See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/282352725

Community-based Oral Health Education Program in a Rural Population of

Haryana: A 25 years Experience

Article  in  Journal of Postgraduate Medicine Education and Research · September 2015

DOI: 10.5005/jp-journals-10028-1156

CITATIONS READS
0 582

4 authors, including:

Ashima Goyal Krishan Gauba

Postgraduate Institute of Medical Education and Research Postgraduate Institute of Medical Education and Research
131 PUBLICATIONS   1,611 CITATIONS    74 PUBLICATIONS   1,102 CITATIONS   

SEE PROFILE SEE PROFILE

Utkal Mohanty
Indian Ministry of Health & Family Welfare
13 PUBLICATIONS   119 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Case report Dentigerous Cyst View project

ICMR Criteria for Dental Fluorosis Research Article View project

All content following this page was uploaded by Ashima Goyal on 05 January 2016.

The user has requested enhancement of the downloaded file.

 Jpmer
jpmer

10.5005/jp-journals-10028-1156
Community-based Oral Health Education Program in a Rural Population of Haryana: A 25 years Experience
Research Article

Community-based Oral Health Education Program in a

Rural Population of Haryana: A 25 years Experience
1
Ashima Goyal, 2Krishan Gauba, 3Utkal Mohanty, 4Amrit Tewari

ABSTRACT out of pocket expenditure incurring toward treatment of these

diseases.
Background: An Indian Council of medical Research (ICMR)
task force project was started in 1985 covering a population of Keywords: Caries, Caries activity, Oral health promotion, Oral
120,000 of Raipur Rani block of Haryana to study the feasibility hygiene, Quality of life.
of implementation of oral health promotion and prevention in the How to cite this article: Goyal A, Gauba K, Mohanty U, Tewari A.
community and in the schools by utilizing existing manpower Community-based Oral Health Education Program in a Rural
at different sectors. Population of Haryana: A 25 years Experience. J Postgrad Med
Edu Res 2015;49(3):101-104.
Objectives: (i) To evaluate the long-term role of healthcare
workers in imparting primary preventive strategies of oral health Source of support: Funded by Indian Council of Medical
to adult community (ii) To study the knowledge, attitude and Research.
practice of the community regarding oral health. Conflict of interest: None
Methodology: A total of 600 households (300 in experimental
block and 300 in control block) were included by stratified ran- introduction
dom sampling method depending on the distance from Com-
munity Health centre of Raipur Rani to assess KAP and Caries In a developing nation like India the burden of non-
activity among the population. communicable diseases including oral diseases are on
rise in addition to the existing burden of communica-
Results: The use of toothbrush as an oral hygiene method is
being practiced by 96.6% of population in the experimental area ble diseases.1 Common oral diseases like dental caries
compared to 84% in the control population where no oral health (50–60%) and periodontitis (80–90%) affect majority of
promotion activity was carried out. A great variation was seen the population2 and also share common risk factors with
in the frequency of its usage; 56% of the population in experi- chronic diseases like CVD, diabetes, etc.3-5 Oral diseases
mental area brushes twice per day compared to 7% of control
are expensive to treat and consume a lot of clinical time.
area. According to the present data, 80% of the population in
the experimental area is aware about the etiology, progress In our country where oral healthcare facilities in public
and consequences of gum diseases due to continuous oral health set up are either nonexistent or existing with a very
health education delivered by the trained health staff during limited spectrum of services, majority of the population
their routine beat program. In the control area where no oral receives treatment by out of pocket expenditure. In the
health program was implemented, this knowledge was seen in above vignette it is imperative to strengthen community-
22 to 35% of the population.
based oral health promotion to prevent and reduce the
Conclusion: In a developing country like India there is a press- burden of oral diseases. Therefore, an ICMR task force
ing need of community-based oral health programs to reduce project was started in 1985 covering a population of
the burden of oral diseases, improve quality of life and reduce
120,000 of Raipur Rani Block of Haryana (Experimental
Area, EA) to study the feasibility of implementation of oral
1
health education in the community through trained health
Professor, 2Professor and Head
3 workers. The Sidhaura block was taken as Control Area
Ex-Senior Resident, 4Emeritus Professor
(CA) where no oral health program was implemented
1,4
Department of Oral Health Sciences Centre, Postgraduate
by the investigators. In 1987, the project staff trained the
Institute of Medical Education and Research, Chandigarh, India
existing health workers, health assistants, multipurpose
2
Department of Pedodontics and Preventive Dentistry, Chair
workers of CHC of the experimental area in primary pre-
Oral Health Sciences Centre, Postgraduate Institute of Medical
Education and Research, Chandigarh, India ventive strategies of oral health, who further imparted
3 lectures on oral health to the community on a regular
Department of Community and Preventive Dentistry, Oral
Health Sciences Centre, Postgraduate Institute of Medical basis making oral health education a part and parcel of
Education and Research, Chandigarh, India their routine program. The health workers were given
Corresponding Author: Ashima Goyal, Professor, Department training manuals for their reference and standardized
of Oral Health Sciences Centre, Postgraduate Institute of oral health education material for training the community
Medical Education and Research, Chandigarh, India, Phone: during their routine beat program. The project staff was
01722756833, e-mail: [email protected]
withdrawn from the field area in 1990 and subsequently
Journal of Postgraduate Medicine, Education and Research, July-September 2015;49(3):101-104 101
Ashima Goyal et al

the health workers were made responsible for delivering samples for Snyder test6 and how to record the color
lectures to community on a routine basis. Since then the changes in Snyder media tubes at different time intervals
project has been running by self rhythm, being continu- after incubation.
ously monitored by faculty and a social worker of the
oral health sciences centre, PGIMER. Preparation and Recording of Snyder Test
Snyder media was prepared and autoclaved in the micro-
Objectives biology department of the institute. Out of the prepared
• To evaluate the long-term role of healthcare workers Snyder media tubes, one tube was incubated for 24 hours
in imparting primary preventive strategies of oral to check for any microbial growth in order to ensure steri-
health to adult community as a result of training lization of the media. The Snyder tubes were carried into
imparted to them by trainers (dentists). the field area in an icebox for collection of saliva samples
• To study the present knowledge, attitude and practice from each adult recorded for KAP. The tube was initially
(KAP) of the community regarding oral health as a rolled between hands to bring its temperature close to
result of implementation of primary preventive oral the body temperature followed by flaming the rim after
health education program through multipurpose opening its cap and drooling unstimulated saliva into it
workers almost 25 years ago and also comparison in amount sufficient to cover the upper surface of the me-
with the baseline values at that time. dia. The rim of the tube was re-flamed and cap replaced.
• To compare the knowledge, attitude and practice of
adult community of the experimental and control Transportation and Evaluation of Snyder tubes
areas to assess the long-term effectiveness/role of The tubes were labelled as to the name of the individuals
health workers in imparting oral health education to and the date of collection and put into an icebox. At the
adult community during their routine beat program end of the day, the icebox was transported to the CHC
in the experimental area. where the media portion of these tubes containing saliva
were divided into four parts and incubated at 37°C. The
Methodology color changes occurring within the media after time
The KAP survey was carried out in the community intervals of 24, 48, 72 and 96 hours were noted. If the
to elicit information on their knowledge, attitude and color changed from green to yellow in 1/4th portion of
practice on the various aspects of oral health. A total of the tube, it was marked as 1+ and accordingly the color
600 households (300 in experimental block and 300 in change in half portion of the tube was marked as 2+, in
control block) were included with stratified sampling 3/4th of the tube as 3+ and full media color change was
design. The stratification was carried out on the basis denoted as 4+. The readings of the Snyder media were
of distance from community health center (CHC). evaluated per person and finally the individual was
Three strata were taken viz. ≤ 5 km, 5 to 10 km and categorized as having high, moderate, low and very low
> 10 km from the CHC of the experimental and control dental caries activity.
blocks. A total of 100 households belonging to 4 to
Results
5 villages were included per strata i.e. 100 from ≤ 5 km,
100 from 5 to 10 km and 100 from >10 km. The villages Oral Hygiene Measures
were selected using systematic random sampling tech-
At the baseline evaluation (1985), 35.5% of the community
nique. From each household, all the available family
in EA used tooth brush as oral hygiene measure, com-
members were interviewed for KAP and saliva samples
pared to 34.4% in the CA. Use of tooth brush increased
were collected of each member for estimation of the
to 84% in experimental area and 61% in control area, 3
Snyder test. The selection criteria followed 25 years post years after intervention of oral health education program
implementation was the same as followed and approved in experimental area (1990), after which the project staff
by ICMR in 1985. The changes in KAP about oral health was withdrawn and the program ran with self rhythm.
and Snyder test of the adult community of the experi- After a gap of 25 years, it is seen that 96.6% of commu-
mental and control blocks was evaluated using a specially nity of EA and 85.4% of the community of CA are using
prepared KAP proforma. brush for cleaning their teeth. The frequency of twice/
day brushing was seen in 7% of population at baseline
Standardization of personnel
which has increased to 56% at present in the EA. Similarly
The social worker was trained in the collection of the 0.8% of community was brushing twice daily at baseline
KAP data, filling up of the proformas, collection of saliva in the control area compared to 7% at present (Graph 1).

102
 Jpmer

Community-based Oral Health Education Program in a Rural Population of Haryana: A 25 years Experience

Knowledge about Dental Plaque and Calculus Thumb Sucking and Mouth Breathing
There was complete ignorance regarding dental plaque Knowledge regarding harmful effects of thumb sucking
and calculus among the population in both EA and CA at was known to only 4% population of EA and 0.3% popu-
baseline. Though the present data show that 70% popu- lation of the CA at base line. At present, 85% of the EA
lation in EA, and 6% population in CA know about dental population is aware about harmful effects of thumb suck-
plaque. Similarly 39% of the population of EA now have ing. Knowledge about harmful effects of mouth breathing
the knowledge regarding dental calculus which was was negligible in the community of both EA and CA at
negligible at base line (Graph 2). the baseline compared to 51% population of EA and 1.3%
of the CA according to the present data (Graph 3).
Knowledge about Gum Diseases
Snyder Test Evaluation
At the base line, knowledge regarding etiology and
progress of gum diseases was negligible in both experi- Susceptibility to dental caries has shown a declining
mental and control areas. The awareness increased signi- trend in EA. Baseline data in 1985 showed that 17% of
ficantly in experimental area on both these aspects, 3 years the population was at very high risk and 29% had no risk
after implementation of the oral health education pro- of developing dental caries. These values have changed
gram. According to the present data, 80% of the popula- to 5% population at very high risk and 50% at no risk of
tion of the EA and about 22 to 35% population of the CA developing dental caries 25 years after implementation
is aware about gum diseases (Graph 2). of the program in the area. The caries activity in CA has

Graph 1: Use of toothbrush as a method of oral hygiene practice Graph 2: Knowledge about common causes of gum diseases
among the population among the community

Graph 3: Knowledge about harmful effects of thumb sucking and Graph 4: Caries risk among the community as per Snyder
mouth breathing test evaluation

Journal of Postgraduate Medicine, Education and Research, July-September 2015;49(3):101-104 103

Ashima Goyal et al

also shown a declining trend but to a lesser extent than Conclusion

the experimental area. At the baseline 38% had very high
The above data clearly reveals that the health workers
caries risk compared to 16% at present. However, there
in rural areas of Haryana are a viable means of imple-
has been no change in terms of the values observed for
menting oral health education program in the commu­-
no caries risk in the CA population (Graph 4).
nity. Once trained, they deliver the oral health education
to the adult community on a regular basis. The results of
Discussion
the present project clearly emphasize that the oral health
The increase in the use of toothbrush in the EA can be education imparted by the trained health workers on a
attributed to frequent oral health education sessions at regular basis was retained and practiced by the community
village level by the trained health workers, Aanganwadi even 25 years after the implementation of the oral health
Workers (AWWs), Auxiliary Nurse Midwife (ANMs), etc. education program in the experimental block of Raipur
during these 25 years. The knowledge of EA community Rani, Haryana.
can be ascribed to the continuous oral health education
lectures delivered by the trained health staff during their acknowledgment
routine beat program which shows that the program is
This research was supported by an ICMR grant to Oral
running by self rhythm. Such a program was however not
Health Sciences Center, PGIMER, Chandigarh (2011-2014).
implemented in the CA. It may be inferred that marginal
increase in twice daily brushing frequency of the control References
area could be due to dissemination of information through
1. Narayan KMV, Ali MK, Koplan JP. Global non-communicable
TV programs, radio and other means of communication.
diseases where worlds meet. N Engl J Med 2010;363(13):
These findings are in agreement with the findings of John 1196-1198.
R Greene.7 Knowledge about dental plaque and calculus 2. National Oral Health Survey and Fluoride mapping 2002-2003
increased among the population of experimental area after India, Dental Council of India, New Delhi.
the community-based program in 1987 was started but 3. Grossi SG, Genco RJ. Periodontal disease and diabetes
mellitus: a two-way relationship. Ann Periodontol 1998;3(1):
gradually it has deteriorated over the years and needs to be
51-61.
stressed upon even in the experimental area. In the control 4. Kinane DF. Periodontal diseases contributions to cardiovas-
area, knowledge on this aspect is nonexistent. These find- cular disease: an overview of potential mechanisms. Ann
ings are in agreement with the study by Tolvalen et al.8 Periodontol 1998;3(1):142-150.
Awareness regarding the thumb sucking and mouth 5. Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G,
breathing was found to be higher in EA compared to CA et al. Periodontal infection as a possible risk factor for preterm
low birth weight. J Periodontol 1996;67(10):1103-1113.
which may be due to the pictorial description of thumb
6. Snyder ML. A simple colorimetric method for the estimation
sucking and its effects on definition as detailed in the oral of relative numbers of lactobacilli in the saliva. J Dent Res
health education album provided to health workers and 1940;19:349-355.
school teachers for regular use. In control area, as per the 7. John RG. Oral health promotion can be effective in changing
present data, 26% have this knowledge. Though change knowledge. Evidence Based Dentist 1998;1(1):12.
8. Tolvanen M, Lahti S, Hausen H. Changes in tooth brushing
in level of knowledge has been demonstrated in this study
frequency in relation to changes in oral health-related knowl-
it may not be feasible to transform it in to behavior every edge and attitudes among children: a longitudinal study. Eur
time as per the systematic review by Kay et al.9 There was J Oral Sci 2010;118(3):284-289.
a decrease in prevalence of very high caries risk indivi­ 9. Kay E, Locker D. A systematic review of the effectiveness of
duals in the experimental area from 17 to 5% which may health promotion aimed at improving oral health. Community
Dent Health 1998;15(3):132-44.
be attributed to improved routine oral hygiene methods,
10. Vanobbergen J, Declerck D, Mwalili S, Martens L. The
use of fluoridated tooth paste, change in the dietary habits, effectiveness of a 6-year oral health education programme
etc. In a similar study by Vanobbergen J et al, measurable for primary schoolchildren. Community Dent Oral Epidemiol
changes in oral health were not found.10 2004;32(3):173-182.

104

View publication stats