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ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 3  |  Page : 130-134

Patterns of dental problems and time gap in utilization of dental services by patients visiting a dental college in North Kerala


Department of Public Health Dentistry, Century International Institute of Dental Science and Research Center, Kasaragod, Kerala, India

Date of Submission10-Jun-2019
Date of Acceptance30-Aug-2019
Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. T Vanishree
Department of Public Health Dentistry, Century International Institute of Dental Science and Research Center, Poinachi, Kasaragod - 671 541, Kerala
India
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DOI: 10.4103/srmjrds.srmjrds_42_19

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  Abstract 

Introduction: Access to dental services is generally regarded as a necessary condition for achieving population-level oral health and well-being. Oral diseases are largely preventable by regular home oral care and preventive dental visits which help in the early detection and treatment of oral diseases. Aim: The objective was to assess the patterns of dental problems and time gap in utilizing dental services. Materials and Methods: A retrospective study was conducted on outpatients who visited Century Dental College, Kasaragod, Kerala, for duration of 6 months from July 2017 to December 2017. The data were collected from medical records from the outpatient department. Descriptive statistics were used to analyze the data. Results: A total of 2593 cases were analyzed. The mean age was 35.66 ± 13.2 years. The most common dental problem reported was decayed teeth (29.3%) followed by dental pain (23.5%) and deposits on teeth (14.4%). Only 3.98% of the patients visited immediately the next day as soon as they noticed black discoloration and/or informed about their decayed tooth. Males reportedly approached the college more than females for most of the chief complaints except for replacement of missing teeth. Conclusions: The most common dental problem reported was decayed teeth followed by dental pain and deposits on teeth. Only 3.77% of the patients reported for a routine dental checkup. Twelve percent of patients reported immediately the next day after experiencing dental pain. Most of the participants visit a dentist only if they had a problem.

Keywords: Dental problems, dental visit, utilization


How to cite this article:
Shekhawat KS, Dinatius P, Vanishree T, Thasneem C B. Patterns of dental problems and time gap in utilization of dental services by patients visiting a dental college in North Kerala. SRM J Res Dent Sci 2019;10:130-4

How to cite this URL:
Shekhawat KS, Dinatius P, Vanishree T, Thasneem C B. Patterns of dental problems and time gap in utilization of dental services by patients visiting a dental college in North Kerala. SRM J Res Dent Sci [serial online] 2019 [cited 2019 Nov 21];10:130-4. Available from: http://www.srmjrds.in/text.asp?2019/10/3/130/269215


  Introduction Top


Oral health is a key indicator of overall health, well-being, and quality of life. WHO defines oral health as a state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual's capacity in biting, chewing, smiling, speaking, and psychosocial well-being.[1] Oral health problems not only cause pain, agony, functional, and esthetic problems but also lead to the loss of working man-hours. Hence, in the long run, they are bound to have a significant impact on our economy. It is estimated that about 50% of school children are suffering from dental caries, and ≥90% of the adult population is affected by periodontal disease.

Oral diseases remained still a public health problem for developed countries and a burden for developing countries such as India, especially among the rural population. India is predominantly rural covering about 69% of the population. Prevalence of oral diseases is very high in India with dental caries (50%, 52.5%, 61.4%, 79.2%, and 84.7% in 5, 12, 15, 35–44, and 65–74 years of age, respectively) and periodontal diseases (55.4%, 89.2%, and 79.4% in 12, 35–44, and 65–74 years of age, respectively) as the two most common oral diseases.[2]

Sometimes, dental care is not considered within the boundaries of a healthy lifestyle, and its importance is often neglected. Healthy teeth can last for a lifetime if proper preventive care is taken regularly. Oral health literacy is interplay between culture and society, the health system, education system, and oral health outcomes indicating that it may be a new determinant of oral health and should be considered more intensively in oral health research. Knowledge of oral health is considered to be a prerequisite for health-related behavior.[3]

Access to dental services is generally regarded as a necessary condition for achieving population-level oral health and well-being. Oral diseases such as dental caries, periodontitis, and oral cancer are major public health problems in low-income countries, and the burden of oral diseases is growing in many low- and middle-income countries.

People in India have lower dental care utilization, higher rates of dental caries, periodontal diseases, and permanent loss of tooth at an earlier age than the population of developed countries for many reasons. Oral diseases are largely preventable by regular home oral care and preventive dental visits which help in the early detection and treatment of oral diseases. However, the provision of preventive dental care for adults depends on each patient's initiatives in utilizing dental care.[1]

The American Dental Association recommends that adults consult a dentist at least once every 6 months, and this is based on the belief that dentists cannot only treat the existing problems but that regular dental visits are necessary for the maintenance of healthy gums and teeth. Although in India, dentists recommend regular dental visits, many people fail to comply with this due to several barriers that exist for the utilization of dental services. Limited knowledge about dental health, ineffective education and motivation, limited availability of dental care, and lower economical conditions are few among them. Dental indifference has been found to be associated with poorer oral health and nonattendance, as well as usually visiting for a problem rather than a checkup.[4]

In the present study, we have assessed the patterns of dental problems and time gap in utilization of dental services by patients visiting a dental college in North Kerala. Understanding factors that initiate and hinder dental service use is necessary if decision makers are to develop policies that adequately address these issues. In this direction, utilization studies serve as an important tool for oral health policy decision-making and understanding oral health-related behavior.


  Materials and Methods Top


Methodology

A retrospective study was conducted for cases reporting to Century Dental College, Kasaragod, Kerala, for duration of 6 months from July 2017 to December 2017, for which the medical records department was contacted for retrieval of outpatient department (OPD) files.

Selection of OPD files was subject to the list of inclusion and exclusion criteria which were prepared previously. Only new cases reporting for the first time and patients with permanent dentitions were included. Patients recalled for any follow-up treatment and patients visiting for the second time were excluded. The total number of new OPD cases reporting to Century Dental College, Kasaragod, Kerala CIIDS in-between July 2017 and December 2017 was obtained, and 25 cases/day were randomly selected from the same. Therefore, a total of 2593 cases were included in the present study. The OPD files were included on the basis of the chief complaint reported by the patient. The chief complaint was considered only when it was accompanied with duration. Data on their age, gender, religion, and alcohol and tobacco consumption were also recorded.

The chief complaints and the duration were coded separately. The time duration with the chief complaint was categorized as having reported after 1 day, within 1 week, after 1 week, after 2 weeks, after 3 weeks, after 1 month, between 2 and 6 months, between 6 months and 1 year, and after 1 year. The chief complaint was coded for various dental problems as reported by the patients. For the second objective of the study, we decided to include five common complaints reported by patients to determine after how long the patients decide to visit a dentist albeit knowing their compliant.

All the data were entered in the Microsoft Excel Sheet 2010 (Microsoft Corp.) and analyzed for descriptive statistics using Statistical Package for Social Sciences (SPSS version 15.0, IL, USA).


  Results Top


A total of 2593 OPD cases were finally selected and analyzed. The mean age was 35.66 ± 13.2 years. Males were more in number (58.2%) than females, and majority of patients were Muslims followed by Hindus. Fifteen percent reportedly consumed tobacco and 2.4% consumed alcohol. Majority of the study participants were in the age group of 25–34 years (29.6%; 769/2593) followed by 15–24 years (23.5%; 612/2593) [Table 1]. The most common dental problem reported was decayed teeth (29.3%; 761/2593) followed by dental pain (23.5%; 611/2593) and deposits on teeth (14.4%; 374/2593) [Figure 1]. Only 3.77% of the patients reported for a routine dental checkup. The distribution of five most commonly reported chief complaint is provided in [Figure 2]. Males reportedly approached the college more than females for most of the chief complaint except for replacement of missing teeth.
Table 1: Distribution of study participants according to age, gender, and religion

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Figure 1: Distribution of commonly reported dental problems by patients visiting CIIDS

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Figure 2: Distribution of most commonly reported dental problems according to gender

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Decayed tooth

The most common complaint reported by patients was decayed tooth, and males were more in proportion than females. About 22.8% (174/761) of patients reported to dentist after waiting for almost 2–6 months followed by 17.8% (137/761) who reported after a time gap of 6 months to 1 year. Surprisingly, 23.3% (178/761) of the patients approached a dentist after ≥1 year. Only 3.98% of the patients visited CIIDS immediately the next day as soon as they noticed black discoloration on their teeth and/or informed about their decayed tooth [Figure 3].
Figure 3: Distribution of study participants reporting with decayed tooth according to time period

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Dental pain

The second most common dental complaint was dental pain which was comparatively higher in males than females. About 34.5% (211/611) of the patients reported after almost 2–6 months followed by about 21% (133/611) who approached after 1 month. About 12% (74/611) of patients reported immediately the next day after experiencing dental pain [Figure 4]. Dental deposits overall 14.4% reported to the college with the chief complaint of deposits. Proportion of males (72.4%; 271/374) reporting was more than females. About 39% (147/374) of patients waited for almost a year before approaching a dentist followed by 24.8% (93/374) who approached a dentist after 2–6 months [Figure 4].
Figure 4: Distribution of study participants reporting with dental pain according to time period

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Fractured restoration and deposits

About 8.7% of patients complained of fractured restoration. This complaint was more reported among males (57%; 129/226) than females (43%; 97/226). About 31% (71/226) reported with this complaint after 2 months and within 6 months of occurrence followed by 24% (55/226) who reported after 1 month. Only 3.9% (9/226) reported to the college after 1 day [Figure 5] and [Figure 6].
Figure 5: Distribution of study participants reporting with deposits according to time period

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Figure 6: Distribution of study participants reporting with fractured restoration according to time period

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Missing teeth

About 6% (157/2593) reported with chief complaint of missing teeth. Females (53.3%; 84/157) reported more than males. About 15.9% (25/157) approached for replacing their missing teeth after 2 months–6 months, and about 26% (41/157) approached after waiting for ≥1 year.


  Discussion Top


A total of 2593 OPD cases were finally selected and analyzed. The mean age was 35.66 ± 13.2 years. Males were more in number (58.2%) than females, and majority of patients were Muslims followed by Hindus. Fifteen percent reportedly consumed tobacco and 2.4% consumed alcohol. Majority of the study participants were in the age group of 25–34 years (29.6%; 769/2593) followed by 15–24 years (23.5%; 612/2593). The most common dental problem reported was decayed teeth (29.3%; 761/2593) followed by dental pain (23.5%; 611/2593) and deposits on teeth (14.4%; 374/2593). Only 3.77% of the patients reported for a routine dental checkup. Males reportedly approached the college more than females for most of the chief complaint except for replacement of missing teeth.

The major concern in this study was to investigate the patterns of dental problems and time gap in utilizing dental services. In our study, only 3.77% of the patients reported for a routine dental checkup. The results of a retrospective study conducted to evaluate the type of patients, disease pattern, and services rendered in dental outreach programs in rural areas of Haryana, indicated that utilization of dental services was found to be more in females than in males.[5]

Whereas, in our study, males reportedly approached the college more than females for most of the chief complaint except for replacement of missing teeth. Edentulism affects the quality of life of the individuals in a multitude of ways. As could be anticipated, lack of required dental care leads to the eventuality of edentulism. There could be many reasons for not seeking required care, one of which could be not realizing the requirement of care itself.[6]

The utilization of dental services was found to be influenced by the sociodemographic characteristics of the population such as age, education, and occupation.

There is a need to motivate people giving them information while paying attention to the individual reasons which restrict their behavior.

Most common complaint reported in our study was decayed teeth. Surprisingly, 23.3% (178/761) of the patients approached a dentist after ≥1 year. Only 3.98% of the patients visited CIIDS immediately the next day as soon as they noticed black discoloration on their teeth and/or informed about their decayed tooth. In a study conducted by Wu on Chinese elderly in 2007, it was observed that only 3.4% of the rural elderly had a dental visit in the past 1 year.[7]

In a study by Subramani and Nagappan, 44% of the study participants had no history of dental visit; this status is attributed to the negligence in oral healthcare, and people tend to visit dental setup only in cases of emergencies and not for preventive dental care needs. In our study patients had mainly visited for toothache (39.7%); similar to the studies reported by Subramani et al.[8] Dental pain adversely affects the quality of life, normal functioning, and daily living of people, and most dental visits are aimed at immediate relief of pain.[8]

In our study, the most common dental problem reported was decayed teeth (29.3%) followed by dental pain (23.5%) and deposits on teeth (14.4%). About 34.5% (211/611) of the patients reported after almost 2–6 months followed by about 21% (133/611) who approached after 1 month. About 12% (74/611) of patients reported immediately the next day after experiencing dental pain.

In a study conducted by Gupta et al., pain was the major reason for the last dental visit among 89.97% of the study participants.[9] Similar results were seen in the studies reported by Subramani et al.[9] In developing countries such as India, cost of the treatment is a very important factor that effects the oral health-care utilization. Low income or low educational qualification has for a long time been well recognized as a barrier to utilization of oral health care.

In our study, overall 14.4% reported to the college with chief complaint of deposits. Proportion of males (72.4%; 271/374) reporting was more than females. About 8.7% of patients complained of fractured restoration. This complaint was more reported among males (57%; 129/226) than females (43%; 97/226). About 6% (157/2593) reported with chief complaint of missing teeth. Females (53.3%; 84/157) reported more than males.

While our study provides important information, there are some limitations. The reason for delay in utilization of dental services was not recorded. The utilization of health services is assessed by means of self-reporting, which could affect the validity of the information as the respondents may have difficulty recalling exact attendance.

However, according to Gilbert et al., this method is sufficiently valid for most important research questions.[10]


  Conclusions Top


The most common dental problem reported was decayed teeth followed by dental pain and deposits on teeth. About 22.8% of patients reported to dentist after waiting for almost 2–6 months after noticing the decayed tooth, whereas 34.5% of the patients reported after almost 2–6 months for the complaint of dental pain. Oral health beliefs have been shown to affect oral health outcomes. Further research is essential to adequately understand the factors that limit the utilization of dental care services among the urban and rural population. Most of the participants visit a dentist only if they had a problem. Hence, there is need to educate the general population regarding the importance of oral health maintenance and routine dental visits.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. World Oral Health Report 2003. World Health Organization; 2003. [Last accessed 2019 May18].  Back to cited text no. 1
    
2.
Ramandeep G, Arshdeep S, Vinod K, Parampreet P. Oral health literacy among clients visiting a rural dental college in North India-a cross-sectional study. Ethiop J Health Sci 2014;24:261-8.  Back to cited text no. 2
    
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Gambhir RS, Gupta T. Need for oral health policy in India. Ann Med Health Sci Res 2016;6:50-5.  Back to cited text no. 3
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4.
Rambabu T, Koneru S. Reasons for use and nonuse of dental services among people visiting a dental hospital in urban India: A descriptive study. J Educ Health Promot 2018;7:99.  Back to cited text no. 4
    
5.
Vashisth S, Gupta N, Bansal M, Rao NC. Utilization of services rendered in dental outreach programs in rural areas of Haryana. Contemp Clin Dent 2012;3:S164-6.  Back to cited text no. 5
    
6.
Bommireddy VS, Koka KM, Pachava S, Sanikommu S, Ravoori S, Chandu VC. Dental service utilization: Patterns and barriers among rural elderly in Guntur district, Andhra Pradesh. J Clin Diagn Res 2016;10:ZC43-7.  Back to cited text no. 6
    
7.
Wu B. Dental service utilization among urban and rural older adults in China – A brief communication. J Public Health Dent 2007;67:185-8.  Back to cited text no. 7
    
8.
Subramani P, Nagappan N. Perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services at peripheral medical centre: Poonjeri, Mamallapuram, India. J Dent Res Rev 2017;4:58-62.  Back to cited text no. 8
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9.
Gupta S, Ranjan V, Rai S, Mathur H, Solanki J, Koppula SK. Oral health services utilization among the rural population of Western Rajasthan, India. J Indian Acad Oral Med Radiol 2014;26:410-3.  Back to cited text no. 9
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10.
Gilbert P, McEwan K, Matos M, Rivis A. Fears of compassion: Development of three self-report measures. Psychol Psychother 2011;84:239-55.  Back to cited text no. 10
    


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