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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 26  |  Issue : 4  |  Page : 410-413

Oral health services utilization among the rural population of western Rajasthan, India


1 Department of Oral Medicine and Radiology, Vyas Dental College and Hospital, Jodhpur, India
2 Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
3 Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
4 Department of Public Health Dentistry, Vyas Dental College and Hospital, Jodhpur, India
5 Department of Oral Medicine and Radiology, Hazaribag College of Dental Sciences, Hazaribag, Jharkhand, India

Date of Submission22-Sep-2014
Date of Acceptance23-Feb-2015
Date of Web Publication22-Apr-2015

Correspondence Address:
Sarika Gupta
Department of Oral Medicine, Radiology and Diagnosis, Vyas Dental College and Hospital, Kudi Haud, Pali Road, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.155688

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   Abstract 

Introduction: The greatest burden of oral diseases is on the disadvantaged and socially marginalized populations. In developing countries like India, the availability and accessibility of oral health services in rural areas are limited, and the provision of oral health care is also very limited. Aims and Objectives: To assess the factors affecting the utilization of oral health services among the rural population of western Rajasthan, India. Materials and Methods: A structured self-administered questionnaire was employed as the instrument for data collection. Study was carried out for a period of 1 year in the rural areas of western Rajasthan, India. A total of 5476 people were selected. The questionnaire was explained to all the participants before the distribution, and the participants returned questionnaires after it was completed. Results: Among the total study group of 5476 subjects, 3934 were males and 1542 females. The study group was divided into five equal age groups from 20 to 60 years and above. It was found that 31.57% were illiterate and only 1.53% were graduates. One thousand, four hundred and thirty-six participants (26.22%) stated that cost of dental treatment was the major factor, followed by 1386 (25.31%) who believed in myths associated with dental treatment. Conclusion: Utilization of oral health services among the rural population has been found to be influenced by socio-demographic factors. Improving access to oral health care is a critical and very important first step to improving oral health outcomes and reducing disparities.

Keywords: Oral health, oral health services, rural, socio-demographic, utilization


How to cite this article:
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

How to cite this URL:
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 [serial online] 2014 [cited 2019 May 20];26:410-3. Available from: http://www.jiaomr.in/text.asp?2014/26/4/410/155688


   Introduction Top


In developing countries like India, the availability and accessibility of oral health services in rural areas are limited, and the provision of oral health care is also very limited. The pattern of utilization of oral health services has been shown by few studies. [1],[2] The epidemiological transition of oral health is apparent in the increasing incidence of oral diseases such as periodontal conditions and dental caries. Conditions such as oral manifestations of HIV/AIDS, oral cancer, and dental trauma are also expected to increase in the near future. [3] The severe impact of lower utilization of oral health services is in terms of pain and impairment of function and its impact on quality of life is also tremendous. [3]

Oral health is a much neglected field of research in developing countries. The few existing reports from these regions show very low utilization of oral health care services, and visits for a dental-care are only undertaken for symptomatic reasons. [4],[5] A study in the Ivory Coast reported that only 11.4% of the city-dwellers had visited a dentist. [5] Self-medication and use of herbal medicines and homemade remedies seems to be a common practice in rural areas of most of the developing counties. [6] There is a need for people to visit dentists regularly even in absence of dental problems so that disease initiation can be recognized and prompt dental treatment can be rendered.

Traditionally assessing oral health care is referred to a patient's ability to obtain or make use of oral health care. External factors like ability to pay for care and adequacy of dental workforce are the primary determinants of access. In the current scenario, however, discussion of assessment of oral health care takes into account the internal factors like language barriers and cultural factors. [7]

Several factors have been identified which have direct and indirect impact on the utilization of oral health services. These factors include age, sex, ethnicity, education, language, perception of need, anxiety states, and feeling of vulnerability. Others may include disability, cost of treatment, transportation, health status of the individual, residence, attitude of dental workforce, and beliefs and charisma of dental health care personnel. [7],[8]

Several factors acting as barriers to high level of utilization of oral health care services are still not clear. India is a developing country with limited oral health care infrastructure in rural areas. Inadequate number and skewed distribution of oral health care personnel in the rural communities has developed a curiosity to assess the factors affecting the utilization of oral health services among the rural population of western Rajasthan, India.


   Materials and Methods Top


This cross-sectional study was conducted among the patients attending the OPD of two satellite centers from villages in western Rajasthan, India. A structured self-administered questionnaire was employed as the instrument for data collection. The questionnaire included age, gender, educational, marital status, occupation, previous dental visit, frequency of dental visit, distance of dental institute from home, transportation, attitude of dentists, time taken during the dental procedures, long appointments, cost of dental procedures, etc. The study was carried out for a period of 1 year. The selection criteria included residents of rural area and excluded people who did not agree to participate in the study. Based on the selection criteria, a total of 5476 people were selected.

The questionnaires were distributed to all the adult patients who visited the OPD of the two satellite centers. The questionnaire was explained to all the participants before the distribution, and the participants returned the questionnaires after it was completed. The data were processed and analyzed by using SPSS 18.0. The characteristics of the study samples were described, and frequencies were used to highlight the socio-demographic status of participants.


   Results Top


The study was done to assess the factors affecting the utilization of oral health services among the rural population of western Rajasthan, India. Among the total study group of 5476 subjects, 3934 were males and 1542 females. The study group was divided into five equal age groups from 20 to 60 years and above. Maximum subjects (1923; 35.11%) were of the age group of 31-40 years. Four thousand, nine hundred and eight-nine subjects were married and 487 were unmarried. When the education status was assessed it was found that 31.57% were illiterate and only 1.53% were graduates. On assessing the occupation it was observed that only one person was a government employee and 1784 (32.57%) were self-employed and 526 (9.60%) had no occupation [Table 1].
Table 1: Socio-demographic characteristics of study subjects

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When the factors associated with dentistry were assessed, it was found that 3004 (54.85%) of the subjects had never visited a dentist and none of the subject had visited a dentist since last 1 month; however, 82 (1.49%) have visited the dentist in the last 6 months. When the reason for last dental visit was assessed it was observed that 89.97% had visited a dentist with a complaint of pain and none had visited a dentist for a regular dental checkup. When the subjects were asked about their satisfaction about their last dental visit 696 (28.15%) were not satisfied with the work. When the subjects were assessed about the cost of dental treatment, 5259 (96.03%) said that dental treatments are costly. One thousand, eight hundred and seventy-six (75.88%) of the subjects found dental treatment to be lengthy and time consuming. Four thousand, three hundred and forty-six (79.36%) subjects were unaware about the importance of oral health. Three thousand, three hundred and forty-nine (61.15%) of the subjects felt that oral problems caused limitations and problems in their regular activities [Table 2].
Table 2: Factors associated with dentistry

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When the various factors associated with the utilization of oral health care were assessed, maximum number of subjects (1436; 26.22%) stated that the cost of dental treatment was the major factor, followed by 1386 (25.31%), who believed in myths associated with dental treatment (myths such as ultrasonic cleaning of teeth leads to tooth mobility and extraction of maxillary teeth leads to weak eyesight). Nine hundred and nine (16.59%) found dental instruments to be frightening and 769 (14.04%) found dental procedures to be time consuming. Factors like distance of oral health center from village, transportation, past dental experience, attitude of dentists, no one to accompany to a dentist, etc. were also observed among the subjects [Table 3].
Table 3: Factors affecting utilization of oral health services

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   Discussion Top


Little is known about factors affecting oral health service utilization among rural populations of developing countries. The factors that contribute to problems with access to oral health care are numerous and complex. These include cultural, social, structural, economic and geographic factors, among others. Lack of access to oral health care also contributes to the profound and persistent oral health disparities that exist in the rural areas of India. However, in the present study we have identified several socio-economic and socio-demographic factors affecting the oral health service utilization among the rural population of western Rajasthan, India.

In the present study it was observed that 54.85% of the subjects had never visited a dentist and none of the subject had visited a dentist since last one month. Similar results were observed by Ajayi and Arigbede. [9] However, our result does not coincide with the results done in western developed countries, where about 40-80% of the adults would have visited a dentist within the last 1 year. [10] The reason for this may be lack of awareness about oral health among the rural people of western Rajasthan, India.

Pain was the major reason for the last dental visit among 89.97% of the study subjects. Similar results were seen in the study carried out by Meng et al. [11] In developing countries like 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. [7] In the present study 26.22% of the people stated this and the results of Njoh [12] and Varenne et al. [4] coincide with the results of present study.

While the dental procedures are being performed, disturbing noise from the dental drill was among the barriers in 16.59% of the subjects. The feeling of insecurity is significantly common among the elderly; similar results (19.34%) were obtained by Shaikh and Hatcher. [13] These results are also in agreement with the results of previous study conducted in the UK. [8]

In today's fast moving world, time is a very important factor. The time taken during dental procedures was also found to be a factor (14.04%) which affects the utilization of oral health services. In rural sector, people are mostly farmers or daily wages workers and the time they spend in a dental clinic can be utilized by them for their daily earning. The result coincides with the findings of Shaikh and Hatcher [13] who observed 16.54% of such individuals.

Having no access to the oral health services and transportation was also found to be an important factor which affected the utilization of oral health services. Difficulty in accessing oral health facilities as a result of poor transport system, residing in a rural area, attitude of dentists, no one to accompany to a dentist and poor health have been identified and well described in the dental literature. [7]

National health authorities should actively take part to develop policies, goals and targets for oral health sectors. National health policies should include oral health promotion, education and disease prevention based on the common risk factors approach and the felt need of the people for whom the policies are being developed. [14] It is recommended that dental camps in rural sector, mobile dental clinics, and oral health education and promotion should be conducted to spread awareness among the people and disseminate treatment. The cost of the dental treatments should be revised and made affordable for the rural population. The health centers should have complete oral health set up, so that all the services could be provided to the rural people in their village and they do not have to travel long distances to get oral health care.


   Conclusion Top


Utilization of oral health services among the rural population has been found to be influenced by socio-demographic factors. The services provided in the programs should be based on the felt needs of the rural population, so that both attendance and the utilization of dental services can be increased, thereby improving the oral health status of the population. Improving access to oral health care is a critical and very important first step to improving oral health outcomes and reducing disparities. The continued separation of oral health care from overall health care contributes to limited access to oral health care among the rural population of India. There should be adequate funds for providing oral health care for vulnerable and under-served populations.

 
   References Top

1.
Petersen PE, Holst D. Utilization of dental services. In: Cohen LK, Gift HC, editors. Disease prevention and oral health promotion: Socio-dental sciences in action. Copenhagen: Munskgaard; 1995. p. 341-86.  Back to cited text no. 1
    
2.
Chen M, Andersen RM, Barmes DE, Leclercq MH, Lyttle CS. Comparing oral health care systems: A second international collaborative study. Geneva: World Health Organization 1997. p. 350.  Back to cited text no. 2
    
3.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21 st century - the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31(Suppl 1):3-23.  Back to cited text no. 3
    
4.
Varenne B, Petersen PE, Ouattara S. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J 2006;56:61-70.  Back to cited text no. 4
    
5.
Samba M, Guinan JC, Sangare A, Da-Danho V, Bakayoko-Ly R. Oral health care practices in Abidjan. Odontostomatol Trop 2004;27:37-40.  Back to cited text no. 5
    
6.
Tapsoba H, Deschamps JP. Use of medicinal plants for the treatment of oral diseases in Burkina Faso. J Ethnopharmacol 2006;104:68-78.  Back to cited text no. 6
    
7.
Guay AH. Access to dental care: Solving the problem for underserved populations. J Am Dent Assoc 2004;135:1599-605; quiz 1623.  Back to cited text no. 7
    
8.
Freeman R. Barriers to accessing dental care: Patient factors. Br Dent J 1999;187:141-4.  Back to cited text no. 8
    
9.
Ajayi DM, Arigbede AO. Barriers to oral health care utilization in Ibadan, South West Nigeria. Afr Health Sci 2012;12:507-13.  Back to cited text no. 9
    
10.
Kiyak HA, Reichmuth M. Barriers to and enablers of older adults' use of dental services. J Dent Educ 2005;69:975-86.  Back to cited text no. 10
    
11.
Meng X, Heft MW, Bradley MM, Lang PJ. Effect of fear on dental utilization behaviors and oral health outcome. Community Dent Oral Epidemiol 2007;35:292-301.  Back to cited text no. 11
    
12.
Njoh AJ. Urbanization and development in sub-Saharan Africa. Cities 2003;20:167-74.  Back to cited text no. 12
    
13.
Shaikh BT, Hatcher J. Health seeking behaviour and health service utilization in Pakistan: Challenging the policy makers. J Public Health (Oxf) 2005;27:49-54.  Back to cited text no. 13
    
14.
Petersen PE, Yamamoto T. Improving the oral health of older people: The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005;33:81-92.  Back to cited text no. 14
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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