be
examined, with males making up half the number, and females the other half.
66. 5, 12, 15, 35-44 65-74 years
315 for each group
Rural 210 Urban 105
ma105 fema105 ma53 fema53
Sample size
67. STUDY TOOLS
• two types of questionnaires/schedules were used in the survey.
One was the WHO schedule on Oral Health Assessment and the
second was an individual questionnaire (specially developed by
the Dental Council of India) for collecting information on
etiologic factors related to oral health awareness, knowledge and
practices of individuals on factors affecting oral health, and their
treatment-seeking behavior
• Data collection:
• A three-day calibration and training workshop
68. • Two types of studies are needed
• One on the incidence and prevalence of oral health problems
and knowledge and practice of people for prevention as well
as treatment of oral health problems.
• Second the existing facilities and infrastructure need to be
assessed for their cost effectiveness and utilisation patterns.
70. Recent affairs
• In 2006, a collaborative program between Gov and WHO was
held and this workshop suggested methods to expand the
role of dental work force in NRHMs(National Rural Health
missions).
• “Model for infant and child oral health promotion” proposed
by Jawdekar in 2013 and “Oral health policy phase 1 for
Karnataka” by Panchmal were among the initiatives towards
national oral health policy.
71. • Oral health policy phase 1 was initiated with an objective to
provide free dentures to the needy senior citizens of
Karnataka who were below poverty line and a draft was
prepared proposing 5 recommendations. It was implemented
in March 2014.
72. Dental problems and treatment practices
5yr old
• 10% responded to the Questioner
No of people reported to have visited dentist during 2002-2003
• 44.6 % the highest reported value was for Assam
• 4.5% in Uttar Pradesh
• 5-15 % for rest of states.
73. • As regards nature of problem 84% in both sexes and more in
urban reported for dental caries
• 15% for gum diseases.
Consulting a trained dentist
• 26.9% had consulted a trained dentist in country
• 10% and below in remaining states
74. • Awareness of availability of dental care facilities19% nation
wide
• 86% highest in Goa
• 35-50% in Jammu Kashmir, Kerala, Madhya Pradesh and
Pondicherrry
• 20-30% in Andhra Pradesh, Haryana, Karnataka, Punjab, Tamil
Nadu and Chandigarh
• 19 % and below in rest
75. • Time taken to reach dental care
• 63% - more in urban responded <30mins
• 34% - more in rural responded 30-60 mins
76. 12yr old
• Total % Suffered from oral health problems last one year :
12.9%.
• Dental caries : 77.6%
Highest dc prevalence in Goa:95.8%
Least in pondicherry :73%
77. • Regarding reason of visit
• 78 % more in urban – dental decay
• 21 % more in rural – gum disease
Of those who has oral health problems on 32% had consulted
a trained dentist (more in Urban )
83% in Delhi ,0% in up
• 60-65 in Jammu Kashmir, Punjab and Pondicherry
78. Awareness of availability of dental care facilities
• 25% in country
• 12% of states and union territories had more percentage of
respondent than national level
Time taken to reach dental care
• 60% - more in urban responded <30mins
• 37% - more in rural responded >60 mins
79. 15yr old
Response
• Suffered from oral health problems last one year is 18% -
more in urban
• 48% in Assam
• 20-30% in Gujarat, Himachal Pradesh, karnataka, Orissa, Goa
and Pondicherry
• 20% or less in remaining states
80. Regarding reason of visit
• 76 % more in urban – dental decay
• chennai:96.9%,orrisa :33.6
• 30 % more in rural – gum disease
• 65% in Chandigarh had gum disease
81. Of those who has oral health problems on 28% had consulted a
trained dentist (more in Rural )
• 75-85 in Jammu Kashmir, Kerala, Chandigarh and Delhi
• 30-40% in Haryana, Karnataka, Maharashtra, TamilNadu,
Pondicherry and Goa
• <20% in rest
82. Awareness of availability of dental care facilities
• 37% in country
• 50% of states and union territories had more percentage
aware of private facilities available
Time taken to reach dental care
• 54% - more in urban responded <30mins
• 44% - more in rural responded >60 mins
83. 35-44yr old
• Suffered from oral health problems last one year is 43% in
country – more in rural and females
• 54-64% in Assam, Himachal Pradesh, Uttar Pradesh
• 40-45% in Andhra Pradesh, Haryana, Karnataka and
Chandigarh
• 35% or less in remaining states
84. Regarding reason of visit
• 70 % both sexes – dental decay assam:94.2%, mp:30%
• 41 % more in rural – gum disease
• 29 % more in rural – foul breath and gum bleeding
• 50% or more in Assam, Gujarat, Madhya Pradesh, Uttar
Pradesh and Delhi had gum disease
• 50-60% in Assam, Himachal Pradesh and Chandigarh had foul
breath.
85. Of those who has oral health problems on 28% had consulted a
trained dentist (more in urban )
• 70-90 in Jammu Kashmir, Kerala, Chandigarh and Delhi
• 40-60% in Haryana, Karnataka, Maharashtra, TamilNadu,
Pondicherry and Goa
86. Awareness of availability of dental care facilities
• 39% in country
• There was large % of respondents than the national average
of awareness in Haryana, Kerala, Madhya Pradesh, Uttar
Pradesh, Goa and Pondicherry
Time taken to reach dental care
• 54% - more in urban responded <30mins
• 46% - more in rural responded 30 >60 mins
87. 65-74yr old
Response
• 45% in country – more in rural
• 50-72% in Andhra Pradesh, Assam, Himachal Pradesh, Uttar
Pradesh
• 22-42% in remaining states
88. Regarding reason of visit
• 60 % both sexes – dental decay
• 58 % both sexes– gum disease
• 37 % more in rural – foul breath and gum bleeding
• 60 % had decay and gum bleeding
89. Of those who has oral health problems on 24% had consulted a
trained dentist (more in urban )
• 70-88 in Jammu Kashmir, Kerala, Chandigarh and Delhi
• 40-45% in Haryana, Karnataka, Maharashtra, TamilNadu,
Pondicherry and Goa
• <3% in Andhra Pradesh and Assam
• 23% in rest
90. Awareness of availability of dental care facilities
• 40% in country (more in urban )
Time taken to reach dental care
• 53% - more in urban responded <30mins
• 45% - more in rural responded 30 >60 mins
91. Dental caries status and treatment need
• Both coronal caries and root caries where recorded
• dmft/DMFT for deciduous and permanent teeth
• Significant Caries Index (SIC)- represented by mean dmft/DMFT
score of one third of population with highest mean dmft/DMFT
score.
• The root caries are accessed for 35-44 and 65-74yr old
92. • Overall the mean number of teeth present in
• older adult 65-74 was 19 indicating lose of 13 teeth
• Younger adults 35-44 was 30
• In children 12 and 15 full dentition was present
• It appeared therefore that there was a rapid loss of teeth beyond
age of 35-44.
• The teeth reported missing in 35-44years were mainly due to
caries while reson other than caries account for majority of lost
or missing teeth in older adult (65-74)
93. • Caries experience was high in all age group surveyed and the
percentage of subjects with caries increased as age advanced
94. • Age 5, 12 and 15 –dmft/DMFT value most prevalent was 1-3
• Age 35-44 - dmft/DMFT value most prevalent was 4-8
• Age 65-74 - dmft/DMFT value most prevalent was 25-32
95. DMFT – 5 YEARS
with caries experience: 50% , with males › females ,rural › urban
Highest goa :86.5% least in rajasthan:24.9%
96. 12 YEARS
Overall with caries experience:52.5% with males › female,
rural › urban
highest in chandigarh:93.4%
least in: rajasthan 36.1%
97. 15 yrs DMFT
With caries experience:61.4% with female › males,
urban › rural
highest chandigarh:96.5%,
RAJASTHAN :39.1%
98. 35-44 YEARS
With caries experience: 79.2%
female › male, urban › rural.
Highest: chandigarh: 97.5%
least in rajasthan :66 %
100. 5yr old
• 39% children had 25% of there teeth caries
affected
• 10.6% had 25-50% teeth affected
• 50% of 52% affected subjects had
experienced caries in one or more but not
more than half of the teeth present.
101. 12 and 15yr old
• 1.8 dmft/DMFT AT 12YRS
• The vast majority had experienced caries in one or more but
not more than one fourth of their teeth
• Almost all of the remaining subjects had experienced caries in
upto one half of their teeth.
• The picture was similar in 35-44 yr old (DMFT -5.4)
102. 65-74 yr old
• The majority had experienced caries in more than half and
almost the whole of their teeth
• DMFT -15
• MT contribute more to the DMFT score.
• FT contribute only negligibly.
There was no gender difference in prevalence
Nor difference in rural and urban population.
103. • In summary therefore , most recorded higher prevalence
than the national average of caries experience across age
group.
• Punjab, Chandigarh and Himachal Pradesh were amongst
worst affected states as far as dental caries prevalence and
mean no of affected teeth were concerned in adults.
106. • Selected districts for survey (4):
• Dharwad –North dry region
• Bangalore –Central region
• Mysuru -South
• Kodagu –Hills &costal region
107. • 31% leave in urban
• 63% in rural
• Monthly expenditure 2500(78% of rural and 47% of urban)
• Hindu 87 %, muslims 10% ,Christians 1.3%
• 7% Scheduled Castes, 3% Scheduled Tribe, 9% Other Back Ward
Castes
• 30% where getting tap water supply
• 55% used tube wells /hand pump(75% in rural and 25% in urban)
• 69% rice as stapled food
• 57% Vegitarian
108. Profile of population
12yr
• 97 % had eduation
15yr
• 95% had literacy (N Dry area had 98%)
• Newspaper reading in 62% (75 urban ,56 rural)
• 77% watched Tv (78 males and 76 females)
109. Oral health knowledge and practices in
karnataka
• Five questions on abnormal habits where
asked
1. Breathing from mouth
2. Habit of sucking or biting fingers or thumb
3. Trusting tongue on teeth
4. Biting nails, lips or objects
5. Grinding teeth
The prevalence was low across all age group
110. 5years 12-15 yrs 35-44years 65-74
Use of tooth brush 61% 68% 63% 38%
tooth paste 57% 56% 59% 41%
Brushing onece a
day
94% 94% 95%
changed toot
brush 1-3 months
43% 45% 44% 44%
changed toot
brush 4-6 months
33% 31% 36% 36%
rinsed their mouth
after meal
20% 34% 44% 82%
Oral hygiene practices among the age groups
124. AUTHOUR YEAR AGE GROUP DC
PREVALENCE
%
dmft DMFT
Patro Bic 2008 2008 82.4%
Sarvanan S 2008 61.3%
Grewal 2009 Nainital
,722,7-12 yrs
77.7% 1.97
Dhar.V 2009 63.20%
Simratvir.M 2009 52.7%
Karim A 2009 85%
**Joyson Moses, et al, Prevalence Of Dental Caries, Socio-Economic Status And Treatment Needs Among School Children.
Journal of Clinical and Diagnostic Research. 2011 Feb, Vol-5(1):146-151150
125. AUTHOUR –YEAR Year Place No.of sub, Age
Group
DC
PREVALENC
E %
dmft DMFT
Ami M Maru et
al,
2012 Gujarath n=189 ,
18-91 yrs
87.5 5.1 + 3.9
Rahul Srivastava
et al
2013 Delhi n=448 sub,60
yrs.
47.1% 14.4.
Vaibhav M et al 2013 Ludiyana 12 , 15 yrs 81.36% 0.89 2.74
Joshi N 2013 Vadodara n=1600,6-12
yrs
69.12% 3.0 0.45
Meenu et al, 2014 Gurgaon n=1003 sub,
5& 12 years
68.5%
37.5%
Ramachandran 2014 Nammakal,TN. n=850,4-6 yrs. 65.88% 2.86
Joyson Mose et
al
2015 Chidambaram n=2362 ,5-15 63.83%
Rahul Bansal 2015 Meerut,UP n=4433, 5-18 30.9%
126. National Oral Health Program(NOHP) July 2015
• The Programme objectives of NOHP are the following :
a) Improvement in the determinants of oral health e.g. healthy diet, oral hygiene
improvement etc and to reduce disparity in oral health accessibility in rural &
urban population.
b) Reduce morbidity from oral diseases by strengthening oral health services at
Sub district/district hospital to start with.
c) Integrate oral health promotion and preventive services with general health
care system and other sectors that influence oral health; namely various National
Health Programmes (National Tobacco Control Program, School Health
Programme, National Program for Prevention & Control of Fluorosis, National
Program for Prevention & Control of CVD, Diabetes & Stroke etc) education, social
welfare, women and child development, etc.
d) Promotion of Public Private Partnerships (PPP) for achieving public health goals
127. AUTHOUR YEAR Place AGE GROUP DC
PREVALEN
CE %
dmft DMFT
Anshul Sachdeva
et al
2015 Haryana n=576
sub,5years
33.85%
P. D. Garkoti 2015 HALDWANI-
Uttarakhand
n=385,1st-5th
standard
58.18%
Jayashri
Prabakar et al
2016 Chandigarh n=4493 ,3-17
yrs
47.3% 1.06 ±
1.995
0.41 ±
1.022
Sagar K 2016 Karnataka n=758,3-6 yrs 62.14% 2.34
Anil kumar 2016 Chhattisgarh n=100 ,5-
75yrs
72%
Deepthi
Athuluru et al
2016 Nellore n=800, 5, 12,
35–44, and
65–74
5: 39.3%
12: 51%
35-44:
64.7%
65-74:
49%
Arthi Veerasam 2016 Tamil nadu n= 974 , 12-15
yrs
61.4% 2.03.
128. AUTHOUR –YEAR Year Place AGE
GROUP
DC
PREVALEN
CE %
dmft DMFT
RaDhey Shyam 2017 Haryana n=586 ,11-
14 yrs
28.6%
K S reddy et al 2017 Mahbubnagar n= 2000,
6-12 yrs
6yrs:64.2
%
12 yrs:
26.6%
1.49 ± 1.56 0.57 ± 1.23
Satish Maran 2017 Bhopal n=1,204
sub, 6-12
yrs
73.17%)
Soumya 2017 Shimoga n=1458
sub, 5- 15
yrs
65.3% 3.36±3.511 1.34±1.832
Gomathy P 2017 Chennai n=357
sub,6-10
yrs
63.9%.
129. IMPLICATIONS FOR PREVENTION AND TREATMENT
1. Sugars : a food policy directed at achieving an annual per
capita sugar intake of 10 kg or less in areas without water
fluoride or fluoride toothpastes is needed.46 In areas with
fluoride, 15 kg of sugar/person/year will ensure a low
prevalence of dental caries.
2. dental check-ups
3. dentists to population ratio.
4. dental health education
130. Conclusion
• Epidemiological data on any disease serve very useful purpose - it
helps in understanding the prevalence of disease in a given
community, age and gender preference/bias, various causative/
modifying factors, and finally in strategic planning to curtail and
prevent the diseases. The oral diseases also have an adverse effect
on the vital organs of the body. incidence of simple oral morbidity
becomes chronic and ultimately life-threatening. One needs not
only to take preventive measures, but early curative steps as well.
It is unfortunate that oral health has received much less attention
perhaps because of its lower life threatening risk. Its role in quality
of life, now, has been recognized and thus all efforts should be
afoot to improve oral health of the people.
131. References
• Text book of essentials of preventive and community dentistry:
soban peter :4th edition.
• Jaiswal, A. K., Srinivas, P. and Suresh, S. (2014), Dental manpower
in India: changing trends since 1920. Int Dent J, 64: 213–218.
doi:10.1111/idj.12111.
• Kothia NR, Bommireddy VS, Devaki T, et al. Assessment of the
status of national oral health policy in India. Int J Health Policy
Manag. 2015;4(9):575–581. doi:10.15171/ijhpm.2015.137.
• National oral health survey 2002-2003.
132. • Reddy KS, Reddy S, Ravindhar P, Balaji K, Reddy H, Reddy A. Prevalence of dental
caries among 6–12 years school children of Mahbubnagar District, Telangana State, India:
A cross-sectional study. Indian J Dent Sci 2017;9:1-7.
• Maran S, Shashikiran ND, Ahirwar P, Maran P, Kannojiya PR, Niranjan B. Prevalence of
Dental Caries and Traumatic Dental Injuries among 6- to 12-year-old Children in Bhopal
City, India. Int J Clin Pediatr Dent 2017;10(2):172-176.
• Maru AM, Narendran S. Epidemiology of Dental Caries among Adults in a Rural Area in
India. J Contemp Dent Pract 2012;13(3):382-388.
• Ramachandran Karunakaran, Sujatha Somasundaram, Murugesan Gawthaman, Selvaraj
Vinodh, Sundaram Manikandan, Subramanian Gokulnathan J Pharm Bioallied Sci. 2014
Jul; 6(Suppl 1): S160–S161. doi: 10.4103/0975-7406.137432
• Joshi N, Sujan S, Joshi K, Parekh H, Dave B. Prevalence, Severity and Related Factors of
Dental Caries in School Going Children of Vadodara City – An Epidemiological Study.
Journal of International Oral Health : JIOH. 2013;5(4):35-39.
Editor's Notes
Epidemic:disease in a community at a particular time
Endemic: regularly found among particular people or in a certain area.
Pandemic: prevalent over a whole country or the world.
The international epidemiological association has listed 3 main aims of epidemiology :
By lowe & kostrzewski 1973
with nearly a fifth of the worlds population.
1st is china 1.4 bilions. 1,324,171,354= 1 billion
100 crores=1 billion or 1000millions
a/c to 2009 it was 68.89 years
Heighest : kerala
Lowest: bihar
or more of Chandigarh, Delhi, Gujarat, Haryana, Madhya Pradesh, Punjab and Uttar Pradesh reported
At around 20 kg, our per capita sugar consumption is still below the global average of 25 kg but is growing at a fast clip. Worldwide, it is recommended that women have no more than six teaspoons of sugar a day and men, nine teaspoons. Since Indians are prone to diabetes, we should restrict intake to five teaspoons of added sugar a day. Some international scientists are now demanding that sugar be regulated in the same way as tobacco and alcohol. Sugar is actually as toxic to the liver as alcohol, which is derived from the fermentation of sugar.
301dental colleges in the country out of which 292 are privately owned and only 40 are run by the government
The surplus production of dental surgeons in the past 10 years made a current figure of 117 825.
The energies, talent and precious time of dental surgeons posted in PHCs and CHCs with limited dental materials is underutilized in some states.
Joyson Moses, et al, Prevalence Of Dental Caries, Socio-Economic Status And Treatment Needs Among School ChildrenAnitha et al 1962 dmft 4.41
Misra and Shee 1979 South Orrisa
Govila 1983, Vaish 1983,orissa
Khera et al 1984, ludiana
e.g. in the cities of Delhi, Chandigarh, Mumbai and Lucknow.
except Kerala(22%) and Goa(28%)
70-74 % in Jammu-Kashmir, Kerala, Punjab and Delhi
35-45% in Himachal Pradesh, Haryana, Karnataka, Chandigarh and Goa.
with caries experience: 50% , males › females, rural › urban .highest punjab:71.5 least in rajasthan:24.9
Overall with caries experience:52.5% males › female, rural › urban , highest in himachal pradesh:72.5% least in: rajasthan 36.1%
With caries experience:61.4% with f › males,urban › rural highest chennai:96.5%, RAJASTHAN :39.1%
With caries experience: 79.2% female › male, urban › rural. Highest: chandigarh: 97.5, least in orissa :69.2
With caries experience:84.7%, females › males, urban › rural : highest in chandigarh:99.7% lowest: madya Pradesh :63.9
dental health education :greatly enhanced if sugar control, sensible use of fluoride and oral cleanliness to reduce
dental health education :greatly enhanced if sugar control, sensible use of fluoride and oral cleanliness to reduce
