| Abstract|| |
Objective: To evaluate the unmet restorative treatment need among orphanage children of Uttara Kannada District.
Materials and Methods: A cross-sectional study was done to evaluate the unmet restorative treatment need among orphanage children of Uttara Kannada district. DFMT, PUFA and Specific caries index were used to evaluate the dental caries. Mouth mirror, explorers, CPI probes were used to examine dental caries under artificial light.
Results: A total of 256 children were surveyed for unmet dental treatment need out of which 138 were girls. 80% of the children were caries free in permanent dentition while only 48% were caries free with respect to deciduous dentition using DMFT/dft indices. Pulpal involvement was seen among 31% of the children using PUFA index. Absolute treatment need with DT and dt indices were 91 and 545 in number while with specific caries index it was seen to be 705.
Conclusion: The unmet restorative treatment need among the orphanage children was high and use of conventional indices alone might result in underestimation of treatment needs. Type of restorative treatment needs like pulpal/restorative, occlusal/non-occlusal, esthetic/non esthetic restorations were underestimated with conventional indices.
Keywords: Caries, children, decay, indices, orphaned, restorative, treatment need, untreated caries
|How to cite this article:|
Pentapati KC, Acharya S, Yeturi SK. Unmet restorative treatment needs among orphanage children of Uttara Kannada District. J Educ Ethics Dent 2014;4:65-8
|How to cite this URL:|
Pentapati KC, Acharya S, Yeturi SK. Unmet restorative treatment needs among orphanage children of Uttara Kannada District. J Educ Ethics Dent [serial online] 2014 [cited 2019 Jun 26];4:65-8. Available from: http://www.jeed.in/text.asp?2014/4/2/65/148989
| Introduction|| |
Oral health is an integral component of general health which has great impact on quality of life. Despite major improvements in oral health care in recent decades, many children in developing countries are still affected by common oral diseases like dental caries.  Oral and general health is much deteriorated among orphan children and maximum burden of all diseases rests with these disadvantaged and socially marginalized. These orphan children demonstrate high caries prevalence, gingivitis, dental trauma and low dental care utilization. Around 19% of the world children reside in India out of which, it was estimated that orphan children would be 23,246,000 by year 2010 accounting to 6.8% of the total child population. Assessment of such diseases is particularly relevant for planning the necessary treatment for specific target population. 
There are numerous studies on the assessment of treatment need in vulnerable populations. All of them are unique and use different indices for assessment of unmet treatment needs. ,,,,, Normative needs assessment is through clinician perspective and has pivotal role in planning the necessary preventive and therapeutic programs while the felt need gives the idea what exactly the population need in their perspective. However, the felt need might not necessarily include all the normative need assessed by clinician. Normative need is the need defined by experts and is not absolute and there may be different standards laid down by different experts while felt need is the need that is perceived by an individual and are limited by individual perceptions and knowledge of services. 
Normative need assessment conventionally uses dental indices out of which DMFT is the most commonly used index. DMFT index is a cumulative index which is most widely used to assess dental decay globally. Apart from assessment of dental caries it also evaluates the missing and filled teeth which were due to caries. However, DMFT has its own limitations viz., a single tooth can have multiple sites of decay like occlusal pits along with buccal pit which will be scored as one decayed tooth. But to the health care provider they are two different lesions and have to be restored separately. Such limitations can be surpassed by use of DMFS index. Even with DMFS there is no clear representation of type of restorative treatment need i.e., occlusal or non-occlusal, esthetic or non-esthetic treatment need. A differential quantification based on the type of restorative treatment need is essential to plan the programs. A decayed tooth with pulpal involvement is equally scored as decayed teeth with enamel or dentinal caries while for the clinician these both represent different treatment scenario. Such limitations can be addressed by use of different indices which might take lot of time and effort for the examiners. Dentition status given by World Health Organization (1997)  is one such system where many things can be addressed, but examiner has to recollect and remember many codes and can be cumbersome. Also, the problems with type of restorative need like occlusal or non-occlusal, aesthetic or non-aesthetic restorations could not be addressed.
Recently, newer indices have been proposed like PUFA  and Specific caries  indices. PUFA index evaluates clinical consequences of caries like pulpal involvement, ulceration, fistula and abscess. Specific caries index evaluates surface specific dental caries which is based on the GV Black's classification. Hence, we aimed to evaluate the unmet restorative treatment need among the orphan children with these indices in order to estimate the overall unmet restorative treatment need to plan the necessary preventive and treatment programs.
| Materials and Methods|| |
We conducted cross-sectional survey among orphanage children of Christ Mitra Ashram, of Uttara Kannada district in 2013. A dental preventive and treatment initiative was proposed by authorities of the orphanage to our institution. Hence, a team of oral epidemiologists conducted a situation analysis of the restorative treatment need among the children.
Only subjects who were willing to participate were included. Prior consent was provided by the orphanage authorities. All the children were examined so as to assess the overall restorative unmet treatment needs to plan the needed preventive and therapeutic services at a later date.
All the children were examined according to the WHO Basic Oral Health Survey guidelines for dental caries (1997) to compute DMFT/dft.  Recordings were performed by a single trained examiner with mouth mirror, CPI probes and explorers in adequate artificial light within the orphanage premises. PUFA (Pulp, ulceration, fistula and abscess) index was used to assess the consequences of dental decay among the children.  Specific caries index was used to assess the restorative treatment need among the children which was based on the GV Black's classification.  A total of 20 children were re-examined for evaluating inter-examiner agreement. Cohen's kappa coefficient for the assessment of dental caries was 0.88, indicating good inter-examiner agreement.
All the analyses were carried out using the Statistical Package for Social Sciences (SPSS version 16.0). Percentage of individuals with dental decay in primary and permanent dentition along with PUFA in permanent dentition was calculated. Absolute treatment need was calculated based on the DT, dt, specific caries indices by counting the affected number of teeth.
| Results|| |
A total of 256 children were surveyed for unmet dental treatment need out of which 138 were girls. 80% of the children were caries free in permanent dentition while only 48% were caries free with respect to deciduous dentition using DT/dt indices. None of the children presented with missing and filled teeth in both permanent and deciduous dentition. Pulpal involvement was seen among 31%. None of the children presented with ulceration, fistula or abscess. Majority of the children needed restoration for Class I (39.1%) and II (28.5%) caries [Table 1]. However, absolute treatment need with DT and dt were 91 and 545 in number. Pulpal treatment was required in 258 teeth. With specific caries index, class VI/VIa was the highest treatment need (258) followed by class I (209) and II (174). The total restorative treatment need with conventional indices (DMFT/dft) was 636 while with specific caries index it was 705 [Table 2].
|Table 1: Distribution of unmet restorative need with|
DMFT, PUFA and Specific caries indices
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|Table 2: Distribution of absolute unmet restorative|
treatment need with DMFT, PUFA and Specific caries indices
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| Discussion|| |
Our study evaluated the unmet restorative treatment need among orphanage children of Uttara Kannada district with the help of three different indices. It was seen that the orphanage children had significant proportions of unmet restorative treatment (20 and 51% in permanent and deciduous dentition respectively). This was similar to the studies done previously among orphanage children which ranged from 50-70% in primary dentition and 40-80% in permanent dentition. ,,,, The restorative treatment need as assessed with DMFT/dft, PUFA and Specific caries index were reported in our study.
In our study, prevalence of dental caries in primary dentition (51%) was similar to that of previous studies (50%).  In permanent dentition (20%) it was lower than previous study conducted by Shanbhog et al., 2014 (88.5%).  Many studies reported the mean DMFT which has limited information to the clinician and planners. In our study, the mean DMFT and DT were same due to lack of MT and FT components. It was seen that the mean (±SD) DT and dt were 0.36 (±0.86) and 2.13 (±2.98), respectively. These were very low when compared with previous studies done by Shanbhog et al., 2014 (3.43 ± 2.03), Al-Zobair et al., 2013 (2.8 ± 2.12), Khare et al., 2012 (1.16 ± 1.14). ,,
The use of conventional indices like the DMFT/dft in reporting the restorative treatment need leads to gross underestimation. This could be partly negated by use of DMFS/dfs index but the number of teeth with clinical pulpal involvement and type of restorative need still remains unknown to the clinician. Multiple independent decayed sites on mandibular molars cannot be differentiated with single large multi-surface decayed tooth. For example, a lower molar with decayed buccal and lingual pit along with decayed occlusal pit will be scored with DMFS as 3 but with specific caries index these would be scored as three class 1 cavities. To the clinician the later information will be more useful in speculating the treatment need rather than DMFS score of 3 which may not reveal any information other than number of surfaces decayed. Another possible limitation is while assessing maxillary molars decay. A maxillary molar can have two independent decayed occlusal pits along with decayed palatal and buccal pits. The DMFS index will give a score of 3 but the specific caries index would give a score of 4 class 1 cavities. The use of specific caries index in evaluating the restorative treatment need could give additional information to the planners in terms of number of restorations, type of restorative materials and need for advanced pulp care therapy. The use of newer indices like PUFA will help us to evaluate the consequences of untreated dental decay. With concomitant use of PUFA, our study differentiated the need for advanced pulp care therapy with that of normal restorative treatment need.
Many factors like prevailing treatment philosophies, attitudes, affordability, availability, and accessibility of dental health care services play a major role for the decision to extract teeth or consider pulp care therapy, type of restorative material or whether to fill or not to fill. There were some limitations with specific caries index viz., no demarcation of deciduous and permanent dentition treatment need/caries, inclusion of grossly decayed teeth and/root stumps in the category of carious lesion on occlusal tips and incisal edges, combination of decayed tooth with that of root stumps and lack of incorporation of caries in middle 1/3rd of anterior teeth. Within the limits of our study, we could conclude that the conventional indices like DMF/df could grossly underestimate the restorative treatment need of the population. The concomitant use of multiple indices (Specific Caries Index and PUFA) can give more realistic information like type of restorative treatment needs like pulpal/restorative, occlusal/non-occlusal, esthetic/non-esthetic restorations to the clinician and planners.
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Dr. Kalyana Chakravarthy Pentapati
Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]