In the modern society, the human life expectancy is showing an upward trend ,thanks to the improved health care, nutrition , sanitation, and relief from communicable diseases. In 1982, Keki Mistry1 reported that the relative improvement in general health was in glaring contrast to the deteriorating situation in oral and dental health in developing countries.
The cause of deterioration in dental health seems readily apparent. Increasing industrialisation is invariably linked to rising levels of sugar consumption and inevitable breakdown of the dentition. This process merely mirrors similar changes in developed countries during the industrial revolution two hundred years ago.
The scenario in India, a subcontinent in the continent of Asia, is changing. India accounts for only 2.4% of the world area i.e., 3.28 million sq. km and has 15% of the world population. There is an effective control in child mortality and life expectancy has increased from 32 years in the fifties to 54 years in the nineties. The literary level has increased. At the economic level, the per capita income is on the rise. To-day, our country is progressing in all fields, leading to changes in the individuals life- style.
Improved marketing strategies and increased transport facilities have brought food materials like bread and chocolates to even the remotest villages. Children who consume these sticky food stuffs are not trained to clean the teeth properly afterwards. Moreover, such items are freely consumed as in between snacks.
In 1979, the World Health Assembly adopted a resolution calling for attainment of "Health for all" by the year 2000. In line with this, the FDI recommended the establishment of specific oral health schedule on the time scale. Of the WHO goals for global oral health, the first goal is that 50% of 5-6 years old children should be caries free and the second goal is that the global average should not be more than 3 decayed, missing, or filled teeth at 12 years of age.
By early 1980 s many industrialised countries had achieved the second goal. By contrast, the developing countries showed increasing DMF values at this time.
Epidemiological studies conducted in the community of Jonkoping, Sweden, by Anders Hugoson and others2 in 1973 and 1983 revealed an increase in the number of teeth in different age groups. In the 20 year olds, the mean number of DS was 6.5 in 1973 and 4.5 in 1983. An analysis of the carious lesions showed that 86% of the lesions were restricted to the enamel. According to recent data for 5-6 year old group, the percentage of caries free children in Sweden is 72. 3
[The recent data for 5-6 year old children indicate a mean dmft value of 2.0 in the USA, and the percentage of caries free children is 50 3..]
On the other hand, dental caries is highly prevalent in India, which is influenced by the lack of dental awareness among the public at large. Epidemiological survey conducted by Ramachandran and others4 during 1966-68 in Tamil Nadu, a south Indian state, revealed a caries prevalence of 66.2% in urban population and 47.8% in rural population.
We conducted a survey on a section of Belgaum population 5 to evaluate the trends in caries in different age groups and the influencing factors for its causation and prevention. This study revealed a DMF/ dft score of 4.61 in the 6-11 years of age group, with a DMFS score of 9.21. In this age group, 88% of the children suffered from dental caries.
So when I say caries prevention in children, the image that conjures up in your minds is entirely different from the picture in my mind.
The 20th century has given tremendous knowledge in the understanding of oral diseases and possibilities for preventing and treating these diseases. This knowledge cannot be put into action in a developing country like India due to financial constraints and lack of man power.
In a country where 70% of population inhabit the villages the dentist population ratio is 1: 35,000, and only one out of five dentists return back to the rural area to serve, prevention of caries will be a much more viable option than rendering restorative treatment Let me just outline the problems we have to face while streamlining a caries prevention programme in India.
1. First of all, in villages where 70% of the population live, there is no communal water supply. So fluoridation of water supply, the most cost effective and a very efficient method of caries prevention will remain an elusive dream for majority of people.
2. Even in urban areas there is no attempt at fluoridating the water supply. There are areas where local water contains high level of fluoride. So unless a fluoride mapping of the entire country is completed, national fluoridation programme cannot be implemented. This involves two hurdles. One is the cost factor. Then there is a strong anti-fluoride lobby in India which widely publicizes that fluoride is a dangerous element which can cause fluorosis of teeth, bones etc., They oppose even topical fluoride applications and usage of fluoride tooth pastes with the contention that even from the tooth paste, the soft tissues absorb fluoride, which will have cumulative effect over a period of time, leading to fluorosis of bones.
3. Indians by nature are highly tolerant. Even when teeth are affected by caries, a good number of them wait till the last stage when the excruciating pain forces them to the dentist. In such a scenario, to make them visit a dentist for measures at prevention demands high motivation. Widespread and intense measures at public awareness are needed to bring dental health to a priority level . Routinely, dental health occupies a very low priority as compared to the general health. Many of them do not hesitate to come and demand extraction of an offending tooth.
4. The cost involved in assessing the high caries risk group by S-mutans test and other methods in Indian situations is so high that it cannot become a routine procedure in the near future.
So you can see, in the existing situation in India, it calls for real dedicated and strenuous effort to implement caries prevention programmes.
Western Methods for caries prevention as such will not be successful here and they need to be modified to suit the local needs and habits.
New methods of identifying caries risk groups should be formulated
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