In class this past Wednesday we talked about current events going on India. We each read an article and then shared current major events going in that region. Mine talked about nuclear reactors that will be beneficial for helping with the growth of India.
I think that staying up to date with current events is very important. Much of what people talk about on a day to day basis are events that are currently going on. If I want to build trust with people, it would be very beneficial to know some of the current events to talk about with people because those are things that matter to them. By knowing current events it shows that you have an interest in and care about the people and culture. It is important to not come across as ignorant, otherwise people are less likely to talk with you and be open. On top of not seeming naive, you can also keep yourself out of hot spots or dangerous zones. As foreigners I think that it is important to stay clear of zones where we could be seen as hostile or anti.
Before flying over to India I want to read up on some major events so that I can be prepared for what is taking place in Coimbatore and Tamil Nadu. I think it will be helpful for finding people to take my survey if I can lay common ground with current events. Overall, I think that the biggest thing about keeping up with current events is that it gives you something to talk about with people.
Friday, March 30, 2012
Thursday, March 29, 2012
Source 34
National Consumer Attitudes Survey reveals neglect of oral health
2 out of 3 consumers have never visited a dentist; only 3% visit a dentist regularly
Only 47% of treatments are by dentists, the rest rely on advice from chemists, general practitioners or self-treatment
Highest awareness is for toothache and tooth decay, yet only 50% are concerned
Almost one fifth suffer from tooth sensitivity, yet half of them do not do anything about it
Mumbai, August 20, 2009: A new national consumer usage and attitudes survey (CUAS) conducted across the four geographic zones in India, comprising a total of 11,324 interviews by IMRB and sponsored by Colgate-Palmolive (India) Limited has revealed that dental problems in India are reflected in the low awareness levels and poor oral hygiene habits. The survey showed that 49% associate dental problems with lifestyle related reasons such as ‘improper eating habits’ and ‘not leading a healthy lifestyle’. Almost half of the respondents relate dental problems to lack of a daily oral care regimen such as ‘regular brushing at least twice a day’.
According to the survey, 67% of Indians have never visited a dentist and around 87% of the Indian population does not believe in visiting dentists unless there is a problem. Only 3 out every 100 respondents said they visited dentists at least once a year. By contrast, the global average for people visiting dentists is 57%.
Because a majority of consumers tend to follow a remedial path where they seek professional dental care only at the time of painful toothaches, there is low awareness of the benefit of a low pain, preventive care approach to regular brushing twice a day and preventive care visits to the dentists at least twice a year. This is reflected in the CUAS findings which show that:
Only 47% of total treatments received are by dentists - the rest prefer to rely on advice from chemists, general practitioners or self-treatment using home remedies and brushing
Of 70% who suffer from cavities/ decay, only 58% visit the dentist
Of 53% who suffer from mouth odor, only 11% visit the dentist
Of 64% who suffer from gum bleeding, only 28% visit the dentist
Of 63% who suffer from mouth ulcers, only 21% visit the dentist
Dr. Ashok Dhoble, Hon. Secretary General, Indian Dental Association said, “Oral health is very important and critical for the overall health. Numerous studies over the years investigating the mouth-body connection have suggested an association between oral health and general health. Research has also shown that dental diseases can best be prevented through early detection and primary prevention. Children, right from the age of three should be made aware of basics like the importance of brushing teeth twice a day, cleaning teeth and gums properly and other oral care information. Starting early will make oral hygiene not a practice but a habit with them.”
The survey revealed that the low oral health awareness is reflected in the consumer’s daily habits:
Only 51% brush with a toothpaste and a toothbrush
Only 19% of respondents feel it is essential to brush at night
Only 28% of respondents brush teeth at least twice a day
According to the survey, the most important triggers to brush teeth are to keep breath fresh and remove the food particles.
According to India’s last National Oral Health Survey (2002-2003), a detailed nation-wide epidemiological study, dental caries (tooth decay) is prevalent among 63.1% of 15 year olds and as much as 80.2% among adults in the age group of 35-44 years. Periodontal diseases (gum diseases) are prevalent in 67.7% of 15 year olds and as much as 89.6% of 35-44 year olds. The mean DMFT (decayed, missing, filled teeth) score is 2.4 in 15 year olds and as high as 5.4 among 35-44 year olds.
This survey is interesting because it shows more statistics about oral care and health in India. It will be interesting to see how the statistics from Mumbai compare to Coimbatore.
2 out of 3 consumers have never visited a dentist; only 3% visit a dentist regularly
Only 47% of treatments are by dentists, the rest rely on advice from chemists, general practitioners or self-treatment
Highest awareness is for toothache and tooth decay, yet only 50% are concerned
Almost one fifth suffer from tooth sensitivity, yet half of them do not do anything about it
Mumbai, August 20, 2009: A new national consumer usage and attitudes survey (CUAS) conducted across the four geographic zones in India, comprising a total of 11,324 interviews by IMRB and sponsored by Colgate-Palmolive (India) Limited has revealed that dental problems in India are reflected in the low awareness levels and poor oral hygiene habits. The survey showed that 49% associate dental problems with lifestyle related reasons such as ‘improper eating habits’ and ‘not leading a healthy lifestyle’. Almost half of the respondents relate dental problems to lack of a daily oral care regimen such as ‘regular brushing at least twice a day’.
According to the survey, 67% of Indians have never visited a dentist and around 87% of the Indian population does not believe in visiting dentists unless there is a problem. Only 3 out every 100 respondents said they visited dentists at least once a year. By contrast, the global average for people visiting dentists is 57%.
Because a majority of consumers tend to follow a remedial path where they seek professional dental care only at the time of painful toothaches, there is low awareness of the benefit of a low pain, preventive care approach to regular brushing twice a day and preventive care visits to the dentists at least twice a year. This is reflected in the CUAS findings which show that:
Only 47% of total treatments received are by dentists - the rest prefer to rely on advice from chemists, general practitioners or self-treatment using home remedies and brushing
Of 70% who suffer from cavities/ decay, only 58% visit the dentist
Of 53% who suffer from mouth odor, only 11% visit the dentist
Of 64% who suffer from gum bleeding, only 28% visit the dentist
Of 63% who suffer from mouth ulcers, only 21% visit the dentist
Dr. Ashok Dhoble, Hon. Secretary General, Indian Dental Association said, “Oral health is very important and critical for the overall health. Numerous studies over the years investigating the mouth-body connection have suggested an association between oral health and general health. Research has also shown that dental diseases can best be prevented through early detection and primary prevention. Children, right from the age of three should be made aware of basics like the importance of brushing teeth twice a day, cleaning teeth and gums properly and other oral care information. Starting early will make oral hygiene not a practice but a habit with them.”
The survey revealed that the low oral health awareness is reflected in the consumer’s daily habits:
Only 51% brush with a toothpaste and a toothbrush
Only 19% of respondents feel it is essential to brush at night
Only 28% of respondents brush teeth at least twice a day
According to the survey, the most important triggers to brush teeth are to keep breath fresh and remove the food particles.
According to India’s last National Oral Health Survey (2002-2003), a detailed nation-wide epidemiological study, dental caries (tooth decay) is prevalent among 63.1% of 15 year olds and as much as 80.2% among adults in the age group of 35-44 years. Periodontal diseases (gum diseases) are prevalent in 67.7% of 15 year olds and as much as 89.6% of 35-44 year olds. The mean DMFT (decayed, missing, filled teeth) score is 2.4 in 15 year olds and as high as 5.4 among 35-44 year olds.
This survey is interesting because it shows more statistics about oral care and health in India. It will be interesting to see how the statistics from Mumbai compare to Coimbatore.
Monday, March 26, 2012
Source 33
AIM:
To follow-up, one year later, a double-blind, randomised study, which investigated the effect of regular brushing with dentifrices on the oral health of an economically disadvantaged rural population in Andhra Pradesh, India who were primarily users of traditional materials.
SUBJECTS:
150 of the original study population.
METHOD:
Examination to determine whether the improvements in oral health status and oral health behaviour (use of toothbrush and dentifrice), being unsupported, had been sustained since completion of the original study.
RESULTS:
Data analysis showed sustained, statistically significant improvements in gingival health as measured by gingival bleeding and plaque indices (GBI and PI) comparing users and non-users of toothbrushes and dentifrice in the original study (PI: p = 0.04; GBI: p = 0.03) and sustained use of toothbrushes and dentifrice by 60% of the subjects at follow-up one year later.
CONCLUSIONS:
This study shows a beneficial effect on oral hygiene indices following the introduction of toothbrushes and dentifrices to a community using traditional oral hygiene materials and sustainability of use of these materials with motivation and support. It may therefore be concluded that it is feasible to achieve significant use of conventional toothbrushes and toothpastes, with consequent major and sustained improvements in plaque control and gingival health in a disadvantaged population hitherto often considered as not amenable to conventional oral hygiene for cultural or economic reasons.
This article is amazing because this is partly what I will be looking into. It's not my main question, but something that I am more curious about. I wondered what attitude people would have to western care for oral health over their traditional oral hygiene. The other amazing part is that this community is economically disadvantaged, meaning they probably cannot afford other care or have not been instructed on proper oral hygiene. The other part that is outstanding is the modern methods improved oral health far better than traditional care. It shows that many people still use traditional treatment, especially in low income communities, and this in turn affects their oral hygiene habits and care.
To follow-up, one year later, a double-blind, randomised study, which investigated the effect of regular brushing with dentifrices on the oral health of an economically disadvantaged rural population in Andhra Pradesh, India who were primarily users of traditional materials.
SUBJECTS:
150 of the original study population.
METHOD:
Examination to determine whether the improvements in oral health status and oral health behaviour (use of toothbrush and dentifrice), being unsupported, had been sustained since completion of the original study.
RESULTS:
Data analysis showed sustained, statistically significant improvements in gingival health as measured by gingival bleeding and plaque indices (GBI and PI) comparing users and non-users of toothbrushes and dentifrice in the original study (PI: p = 0.04; GBI: p = 0.03) and sustained use of toothbrushes and dentifrice by 60% of the subjects at follow-up one year later.
CONCLUSIONS:
This study shows a beneficial effect on oral hygiene indices following the introduction of toothbrushes and dentifrices to a community using traditional oral hygiene materials and sustainability of use of these materials with motivation and support. It may therefore be concluded that it is feasible to achieve significant use of conventional toothbrushes and toothpastes, with consequent major and sustained improvements in plaque control and gingival health in a disadvantaged population hitherto often considered as not amenable to conventional oral hygiene for cultural or economic reasons.
This article is amazing because this is partly what I will be looking into. It's not my main question, but something that I am more curious about. I wondered what attitude people would have to western care for oral health over their traditional oral hygiene. The other amazing part is that this community is economically disadvantaged, meaning they probably cannot afford other care or have not been instructed on proper oral hygiene. The other part that is outstanding is the modern methods improved oral health far better than traditional care. It shows that many people still use traditional treatment, especially in low income communities, and this in turn affects their oral hygiene habits and care.
Learning Journal 29
For class on Monday we met in our big group and talked about problems that we could run into while on our Field Study. After hearing stories throughout most of the semester, I actually felt like I had heard most of the concerns. I heard that people had problems finding translators and that it always varies. Of course we always hope that it will be easy to find whatever we need. In reality, it may end up being one of the biggest struggles. The hard part is that not too much can be done to prevent or prepare for this before we arrive. Since I will be in the city, especially on universities and colleges, I hope that I can find someone willing to help me. Another problem that people faced was getting access to their site. I addressed this in my proposal as a problem and something that needs to be thought about before I arrive. I have made lots of social triangles to try and figure out where else I could find people for my survey. I have come up with some good places to try, but will ultimately need to look around once I get there to see if the informants I am looking for are there. This just involves brainstorming and hoping for the best once I get there. Another problem I heard was keeping your head up. This is probably something that everyone faces at one point or another so I just need to remind myself why I am doing it and motivate myself to continue. I like to think that I am head strong and will just keep plowing ahead, but we will see. I think that sickness will get the best of me at some points and will be my biggest enemy. Its hard to get the motivation to beat a sickness that is constantly pulling you down. Getting along in our group was another problem that I heard. As much as we love each other and try our best, there may be days where we bug and annoy each other. I guess the best thing to do is to try and work things out so pinned up anger doesn't eventually erupt. We may disagree at some points about certain things, but hopefully they won't be so big that our group falls apart. I hope that I don't get pick pocketed or mugged, I guess I just got the perspective to carry the basics with me and to leave everything else at home. I will be sure to do this with money and identification so that if I get into trouble I can hopefully pull myself or buy myself out of the situation. I hope that we are not vulnerable targets as white Americans in India.
These were some of the main points that I could think of form the lesson today. I guess I just want to make sure that I can apply each one of these to me and what I would do in the situation. It's important to be prepared for these things so that I do not get smacked in the back of the head without knowing.
These were some of the main points that I could think of form the lesson today. I guess I just want to make sure that I can apply each one of these to me and what I would do in the situation. It's important to be prepared for these things so that I do not get smacked in the back of the head without knowing.
Sunday, March 25, 2012
Learning Journal 28
This week we met in groups to talk about our proposals. First of all, I am a horrible at English. I am bad at reading and even worse at writing. When it comes to writing, I write like I talk and like I am writing a scientific research journal. I have a hard time rereading papers after I have wrote them. I can often go through and notice if something stands out in a sentence, but i have a hard time making sure that the paragraph is fluid and fits within the whole idea. Well in class we took notecards and wrote down the main ideas of each paragraph. As I was doing this, I noticed that some items in my proposal could use a little work. Some of my paragraphs worked great for the topic and represented the idea in a clear matter. Other paragraphs went a little off topic or were irrelevant to what needed to be discussed. It was a good activity for me to be able to determine what to work on next. I still have to read through the rest of my paper but I think that it will be helpful as I do so. Luckily most of the hard work for the project is done, so now it's just typing up the loose ends.
This will all be important when it comes to writing the final paper. Sections from my proposal might go straight into my final project. If I work hard at making this copy good, then I won't have to adjust too much at the end. I look forward to putting together my results to be able to draw some conclusions about my main question. I am hoping to submit my paper to some online dental journal databases to see if they will accept mine. I know that mine will not be the most professional, but I hope that valuable information can be learned from it.
This will all be important when it comes to writing the final paper. Sections from my proposal might go straight into my final project. If I work hard at making this copy good, then I won't have to adjust too much at the end. I look forward to putting together my results to be able to draw some conclusions about my main question. I am hoping to submit my paper to some online dental journal databases to see if they will accept mine. I know that mine will not be the most professional, but I hope that valuable information can be learned from it.
Saturday, March 24, 2012
Source 32
Children who suffer from poor oral health are 12 times more likely to have more restricted-activity days, including missing school, than those who do not. Annually, more than 50 million hours are lost from school due to oral diseases.
Few aspects of health are as accessible to personal control as oral hygiene, which can be improved by simple behavioral changes. A dental health education [DHE] program, which has as its objective, the improvement of the oral hygiene status of the participants would have obvious merits. DHE encompasses publicity campaigns, occasional talks at an elementary school, a showing of dental health films, and an extensive, reinforced program in a school curriculum. Several factors are important for effective DHE such as repetition and reinforcement of oral hygiene instructions. These concepts show significant, positive, short-range and long-term effects.
Adolescents are in particular need of preventive programs as they have high levels of plaque and their oral hygiene practices are based on short-term rewards [to improve appearance and social attractiveness].
Therefore, this study was conducted with the following objectives:
To determine whether DHE given at three-week intervals for 18 weeks was more effective than DHE given at six-week intervals for 18 weeks in improving oral health knowledge, practices, oral hygiene status, and gingival health in 12- to 13-year-old schoolchildren.
To determine if there was retention of oral health knowledge and improved practices, 18 weeks after cessation of the program, in subjects who received DHE at three-week intervals for 18 weeks.
To determine if the socioeconomic status played a role in influencing oral health knowledge, practices, oral hygiene status, and gingival health of schoolchildren.
The study design prevented 'contamination' and ensured that the responses obtained were due to the intervention, in contrast to studies with the test and control groups from the same school, where the carry-over effect could not be disregarded.
The lecture-demonstration method of DHE used was similar to the other studies. Bass method of tooth brushing was taught as it is the easiest and most effective technique for children to learn. The initially low twice-daily tooth brushing frequency increased significantly in the intervention schools in contrast to another study.
At baseline, approximately 19% of the study subjects knew that bleeding from the gums was symptomatic of gum disease. This increased markedly to almost 100% for the intervention schools at the end of the study. No significant differences were noted between the social classes. Intervention schools showed significant reductions in plaque and gingival scores as compared to the controls at the end of 36 weeks.
At baseline, 31% of the subjects knew that sticky/sugary foods caused dental caries. Correct responses increased significantly at the end of the study. There were significant differences between schools 1A and 1B (Oral health knowledge scores of 1A were better), but not between the two social classes. When asked about the best time to eat sugary foods, only a few correct responses ('at meal times') were obtained at baseline. These increased significantly in all the intervention schools at the end of the study, in contrast to another study. There were no differences between the social classes or between schools receiving differing interventions .
Reinforcement through repeated DHE sessions in the intervention schools resulted in significant improvements in oral health knowledge and practices, and reductions in plaque and gingival scores. There was retention of oral health knowledge and maintenance of reduced plaque and gingival scores even after cessation of the program, as seen in schools 1A and 2A at the end of 36 weeks. On almost all aspects evaluated, schools with more frequent exposures to the program [1A and 2A] scored better than schools with fewer exposures [1B and 2B], in contrast to studies of short duration with no reinforcement, which showed good immediate results but failed to show long-term positive results.
In comparison to social class V, social class I scored better on questions about: 'Importance of teeth,' 'oral hygiene aids used,' 'frequency in change of toothbrush' and 'ideal time to change a tooth brush.' This may be due to the differences in socioeconomic status and the lesser importance that lower socioeconomic classes attach to their teeth. No significant differences were found between the two social classes on general topics like, 'why we need teeth in our mouth', 'number of deciduous and permanent teeth' and 'diet and its effects on oral tissues.'
Limitations of this study are: (a) schools were not randomly allocated to intervention and control groups; (b) long-term value of the improvements seen need to be confirmed by further studies because improved oral hygiene in children may exist only during the program or for a short period thereafter; (c) DHE was given only once in the residual control group, withholding the benefits of reinforcement; (d) school personnel and teachers were not involved - they might have ensured enduring benefits after discontinuation of program; (e) intervention groups may have derived information from other sources - a difficulty of carrying out research in real-life settings; (f) intervention was targeted only at schoolchildren - not a complete health promotion scenario, as no changes in environment or lifestyle were advocated; (g) an inherent bias was that one of the outcome variables (practices) was measured as self-reported - an over-report of favorable behaviors might be expected; (h) children of other socioeconomic classes were not considered; (i) interference with school curriculum might be an added problem; (j) clinical significance of the changes observed needed to be estimated and interpreted in terms of the overall cost of the intervention (with respect to monetary resources, manpower, and time).
Results of this study can be generalized to situations in India and parts of Southeast Asia, which share similar socioeconomic profiles and cultural traditions, with regard to the importance of oral hygiene.
I thought that this study was interesting because it shows the health education can help improve oral health. This could important for helping the current oral condition of India to improve. This program could be applied to different age groups and there would probably be improvement across the board. I thought that it was a well done study.
Few aspects of health are as accessible to personal control as oral hygiene, which can be improved by simple behavioral changes. A dental health education [DHE] program, which has as its objective, the improvement of the oral hygiene status of the participants would have obvious merits. DHE encompasses publicity campaigns, occasional talks at an elementary school, a showing of dental health films, and an extensive, reinforced program in a school curriculum. Several factors are important for effective DHE such as repetition and reinforcement of oral hygiene instructions. These concepts show significant, positive, short-range and long-term effects.
Adolescents are in particular need of preventive programs as they have high levels of plaque and their oral hygiene practices are based on short-term rewards [to improve appearance and social attractiveness].
Therefore, this study was conducted with the following objectives:
To determine whether DHE given at three-week intervals for 18 weeks was more effective than DHE given at six-week intervals for 18 weeks in improving oral health knowledge, practices, oral hygiene status, and gingival health in 12- to 13-year-old schoolchildren.
To determine if there was retention of oral health knowledge and improved practices, 18 weeks after cessation of the program, in subjects who received DHE at three-week intervals for 18 weeks.
To determine if the socioeconomic status played a role in influencing oral health knowledge, practices, oral hygiene status, and gingival health of schoolchildren.
The study design prevented 'contamination' and ensured that the responses obtained were due to the intervention, in contrast to studies with the test and control groups from the same school, where the carry-over effect could not be disregarded.
The lecture-demonstration method of DHE used was similar to the other studies. Bass method of tooth brushing was taught as it is the easiest and most effective technique for children to learn. The initially low twice-daily tooth brushing frequency increased significantly in the intervention schools in contrast to another study.
At baseline, approximately 19% of the study subjects knew that bleeding from the gums was symptomatic of gum disease. This increased markedly to almost 100% for the intervention schools at the end of the study. No significant differences were noted between the social classes. Intervention schools showed significant reductions in plaque and gingival scores as compared to the controls at the end of 36 weeks.
At baseline, 31% of the subjects knew that sticky/sugary foods caused dental caries. Correct responses increased significantly at the end of the study. There were significant differences between schools 1A and 1B (Oral health knowledge scores of 1A were better), but not between the two social classes. When asked about the best time to eat sugary foods, only a few correct responses ('at meal times') were obtained at baseline. These increased significantly in all the intervention schools at the end of the study, in contrast to another study. There were no differences between the social classes or between schools receiving differing interventions .
Reinforcement through repeated DHE sessions in the intervention schools resulted in significant improvements in oral health knowledge and practices, and reductions in plaque and gingival scores. There was retention of oral health knowledge and maintenance of reduced plaque and gingival scores even after cessation of the program, as seen in schools 1A and 2A at the end of 36 weeks. On almost all aspects evaluated, schools with more frequent exposures to the program [1A and 2A] scored better than schools with fewer exposures [1B and 2B], in contrast to studies of short duration with no reinforcement, which showed good immediate results but failed to show long-term positive results.
In comparison to social class V, social class I scored better on questions about: 'Importance of teeth,' 'oral hygiene aids used,' 'frequency in change of toothbrush' and 'ideal time to change a tooth brush.' This may be due to the differences in socioeconomic status and the lesser importance that lower socioeconomic classes attach to their teeth. No significant differences were found between the two social classes on general topics like, 'why we need teeth in our mouth', 'number of deciduous and permanent teeth' and 'diet and its effects on oral tissues.'
Limitations of this study are: (a) schools were not randomly allocated to intervention and control groups; (b) long-term value of the improvements seen need to be confirmed by further studies because improved oral hygiene in children may exist only during the program or for a short period thereafter; (c) DHE was given only once in the residual control group, withholding the benefits of reinforcement; (d) school personnel and teachers were not involved - they might have ensured enduring benefits after discontinuation of program; (e) intervention groups may have derived information from other sources - a difficulty of carrying out research in real-life settings; (f) intervention was targeted only at schoolchildren - not a complete health promotion scenario, as no changes in environment or lifestyle were advocated; (g) an inherent bias was that one of the outcome variables (practices) was measured as self-reported - an over-report of favorable behaviors might be expected; (h) children of other socioeconomic classes were not considered; (i) interference with school curriculum might be an added problem; (j) clinical significance of the changes observed needed to be estimated and interpreted in terms of the overall cost of the intervention (with respect to monetary resources, manpower, and time).
Results of this study can be generalized to situations in India and parts of Southeast Asia, which share similar socioeconomic profiles and cultural traditions, with regard to the importance of oral hygiene.
I thought that this study was interesting because it shows the health education can help improve oral health. This could important for helping the current oral condition of India to improve. This program could be applied to different age groups and there would probably be improvement across the board. I thought that it was a well done study.
Thursday, March 22, 2012
Learning Journal 27
This Wednesday in Class we watched a video on Hinduism. The first thing that I noticed was how much I had been butchering the names of not only the characters in the Ramayana, but also the title itself. I also thought that it was interesting to see how much those characters are in the everyday life of people in India. They have gigantic paper mache characters from the Ramayana and do all sorts of dancing and acting to sell the story. I think it would interesting to watch one of these now that I have read the story. I almost feel like I would need to reread the Ramayana again to make sure that I could remember it all. Hopefully I didn't miss too much because we read the abridged version. This won't be important for my project, but it will be important for adapting to the culture and fitting in. Since it is such a well known story in India, it is really important that I know what happens in it to help build rapport and trust in the people I talk with.
I am interested to see how karma, a pillar of hinduism, works in India. I don't know if I should expect more 'do unto others as you would want them to do unto you' or if life will feel the same. I don't think people will be tripping over each other to help each other, but instead everyone will go about their normal daily lives.
I knew that Hinduism was monotheistic, but I didn't really understand how. The paper helped explain how they worship so many idols, yet believe in one God.
I also learned a little about dharma. Dharma sounds like it could be very similar to the moral and virtuous standards of the church. It insists on being correct, proper or having decent behavior. They also believe that there is a divine order of things and justice, social harmony and human happiness require that human beings discern and live in a manner appropriate to the requirements of that order. We would say that God has established a way of happiness for us and that involves living the commandments and living a Christ-like life. The Church and Hinduism share a lot of common beliefs and practices.
I also thought it was interesting how big Hinduism is for a faith that doesn't use religious propaganda because God doesn't need any trumpeting. The faith is very tolerant of all religions and accepting of all people.
The other part of the movie that caught my attention were the different phases of life. As a child you were chaste, as an adult you were supposed to pro create, and as an elder you were supposed to transition your focus of life and be chaste...but not chaste.
Overall, I learned a lot, but still have a lot to learn. It will be interesting to see what life is like in India amongst Hindus. It sounds like respect is pretty important, so being treated nicely won't be a problem. I can't really apply this to my project, but it will be helpful to identify with people and inquire more about while over there.
I am interested to see how karma, a pillar of hinduism, works in India. I don't know if I should expect more 'do unto others as you would want them to do unto you' or if life will feel the same. I don't think people will be tripping over each other to help each other, but instead everyone will go about their normal daily lives.
I knew that Hinduism was monotheistic, but I didn't really understand how. The paper helped explain how they worship so many idols, yet believe in one God.
I also learned a little about dharma. Dharma sounds like it could be very similar to the moral and virtuous standards of the church. It insists on being correct, proper or having decent behavior. They also believe that there is a divine order of things and justice, social harmony and human happiness require that human beings discern and live in a manner appropriate to the requirements of that order. We would say that God has established a way of happiness for us and that involves living the commandments and living a Christ-like life. The Church and Hinduism share a lot of common beliefs and practices.
I also thought it was interesting how big Hinduism is for a faith that doesn't use religious propaganda because God doesn't need any trumpeting. The faith is very tolerant of all religions and accepting of all people.
The other part of the movie that caught my attention were the different phases of life. As a child you were chaste, as an adult you were supposed to pro create, and as an elder you were supposed to transition your focus of life and be chaste...but not chaste.
Overall, I learned a lot, but still have a lot to learn. It will be interesting to see what life is like in India amongst Hindus. It sounds like respect is pretty important, so being treated nicely won't be a problem. I can't really apply this to my project, but it will be helpful to identify with people and inquire more about while over there.
Source 31
New Delhi: Indians have "low level of awareness about the importance of oral health and hygiene" and nearly half of them do not use toothbrush and toothpaste, a survey said Monday.
This was revealed by the Consumer Usage and Attitudes Survey conducted across the four geographic zones in India.
The study conducted by research firm IMRB said only 51 percent of the people brush their teeth with a toothpaste and a toothbrush.
"Only 28 percent of the respondents brush their teeth twice a day and 34 percent believe that the current frequency of brushing once a day is sufficient," the survey said.
Similarly, it found that 56 percent of the respondents feel there are no serious consequences of not changing the toothbrush. Moreover, 65 percent of the respondents feel that improper eating habits do not cause dental problems.
"Two out of three consumers have never visited a dentist."
Ashok Dhoble, honorary secretary general of the Indian Dental Association said: "Oral health is very important and critical for one`s overall health. Yet it is often neglected until a toothache makes it unbearable."
"For most, oral care is about finding a cure for their toothache, little realizing that a few simple daily routines can prevent painful cavities and enable people of all ages to enjoy healthier lives," he said.
"Children, right from the age of three should be made aware of basics like the importance of brushing teeth twice a day, cleaning teeth and gums properly and other oral care information. Starting early will make oral hygiene not a practice but a habit," he added.
Following the five basic oral care habits like brushing the teeth twice a day, visiting the dentist every six months, replacing the toothbrush every three months, eating foods that have vitamins and minerals and use of trusted dental aids can go a long way in having better oral health and leading a healthy life, the study said.
The study also said that only 47 percent of total treatments received are by dentists. The rest prefer to rely on advice from chemists, general practitioners or self-treatment using home remedies.
I was looking for more generation information about oral hygiene habits and ran across this. Since I am narrowing down my project, I will want to focus on information that is similar and will be helpful when writing a final paper. I am mostly discussing the oral hygiene habits of people in Coimbatore India, so the more information I can find about general habits in India, the better off I will be. The statistics are interesting for this paper, I was expecting lower percentages.
This was revealed by the Consumer Usage and Attitudes Survey conducted across the four geographic zones in India.
The study conducted by research firm IMRB said only 51 percent of the people brush their teeth with a toothpaste and a toothbrush.
"Only 28 percent of the respondents brush their teeth twice a day and 34 percent believe that the current frequency of brushing once a day is sufficient," the survey said.
Similarly, it found that 56 percent of the respondents feel there are no serious consequences of not changing the toothbrush. Moreover, 65 percent of the respondents feel that improper eating habits do not cause dental problems.
"Two out of three consumers have never visited a dentist."
Ashok Dhoble, honorary secretary general of the Indian Dental Association said: "Oral health is very important and critical for one`s overall health. Yet it is often neglected until a toothache makes it unbearable."
"For most, oral care is about finding a cure for their toothache, little realizing that a few simple daily routines can prevent painful cavities and enable people of all ages to enjoy healthier lives," he said.
"Children, right from the age of three should be made aware of basics like the importance of brushing teeth twice a day, cleaning teeth and gums properly and other oral care information. Starting early will make oral hygiene not a practice but a habit," he added.
Following the five basic oral care habits like brushing the teeth twice a day, visiting the dentist every six months, replacing the toothbrush every three months, eating foods that have vitamins and minerals and use of trusted dental aids can go a long way in having better oral health and leading a healthy life, the study said.
The study also said that only 47 percent of total treatments received are by dentists. The rest prefer to rely on advice from chemists, general practitioners or self-treatment using home remedies.
I was looking for more generation information about oral hygiene habits and ran across this. Since I am narrowing down my project, I will want to focus on information that is similar and will be helpful when writing a final paper. I am mostly discussing the oral hygiene habits of people in Coimbatore India, so the more information I can find about general habits in India, the better off I will be. The statistics are interesting for this paper, I was expecting lower percentages.
Tuesday, March 20, 2012
Learning Journal 26
A few classes ago we were given a paper titled 'Entering a Community'. It used to be an assignment that was given out to students, but now it is just for our help in figuring out how we will enter a community. It asks all sorts of questions about how to make sure you are properly prepared to enter a community. It helps you to cross the t's and dot the i's, so that when you get to your country, you can hit the ground running. I definitely think that entering a community is very important.
For instance, one individual that presented at the inquiry conference had to gain entrance to a Rugby team so that she could do her research. She had to figure out which school she would go to, which gatekeepers she would ask for permission, and how she would go about gathering data in that situation. For me, I am planning on gathering informants at colleges and universities. To do this I will have to go through a few gatekeepers. I will most likely need to get permission from the board of the school and make sure that it is okay that I am on their campus. While doing this project I thought about what would happen if I could not get approval on campus, where else would I go? Margaret brought up a good point about using Institute. I want to make sure that the Institute students don't feel pressured to find people for me, but if they have friends that might be open to our research then it would be helpful. From their friends I could then use snowballing sampling and find more college aged students to talk with. I also made many social situation triangles to try and think of more places to find students. I thought of restaurants, coffee shops, clubs, malls, etc. I will hopefully be able to come up with more locations that I can find students before I get over there, but if not I can just ask around for places.
One other problem with colleges and universities is that we will be there while school is out. I hope that there will still be students going to school year round like what happens at BYU. Some universities may be closed, but I hope that I will find other colleges that are open. I am sure that if worse comes to worse that I will be able to find alternative ways to find informants. If nothing else works I can walk the streets in search of informants to take a quick survey.
If I go to any of these other social places I might not need to go through a gatekeepers. If I do need one I am sure I will talk to the necessary people to get approval.
To the question: What ascribed characteristics do you bring, as a researcher, that may help to gain or limit access? I hope that being college students from a foreign country will help them to realize the importance of our project, although it may actually do the opposite. We are white, males, seeking to improve our education. I am able to talk with people and not afraid to spark up a conversation.
I am sure that there are many things involved with entering a community, which this paper that I am looking at shows. I look forward to actually getting to India and working towards getting approval to do research.
For instance, one individual that presented at the inquiry conference had to gain entrance to a Rugby team so that she could do her research. She had to figure out which school she would go to, which gatekeepers she would ask for permission, and how she would go about gathering data in that situation. For me, I am planning on gathering informants at colleges and universities. To do this I will have to go through a few gatekeepers. I will most likely need to get permission from the board of the school and make sure that it is okay that I am on their campus. While doing this project I thought about what would happen if I could not get approval on campus, where else would I go? Margaret brought up a good point about using Institute. I want to make sure that the Institute students don't feel pressured to find people for me, but if they have friends that might be open to our research then it would be helpful. From their friends I could then use snowballing sampling and find more college aged students to talk with. I also made many social situation triangles to try and think of more places to find students. I thought of restaurants, coffee shops, clubs, malls, etc. I will hopefully be able to come up with more locations that I can find students before I get over there, but if not I can just ask around for places.
One other problem with colleges and universities is that we will be there while school is out. I hope that there will still be students going to school year round like what happens at BYU. Some universities may be closed, but I hope that I will find other colleges that are open. I am sure that if worse comes to worse that I will be able to find alternative ways to find informants. If nothing else works I can walk the streets in search of informants to take a quick survey.
If I go to any of these other social places I might not need to go through a gatekeepers. If I do need one I am sure I will talk to the necessary people to get approval.
To the question: What ascribed characteristics do you bring, as a researcher, that may help to gain or limit access? I hope that being college students from a foreign country will help them to realize the importance of our project, although it may actually do the opposite. We are white, males, seeking to improve our education. I am able to talk with people and not afraid to spark up a conversation.
I am sure that there are many things involved with entering a community, which this paper that I am looking at shows. I look forward to actually getting to India and working towards getting approval to do research.
Source 30
To date, the most dependable mode of plaque control is mechanical cleaning with a toothbrush and other oral hygiene aids.1 Unfortunately, the majority of people are unable or unwilling to realize the need to spend time to remove plaque adequately from all tooth surfaces.2 Barnes et al.3 suggested that chewing-gum may serve as an effective oral hygiene device when brushing may not be possible. Sugar-free gums are simple, inexpensive and are readily available. Studies have shown that daily chewing-gum has beneficial effects. It increases salivary flow, raises the pH of plaque and saliva,4,5 reduces oral malodor6 and is effective for stain removal.7 Very few studies have examined the antiplaque effect of sugar-free chewing-gum and the results of these studies were variable. Some studies showed the antiplaque effect of chewing-gum,3,8,9 but other studies suggested that chewing sugar-free gum can reduce occlusal plaque but has no plaque inhibitory effect on smooth surfaces.10–12 Imfeld4 stated that chewing-gum can result in some reduction of debris, but little or no reduction of plaque. Variations on study design and methodology, as well as on the composition of the tested chewing-gum make it difficult to support or refute the antiplaque property of chewing-gum.
Fundamentally, the use of dental floss or interproximal brush appears to provide an adjunct effect on interdental hygiene when associated with tooth brushing.13 However, the main problems with all interdental cleaning methods are the individuals manual dexterity and motivation.14,15 For that reason, there is a tendency to look for other simpler options for cleaning interdental areas.
There is little information in the literature regarding the effect of gum chewing on interdental debris indicating that this topic remains unexplored. However, one study tried to assess the effect of chewing gum on salivary debris by having volunteers chew liquorice cakes and, after 10 minutes, collecting saliva samples with and without chewing the gum. A 50% reduction in the wet weight of liquorice debris in the saliva was recorded post-gum chewing.11 For the chewing-gum studies, the trend has been to study the preventive action10 of the gum in the absence of tooth brushing and other oral hygiene practices employing a 4 or 5 day plaque regrowth model.12–14 The results of these studies were disappointing and showed no significant antiplaque effect on the buccal and lingual surfaces. Hence, it was felt that there is a need to study the effect of chewing-gum as an adjunct to tooth brushing and also to assess the therapeutic action of the chewing-gum on established plaque and interdental debris.
The aim of the study was to evaluate the effect of chewing sugar-free gum in addition to tooth brushing on dental plaque and interdental debris. The null hypothesis was that chewing sugar-free gum after meals in addition to tooth brushing would not effectively remove dental plaque and interdental debris.
Brushing is the most effective method in cleaning the teeth. Nevertheless, toothbrush can remove only 71-86% of deposits from tooth surfaces and 60-74% from the accessible proximal surfaces.17 Hence, this study was conducted to evaluate whether chewing sugar-free gum twice a day after meals can add any supplemental value to brushing the teeth in reducing surface plaque and interdental debris. At the end of study, half of the null hypothesis was accepted; this half stated that chewing sugar-free gum after meals along with daily tooth brush has no effect on established plaque. But, the second half of null hypothesis (no effect of chewing sugar-free gum on interdental debris) was rejected. The absence of anti-plaque effect of chewing gum on buccal and lingual surfaces is in consensus with the earlier study reports.10–12 The participants in these studies had to refrain from daily brushing their teeth and used only chewing-gum as an oral hygiene aid. This suggests that chewing a piece of gum alone or as an adjunct to brushing the teeth is not beneficial for reducing the plaque. However, the anti-debris result is in consensus with the study done by Addy et al.11 Given the fact that most people brush for only one minute or less18,19 and the use of interdental cleansing aids have reduced patients’ compliance,13 effective dental plaque removal from proximal surfaces of teeth does not seem to be realistic for most people. Thus, under these circumstances, chewing a piece of gum can serve as an effective adjunct along with brushing to have the interdental spaces free from debris. The small difference between interdental debris scores at the end of control phase (B10) and ten days after chewing gum (T11) was not significant and probably over a period of time as the individual is used to chewing, the difference could be significantly larger.
The interesting outcome of this study that chewing gum was effective in removing the interdental debris but not the established surface plaque, supports the idea that the debris which is loosely bound in the interdental spaces, might be removed by the increased salivary flow which is stimulated by chewing the gum4,5 but that is not true for dental plaque, which is firmly adhered to the tooth surface. Ozcan et al.7 indicated that as the bolus of gum is softened by chewing and moved around the mouth, its texture and mechanical action may reduce the plaque and pellicle and thus, stain formation. Recalling that only one pellet of gum was used and considering the gum shrinkage while chewing, there is a possibility that the small-sized gum bolus hampered the mechanical property of plaque removal in our study. Hence, this may be indicative that for effective mechanical action of plaque removal by the gum, more than one pellet are needed to be chewed at a time. Holgerson et al.9 and Mouton et al.20 have previously confirmed the antiplaque effect of chewing gum. They conducted their study with a kind of sugar free gum containing xylitol as a sweetener which is an active ingredient unlike aspartame used as the sweetener in the present study. It is shown that xylitol reduces the formation of dental plaque and inhibits the growth of streptococcus mutans. It is non-cariogenic and can decrease lactic acid production in dental plaque which results in higher pH of the plaque.4,9 However, whether this difference in the gum base has been attributed to the absence of an anti-plaque effect in this study, remains unanswered and needs confirmation with future comparative studies.
The novel approach of this study was to evaluate the effect of chewing gum on interdental debris accumulation, which has not been done earlier. Also, a self-designed interdental debris index was used in this study. This index is simple and provides consistent results since evaluation is based on binary system: presence or absence of the debris. In previous studies, authors used Oral Hygiene Index-Simplified which is the best suited assessment tool for assessment of debris and calculus.9 The assessment tool for plaque used in the present study was Personal Hygiene Performance Index (PHP-M). Though the assessment is based on only 6 index teeth, it can yield reliable data in evaluating the difference in visible plaque; its well defined criteria for both tooth selection and scoring make it an index that can be determined fairly rapidly and consistently.16
One can question why a randomized control cross-over study with a wash out period was not a chosen study design and why there was a difference in the duration of study phase and that of control phase? However, considering the time limitation, the best suitable study design was chosen; a non-randomized, controlled before and after study design (here the study group was its own control), which eliminated virtually all group differences21 and gave the advantage of 24 participants for both study and control groups vis-Ã -vis 12 participants in the study and control groups, if the study was a randomized controlled trial in the ideal setting. The compliance in the study was good. On personal communication with the participants, it was noted that chewing the gum after meals produced a fresh feeling in the mouth. They also reported an increased salivary flow in their mouths. None of them reported any serious adverse effects like muscle fatigue or pain in their temporomandibular joints after chewing the gum for 30 minutes twice a day. There was no control over the individual chewing style (chewing force, chewing frequency and unilateral or bilateral chewing) which can influence the study results. The sample was a cohort of dental students, whose oral hygiene can be considered more superior compared to the general population and hence, this may reduce the external validity of the study. This was a short term evaluation study and only one brand of the chewing gum was used. Hence, the results need to be carefully interpreted.
Within the limits of the present study, the results of this short term evaluation study indicated that chew chewing sugar-free gum after meals, in addition to daily tooth brushing reduced the interdental debris but had no effect on buccal and lingual established plaque.
It is interesting that gum that brushing and chewing gum after a meal can reduce interdental debris. I thought that this might be good for a developing country because gum is cheap, easily accessible, and often desired. The only downside is that chewing gum or water rinsing does not reduce the plaque count in the mouth. It sounded like a good alternative in a country that may not be accustomed to brushing their teeth, but it looks like gum chewing will not make the cut.
Fundamentally, the use of dental floss or interproximal brush appears to provide an adjunct effect on interdental hygiene when associated with tooth brushing.13 However, the main problems with all interdental cleaning methods are the individuals manual dexterity and motivation.14,15 For that reason, there is a tendency to look for other simpler options for cleaning interdental areas.
There is little information in the literature regarding the effect of gum chewing on interdental debris indicating that this topic remains unexplored. However, one study tried to assess the effect of chewing gum on salivary debris by having volunteers chew liquorice cakes and, after 10 minutes, collecting saliva samples with and without chewing the gum. A 50% reduction in the wet weight of liquorice debris in the saliva was recorded post-gum chewing.11 For the chewing-gum studies, the trend has been to study the preventive action10 of the gum in the absence of tooth brushing and other oral hygiene practices employing a 4 or 5 day plaque regrowth model.12–14 The results of these studies were disappointing and showed no significant antiplaque effect on the buccal and lingual surfaces. Hence, it was felt that there is a need to study the effect of chewing-gum as an adjunct to tooth brushing and also to assess the therapeutic action of the chewing-gum on established plaque and interdental debris.
The aim of the study was to evaluate the effect of chewing sugar-free gum in addition to tooth brushing on dental plaque and interdental debris. The null hypothesis was that chewing sugar-free gum after meals in addition to tooth brushing would not effectively remove dental plaque and interdental debris.
Brushing is the most effective method in cleaning the teeth. Nevertheless, toothbrush can remove only 71-86% of deposits from tooth surfaces and 60-74% from the accessible proximal surfaces.17 Hence, this study was conducted to evaluate whether chewing sugar-free gum twice a day after meals can add any supplemental value to brushing the teeth in reducing surface plaque and interdental debris. At the end of study, half of the null hypothesis was accepted; this half stated that chewing sugar-free gum after meals along with daily tooth brush has no effect on established plaque. But, the second half of null hypothesis (no effect of chewing sugar-free gum on interdental debris) was rejected. The absence of anti-plaque effect of chewing gum on buccal and lingual surfaces is in consensus with the earlier study reports.10–12 The participants in these studies had to refrain from daily brushing their teeth and used only chewing-gum as an oral hygiene aid. This suggests that chewing a piece of gum alone or as an adjunct to brushing the teeth is not beneficial for reducing the plaque. However, the anti-debris result is in consensus with the study done by Addy et al.11 Given the fact that most people brush for only one minute or less18,19 and the use of interdental cleansing aids have reduced patients’ compliance,13 effective dental plaque removal from proximal surfaces of teeth does not seem to be realistic for most people. Thus, under these circumstances, chewing a piece of gum can serve as an effective adjunct along with brushing to have the interdental spaces free from debris. The small difference between interdental debris scores at the end of control phase (B10) and ten days after chewing gum (T11) was not significant and probably over a period of time as the individual is used to chewing, the difference could be significantly larger.
The interesting outcome of this study that chewing gum was effective in removing the interdental debris but not the established surface plaque, supports the idea that the debris which is loosely bound in the interdental spaces, might be removed by the increased salivary flow which is stimulated by chewing the gum4,5 but that is not true for dental plaque, which is firmly adhered to the tooth surface. Ozcan et al.7 indicated that as the bolus of gum is softened by chewing and moved around the mouth, its texture and mechanical action may reduce the plaque and pellicle and thus, stain formation. Recalling that only one pellet of gum was used and considering the gum shrinkage while chewing, there is a possibility that the small-sized gum bolus hampered the mechanical property of plaque removal in our study. Hence, this may be indicative that for effective mechanical action of plaque removal by the gum, more than one pellet are needed to be chewed at a time. Holgerson et al.9 and Mouton et al.20 have previously confirmed the antiplaque effect of chewing gum. They conducted their study with a kind of sugar free gum containing xylitol as a sweetener which is an active ingredient unlike aspartame used as the sweetener in the present study. It is shown that xylitol reduces the formation of dental plaque and inhibits the growth of streptococcus mutans. It is non-cariogenic and can decrease lactic acid production in dental plaque which results in higher pH of the plaque.4,9 However, whether this difference in the gum base has been attributed to the absence of an anti-plaque effect in this study, remains unanswered and needs confirmation with future comparative studies.
The novel approach of this study was to evaluate the effect of chewing gum on interdental debris accumulation, which has not been done earlier. Also, a self-designed interdental debris index was used in this study. This index is simple and provides consistent results since evaluation is based on binary system: presence or absence of the debris. In previous studies, authors used Oral Hygiene Index-Simplified which is the best suited assessment tool for assessment of debris and calculus.9 The assessment tool for plaque used in the present study was Personal Hygiene Performance Index (PHP-M). Though the assessment is based on only 6 index teeth, it can yield reliable data in evaluating the difference in visible plaque; its well defined criteria for both tooth selection and scoring make it an index that can be determined fairly rapidly and consistently.16
One can question why a randomized control cross-over study with a wash out period was not a chosen study design and why there was a difference in the duration of study phase and that of control phase? However, considering the time limitation, the best suitable study design was chosen; a non-randomized, controlled before and after study design (here the study group was its own control), which eliminated virtually all group differences21 and gave the advantage of 24 participants for both study and control groups vis-Ã -vis 12 participants in the study and control groups, if the study was a randomized controlled trial in the ideal setting. The compliance in the study was good. On personal communication with the participants, it was noted that chewing the gum after meals produced a fresh feeling in the mouth. They also reported an increased salivary flow in their mouths. None of them reported any serious adverse effects like muscle fatigue or pain in their temporomandibular joints after chewing the gum for 30 minutes twice a day. There was no control over the individual chewing style (chewing force, chewing frequency and unilateral or bilateral chewing) which can influence the study results. The sample was a cohort of dental students, whose oral hygiene can be considered more superior compared to the general population and hence, this may reduce the external validity of the study. This was a short term evaluation study and only one brand of the chewing gum was used. Hence, the results need to be carefully interpreted.
Within the limits of the present study, the results of this short term evaluation study indicated that chew chewing sugar-free gum after meals, in addition to daily tooth brushing reduced the interdental debris but had no effect on buccal and lingual established plaque.
It is interesting that gum that brushing and chewing gum after a meal can reduce interdental debris. I thought that this might be good for a developing country because gum is cheap, easily accessible, and often desired. The only downside is that chewing gum or water rinsing does not reduce the plaque count in the mouth. It sounded like a good alternative in a country that may not be accustomed to brushing their teeth, but it looks like gum chewing will not make the cut.
Monday, March 19, 2012
Learning Journal 25
In class on Friday we met in groups to discuss our IRB. I was able to read two other IRB proposals and get some good insight about how others were putting together their project. I got some insight from our instructor about minor changes I could make to help improve the process of getting approved. The main thing that I learned about the IRB is that I want to help the committee to see that my project is ethical and will not cause any harm to informants. I hope that the IRB understands that my project involves minor risks, so to make this clear I made some changes. My India proposal is mainly for my benefit to make sure that I think about all aspects of the project. The proposal has helped me to get out loose ends that I might not have thought about. The proposal was actually very helpful for doing my IRB because a lot of the questions were very similar.
Working on my proposal and IRB over the semester has given me the time necessary to narrow down my topic enough to decide exactly what I want to do. It has allowed me to talk with people, look up resources, and put together data that will be helpful for while I am in India. That's not to say that I am done and ready to go to India because I still have a lot to do. To keep a list of things that I still need to work on:
Finish the last parts of my IRB and put together a final draft
Figure out which schools we will go to in Coimbatore
Make sure my survey is worded and put together the way I want
Figure out anywhere else I can find informants if the universities and colleges don't allow us
These are the major things right now. I am excited to continue to think about each of these and come to some decisions! Being able to think about my IRB and proposal has allowed me to become more aware of what needs to be done before I leave. I guess the mentality before you leave is that all you need to do is put together a survey and go over to India to gather the data, but there is much more to it than that. This class takes lots of time and thought but it is needed for such a big project.
Working on my proposal and IRB over the semester has given me the time necessary to narrow down my topic enough to decide exactly what I want to do. It has allowed me to talk with people, look up resources, and put together data that will be helpful for while I am in India. That's not to say that I am done and ready to go to India because I still have a lot to do. To keep a list of things that I still need to work on:
Finish the last parts of my IRB and put together a final draft
Figure out which schools we will go to in Coimbatore
Make sure my survey is worded and put together the way I want
Figure out anywhere else I can find informants if the universities and colleges don't allow us
These are the major things right now. I am excited to continue to think about each of these and come to some decisions! Being able to think about my IRB and proposal has allowed me to become more aware of what needs to be done before I leave. I guess the mentality before you leave is that all you need to do is put together a survey and go over to India to gather the data, but there is much more to it than that. This class takes lots of time and thought but it is needed for such a big project.
Sunday, March 18, 2012
Source 29
Oral health is fundamental to general health and well being. From a theoretical point of view, three major dimensions of oral health has been identified; clinically assessed disease and impairment, disease and treatment specific symptoms and functional and psychological disabilities. It is now widely accepted that in addition to clinical indicators, functional, social and psychological aspects of oral health status should be considered when assessing dental needs. Several subjective oral health indicators have been developed to assess functional, social and psychological oral health outcomes ranging from single item global indicators, such as satisfaction with oral health and satisfaction with appearance of teeth, to complex inventories and scoring systems. In dentistry, many multi-item scales have been applied, but single item indicators have shown to be advantageous and is widely used in oral health research. Cunny and Perri suggest that when operational costs tend to increase, single-item indicators might be appropriate for use as they are strongly correlated with multi-item scales.
The majority of subjective oral health indicators have been used to evaluate oral health outcomes in adult populations. Oral health outcomes in children have also been explored. According to recent reports, age-specific questionnaires are valid and reliable instruments for assessing oral health outcomes in children. In this study information on subjective oral health was achieved by introducing a questionnaire to 12-year-old schoolchildren. By this age, children are thought to have matured enough to report on oral health and influencing factors.
Reisine and Bailit suggested that age, gender, social class and clinical status may be important variables in understanding how an individual perceives his/her oral health status. It is evident, for instance, that girls perceive their oral health more positively than boys, but tend to be less satisfied with the appearance of teeth. Subjects of higher socio-economic status (SES) tend to be more satisfied with oral health than lower SES counterparts, whereas dental pain has been reported to be most prevalent in families of lower income and education. On the other hand, schoolchildren resident in urban areas have been found to be more dissatisfied with oral health than those from rural areas. Gherunpong et al. and Marshman et al.provided evidence that bleeding gums and number of missing teeth impacted the oral health related quality of life of schoolchildren. Oral problems such as bad breath and bleeding gums have been identified to impact on students' perceived health and well-being.
Few attempts have been made to assess the prevalence and socio-behavioural determinants of children's perceived oral health status in developing countries such as India. This is notable, since children experience more oral impacts than adults. Children who have poor oral health have been found to be 12 times more likely to have restricted activity days than those who do not. As developing countries have limited resources allocated for oral health services, as for instance in India where less than seven percent of the gross national product is spent on health care, it is anticipated that self-reports can be utilized together with clinical indicators to assess the need for dental care. In this study, self-reported state of teeth refers to the child's present opinion regarding his or her state of teeth as good or bad. The aims of the present study were to assess the prevalence and correlates of self-reported state of teeth in 12-year-old schoolchildren in Kerala, India.
Nearly one-fourth (23%) of the 12-year-old schoolchildren reported having bad teeth. Self-reported state of teeth was significantly associated with poor school performance, self-reported oral problems in terms of bad breath and food impaction, dental visits, dissatisfaction with appearance of teeth and having caries experience. Similar findings have been reported elsewhere in terms of social and behavioural factors impacting on adult's as well as on schoolchildren's self-reported oral health. The prevalence of impaired oral health assessed here falls below what has been obtained with multi-item indicators in previous studies from developing and developed countries. The low prevalence of self-reported bad state of teeth accords with the caries prevalence observed in this study population. Compared to the European average DMFT score of 2.6 in 12-year-olds, the present DMFT score of 0.45 is low. It compares, however with findings from other developing countries in that a high proportion (91%) of the DMFT score was attributable to untreated caries. A majority of the children (81%) investigated showed good oral hygiene, although 83% of the pupils confirmed experience with bleeding gums.
The structured questionnaires applied in this study might have certain limitations. Reporting bias due to giving socially desirable answers and lack of recall are frequently encountered by children. Thus, the percentage of children reporting bad state of teeth may have been underestimated, because of socially desirable answers or the fact that children were reluctant to express negative opinions and attitudes. Alternatively, a global single item measure of oral health as used in this study might not have been sensitive enough to determine differences in state of teeth scores. Nevertheless, the positive associations between self-reported state of teeth, clinical dental status and self-reported oral problems accords with results from other studies and with theory, thus supporting the validity of the single item self-reported oral health indicator used in this study. According to theoretical models, impairments refer to the immediate biophysical outcomes of disease, commonly assessed by clinical indicators. Functional limitations, pain and discomfort constitute the earliest negative impacts, which in turn are followed by oral disadvantage and individual's overall assessment of oral health status. Reproducibility scores of the dental caries examination and of the questionnaire items were acceptable. The reliability was strengthened by translating the questionnaire into the local language and consequently ensuring cross-cultural adaptation and validation.
Evidence suggests that children and adults belonging to wealthy families, in terms of education and economic status, tend to have less impaired oral health than their poorer counterparts. Nicolau et al., have suggested that lower socio-economic status and family living conditions affect school performance and oral health behaviour. School performance was included in multiple logistic regression analysis along with the sociodemographic variables as it has been acknowledged that school progress shows a positive gradient with material possessions. In this study, children who performed poorly in school were more likely to report their teeth status to be bad when compared to subjects who considered that they performed well in school. Although the question regarding school performance was judged according to schoolchildren's own view rather than to their actual grades, it seems surprising to find one-fifth claiming to have performed poorly. It was anticipated that on being questioned about themselves the children would provide positive remarks , which does not seem to be the case in this study. The reported bad school performance might be a reflection of children's general state of life as well as of their bad state of teeth.
Consistent with findings in previous studies, the present results revealed positive associations between self-reported state of teeth and dental caries and self-reported oral problems. Studies should be done to see whether perceived oral health status could be improved through strengthening of preventive and therapeutic dental services for primary school children. Gherunpong et al., found that gingival inflammation and bleeding impacted negatively on children's oral quality of life and subsequently prevented them from brushing their teeth. Whereas numerous studies have identified a gap between professionally – and self-defined oral health others have found statistically significant associations of various strength. Thus, the present finding also supports previous studies suggesting that caries experience is a consistent clinical correlate of adolescent's oral quality of life. The positive association between DMFT scores and self-reported state of teeth might be attributed partly to a high level of untreated dental caries and a high level of unmet need for dental care and partly to a high level of awareness and self-perception of dental disease on the part of the children investigated. Contrary to the results reported by Ostberg et al, the DMFT index was possibly sensitive enough to be associated with self-reported state of teeth even in the presence of low mean DMFT scores.
It is noteworthy that schoolchildren who had experience with dental visits, reported to have bad state of teeth more often than their counterparts with no dental visits. Similar results have been reported previously in developing countries and might reflect symptomatic dental visiting habits and need for emergency care rather than an unexpected response to dental treatment.
Children who were dissatisfied with their appearance of teeth tended to perceive their teeth status as bad. Earlier studies have reasoned children to be dissatisfied with dental appearance in the presence of fractured anterior teeth, malpositioned teeth and untreated malocclusion. Although children in the present study had fractured anterior teeth, no significant difference was found between those with and without anterior trauma when reporting the state of their teeth as bad. This type of difference in self-perception might be predisposed by socio-cultural variations. Further investigation might be required to assess the impact of malpositened teeth and malocclusion on self-reported state of teeth.
It is interesting how the perception of bad oral health is connected with bad school performance. In a developing country with a part of the population not being able to get formal education, there might be a higher perception of bad oral health. Those unfamiliar with how to maintain proper oral health may not understand the importance of it. It will be interesting to see how this plays out in India.
The majority of subjective oral health indicators have been used to evaluate oral health outcomes in adult populations. Oral health outcomes in children have also been explored. According to recent reports, age-specific questionnaires are valid and reliable instruments for assessing oral health outcomes in children. In this study information on subjective oral health was achieved by introducing a questionnaire to 12-year-old schoolchildren. By this age, children are thought to have matured enough to report on oral health and influencing factors.
Reisine and Bailit suggested that age, gender, social class and clinical status may be important variables in understanding how an individual perceives his/her oral health status. It is evident, for instance, that girls perceive their oral health more positively than boys, but tend to be less satisfied with the appearance of teeth. Subjects of higher socio-economic status (SES) tend to be more satisfied with oral health than lower SES counterparts, whereas dental pain has been reported to be most prevalent in families of lower income and education. On the other hand, schoolchildren resident in urban areas have been found to be more dissatisfied with oral health than those from rural areas. Gherunpong et al. and Marshman et al.provided evidence that bleeding gums and number of missing teeth impacted the oral health related quality of life of schoolchildren. Oral problems such as bad breath and bleeding gums have been identified to impact on students' perceived health and well-being.
Few attempts have been made to assess the prevalence and socio-behavioural determinants of children's perceived oral health status in developing countries such as India. This is notable, since children experience more oral impacts than adults. Children who have poor oral health have been found to be 12 times more likely to have restricted activity days than those who do not. As developing countries have limited resources allocated for oral health services, as for instance in India where less than seven percent of the gross national product is spent on health care, it is anticipated that self-reports can be utilized together with clinical indicators to assess the need for dental care. In this study, self-reported state of teeth refers to the child's present opinion regarding his or her state of teeth as good or bad. The aims of the present study were to assess the prevalence and correlates of self-reported state of teeth in 12-year-old schoolchildren in Kerala, India.
Nearly one-fourth (23%) of the 12-year-old schoolchildren reported having bad teeth. Self-reported state of teeth was significantly associated with poor school performance, self-reported oral problems in terms of bad breath and food impaction, dental visits, dissatisfaction with appearance of teeth and having caries experience. Similar findings have been reported elsewhere in terms of social and behavioural factors impacting on adult's as well as on schoolchildren's self-reported oral health. The prevalence of impaired oral health assessed here falls below what has been obtained with multi-item indicators in previous studies from developing and developed countries. The low prevalence of self-reported bad state of teeth accords with the caries prevalence observed in this study population. Compared to the European average DMFT score of 2.6 in 12-year-olds, the present DMFT score of 0.45 is low. It compares, however with findings from other developing countries in that a high proportion (91%) of the DMFT score was attributable to untreated caries. A majority of the children (81%) investigated showed good oral hygiene, although 83% of the pupils confirmed experience with bleeding gums.
The structured questionnaires applied in this study might have certain limitations. Reporting bias due to giving socially desirable answers and lack of recall are frequently encountered by children. Thus, the percentage of children reporting bad state of teeth may have been underestimated, because of socially desirable answers or the fact that children were reluctant to express negative opinions and attitudes. Alternatively, a global single item measure of oral health as used in this study might not have been sensitive enough to determine differences in state of teeth scores. Nevertheless, the positive associations between self-reported state of teeth, clinical dental status and self-reported oral problems accords with results from other studies and with theory, thus supporting the validity of the single item self-reported oral health indicator used in this study. According to theoretical models, impairments refer to the immediate biophysical outcomes of disease, commonly assessed by clinical indicators. Functional limitations, pain and discomfort constitute the earliest negative impacts, which in turn are followed by oral disadvantage and individual's overall assessment of oral health status. Reproducibility scores of the dental caries examination and of the questionnaire items were acceptable. The reliability was strengthened by translating the questionnaire into the local language and consequently ensuring cross-cultural adaptation and validation.
Evidence suggests that children and adults belonging to wealthy families, in terms of education and economic status, tend to have less impaired oral health than their poorer counterparts. Nicolau et al., have suggested that lower socio-economic status and family living conditions affect school performance and oral health behaviour. School performance was included in multiple logistic regression analysis along with the sociodemographic variables as it has been acknowledged that school progress shows a positive gradient with material possessions. In this study, children who performed poorly in school were more likely to report their teeth status to be bad when compared to subjects who considered that they performed well in school. Although the question regarding school performance was judged according to schoolchildren's own view rather than to their actual grades, it seems surprising to find one-fifth claiming to have performed poorly. It was anticipated that on being questioned about themselves the children would provide positive remarks , which does not seem to be the case in this study. The reported bad school performance might be a reflection of children's general state of life as well as of their bad state of teeth.
Consistent with findings in previous studies, the present results revealed positive associations between self-reported state of teeth and dental caries and self-reported oral problems. Studies should be done to see whether perceived oral health status could be improved through strengthening of preventive and therapeutic dental services for primary school children. Gherunpong et al., found that gingival inflammation and bleeding impacted negatively on children's oral quality of life and subsequently prevented them from brushing their teeth. Whereas numerous studies have identified a gap between professionally – and self-defined oral health others have found statistically significant associations of various strength. Thus, the present finding also supports previous studies suggesting that caries experience is a consistent clinical correlate of adolescent's oral quality of life. The positive association between DMFT scores and self-reported state of teeth might be attributed partly to a high level of untreated dental caries and a high level of unmet need for dental care and partly to a high level of awareness and self-perception of dental disease on the part of the children investigated. Contrary to the results reported by Ostberg et al, the DMFT index was possibly sensitive enough to be associated with self-reported state of teeth even in the presence of low mean DMFT scores.
It is noteworthy that schoolchildren who had experience with dental visits, reported to have bad state of teeth more often than their counterparts with no dental visits. Similar results have been reported previously in developing countries and might reflect symptomatic dental visiting habits and need for emergency care rather than an unexpected response to dental treatment.
Children who were dissatisfied with their appearance of teeth tended to perceive their teeth status as bad. Earlier studies have reasoned children to be dissatisfied with dental appearance in the presence of fractured anterior teeth, malpositioned teeth and untreated malocclusion. Although children in the present study had fractured anterior teeth, no significant difference was found between those with and without anterior trauma when reporting the state of their teeth as bad. This type of difference in self-perception might be predisposed by socio-cultural variations. Further investigation might be required to assess the impact of malpositened teeth and malocclusion on self-reported state of teeth.
It is interesting how the perception of bad oral health is connected with bad school performance. In a developing country with a part of the population not being able to get formal education, there might be a higher perception of bad oral health. Those unfamiliar with how to maintain proper oral health may not understand the importance of it. It will be interesting to see how this plays out in India.
Friday, March 16, 2012
Source 28
Early childhood caries (ECC) is a severe form of dental caries (DC), in which one or more decayed (cavitated or non cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth, are present in a child 71 months of age or younger. In 2004, the American Academy of Pediatric Dentistry defined severe early childhood caries (sECC) as any sign of smooth-surface caries in children younger than three years of age. For children in the age group of three to five, one or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth, or a decayed, missing, or filled score of > 4 (3 years old), > 5 (4 years old), or > 6 (5 years old) surfaces constitutes sECC. Despite the advances in the field of medical science, dental caries continues to be a major health problem in the developing nations because of the lack of education, awareness and poor socio economic status. Socio economic status influences the nutrition and access for health care services. In the developing nations children suffer from a dual risk of malnutrition, with obesity in those living in urban areas and under nutrition in children from rural and slum areas. Recently, United Nations International Children's Emergency Fund (UNICEF) reported that about 146 million children below five years of age were underweight. It was the target of the millennium's development goals to half the count of the world's population of underweight five year old children by 2015.
This cannot be accomplished with food deliveries alone. Factors like maternal educational levels, socio-economic status and family size have to be addressed, to reduce the number of children in the underweight category.
Prevalence of DC is more in younger children. A study by Goel P et al. showed a prevalence of DC at about 81.25% in the age group of five to six years. Children with DC (with at least one pulpally involved tooth) can weigh less than those without it. It can also have a major impact on their physical, mental and overall systemic health. DC increases their susceptibility for iron deficiency anaemia, by lowering the serum ferritin levels. Some severe cases have even shown features of failure to thrive without any other obvious reasons.
Anthropometry is the single most universally applicable, inexpensive, and non-invasive method available to assess the size, proportions, and composition of the human body. Paediatricians have long used child growth as an important parameter in evaluating the health and general well-being of children. Low height and/or weight relative to reference data have been used as classic indicators of undernutrition for individuals and groups. World health Organization (WHO) has recommended the use of pediatric growth charts by the health professionals to monitor the physical growth of infants, children and adolescents. The measured values are plotted on the growth chart to determine the percentile relative to the child's age and gender. The anthropometric parameters below 3 rd percentile are indicative of insufficient growth and nutrition.
With this background, the present study was conducted with the objectives of evaluating the affect of sECC and its comprehensive rehabilitation on the growth parameters and QoL of children from low socioeconomic strata of the society.
In the present study, 100 preschool children from low socioeconomic sections of the society were evaluated. The results suggested that DC had a negative impact on QoL of children, and if left untreated may affect the weight of children. All untreated DC may not be detrimental to the general health; however, it significantly influences the QoL and dietary intake of children, especially when it is associated with pain and discomfort. Disturbed sleep as a result of pain can affect glucosteroid production in the body and thereby the growth. Another possible mechanism of impact of sECC on growth could relate to chronic inflammation from pulpitis and dental abscesses. Both of these conditions alter the metabolic pathways resulting in increased cytokine production. Cytokines like interleukin- 1 (IL-1) inhibit the process of erythropoiesis in bone marrow. The resultant reduced levels of haemoglobin may lead to anaemia of chronic disease.
According to WHO, affected eating pattern can rapidly manifest in younger children of 3 to 6 years of age. Hence, this age group was selected for the study. The children were from similar socioeconomic background and were provided with daytime meal from the preschool, this minimized the bias between the controls and sECC group for any change in weight related to different eating patterns.
Low QoL was observed in children with sECC. The mean values of anthropometric measurements were lower in the sECC group as compared to the controls (Wt ~ 850gms less). Similar results have also been reported earlier in 3 year old children with nursing caries.
After dental rehabilitation, there was a significant improvement in the QoL of sECC group children. The mean values of growth parameters were still higher in the control group as compared to sECC group; however, the difference in values was less as compared to baseline. There was a significant increase in Wt of the children after dental rehabilitation, which was similar to that reported in earlier studies. Overall intergroup comparison after dental rehabilitation showed that sECC group no longer differed from the controls in relation to various growth parameters.
This will be interesting to observe in India because a large part of its population is in poverty. Along with poverty comes poor nutrition and possibly lower QoL. I won't be testing this exactly, but it is good information to know that those with severe childhood caries may face more problems than those without.
This cannot be accomplished with food deliveries alone. Factors like maternal educational levels, socio-economic status and family size have to be addressed, to reduce the number of children in the underweight category.
Prevalence of DC is more in younger children. A study by Goel P et al. showed a prevalence of DC at about 81.25% in the age group of five to six years. Children with DC (with at least one pulpally involved tooth) can weigh less than those without it. It can also have a major impact on their physical, mental and overall systemic health. DC increases their susceptibility for iron deficiency anaemia, by lowering the serum ferritin levels. Some severe cases have even shown features of failure to thrive without any other obvious reasons.
Anthropometry is the single most universally applicable, inexpensive, and non-invasive method available to assess the size, proportions, and composition of the human body. Paediatricians have long used child growth as an important parameter in evaluating the health and general well-being of children. Low height and/or weight relative to reference data have been used as classic indicators of undernutrition for individuals and groups. World health Organization (WHO) has recommended the use of pediatric growth charts by the health professionals to monitor the physical growth of infants, children and adolescents. The measured values are plotted on the growth chart to determine the percentile relative to the child's age and gender. The anthropometric parameters below 3 rd percentile are indicative of insufficient growth and nutrition.
With this background, the present study was conducted with the objectives of evaluating the affect of sECC and its comprehensive rehabilitation on the growth parameters and QoL of children from low socioeconomic strata of the society.
In the present study, 100 preschool children from low socioeconomic sections of the society were evaluated. The results suggested that DC had a negative impact on QoL of children, and if left untreated may affect the weight of children. All untreated DC may not be detrimental to the general health; however, it significantly influences the QoL and dietary intake of children, especially when it is associated with pain and discomfort. Disturbed sleep as a result of pain can affect glucosteroid production in the body and thereby the growth. Another possible mechanism of impact of sECC on growth could relate to chronic inflammation from pulpitis and dental abscesses. Both of these conditions alter the metabolic pathways resulting in increased cytokine production. Cytokines like interleukin- 1 (IL-1) inhibit the process of erythropoiesis in bone marrow. The resultant reduced levels of haemoglobin may lead to anaemia of chronic disease.
According to WHO, affected eating pattern can rapidly manifest in younger children of 3 to 6 years of age. Hence, this age group was selected for the study. The children were from similar socioeconomic background and were provided with daytime meal from the preschool, this minimized the bias between the controls and sECC group for any change in weight related to different eating patterns.
Low QoL was observed in children with sECC. The mean values of anthropometric measurements were lower in the sECC group as compared to the controls (Wt ~ 850gms less). Similar results have also been reported earlier in 3 year old children with nursing caries.
After dental rehabilitation, there was a significant improvement in the QoL of sECC group children. The mean values of growth parameters were still higher in the control group as compared to sECC group; however, the difference in values was less as compared to baseline. There was a significant increase in Wt of the children after dental rehabilitation, which was similar to that reported in earlier studies. Overall intergroup comparison after dental rehabilitation showed that sECC group no longer differed from the controls in relation to various growth parameters.
This will be interesting to observe in India because a large part of its population is in poverty. Along with poverty comes poor nutrition and possibly lower QoL. I won't be testing this exactly, but it is good information to know that those with severe childhood caries may face more problems than those without.
Learning Journal 24
In sections this past week we discussed reciprocity. This is a topic that I know nothing about when talking about India. For instance, In America it is polite to follow the lead of the host. The host will invite you to sit down until dinner is ready and then invite you to the table when it is served. You usually remain at the table until the host invites you to sit elsewhere. In return you can invite the family over for dinner at your house, leave them a small personal gift, or bring a dessert to share with the family. It is really important to thank the host for their preparation, food, and time. I imagine that reciprocity would be similar in India, but they may have different customs that I am not familiar with. They may thank the family with different gifts or offer something in return. I could read online about how to properly thank those who have helped you, but I am not sure if it is different for each person. I might not be able to determine what is appropriate for each situation until I specifically ask.
Tuesday, March 13, 2012
Source 27
HAVE YOU VISITED A DENTIST IN THE PAST 12 MONTHS?
Percent who answered yes, from worst state to best (including Washington, D.C.):
Rank/state Yes
51. Mississippi 53%
50. Arkansas 55%
49. West Virginia 56%
48. Texas 58%
47. Oklahoma 58%
46. Louisiana 58%
45. Tennessee 59%
44. Kentucky 59%
43. Missouri 60%
42. Montana 61%
41. Alabama 61%
40. Nevada 62%
39. South Carolina 62%
38. New Mexico 63%
37. Florida 63%
36. Indiana 64%
35. Georgia 64%
34. North Carolina 64%
33. Kansas 64%
32. Arizona 65%
31. Wyoming 65%
30. Idaho 65%
29. Ohio 65%
28. Alaska 65%
27. Delaware 66%
26. Maine 66%
25. Oregon 66%
24. South Dakota 66%
23. North Dakota 66%
22. Nebraska 66%
21. Iowa 67%
20. Colorado 68%
19. Illinois 68%
18. Pennsylvania 68%
17. Washington, D.C. 68%
16. California 68%
15. Virginia 68%
14. Washington 69%
13. Michigan 70%
12. Maryland 70%
11. New York 70%
10. Utah 71%
9. New Jersey 72%
8. Vermont 72%
7. Wisconsin 72%
6. New Hampshire 73%
5. Minnesota 73%
4. Rhode Island 75%
3. Connecticut 75%
2. Hawaii 76%
1. Massachusetts 76%
What would prevent people from attending the dentist? These fears may be similar to the fears in India.
COST - Many people use the excuse of “I don’t have any dental insurance.” The facts are many payment plans are available, some with zero interest, which give you financial options to stay within your budget. Everyone is concerned about the budgets-these programs allow you to proceed with your dentistry without breaking the bank.
FEAR – Today with sedation dentistry, the use of medications specifically used in conjunction with your individual medical history and conditions takes fear out of the equation. It is common to hear patients say they never knew it could be done so comfortably-the apprehension is gone. Patients who formerly avoided the dentist now actually look forward to going.
TIME – Let’s face it; everyone is busy- so busy that their dental health gets shoved to the back burner. Next thing you know a dental emergency occurs. With a complete examination and thoughtful planning, sequencing dental needs easily can be contained to fewer appointments. A case in point, root canals use to involve 2, 3, 4 or even 5 appointments. Now they can be done in one appointment! It is common for even cosmetic procedures like veneers to only need 2 appointments.
Percent who answered yes, from worst state to best (including Washington, D.C.):
Rank/state Yes
51. Mississippi 53%
50. Arkansas 55%
49. West Virginia 56%
48. Texas 58%
47. Oklahoma 58%
46. Louisiana 58%
45. Tennessee 59%
44. Kentucky 59%
43. Missouri 60%
42. Montana 61%
41. Alabama 61%
40. Nevada 62%
39. South Carolina 62%
38. New Mexico 63%
37. Florida 63%
36. Indiana 64%
35. Georgia 64%
34. North Carolina 64%
33. Kansas 64%
32. Arizona 65%
31. Wyoming 65%
30. Idaho 65%
29. Ohio 65%
28. Alaska 65%
27. Delaware 66%
26. Maine 66%
25. Oregon 66%
24. South Dakota 66%
23. North Dakota 66%
22. Nebraska 66%
21. Iowa 67%
20. Colorado 68%
19. Illinois 68%
18. Pennsylvania 68%
17. Washington, D.C. 68%
16. California 68%
15. Virginia 68%
14. Washington 69%
13. Michigan 70%
12. Maryland 70%
11. New York 70%
10. Utah 71%
9. New Jersey 72%
8. Vermont 72%
7. Wisconsin 72%
6. New Hampshire 73%
5. Minnesota 73%
4. Rhode Island 75%
3. Connecticut 75%
2. Hawaii 76%
1. Massachusetts 76%
What would prevent people from attending the dentist? These fears may be similar to the fears in India.
COST - Many people use the excuse of “I don’t have any dental insurance.” The facts are many payment plans are available, some with zero interest, which give you financial options to stay within your budget. Everyone is concerned about the budgets-these programs allow you to proceed with your dentistry without breaking the bank.
FEAR – Today with sedation dentistry, the use of medications specifically used in conjunction with your individual medical history and conditions takes fear out of the equation. It is common to hear patients say they never knew it could be done so comfortably-the apprehension is gone. Patients who formerly avoided the dentist now actually look forward to going.
TIME – Let’s face it; everyone is busy- so busy that their dental health gets shoved to the back burner. Next thing you know a dental emergency occurs. With a complete examination and thoughtful planning, sequencing dental needs easily can be contained to fewer appointments. A case in point, root canals use to involve 2, 3, 4 or even 5 appointments. Now they can be done in one appointment! It is common for even cosmetic procedures like veneers to only need 2 appointments.
Learning Journal 23
In class this past Monday we talked about an article titled "Choosing a Site and Gaining Access" by Neuman. It is a rather important topic and needs to be considered for students planning on participating in a field study. The author mentions how gatekeepers need to be addressed. Give the gatekeeper as much information as you can without compromising the research. This will help the gatekeeper to develop trust and if something is discovered that the gatekeeper wasn't told about it could end in a termination of the research.
Presentation of self was another point that was addressed. It is important to address the subjects in a manner that will send a feeling of respect but not arrogance and an appearance of normal without standing out too much. I think to address the gatekeepers for our initial disclosure it would be important to dress professionally. If they get that we are serious about our project and professional, they may be much more likely to help us out. For talking with the students it is probably much more appropriate to dress in attire that would be similar to theirs.
One problem that researchers have is defocusing. This involves removing past assumptions and preconceptions to become more open to events in a field study. I don't think I will have had much experience similar to India before I travel there, so hopefully I will not have to blank my mind too much. I will need to remove a few assumptions and preconceptions that I have heard about India before I travel there but they are so lightly layered that they can be easily thrown away. Likewise, an attitude of strangeness will not be too much of a problem for me. The culture shock will be so new to me that identifying everything new will not be hard.
The last thing that I enjoyed was to build trust through charm. This is important because you need the informants that you are interviewing to be open with you. Oftentimes charm is sent through messages that we can't even control - like looks. I hope that I can work on building trust right off of the bat in order to receive better feedback from the informants. I have to be quick and charismatic to help the students feel comfortable and unpressured to answer my survey.
Presentation of self was another point that was addressed. It is important to address the subjects in a manner that will send a feeling of respect but not arrogance and an appearance of normal without standing out too much. I think to address the gatekeepers for our initial disclosure it would be important to dress professionally. If they get that we are serious about our project and professional, they may be much more likely to help us out. For talking with the students it is probably much more appropriate to dress in attire that would be similar to theirs.
One problem that researchers have is defocusing. This involves removing past assumptions and preconceptions to become more open to events in a field study. I don't think I will have had much experience similar to India before I travel there, so hopefully I will not have to blank my mind too much. I will need to remove a few assumptions and preconceptions that I have heard about India before I travel there but they are so lightly layered that they can be easily thrown away. Likewise, an attitude of strangeness will not be too much of a problem for me. The culture shock will be so new to me that identifying everything new will not be hard.
The last thing that I enjoyed was to build trust through charm. This is important because you need the informants that you are interviewing to be open with you. Oftentimes charm is sent through messages that we can't even control - like looks. I hope that I can work on building trust right off of the bat in order to receive better feedback from the informants. I have to be quick and charismatic to help the students feel comfortable and unpressured to answer my survey.
Sunday, March 11, 2012
Learning Journal 22
This week in class we discussed our IRB with other classmates and got some feedback from each other. This was nice, but not as helpful as the feedback from our facilitator which I was happy to receive. It is good to have someone who has filled out an IRB before and knows what changes need to be made to improve the proposal.
What I mainly wanted to focus on was one of the articles that we read for class. The article was titled 'Eating Christmas in the Kalahari'. I guess one main point that I got from this article is that we are entering a peoples country, lifestyle, culture, and daily living; so we cannot expect to come in and run the show. The author in this article had been among the bushmen for 3 years and kindly wanted to thank the people by purchasing the biggest ox that he could find for Christmas. Although this was a very generous offer of gratitude, the author did not get the response he was expecting. After being mocked and criticized for his pathetic purchase, the author finally comes to a few conclusions. He realizes that 'there are no totally generous acts. All "acts" have an element of calculation'. I guess he also learned a humbling lesson about good intentions. The author realizes that he gave the people no more than what they get for each other every day and he was expecting more fanfare. His world was turned upside down after he was not getting the expected feedback from people.
This is important for me because I will be in a completely different culture and country. I cannot simply repay or thank people by purchasing them something before I leave. It seems like the author tried to give the Bushmen his parting present with feelings that it should be sufficient. Like the scout rule to leave a campsite looking better than when you first arrived; I feel like this same thing can apply to the places we travel. We aren't there to fix or cure or solve things for people, but we can leave an inspirational and caring impression on those we talk with. The author wanted to give the people something for letting him stay with them, but this act was not totally generous because he felt as if he owed something.
So what can I do? I need to make sure that I build relationships with the host families. I need to help around the house with things that need to get done. I need to be willing to get to know those that I talk with and care about them. I need to be able to get the data for my research, but not in a way where I simply use the people for my data. I can overcome this by just caring for and loving the people. I can't go through all of the motions of research and expect that I can just give a thank you present at the end, it has to be something that I work on continually. Nice acts of service throughout my stay will show my appreciation.
What I mainly wanted to focus on was one of the articles that we read for class. The article was titled 'Eating Christmas in the Kalahari'. I guess one main point that I got from this article is that we are entering a peoples country, lifestyle, culture, and daily living; so we cannot expect to come in and run the show. The author in this article had been among the bushmen for 3 years and kindly wanted to thank the people by purchasing the biggest ox that he could find for Christmas. Although this was a very generous offer of gratitude, the author did not get the response he was expecting. After being mocked and criticized for his pathetic purchase, the author finally comes to a few conclusions. He realizes that 'there are no totally generous acts. All "acts" have an element of calculation'. I guess he also learned a humbling lesson about good intentions. The author realizes that he gave the people no more than what they get for each other every day and he was expecting more fanfare. His world was turned upside down after he was not getting the expected feedback from people.
This is important for me because I will be in a completely different culture and country. I cannot simply repay or thank people by purchasing them something before I leave. It seems like the author tried to give the Bushmen his parting present with feelings that it should be sufficient. Like the scout rule to leave a campsite looking better than when you first arrived; I feel like this same thing can apply to the places we travel. We aren't there to fix or cure or solve things for people, but we can leave an inspirational and caring impression on those we talk with. The author wanted to give the people something for letting him stay with them, but this act was not totally generous because he felt as if he owed something.
So what can I do? I need to make sure that I build relationships with the host families. I need to help around the house with things that need to get done. I need to be willing to get to know those that I talk with and care about them. I need to be able to get the data for my research, but not in a way where I simply use the people for my data. I can overcome this by just caring for and loving the people. I can't go through all of the motions of research and expect that I can just give a thank you present at the end, it has to be something that I work on continually. Nice acts of service throughout my stay will show my appreciation.
Source 26
The aim of this study was to compare the usefulness of two different questionnaires assessing oral health-related quality of life (OHRQoL) at the basic examination and after initial dental hygiene treatment (DHtx). Methods: A total of 42 patients referred for periodontal treatment completed the Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI) at the basic periodontal examination. They underwent DHtx and completed the questionnaires once again after the treatment. Results: No statistically significant differences could be found between the two assessments, neither for the total scores nor for any of the separate items of the OHIP-14 or the GOHAI. However, the GOHAI questionnaire seems to result in a greater variety in the responses indicating that the floor effect is not as pronounced as for the OHIP-14. Those who had rated their oral health as good reported significantly better OHRQoL on both questionnaires. The same pattern was found for patients who reported that they were satisfied with their teeth. After DHtx and necessary extractions, there was a statistically significant correlation between the number of teeth and the total scores on both questionnaires. No other statistically significant correlations with periodontal variables could be found. Conclusion: No statistically significant difference could be found after DHtx compared to before in regard to OHRQoL assessed with OHIP-14 and GOHAI. However, there was a greater variety in the responses with the GOHAI questionnaire; it may hereby be more useful for patients with periodontal disease.
Thursday, March 8, 2012
Source 25
I wanted to make sure that I could get the data table so I just posted the link.
http://download.journals.elsevierhealth.com/pdfs/journals/0975-962X/PIIS0975962X11600075.pdf
In the preamble of its constitution, WHO states that ‘health is a state of complete physical, mental and social well being and not merely the absence of disease and infirmity’. In dentistry, this new perspective on health suggests that the ultimate goal of dental care is not merely the absence of caries or periodontal disease or oral cancer but also the mental and social well being of the patient. The concept of oral health-related quality of life (OHRQOL) captures the aim of this new perspective.
There is an increased recognition of incorporating OHRQOL measures while evaluating oral health. It can be used to measure the impact of various oral diseases on the general population and high risk groups in order to study the success of various preventive and curative procedures on improving the QOL of an individual. This literature review attempts to explain various aspects of OHRQOL, its method of assessment, use in future research, and role that it can play in improving the current dental curriculum.
WHAT IS ORAL HEALTH-RELATED QUALITY OF LIFE?
There are various definitions of OHRQOL that are in use, but the most useful of these can be derived by understanding health- related QOL. This is explained by using the personal assess- ment of how the following factors affect his/her well being:
1. Functional factors
2. Psychological factors (concerning the person’s appear-
ance and self esteem)
3. Social factors (such as interaction with others). Experience of pain or discomfort
Oral health-related quality of life can be assessed when these parameters center around orofacial concerns (Figure 1).
Assessment of Oral Health-related Quality of Life
The priority according to OHRQOL demands that we have a solid, scientific basis for assessing it. Researchers, clinicians, and public health practitioners have a responsibility to document and evaluate OHRQOL using rigorous, reliable, and valid assessment tools. As the demand grew for measures of health status (in contrast to the clinical measures of disease status), researchers focused on developing standardized questionnaires that could be used in clinical settings or OHRQOL—the concept, its assessment and relevance in dental research and education
large population surveys. The measurement of OHRQOL is divided into three categories: societal indicators, global self- ratings of OHRQOL, and multiple-item questionnaires of OHRQOL.
Assessment of Societal Indicators
While assessing the societal impact of oral conditions, large population surveys inquire about the days of restricted activity, work loss, and school absenteeism due to bad oral health conditions (Table 1). These surveys typically yield the rate of impacts that are negligible for individuals while substantial when expressed in terms of the illness in a given year. This is partly owing to the fact that there is a high prevalence of oral conditions that causes disabling pain in the head and neck, and the tendency for many such oral diseases to persist and recur. Take for example, a US population survey revealed that bad oral health conditions lead to more days of work loss than those compared to stroke, or, in younger adults, as much work loss as all neoplasms considered together.
While societal measures are useful for demonstrating public health significance of oral diseases, there are obvious limitations in using measures such as work loss to assess OHRQOL. This can be proved by considering that even some severe levels of discomfort can occur without causing any work loss. Further, many individuals who are suffering may not be in the workforce. However, for those in the workforce, the need to take time off is influenced by the structure, organization, and delivery of dental services. Reisine5 found that 95% of the work loss episodes were for preventive or curative treatment. Finally, from a statistical perspective, societal indicators such as work loss, are simply too infrequent to be considered sensitive markers of impact in epidemiologic studies or clinical trials. This is particularly important in public health, where it is essential to document the burden of illness using measures that are meaningful to policy makers.
Assessment of Individuals’ Oral Health-related Quality of Life Using Global Self-ratings
An intuitively appealing method to assess OHRQOL is to ask a global question about self-rated oral health of the respondents. Consider asking, ‘how would you rate the health of your teeth, gums, and mouth?’ Responses are provided on a five-point ordinal scale ranging from ‘excellent’ to ‘very poor’. However, this process varies from individual to individual. For example, some people may regard their oral health to be excellent as long as they do not experience any dental pain, while others may consider it to be fair despite having lost several teeth.
The potential for different individuals to use different yardsticks in evaluating their oral health is not seen as a limitation, but as a strength because it permits them to integrate multidimensional experience and select the ones which are most salient. Another feature of single, global assessment is that they offer positive response and are not limited to measuring only the adverse impact of oral health. Finally, global self-ratings require a single question with a simple response format. Therefore, it is feasible for large interviews or questionnaires that explore numerous research questions, as it often occurs in national health surveys. However, it would be a mistake to interpret this as an average rating of the nation’s oral health, because there is no physical scale that can be attached to the response categories. For example, there is no specific reason to believe that the difference between ‘excellent’ and ‘very good’ is equivalent to that between ‘good’ and ‘fair’. This is despite the fact that the numerical differences between the scores assigned to these ratings are identical.
One approach to this psychometric problem is to offer a numerical scale to the respondents. A visual analog scale (VAS) that is used frequently in pain research is one such scale. However, it would be illusionary to believe that this improves the metric qualities of the response scale; because different respondents would use different subconscious yardsticks when deciding on where to mark the VAS. The ease of administering single-item questions make them ideal for large-scale health surveys, including surveys conducted across several countries.
Assessment of Individuals Oral Health-related Quality of Life Using Multiple-item Questionnaire
The other commonly used method to evaluate multiple dimensions of OHRQOL is to ask numerous questions from the subjects. For example, some questions that focus on function, some are concerned with pain or discomfort while others evaluate self-image and social interaction. This approach attempts to delineate specific experiences that encompass the researcher’s definition of OHRQOL. Typically, these multiple-item questionnaires capture more statistical variation than single-item questions. Hence, the motivation to develop multiple-item questionnaires often is both philosophical (researchers focus on a specific dimension of OHRQOL using a predetermined set of questions and response categories) and methodological (researchers attempt to capture maximum variation in OHRQOL).
Given that the definitions of OHRQOL are vague, it is not surprising that there is a significant heterogeneity in focus, length, and format of the multiple-item question- naires developed to evaluate OHRQOL. Questionnaires range in length from 3 to 56 items6–13 (Table 1). The format of questions and responses vary from simple, fact-based questions with yes–no response (e.g., Are there any types of food that you find difficult to chew?) to four-part questions that inquire about the frequency, severity and importance of a specific problem (e.g., oral impact on daily perfor- mances).13 While most questionnaires are limited to the negative impact of oral diseases, two questionnaires ask if oral conditions had either an adverse impact on the respon- dent’s well being (i.e., OHRQOL inventory7 and dental impact profile10). A common feature of the OHRQOL ques- tionnaires is that these can be analyzed as responses to indi- vidual questions and summarized as numeric scores. In many of the questionnaires, sub scales can be computed. For example, the oral health impact profile (OHIP)8 that has 7 substances, each measuring a hypothesized unique dimen- sion of OHRQOL (e.g., functional limitation). In some cases, these summary scores do not have a true metric. For example, the General Oral Health Assessment Index (GOHAI)6 that assigns a value of zero through five to all responses of ‘never’ to ‘always’, respectively, to each of the 12 items queried.
However, in some cases, summary scores are computed as the number of items endorsed at a particular threshold. For these, the values have a literal meaning. For example, an alternative method of summarizing the 49-item OHIP is by reporting the number of items answered with ‘occa- sionally’, ‘fairly often’, or ‘very often’. In such cases, the mean value has an intuitive meaning unlike the abstract concept of ‘between good and fair’ and hence may be more interpretable for users of the data. Recent methods that are used have fewer questions in the OHIP. These have been found to be more suitable in large population surveys.
OHRQOL—the concept, its assessment and relevance in dental research and education
Direction for Future Research
The currently used method of assessing OHRQOL has fol- lowing limitations:
1. While some questionnaires focus on adverse impacts of
OHRQOL, additional methods are needed to capture positive dimensions of health. This is particularly important for tracking improvement amongst people who are initially free of any adverse symptoms.
2. Previous studies have concentrated on limited factors associated with OHRQOL. There is a need to identify additional determinants of OHRQOL, including psychological and social variables and those describing organization of the health care system.
3. There are only few studies on the impact of specific treatments of QOL. Additional research is needed to evaluate the treatment of existing disease, its prevention, and enhancement of health. Also, more studies on the latest techniques such as effect of implants on OHRQOL15 should be conducted.
4. Clinical decision making calls for integration of additional outcomes besides OHRQOL, including clinical indices, patient satisfaction, longevity, and cost. However, OHRQOL has been evaluated as a primary outcome in most of the studies and methods that have not been developed to permit a clinician to systemically incorporate OHRQOL with the other relevant patient outcomes.
Oral Health-related Quality of Life and Need to Refocus Dental Education
Oral Health-related Quality of Life plays a central role in the future of dental education. Considering the structural factors that will shape dental health care in future, the challenges that oral health care providers face currently, and the recommendations for the future of dental education, the dental education community must begin to evaluate whether it is preparing future health care providers to be:
1. Truly patient centric
2. Culturally competent
3. Able to work from an interdisciplinary perspective that
places oral health in the context of a patient’s overall health
Oral Health-related Quality of Life is useful in refocus-
ing the content of educational efforts on these three goals.
CONCLUSION
Research on trends in dentistry and dental education shows that in future, fewer dentists will take care of the increasing number of patients. Therefore, educating these patients about promoting good oral health and preventive care will be crucial. Research also shows that certain population segments are drastically underserved. Dental education has to make a contribution if this situation is to change. Finally, with rapidly changing knowledge base and technology in all health-care fields, interdisciplinary considerations and collaborations become increasingly important. QOL measures are not only being used in population surveys but also in randomized clinical trials, technology assessment in health care and evaluation of health-care delivery systems.
http://download.journals.elsevierhealth.com/pdfs/journals/0975-962X/PIIS0975962X11600075.pdf
In the preamble of its constitution, WHO states that ‘health is a state of complete physical, mental and social well being and not merely the absence of disease and infirmity’. In dentistry, this new perspective on health suggests that the ultimate goal of dental care is not merely the absence of caries or periodontal disease or oral cancer but also the mental and social well being of the patient. The concept of oral health-related quality of life (OHRQOL) captures the aim of this new perspective.
There is an increased recognition of incorporating OHRQOL measures while evaluating oral health. It can be used to measure the impact of various oral diseases on the general population and high risk groups in order to study the success of various preventive and curative procedures on improving the QOL of an individual. This literature review attempts to explain various aspects of OHRQOL, its method of assessment, use in future research, and role that it can play in improving the current dental curriculum.
WHAT IS ORAL HEALTH-RELATED QUALITY OF LIFE?
There are various definitions of OHRQOL that are in use, but the most useful of these can be derived by understanding health- related QOL. This is explained by using the personal assess- ment of how the following factors affect his/her well being:
1. Functional factors
2. Psychological factors (concerning the person’s appear-
ance and self esteem)
3. Social factors (such as interaction with others). Experience of pain or discomfort
Oral health-related quality of life can be assessed when these parameters center around orofacial concerns (Figure 1).
Assessment of Oral Health-related Quality of Life
The priority according to OHRQOL demands that we have a solid, scientific basis for assessing it. Researchers, clinicians, and public health practitioners have a responsibility to document and evaluate OHRQOL using rigorous, reliable, and valid assessment tools. As the demand grew for measures of health status (in contrast to the clinical measures of disease status), researchers focused on developing standardized questionnaires that could be used in clinical settings or OHRQOL—the concept, its assessment and relevance in dental research and education
large population surveys. The measurement of OHRQOL is divided into three categories: societal indicators, global self- ratings of OHRQOL, and multiple-item questionnaires of OHRQOL.
Assessment of Societal Indicators
While assessing the societal impact of oral conditions, large population surveys inquire about the days of restricted activity, work loss, and school absenteeism due to bad oral health conditions (Table 1). These surveys typically yield the rate of impacts that are negligible for individuals while substantial when expressed in terms of the illness in a given year. This is partly owing to the fact that there is a high prevalence of oral conditions that causes disabling pain in the head and neck, and the tendency for many such oral diseases to persist and recur. Take for example, a US population survey revealed that bad oral health conditions lead to more days of work loss than those compared to stroke, or, in younger adults, as much work loss as all neoplasms considered together.
While societal measures are useful for demonstrating public health significance of oral diseases, there are obvious limitations in using measures such as work loss to assess OHRQOL. This can be proved by considering that even some severe levels of discomfort can occur without causing any work loss. Further, many individuals who are suffering may not be in the workforce. However, for those in the workforce, the need to take time off is influenced by the structure, organization, and delivery of dental services. Reisine5 found that 95% of the work loss episodes were for preventive or curative treatment. Finally, from a statistical perspective, societal indicators such as work loss, are simply too infrequent to be considered sensitive markers of impact in epidemiologic studies or clinical trials. This is particularly important in public health, where it is essential to document the burden of illness using measures that are meaningful to policy makers.
Assessment of Individuals’ Oral Health-related Quality of Life Using Global Self-ratings
An intuitively appealing method to assess OHRQOL is to ask a global question about self-rated oral health of the respondents. Consider asking, ‘how would you rate the health of your teeth, gums, and mouth?’ Responses are provided on a five-point ordinal scale ranging from ‘excellent’ to ‘very poor’. However, this process varies from individual to individual. For example, some people may regard their oral health to be excellent as long as they do not experience any dental pain, while others may consider it to be fair despite having lost several teeth.
The potential for different individuals to use different yardsticks in evaluating their oral health is not seen as a limitation, but as a strength because it permits them to integrate multidimensional experience and select the ones which are most salient. Another feature of single, global assessment is that they offer positive response and are not limited to measuring only the adverse impact of oral health. Finally, global self-ratings require a single question with a simple response format. Therefore, it is feasible for large interviews or questionnaires that explore numerous research questions, as it often occurs in national health surveys. However, it would be a mistake to interpret this as an average rating of the nation’s oral health, because there is no physical scale that can be attached to the response categories. For example, there is no specific reason to believe that the difference between ‘excellent’ and ‘very good’ is equivalent to that between ‘good’ and ‘fair’. This is despite the fact that the numerical differences between the scores assigned to these ratings are identical.
One approach to this psychometric problem is to offer a numerical scale to the respondents. A visual analog scale (VAS) that is used frequently in pain research is one such scale. However, it would be illusionary to believe that this improves the metric qualities of the response scale; because different respondents would use different subconscious yardsticks when deciding on where to mark the VAS. The ease of administering single-item questions make them ideal for large-scale health surveys, including surveys conducted across several countries.
Assessment of Individuals Oral Health-related Quality of Life Using Multiple-item Questionnaire
The other commonly used method to evaluate multiple dimensions of OHRQOL is to ask numerous questions from the subjects. For example, some questions that focus on function, some are concerned with pain or discomfort while others evaluate self-image and social interaction. This approach attempts to delineate specific experiences that encompass the researcher’s definition of OHRQOL. Typically, these multiple-item questionnaires capture more statistical variation than single-item questions. Hence, the motivation to develop multiple-item questionnaires often is both philosophical (researchers focus on a specific dimension of OHRQOL using a predetermined set of questions and response categories) and methodological (researchers attempt to capture maximum variation in OHRQOL).
Given that the definitions of OHRQOL are vague, it is not surprising that there is a significant heterogeneity in focus, length, and format of the multiple-item question- naires developed to evaluate OHRQOL. Questionnaires range in length from 3 to 56 items6–13 (Table 1). The format of questions and responses vary from simple, fact-based questions with yes–no response (e.g., Are there any types of food that you find difficult to chew?) to four-part questions that inquire about the frequency, severity and importance of a specific problem (e.g., oral impact on daily perfor- mances).13 While most questionnaires are limited to the negative impact of oral diseases, two questionnaires ask if oral conditions had either an adverse impact on the respon- dent’s well being (i.e., OHRQOL inventory7 and dental impact profile10). A common feature of the OHRQOL ques- tionnaires is that these can be analyzed as responses to indi- vidual questions and summarized as numeric scores. In many of the questionnaires, sub scales can be computed. For example, the oral health impact profile (OHIP)8 that has 7 substances, each measuring a hypothesized unique dimen- sion of OHRQOL (e.g., functional limitation). In some cases, these summary scores do not have a true metric. For example, the General Oral Health Assessment Index (GOHAI)6 that assigns a value of zero through five to all responses of ‘never’ to ‘always’, respectively, to each of the 12 items queried.
However, in some cases, summary scores are computed as the number of items endorsed at a particular threshold. For these, the values have a literal meaning. For example, an alternative method of summarizing the 49-item OHIP is by reporting the number of items answered with ‘occa- sionally’, ‘fairly often’, or ‘very often’. In such cases, the mean value has an intuitive meaning unlike the abstract concept of ‘between good and fair’ and hence may be more interpretable for users of the data. Recent methods that are used have fewer questions in the OHIP. These have been found to be more suitable in large population surveys.
OHRQOL—the concept, its assessment and relevance in dental research and education
Direction for Future Research
The currently used method of assessing OHRQOL has fol- lowing limitations:
1. While some questionnaires focus on adverse impacts of
OHRQOL, additional methods are needed to capture positive dimensions of health. This is particularly important for tracking improvement amongst people who are initially free of any adverse symptoms.
2. Previous studies have concentrated on limited factors associated with OHRQOL. There is a need to identify additional determinants of OHRQOL, including psychological and social variables and those describing organization of the health care system.
3. There are only few studies on the impact of specific treatments of QOL. Additional research is needed to evaluate the treatment of existing disease, its prevention, and enhancement of health. Also, more studies on the latest techniques such as effect of implants on OHRQOL15 should be conducted.
4. Clinical decision making calls for integration of additional outcomes besides OHRQOL, including clinical indices, patient satisfaction, longevity, and cost. However, OHRQOL has been evaluated as a primary outcome in most of the studies and methods that have not been developed to permit a clinician to systemically incorporate OHRQOL with the other relevant patient outcomes.
Oral Health-related Quality of Life and Need to Refocus Dental Education
Oral Health-related Quality of Life plays a central role in the future of dental education. Considering the structural factors that will shape dental health care in future, the challenges that oral health care providers face currently, and the recommendations for the future of dental education, the dental education community must begin to evaluate whether it is preparing future health care providers to be:
1. Truly patient centric
2. Culturally competent
3. Able to work from an interdisciplinary perspective that
places oral health in the context of a patient’s overall health
Oral Health-related Quality of Life is useful in refocus-
ing the content of educational efforts on these three goals.
CONCLUSION
Research on trends in dentistry and dental education shows that in future, fewer dentists will take care of the increasing number of patients. Therefore, educating these patients about promoting good oral health and preventive care will be crucial. Research also shows that certain population segments are drastically underserved. Dental education has to make a contribution if this situation is to change. Finally, with rapidly changing knowledge base and technology in all health-care fields, interdisciplinary considerations and collaborations become increasingly important. QOL measures are not only being used in population surveys but also in randomized clinical trials, technology assessment in health care and evaluation of health-care delivery systems.
Tuesday, March 6, 2012
Source 24
Eruption of teeth (teething) is defined as the movement of the teeth from their pre-eruptive position in the alveolar bone through the mucosa into the oral cavity.
Teething time is of great interest to physicians, dentists, and particularly parents who consider this is an important event in their children’s lives. The event is, therefore, eagerly awaited by all being an important milestone in an infant’s first year of life.
Teething generally begins around 6 months of age and continues until the baby is about 3 years old. In years gone by, numerous customs were observed to ensure that misfortune would not befall on a teething child and the process would go on smoothly. We may like to think that we live in a sophisticated age, but even in the 21st century, many customs and superstitions linger on. People in all socio-economic classes, educational levels, age groups, and ethnic backgrounds still believe that teething causes ailments.
The beliefs and superstitions associated with teething throughout history appear amusing and it may cause concern that the profession was so willing to go along with practices so incorrect. Yet, it is sobering to appreciate that our historic colleagues were acting on their existing knowledge and their professional and personal standing relied heavily on their reputation amongst their peers and patients.
TEETHING SUPERSTITIONS IN ASIA
In Pakistan, some Punjabi mothers perform a special ritual by arranging a ceremony where a person other than the baby’s mother, throws chewed coconut in the baby’s face when he is about to cut his first teeth hoping his teeth will be as good as the person who is chosen to throw coconut.
Coral necklaces are often placed on children to give them relief from teething in Japan.
The Koris (Hindu weavers) in North Western India believe that feeding a hen to a teething child will relieve his trouble. Amber teething necklaces are tied around the baby’s neck in various Asian cultures.
Bury your child’s first tooth in cow-dung and throw it over your roof, it will hasten the child’s teething process. Christian tradition stated that donkeys originally had unmarked hides, and that it was only after Christ’s entry into Jerusalem on the back of a donkey that they received the dark cross on their backs. The hairs from the cross were widely believed to cure a number of ailments, and were often worn in a charm around the neck to guard against whooping cough, toothache, fits, and to ease teething pains in babies. Sometimes the hairs were eaten in a sandwich instead.
TEETHING SUPERSTITIONS IN AFRICA
Biltong is a kind of cured meat that originated in South Africa.9 Biltong can be particularly used as a teething aid for babies.
• To allow a child to look into a mirror before it is a month
old will cause it trouble in teething.
• Swamp lily root, dried and strung around the neck.
• Dried pumpkin stem on string around the neck.
• Hang piece of rosary beads around neck on string.
• Nine prayer beads from rosary on string around neck.
• Take bone from animal, tie on string around neck.
• Rabbit bone (the one with the hole in it) tied on a string
around the infant’s neck.
• String an alligator tooth around infant’s neck.
• Garlic in sack around neck.
• Asafetida bag around neck.
• Asafetida tea made with rainwater.
• String with 9 knots and a little stick in the middle (from
any tree) around neck for 9 days.
• Rub gums with crayfish tail.
• Rub gums with shrimp.
• Rub gums with salt and recite certain prayers. • Drink water from mould on wood.
TEETHING SUPERSTITIONS IN NORTH AMERICA
• To be born with teeth is a sign of future greatness. History tells of men with this peculiarity, among them Napolean I, King Henry VIII, Caesar.
• In Mexico, if a child is born with teeth there is a supersti- tion that he/she will become extremely selfish.
• A baby’s tooth, set in a ring or brooch, was sometimes worn in order to bring good luck.
• Rub an unbroken egg shell on a baby’s gums, to ease the pains of teething.
• Suspend a borrowed egg in a paper sack from the ceiling, to cause the baby to cut its teeth easily.
• Sore gums in a baby may be cured by the application of a groundhog’s brains.
• Children’s first lost teeth are burned in order to prevent snaggle teeth from coming in.
• Coral necklaces are worn to ensure easy teething.
TEETHING SUPERSTITIONS IN SOUTH AMERICA
• To allow a child to look into a mirror before it is a month old will cause it trouble in teething.
TEETHING SUPERSTITIONS IN ANTARCTICA
• Coral necklaces are worn to ensure easy teething.
• If you have your newborn baby licked by a dog, it will ease
teething pains in babies.
TEETHING SUPERSTITIONS IN EUROPE
Teething superstitions, voodoos, old wives’ tales, omen...?
“Soon teeth, soon toes” is a Winchcombe (England) wise saw, signifying that there will soon be an addition to the family.
Child will cut teeth easier if he/she wears coral.
In medieval times, animal substances were still being rubbed into the gums and teething infants were encour- aged to chew on hard objects such as roots.
In 1429, Von Louffenberg, a German priest, summarized the care of a teething baby as:6
‘Now when your baby’s teeth appear, you must of these take prudent care,
For teething comes with grievous pain, so to my word take heed again.
When now the teeth are pushing through, to rub the gums thou thus shall do,
Take fat from chicken, brain from hare and these full oft on gums shall smear.
If ulcers sore thereon should come, then thou shalt rub upon the gum,
Honey and salt and oil thereto. But one thing more I counsel you,
A salve of oil of violet, for neck and throat and gums to get,
And also bathe his head a while, with water boiled with camomile.’
• In 1545, Thomas Phaire, an English physician, advised an ointment containing oil of roses and juice of night- shade. His recommended charm was, ‘The fyrst cast tooth of a colt set in silver and bone, or red coralle in lyke manner hanged about the neck, whereupon the chylde should oftentimes labour his gums’.
• The use of coral was considered protective in other ways.
‘By consent of all authors, it resisteth the force of lightening, helpeth the chyldren of the falling evil (epilepsy) and is very good to be made in powder and dronken against all manner of bleeding of the nose or fundament’.
• About the same time, Flemish physicians advised, ‘Make use, in this affliction, of the canine tooth of a wolf chiefly; and that of the she wolf has a greater reputation than that of the male wolf’.
• Ambriose Pare (1517–1592), the French army surgeon, began to advocate a new solution to the age old problem of ‘breeding teeth’: cutting the gums with a lancet.
• Eighteenth and nineteenth century therapies were varied and depended on local superstition and the beliefs of the attending physician. Doses of mercury salts, opiates, purgatives, and emetics were recommended, even if the child was experiencing diarrhea or vomiting beforehand.
• It was believed that teething troubles could be eased if the gums were rubbed with the mother’s gold wedding ring.11
• If you let a child look into a looking-glass before it is a
year old, it will cut its teeth hard.
• Jewelers in Italy sell teething rings as charms to assist
infants in teething. To these rings are frequently fastened
red coral charms, or little silver bells to drive away witches.
• The ashes of dogs’ teeth mixed with wine, “boiled down to one-half and sweetened with honey” is a boon for teething.
• Children who wore the Androdyne necklace for a single
night would cut their teeth immediately with safety.
• In some parts of England peony seeds are still used as a
prevention of convulsions in teething.
TEETHING SUPERSTITIONS IN AUSTRALIA
• When a child is teething, you should bite off the head of a living mouse, and hang the head around the child’s neck in a string, taking care, however, not to make a knot in the string.18
• Sweet pickles actually help a teething baby.
CONCLUSIONS AND RECOMMENDATIONS
Superstitious beliefs and practices, including voodoo, persist among selected populations and cultures worldwide and affect the health practices of these people. These influences have implications for public health nursing. Many health education and public health activities undertaken by the entire dental fraternity would be benefited if specific superstitions and voodoo practices peculiar to local cultures were explained during orientation and in service programs for dentists, hygienists, nurses and other health personnel such that in treating with compassion, we can bring about more awareness in the society who attributes anything from common drooling of saliva to grotesque vomiting and even convulsions to teething!
Teething time is of great interest to physicians, dentists, and particularly parents who consider this is an important event in their children’s lives. The event is, therefore, eagerly awaited by all being an important milestone in an infant’s first year of life.
Teething generally begins around 6 months of age and continues until the baby is about 3 years old. In years gone by, numerous customs were observed to ensure that misfortune would not befall on a teething child and the process would go on smoothly. We may like to think that we live in a sophisticated age, but even in the 21st century, many customs and superstitions linger on. People in all socio-economic classes, educational levels, age groups, and ethnic backgrounds still believe that teething causes ailments.
The beliefs and superstitions associated with teething throughout history appear amusing and it may cause concern that the profession was so willing to go along with practices so incorrect. Yet, it is sobering to appreciate that our historic colleagues were acting on their existing knowledge and their professional and personal standing relied heavily on their reputation amongst their peers and patients.
TEETHING SUPERSTITIONS IN ASIA
In Pakistan, some Punjabi mothers perform a special ritual by arranging a ceremony where a person other than the baby’s mother, throws chewed coconut in the baby’s face when he is about to cut his first teeth hoping his teeth will be as good as the person who is chosen to throw coconut.
Coral necklaces are often placed on children to give them relief from teething in Japan.
The Koris (Hindu weavers) in North Western India believe that feeding a hen to a teething child will relieve his trouble. Amber teething necklaces are tied around the baby’s neck in various Asian cultures.
Bury your child’s first tooth in cow-dung and throw it over your roof, it will hasten the child’s teething process. Christian tradition stated that donkeys originally had unmarked hides, and that it was only after Christ’s entry into Jerusalem on the back of a donkey that they received the dark cross on their backs. The hairs from the cross were widely believed to cure a number of ailments, and were often worn in a charm around the neck to guard against whooping cough, toothache, fits, and to ease teething pains in babies. Sometimes the hairs were eaten in a sandwich instead.
TEETHING SUPERSTITIONS IN AFRICA
Biltong is a kind of cured meat that originated in South Africa.9 Biltong can be particularly used as a teething aid for babies.
• To allow a child to look into a mirror before it is a month
old will cause it trouble in teething.
• Swamp lily root, dried and strung around the neck.
• Dried pumpkin stem on string around the neck.
• Hang piece of rosary beads around neck on string.
• Nine prayer beads from rosary on string around neck.
• Take bone from animal, tie on string around neck.
• Rabbit bone (the one with the hole in it) tied on a string
around the infant’s neck.
• String an alligator tooth around infant’s neck.
• Garlic in sack around neck.
• Asafetida bag around neck.
• Asafetida tea made with rainwater.
• String with 9 knots and a little stick in the middle (from
any tree) around neck for 9 days.
• Rub gums with crayfish tail.
• Rub gums with shrimp.
• Rub gums with salt and recite certain prayers. • Drink water from mould on wood.
TEETHING SUPERSTITIONS IN NORTH AMERICA
• To be born with teeth is a sign of future greatness. History tells of men with this peculiarity, among them Napolean I, King Henry VIII, Caesar.
• In Mexico, if a child is born with teeth there is a supersti- tion that he/she will become extremely selfish.
• A baby’s tooth, set in a ring or brooch, was sometimes worn in order to bring good luck.
• Rub an unbroken egg shell on a baby’s gums, to ease the pains of teething.
• Suspend a borrowed egg in a paper sack from the ceiling, to cause the baby to cut its teeth easily.
• Sore gums in a baby may be cured by the application of a groundhog’s brains.
• Children’s first lost teeth are burned in order to prevent snaggle teeth from coming in.
• Coral necklaces are worn to ensure easy teething.
TEETHING SUPERSTITIONS IN SOUTH AMERICA
• To allow a child to look into a mirror before it is a month old will cause it trouble in teething.
TEETHING SUPERSTITIONS IN ANTARCTICA
• Coral necklaces are worn to ensure easy teething.
• If you have your newborn baby licked by a dog, it will ease
teething pains in babies.
TEETHING SUPERSTITIONS IN EUROPE
Teething superstitions, voodoos, old wives’ tales, omen...?
“Soon teeth, soon toes” is a Winchcombe (England) wise saw, signifying that there will soon be an addition to the family.
Child will cut teeth easier if he/she wears coral.
In medieval times, animal substances were still being rubbed into the gums and teething infants were encour- aged to chew on hard objects such as roots.
In 1429, Von Louffenberg, a German priest, summarized the care of a teething baby as:6
‘Now when your baby’s teeth appear, you must of these take prudent care,
For teething comes with grievous pain, so to my word take heed again.
When now the teeth are pushing through, to rub the gums thou thus shall do,
Take fat from chicken, brain from hare and these full oft on gums shall smear.
If ulcers sore thereon should come, then thou shalt rub upon the gum,
Honey and salt and oil thereto. But one thing more I counsel you,
A salve of oil of violet, for neck and throat and gums to get,
And also bathe his head a while, with water boiled with camomile.’
• In 1545, Thomas Phaire, an English physician, advised an ointment containing oil of roses and juice of night- shade. His recommended charm was, ‘The fyrst cast tooth of a colt set in silver and bone, or red coralle in lyke manner hanged about the neck, whereupon the chylde should oftentimes labour his gums’.
• The use of coral was considered protective in other ways.
‘By consent of all authors, it resisteth the force of lightening, helpeth the chyldren of the falling evil (epilepsy) and is very good to be made in powder and dronken against all manner of bleeding of the nose or fundament’.
• About the same time, Flemish physicians advised, ‘Make use, in this affliction, of the canine tooth of a wolf chiefly; and that of the she wolf has a greater reputation than that of the male wolf’.
• Ambriose Pare (1517–1592), the French army surgeon, began to advocate a new solution to the age old problem of ‘breeding teeth’: cutting the gums with a lancet.
• Eighteenth and nineteenth century therapies were varied and depended on local superstition and the beliefs of the attending physician. Doses of mercury salts, opiates, purgatives, and emetics were recommended, even if the child was experiencing diarrhea or vomiting beforehand.
• It was believed that teething troubles could be eased if the gums were rubbed with the mother’s gold wedding ring.11
• If you let a child look into a looking-glass before it is a
year old, it will cut its teeth hard.
• Jewelers in Italy sell teething rings as charms to assist
infants in teething. To these rings are frequently fastened
red coral charms, or little silver bells to drive away witches.
• The ashes of dogs’ teeth mixed with wine, “boiled down to one-half and sweetened with honey” is a boon for teething.
• Children who wore the Androdyne necklace for a single
night would cut their teeth immediately with safety.
• In some parts of England peony seeds are still used as a
prevention of convulsions in teething.
TEETHING SUPERSTITIONS IN AUSTRALIA
• When a child is teething, you should bite off the head of a living mouse, and hang the head around the child’s neck in a string, taking care, however, not to make a knot in the string.18
• Sweet pickles actually help a teething baby.
CONCLUSIONS AND RECOMMENDATIONS
Superstitious beliefs and practices, including voodoo, persist among selected populations and cultures worldwide and affect the health practices of these people. These influences have implications for public health nursing. Many health education and public health activities undertaken by the entire dental fraternity would be benefited if specific superstitions and voodoo practices peculiar to local cultures were explained during orientation and in service programs for dentists, hygienists, nurses and other health personnel such that in treating with compassion, we can bring about more awareness in the society who attributes anything from common drooling of saliva to grotesque vomiting and even convulsions to teething!
Sunday, March 4, 2012
Source 23
The commonest systemic condition that leads to periodontal disease is the variation in the hormonal levels. The increased levels of the hormones during pregnancy affect many organs in the body and periodontium is no exception. Gingivitis is a common feature of pregnancy. It is caused by bacterial plaque just as it is in non-pregnant individuals.
The estrogen and progesterone receptors have been recog- nized in the gingiva, these receptors exacerbate the gingival response to plaque. The imbalance or increased levels of these hormones modifies the bacterial composition of plaque resulting in the growth of gram-negative anaerobic microbiota which modifies the resultant clinical picture in pregnancy.
Pre-term/low birth weight (PLBW) infants represent a major medical, social and economic problem accounting for a large proportion of maternal and especially neonatal mor- tality and morbidity. Offenbacher et al showed the relation between the periodontal disease and preterm infants who are born before 37 weeks of gestation and low birth weight infants, birth weight < 2500 g.
The various risk factors for preterm delivery and low birth weight infants are low maternal age, first delivery, history of PLBW, abortion, habits like tobacco, coffee, drug abuse, edu- cation, and gender of fetus. Offenbacher et al hypothesized that gram-negative anaerobic pathogens from periodontium and associated endotoxins and maternal inflammatory mediators could have a possible adverse effect on the developing fetus.
Experiments carried out by Collins et al in the pregnant hamster model showed that periodontitis can affect fetal growth.2 Later human case-control studies performed by Dasanayke, Davenport et al, Offenbacher et al, demonstrated that women who have low birth weight infants as a consequence of premature rupture of membranes tend to have more severe periodontal disease than mother with normal weight infants.
Since birth weight is easier to ascertain than gestational age, especially in countries like India, where no ultrasound scan is carried out in early pregnancy, many have advocated the use of birth weight for the definition of preterm birth rather than gestational age.
The following study was undertaken to study the risk fac- tors for preterm delivery and low birth weight infants and the prevalence of periodontal disease among mothers of the study population.

The estrogen and progesterone receptors have been recog- nized in the gingiva, these receptors exacerbate the gingival response to plaque. The imbalance or increased levels of these hormones modifies the bacterial composition of plaque resulting in the growth of gram-negative anaerobic microbiota which modifies the resultant clinical picture in pregnancy.
Pre-term/low birth weight (PLBW) infants represent a major medical, social and economic problem accounting for a large proportion of maternal and especially neonatal mor- tality and morbidity. Offenbacher et al showed the relation between the periodontal disease and preterm infants who are born before 37 weeks of gestation and low birth weight infants, birth weight < 2500 g.
The various risk factors for preterm delivery and low birth weight infants are low maternal age, first delivery, history of PLBW, abortion, habits like tobacco, coffee, drug abuse, edu- cation, and gender of fetus. Offenbacher et al hypothesized that gram-negative anaerobic pathogens from periodontium and associated endotoxins and maternal inflammatory mediators could have a possible adverse effect on the developing fetus.
Experiments carried out by Collins et al in the pregnant hamster model showed that periodontitis can affect fetal growth.2 Later human case-control studies performed by Dasanayke, Davenport et al, Offenbacher et al, demonstrated that women who have low birth weight infants as a consequence of premature rupture of membranes tend to have more severe periodontal disease than mother with normal weight infants.
Since birth weight is easier to ascertain than gestational age, especially in countries like India, where no ultrasound scan is carried out in early pregnancy, many have advocated the use of birth weight for the definition of preterm birth rather than gestational age.
The following study was undertaken to study the risk fac- tors for preterm delivery and low birth weight infants and the prevalence of periodontal disease among mothers of the study population.

Saturday, March 3, 2012
Learning Journal 21
This past Friday in class we started the IRB process. The best part about filling out the form is that we can simply copy and paste a lot of the required information to the IRB form from our project proposal. This form will take a little while to fill out since it requires more than just yes or no answers. I think that the IRB is a good process to ensure that researchers are ethical in their studies. This process allows me to make sure that my project is ethical, prepared, that it won't offend people, and that I am qualified to do what I am questioning people about. It helps me to avoid vulnerable questions that might be hard to focus on. There can be many challenges when working with kids so it is nice to be able to avoid it all completely.
Other than the IRB, not much was covered. Except, we did need to complete another part of our proposal for class. It was the methods and procedure section of the proposal. It was good to think about this with Nate because we are doing similar projects and focusing on similar groups. We thought about how we were going to randomize our data. We also thought about how we were going to get permission for performing our project at colleges and universities. It is important to know what we are going to do over there, otherwise it's like we are walking around with our heads cut off trying to guess what to do. Pondering how we are actually going to go about things once we are in India is helpful, I now have a better idea of the whole process. We still have some kinks to work out, but I feel more prepared. That is the whole point, step by step, get more and more ready.
Other than the IRB, not much was covered. Except, we did need to complete another part of our proposal for class. It was the methods and procedure section of the proposal. It was good to think about this with Nate because we are doing similar projects and focusing on similar groups. We thought about how we were going to randomize our data. We also thought about how we were going to get permission for performing our project at colleges and universities. It is important to know what we are going to do over there, otherwise it's like we are walking around with our heads cut off trying to guess what to do. Pondering how we are actually going to go about things once we are in India is helpful, I now have a better idea of the whole process. We still have some kinks to work out, but I feel more prepared. That is the whole point, step by step, get more and more ready.
Friday, March 2, 2012
Source 22
This was an article I read dealing with Insurance. Insurance coverage is still really low in this developing country but it is increasing. It is really important because it may cover dental care in some instances and help people to get the care they need.
I had this question in my mind for a very long time – How many Indians are actually covered under Insurance. The reason I was curious about this number was because I am really surprised at the amount of ignorance Indian people have about Insurance – Many of my well educated friends also do not avail of insurance and do not feel any need for it.
The Insurance sector in India was opened to private players in 2000 and with private Insurance companies coming in and sensitizing the citizens through barrage of advertising, the awareness of insurance seems to have increased lately. However, I came across some numbers released by Insurance Regulatory and Development Authority (IRDA) yesterday and looks like India needs to do lot more to increase awareness of Insurance amongst the masses.
State of Insurance in India
According to latest IRDA figures, India has about 57 crore of insurable people. Out of which Private Life Insurance companies have 4.03 crore Policies in force which cover about 4.20 crore lives [upto 31st March 2010].
Here are some of the highlights released by IRDA:
The insurance penetration has increased from 2.32% to 5.51% over the period 2000 to 2010.
The number of insurance offices has increased from 2,199 in 2000 to 12,018 in 2010.
From the single channel system of tied agents which was predominant before opening up of the sector in 2000, multiple channels of distribution comprising brokers, bank assurance, corporate agents emerged accounting for nearly 21 percent of all new business in the year 2009-10.
The first year life insurance premium grew from Rs.19,857.28 crore in 2001-02 to Rs.1,09,894.02 crore in 2009-10.
The total life insurance premium rose from Rs. 50,094.46 crore in 2001-02 to Rs. 2,65,450.37 crore in 2009-10.
Number of Public & Private Sector Insurance Companies in India
Life Insurers (As on 20.06.2011) Non-Life Insurers(As on 05.08.2011)
Public Sector: Public Sector:
1. National Insurance Co. Ltd
1. Life Insurance Corporation of India 2. The New India Assurance Co. Ltd
3. The Oriental Insurance Co. Ltd
4. United India Insurance Co. Ltd.
Private Sector: Private Sector:
1. Bajaj Allianz Life Insurance Company Ltd 1. Bajaj Allianz General Insurance Co. Ltd
2. Birla Sun Life Insurance Company Ltd 2. ICICI Lombard General Insurance Co Ltd
3. HDFC Standard Life Insurance Company Ltd 3. IFFCO Tokio General Insurance Co. Ltd
4. ICICI Prudential Life Insurance Company Ltd 4. Reliance General Insurance Co. Ltd
5. ING Vysa Life Insurance Company Ltd 5. Royal Sundaram Alliance Insurance Co. Ltd
6. Max New York Life Insurance Co Ltd 6. Tata AIG General Insurance Co. Ltd
7. Met Life Insurance Company Ltd 7. Cholamandalam MS General Insurance Co. Ltd
8. Kotak Mahindra Old Mutual Life Insurance Company Ltd 8. HDFC ERGO General Insurance Co. Ltd
9. SBI Life Insurance Co Ltd 9. Export Credit Guarantee Corporation of India Ltd
10. Tata AIG LIFE Insurance Co. Ltd 10. Agriculture Insurance Co. Ltd
11. Reliance Life Insurance Co Limited 11. Star Health Insurance Co. Ltd
12. Aviva Life Insurance Co Ltd 12. Apollo Munich Health Insurance Co. Ltd
13. Sahara India Life Insurance Co. Ltd 13. Future Generalli India Insurance Co. Ltd
14. Shriram Life Insurance Co. Ltd 14. Universal Sompo General Insurance Co. Ltd
15. Bharti AXA Life Insurance Company Ltd 15. Shriram General Insurance Co Ltd
16. Future Generali India Life InsuranceCo.Ltd 16. Bharti AXA General Insurance Company Limited
17. IDBI Federal Life Insurance Co. Ltd 17. Raheja QBE General Insurance Company Limited
18. Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd 18. SBI General Insurance Co. Ltd
19. AEGON Religare Life Insurance Co. Ltd 19. Max Bupa Health Insurance Co. Ltd
20. DLF Paramica Life Insurance Co. Ltd 20. L&T General Insurance Co. Ltd
21. Star Union Dia-ichi Life Insurance Co. Ltd
22. India First Life Inasurance Co. Ltd. Re-Insurer:
23. Edelweiss Tokio Life Insurance Co. Ltd. 1. General Insurance Corporation of India
Conclusion: Although, India has seen more than 10 fold rise in Insurance (coverage as well as premium), the Insurance penetration in India is extremely low compared to most developed countries.
For example, in America, in 2010, over 83.3 percent of people had health insurance compared to just 5.51 percent Indians. Although American health insurance Industry is primarily driven by relatively huge medical bills, India is also moving towards similar path.
I had this question in my mind for a very long time – How many Indians are actually covered under Insurance. The reason I was curious about this number was because I am really surprised at the amount of ignorance Indian people have about Insurance – Many of my well educated friends also do not avail of insurance and do not feel any need for it.
The Insurance sector in India was opened to private players in 2000 and with private Insurance companies coming in and sensitizing the citizens through barrage of advertising, the awareness of insurance seems to have increased lately. However, I came across some numbers released by Insurance Regulatory and Development Authority (IRDA) yesterday and looks like India needs to do lot more to increase awareness of Insurance amongst the masses.
State of Insurance in India
According to latest IRDA figures, India has about 57 crore of insurable people. Out of which Private Life Insurance companies have 4.03 crore Policies in force which cover about 4.20 crore lives [upto 31st March 2010].
Here are some of the highlights released by IRDA:
The insurance penetration has increased from 2.32% to 5.51% over the period 2000 to 2010.
The number of insurance offices has increased from 2,199 in 2000 to 12,018 in 2010.
From the single channel system of tied agents which was predominant before opening up of the sector in 2000, multiple channels of distribution comprising brokers, bank assurance, corporate agents emerged accounting for nearly 21 percent of all new business in the year 2009-10.
The first year life insurance premium grew from Rs.19,857.28 crore in 2001-02 to Rs.1,09,894.02 crore in 2009-10.
The total life insurance premium rose from Rs. 50,094.46 crore in 2001-02 to Rs. 2,65,450.37 crore in 2009-10.
Number of Public & Private Sector Insurance Companies in India
Life Insurers (As on 20.06.2011) Non-Life Insurers(As on 05.08.2011)
Public Sector: Public Sector:
1. National Insurance Co. Ltd
1. Life Insurance Corporation of India 2. The New India Assurance Co. Ltd
3. The Oriental Insurance Co. Ltd
4. United India Insurance Co. Ltd.
Private Sector: Private Sector:
1. Bajaj Allianz Life Insurance Company Ltd 1. Bajaj Allianz General Insurance Co. Ltd
2. Birla Sun Life Insurance Company Ltd 2. ICICI Lombard General Insurance Co Ltd
3. HDFC Standard Life Insurance Company Ltd 3. IFFCO Tokio General Insurance Co. Ltd
4. ICICI Prudential Life Insurance Company Ltd 4. Reliance General Insurance Co. Ltd
5. ING Vysa Life Insurance Company Ltd 5. Royal Sundaram Alliance Insurance Co. Ltd
6. Max New York Life Insurance Co Ltd 6. Tata AIG General Insurance Co. Ltd
7. Met Life Insurance Company Ltd 7. Cholamandalam MS General Insurance Co. Ltd
8. Kotak Mahindra Old Mutual Life Insurance Company Ltd 8. HDFC ERGO General Insurance Co. Ltd
9. SBI Life Insurance Co Ltd 9. Export Credit Guarantee Corporation of India Ltd
10. Tata AIG LIFE Insurance Co. Ltd 10. Agriculture Insurance Co. Ltd
11. Reliance Life Insurance Co Limited 11. Star Health Insurance Co. Ltd
12. Aviva Life Insurance Co Ltd 12. Apollo Munich Health Insurance Co. Ltd
13. Sahara India Life Insurance Co. Ltd 13. Future Generalli India Insurance Co. Ltd
14. Shriram Life Insurance Co. Ltd 14. Universal Sompo General Insurance Co. Ltd
15. Bharti AXA Life Insurance Company Ltd 15. Shriram General Insurance Co Ltd
16. Future Generali India Life InsuranceCo.Ltd 16. Bharti AXA General Insurance Company Limited
17. IDBI Federal Life Insurance Co. Ltd 17. Raheja QBE General Insurance Company Limited
18. Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd 18. SBI General Insurance Co. Ltd
19. AEGON Religare Life Insurance Co. Ltd 19. Max Bupa Health Insurance Co. Ltd
20. DLF Paramica Life Insurance Co. Ltd 20. L&T General Insurance Co. Ltd
21. Star Union Dia-ichi Life Insurance Co. Ltd
22. India First Life Inasurance Co. Ltd. Re-Insurer:
23. Edelweiss Tokio Life Insurance Co. Ltd. 1. General Insurance Corporation of India
Conclusion: Although, India has seen more than 10 fold rise in Insurance (coverage as well as premium), the Insurance penetration in India is extremely low compared to most developed countries.
For example, in America, in 2010, over 83.3 percent of people had health insurance compared to just 5.51 percent Indians. Although American health insurance Industry is primarily driven by relatively huge medical bills, India is also moving towards similar path.
Learning Journal 20
This week in our sections we talked about the Caste system and parts of our research that might be personal or involve vulnerable populations. The article that we read for class involving the caste system was pretty interesting. It almost made me want to determine the differences of dental care between castes. We talked about how one student wanted to study the difference between castes and was going to use appearance as a caste indicator. Well, I definitely do not want to do that. Especially since in the article we read it talked about how one Brahmin was not satisfied about his social standing and wanted more in his life; he did not fit into the Brahmin stereotype. Sometimes the way they dress and live is not a direct representation of the caste they belong to. One of my big questions is trying to narrow down what sort of questions I will ask the college and university students about their sociodemographic condition. I want to be able to find out key difference between people that would prevent them from attending the dentist.
It will be interesting to see how the caste system plays a role in college and university settings. Are those from a caste going into their respective 'caste careers' or are they branching out and going into what they want? Are all castes represented at a college setting? I am sure that I will learn the answer to these questions with how much time I spend on campuses.
While talking about vulnerable populations I had to make sure that my research did not fall into one of the categories. I had to clarify in my proposal that I will be researching enrolled students that are above the age of 18 since the age of majority is 18 in India. I shouldn't have any other problems with vulnerable populations, but I will want to figure out how to address women on campus. It will be something that I will need to figure out once I get over there or something that Margaret or others can shed light on.
It will be interesting to see how the caste system plays a role in college and university settings. Are those from a caste going into their respective 'caste careers' or are they branching out and going into what they want? Are all castes represented at a college setting? I am sure that I will learn the answer to these questions with how much time I spend on campuses.
While talking about vulnerable populations I had to make sure that my research did not fall into one of the categories. I had to clarify in my proposal that I will be researching enrolled students that are above the age of 18 since the age of majority is 18 in India. I shouldn't have any other problems with vulnerable populations, but I will want to figure out how to address women on campus. It will be something that I will need to figure out once I get over there or something that Margaret or others can shed light on.
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