Dental Outreach Program - How Effective it is in Reaching Out to the Community.

Good oral health helps to ensure overall health and well-being. There has been an indicative social and economic ramification due to poor oral health. In the US alone, illnesses related to oral health result in 6.1 million days of bed disability, 12.7 million days of restricted activity, and 20.5 million workdays lost each year.1 There has been a significant improvement in health for the past few years, but this is not distributed equally across the population as it is utilized higher among the better off. India being a developing country and records second highest population in the world unmatching of the population and oral health professionals serving them has been observed. It has been witnessed that about 80% of dentists are practicing in major cities in India which is very less compared to the 70% of the population residing in rural areas. The ratio of dentist and population in urban areas is 1:10,000 as compared to rural areas which are 1:150,000. The number of qualified dentists in our country is found to be 118,000 still there is lack of availability of basic oral health education and simple intercession to a larger sector of population, resulting in poor oral health also affecting the quality and standard of life, individuality, narcissism and has been linked to demeanor and ontogenic problems.2

The disintegration in the oral diseases can be prevented by making an early identification, investigation and providing the desired treatment which is possible by introducing dental outreach programs. The community-based dental outreach programs play a very crucial role in declining discovery-delivery disconnect by introducing awareness through health education and dental adumbrating services to the community members. These programs are found to be very effective for diminishing health unevenness.3

An outreach program is complete entanglement between the community and the health institution or organizations. It is an attempt by the organizing members to impart its objectives, opinions, skills and practices to the target population or general population thereby generating awareness and improving oral health. Dental outreach programs are generally non-profitable organizations, which may be non-government or government and are directed towards the cost effectiveness and benefit of the community using the community itself as a resource.4

The systematic review was searched in MEDLINE, PSYCINFO, ECONLIT, EMBASE and CINAHL to identify cost effectiveness evaluations of outreach programs in indigenous populations around the world. There were inclusions of 19 studies reporting on 27 interventions in the review. Among them, 23 were interventions that specifically targeted indigenous populations and outreach programs were shown to be consistently cost-effective.5

Peer-reviewed national publications have demonstrated that early prevention can substantially reduce future dental care costs and one such dental outreach program (ABCD) in washinton has proved to be cost-effective method of improving oral health status of young children.6

Several studies examining oral health outcomes have been conducted and are currently in progress to assess the efficacy of the outreach model. Henry Schein Cares Global in 2010 conducted a survey at Grenada a tri-island nation in the Caribbean and found results which were astonishing: More than 83% of Grenada’s children suffer from untreated tooth decay. After performing dental outreach programs in these areas. In May 2013, the national oral health survey was repeated, and it showed 90% decrease in new tooth decay. A mixed-methods impact evaluation was performed to capture the knowledge, attitudes, and practices of parents and teachers relating to oral health and the Smile Grenada program.7

A 3-year study conducted by Pawar et al. showed dental outreach program to be very effective in improving oral status of school childrens during a 3-year follow-up period in Lucknow city.8

On the basis of utilization of outreach programs, the results from the study conducted by Kadaluru et al. show that utilization of the dental service among adults attending outreach program was very low (28%),9 it was in concordant with reports from China (20%) and Spain (34.3%).4,10 In some other studies utilization is high in developed countries, with figures of 75% in the US, 61% in the Danish adult population,11 47% in the UK,12 56% in Finland,13 and 43% in Singapore.14

Basic awareness, literacy, and health insurance which cover dental services in these countries can be speculated for the high utilization, which is non-existent in India. Insurance schemes either at the micro level or at the macro level for oral health services for our population should be considered.

In a study conducted by Vashisth et al. the disease pattern showed dental caries was found to be in maximum proportion followed by gingivitis. The commonly utilized services in the dental outreach programs were oral prophylaxis, restoration, and extractions.15 Similar findings were reported by national oral health survey (2002-2003).16

The data from Western studies suggests the main reasons for oral care were dental examination (44.4%), tooth restoration (35.0%), and dental cleaning (32.1%).17

The outreach health programs organized by Trinity Care Foundation a Public Health organization has been very successful in identifying and providing Holistic Treatment for Children with Facial Deformities and organizing School Health Programs in Karnataka State, India.3

The utilization of dental services can be improved by identifying the barriers and by providing appropriate education and intervention. The conclusion from various studies showed a positive impact on the oral hygiene status and has been estimated to be on the more positive aspect in future. These outreach programs intends to create replicable models that will improve oral health around the world. By changing the way individuals perceive their own and their children’s oral health, and by transforming the role of dentists in society, sustainability can truly be achieved.