~.._~dm_7o Pedlm~, 46 t 49, 1979

PREVENTION

OF D E N T A L C A R I E S - W H O S E

R E S P O N S I B I L I T Y ?*

H.N. MATIIURAND T.P. JAm

Uctai/,u, Dental caries, a h h o u g h not a life endangering disease, is extremely trot,belsome, incapacitating and expensive. It can directly or i n d i r e c d y be responsible for pain, infecti o n , facial disfigurement, chewing and speech i m p a i r e m e n t as well as malnutrition (Abraham 1977). D e n t a l caries is one of the most common pathological conditions found in the population, specially among children. T o o t h decay begins at an early age. Dental caries in prtmary d e n t i t i o n is k n o w n to occur as early as the first year of life. Tiwari, Chawla and Singh (1977) found 29.33% children at 6 years, of age to have D M F teeth. This figure at 14 years was found to be 86.76%. He also found t h e percentage o f D M F teeth at 6 years o f age to be 7.72 and at 16 years to be 18.11 (Showrie and Sons (1950), Kokila (1951), Vacher (1952), T h a p e r (1953), Shourie (1953), Chawla and C h a u d h a r y (1957), Rao (1961), Dutta (1965), Ramchandra ,t al. (i973) Singh et al. (1977), M a t h u r and Jain (1977) besides- many others have highlighted the problem of dental caries in different parts of the country in various age groups at various times. Most of them covered the school age group and found the prevalence of dental caries amongst t h e m to be quite high (range 9.0 to

71.8%). *From the Department of Preventiveand Social Medicine, R.N.T. Medical College, Udaipur. Received April 9.5, 1078.

Dental caries on one hand is important from the point of view of high p~evalence and on the other can damage various parts of the body including heart, lung, eyes, nerves and joints etc. and hence it would be wise to prevent it. "Prevention is better than cure" is a well known but least practised proverb. This is very much true for dental caries for every filling and every extraction represents a failure which can be avoided by the joint efforts of the patients and the dentist (t~ock and Shovelton I975). In 1960--1962 two billion dollars were spent for repair of decayed teeth in the U.S. and it was estimated that it would have cost.eight billion dollars more to completely repair the damage caused by caries (Abraham 1977). Can be afford it? Certainly not ! But can we ignore this problem ? Again certainly not ! As such, the best way to tackle the problem in a country like ours is prevention. Dental problems in India of which dental caries forms tile bulk are very complex in character for the following reasons. 1. High attack rate. 2. Widespread failure to seek adequate treatment for various socio-cnhural reasons leads to accumulation of backlog. 3. Scarcity of dental resources (high dentist population ratio and few dental colleges). 4. Low priority given to dental diseases, both by the community as well as by planners and administrators.

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INDIANJOURNAL OF PEDIATRICS

Denta} caries has a multifactorial aetio]ogy and hence multiple preventive measures can be advocated.Various commonly preventive measures (water fluoridation, fluoride tablets, salt and milk fluoridation, community dental health programme) as well as individu~,l meamures like plaque control; topical application of fluorides and tissue sealing have been advocated (Rock and Shovehon 1975 ). Community acceptance is a vital factor for the success o f any programme, specially a preventive one, As has been our experience with various community health programmes, community acceptance cannot be achieved by imposition w h i c h at bekt can only be temporary. T h e better course wouid be to generate the demand. Once people feel it as their own need, they would accept it and rush for it. Merely putting in the 'inputs' dose not necessarily improve the 'output' for which utilisation of the input is very essential. Thus producing more dentists or making fluoridated salt, milk or pastes available would be like increasing the inputs only, which the community would avail themselves of orAy if they feel the necessity for it and like it. Making people aware of (i) the magnitude of the dental caries problem (ii) the damage that dental caries can cause and (iii) the various preventive measuresavaiable, should be the first step to generate demand, which would lead to community acceptance. Once this demand is generated, all the inputs that would be poured in would be most effectively utilised. N o doubt it is the task of the dental profession to raise the standard o f dental fitness in the community and to make and keep as high a proportion of the popu-

VOL, a6, NlO ~'~

latlon as possible dentally fit, bu: is it possible with the high dentis population ratio and with the attitud~l that the dentist i~ consulted only fofn curative purposes generally, never for pre vention. Logically the dentist should be assisted by various other agencies, special.ly in creating awareness amongst the people. The problem that arises is again concerned with human behaviour, that is, will the other agencies accept this new responsibility gladly and readily ? Principally, all should accept it for the reason that though the teeth may be the domain of the dentist, the health of the child (in whom caries formationstarts) and that of the adult as a whole is the respomibillty of the t o t a l medical profession, and since dentaNcaries can affect the health adversely in so many ways, naturally, the entire medical profession, specially the paediatrician and persons cottcerned with health care, should aim at minimising the incidence of dental caries. Paediatricians will have to play a very important role if the inc:'dence of dental caries is to be reduced, since he is the person mostly consulted and whose advice for the health of the child caries maximum weight. Invariably, the paediatrician takes a look at the throat of the child; in the process he also takes note of the tongue bupt the poor teeth escape his attention, as if they are not his concern at all. Besides adVising the mother on care of the teeth of her child, the paediatrician may advise and encourage her to show the child to a dentist for preventive dental services if the child is under three years df age. Based on present scientific knowledge in oral biology and preventive dentistry, Abraham (1977) expects a decrease

blATHUR AND JA1N~pREVENTION OF DENTAL CARlES~ WHOSE RESPO~NSlBILITY .'P

in dental health statistics by 60-75%, but only when the paediatrician also agsumes responsibility. Thus dental health care should b e an essential compoh~nt of the health education to be imparted in Under Five Clinics. T h e dentist in turn should the recent apprise the p a ~ u. ., .a.,. .t~mn ... on advances in preventive dentistry so as to make his knowledge of preventive dentistry up to date. Besides this health education by the paediatrician, various audio-visual aids should be extensively used to make health propaganda, if not health education, for preventive dentistry.

51

In fact, the dental caries problem is of such a high magnitude that it amounts to a public health problem and should be treated as top priority with a multi-pronged action from various agencies. References

Abraham, E. Nizel (1977). Preventing dental caries. Paediat Clin. ~orth Am. 2'1, 141. Bowen, W.H. (1969). A vaccine against dental caries BjTJ, 126, 159. Clhawla, T.N., Chaudhary, K. (1057). Dental health survey of medical students. 3. All India Dent. Assn. 29, 156. Comby, C.P., Bernier, J.L. (104$). Bacteriological studies in dental caries. 07. Am. Dent' Assn. 29,

606. There is ample scope for dental c~/ries prevention in the school health programme since this is the group most affected. School health programmes in other countries lay a lot of emphasis on dental health care. The school teacher, i f trained a little and motivated, can be a very effective tool for sowing hygienic habits in the virgin mind of children which would be with the child for ever. The d e p a r t m e n t o f Public Health Engineering i.e. the water works department should also be persuaded to check the fluoride content of water and whenever it is less, fluoridation o f drinking water should be done. Similarly, all toothpaste companies should be instructed to fluoridate their products. Bowen (1969), Comby and Bernier (1942), Hill (1941), Hobbs (1970), Lehnar (1975), T a m b m a n and Smith (1974) and Wagner (1975) have tried to develop a vaccine against tooth decay but the prospects of a vaccine against dental caries appear remote at present.

Dutta, A. (1965)0 A study of the prevalence of peridental diseases and dental caries amongst school going children in Calcutta. 3- indian. Dent. Assn. 37, 367.

HilI,J.J. (1941) The influence of immunological factors on dental caries. 07. Am. Denl, Assn. 28, 109. Hobbs, J.g. (1970). Immunoglobins in some diseases. 07. Hos. Med. 3, 669. KokilaJai (1951). Incidence of dental caries in Gujrati, childlen. 07. India Dent. Assn. 23. Lehnar, T. (1975). Immunological aspects of dental Canes and periodontal diseases. B~it. Meet. Bull. 31, 125. Mathur, H.N., Jain, T.P. (1977). Prevalence of dental caries anaongst school girls. Scientific paper presented at the VIII Annum Conference of indian Association of t~rcventiveand ~$ocialMedicine. Ramchandran, K., gajan, B.P., Shamugaon, S. (1973). Epidcmiological stuaies Of dental dLseases in Tamil thadu population ~. lndmn Dent, Assn. 45, 65. Rock, W.P.I Shovchon, David, S. t1975). The prevention of dental caries, lnd,an Dent. Ass. 47. Kao, B.K.J. (1~61). Nutrition and health status of school children. Indian 3. Pediatr. 28, 203. Shourie, K.L., Soni, N.N. (1950). Dental caries experience in children in Bombay City. 07, All India Dent. Ass. 22, 185.

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INDIAN JOURNAL OF PEDIATRICS

Singh, Surendra, Singh, Harehafan, Joshi, Vasudeo Slngh (1077). Dental diseasesamongst pzimary school, children of Patiala City. Indian ~. of D#nl. Assn. 49, 107. Tambman, M.A,, Smith, D.I. (1974). Elleet of immunization with Strup. mutans on indication of salivary lmmunoglobulinsAntibody and experimental dental caries in rats. Infeciion and lmmuaily 9, 1079. Thapcr, S.L. (t973). Incidence of dental caries in Punjabi children. 07. All India D*nt. A~sn. 26, 1973.

Vol: 46, No. 373 Tiwari, Amrit, Chawla, T.N, Harpinder Singh. study of prevalence of dental caries in an urban~ area of India. ft. indiaR Dental Assn. 49, 231. Vaeher, W.R. (1952). Dental survey of scho01 children in Amritsar (Punjab) 07. All India Dent. dssn 24, I. Wagner, M. (1975). Specific immunization against Strepto f~calis induced dental caries in natobio, tics rats. BacterloL Proc. 99, Abstract 11167. Cited in Lehner, T. Immunological aspects of dental cases and peri-odental diseases. Brit. Med. Bull. $1, 125.