Dentition status and treatment needs of prisoners of Haryana state, India Vikram Bansal, G.M. Sogi, K.L. Veeresha, Adarsh Kumar and Shelly Bansal
Vikram Bansal is Senior Lecturer, G.M. Sogi is Professor, K.L. Veeresha is Professor and Head of the Department of Public Health Dentistry, all in the Department of Public Health Dentistry, M.M. College of Dental Sciences and Research, Mullana, India. Adarsh Kumar is Assistant Professor, Department of Public Health Dentistry, Government Dental College, Rohtak, India. Shelly Bansal is a Lecturer in the Department of Conservative Dentistry, M.M. College of Dental Sciences and Research, Mullana, India.
Abstract Purpose – This paper aims to explore prisoner dental health in Haryana, India. Design/methodology/approach – The authors assessed the prevalence of dental caries and the treatment needs of prisoners in all 19 prisons in Haryana. The results were compared with the prison populations of other countries and the general population of Haryana. Findings – The mean age of 1,393 subjects examined was 35.26 ^ 12.29 years. A large number of the subjects reported to be in need of dental treatment. The number of decayed teeth was found to be similar to the general population of Haryana but the number of filled teeth was quite low. The number of teeth missing and the need for tooth extraction was high. Social implications – Long-standing prisoner dental problems indicated a need for dental treatment in prisons. Originality/value – This is the first study of its kind covering all 19 prisons in Haryana, India. The results indicate that the government needs to further consider and address the oral health needs of prisoners. Keywords Dental caries, Dentition, Tooth extraction, Oral hygiene, Prisoners, Health services, Health care, India Paper type Research paper
Introduction Prisoners are a psychologically, socially and morally affected group who are disproportionately from a low socioeconomic background (Cunningham et al., 1985). Such socio-demographic factors are closely associated with poor health in the community, which gets worse when they are incarcerated. Admission to correctional institutions, increases stress factors – the loss of freedom of movement, isolation from family members, overcrowding, and little or no recreational facilities are all factors that can compound extant health problems and lead to depression and loss of health. While prisoners are incarcerated, it becomes the total responsibility of the government to provide health services (Moller et al., 2007). The problem is that since India is facing economic, material and manpower stringency to deliver health care for the general public (Raban et al., 2010) good oral health care for prisoners is a secondary priority. Haryana is one of the 29 states of India and is situated in the sub Himalayan plateau of North India. It consists of 21 districts with a population of 21,144,564 and a density of 478 persons/km2 (Kumar et al., 2006). The literacy rate in Haryana is 67.91 percent, which is more than India’s average literacy rate while unemployment rate is 3.7 percent (Kumar et al., 2006), which is lower than the national unemployment rate. In Haryana, the prevalence of dental caries in the 35-44 year old age group is 77.2 percent (Mathur et al., 2004). A study reported 69.5 percent prevalence of dental caries in the rural population of the Ambala district (Kumar et al., 2010). Another study reported that out of 152 study subjects of the Ambala division aged 60 years and above, 36.8 percent had never visited a dental surgeon in their life time (Bansal et al., 2010). Prevalence of tobacco consumption amongst prisoners was reported to be 68.5 percent in India (Dahiya and Croucher, 2010). The burden of oral diseases and conditions is disproportionately
DOI 10.1108/17449201211268264
VOL. 8 NO. 1 2012, pp. 27-34, Q Emerald Group Publishing Limited, ISSN 1744-9200
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borne by those of lower social standing at each stage of life. Poor nutrition, lack of preventive oral health care, violence leading to facial trauma, and tobacco and alcohol use affect teeth and their supporting structures which leads to dental caries, periodontal diseases and tooth loss and oral and pharyngeal cancers (Treadwell et al., 2007). A thorough search of the literature did not yield any survey regarding dental caries or oral health of prisoners in Haryana. This study was undertaken because there were no study reports on the oral health status and treatment needs of prisoners and oral health care facilities in Haryana prisons. This paper reports a part of the findings of the larger study aiming to assess the oral health status and treatment needs of prisoners. The aim of this paper was to assess the dental caries status and treatment needs of the prisoners of Haryana state.
Method Permission and ethical clearance The study was conducted after obtaining written permission from the Director General of Prisons, Haryana state, and clearance from the institutional ethical committee, M.M.C.D.S. and R., Mullana. The study was conducted between September 2007 and June 2008. The pilot study was conducted at the District jail Kurukshetra to assess the feasibility and practical difficulties. Inclusion criteria The study population consisted of prisoners in all of the 19 Haryana prisons. The inclusion criterion for the study was incarceration for at least six months. It did not matter if the prisoner had been convicted or was currently on trial or had a history of imprisonment. Researchers were prohibited from entering the cells that housed the prisoners and access to prisoner records was also prohibited. The random allocation of the subjects for the study, therefore, was left to the prison authorities. In each prison, one police official was assigned to randomly pick the prisoners from each cell and ask them to participate. The sample size was calculated using the formula n¼4( pq/L 2) where p¼ population proportion of positive character, q ¼ 1 2 p and L ¼ allowable error. For this study L was presumed to be 2 percent giving a power of (1 2 L), i.e. 98 percent to study. The p-value was 85 percent (prevalence of dental caries), as obtained from pilot study. The required sample size was 1,275 subjects. The total number of prisoners in Haryana prisons was approximately 12,000. Based on the required sample size 10.63 percent of the subjects were required. To give an adequate representation to subjects from each prison, the sample was targeted to cover at least 5 percent of the prison population of each prison. A total number of 1,393 subjects were examined and the data collected. Data collection Subjects were interviewed regarding information on demographic and health details. Dentition status and treatment needs were taken from the World Health Organization (WHO) (1997) format for oral health status and treatment needs. The details of the existing health and oral health care facilities were collected from the prison authorities. The subjects were made to sit on a stool/chair available and a type III examination was conducted using mouth mirrors and a consumer price index (CPI) probe under adequate illumination. A single examiner (Vikram Bansal) conducted the examinations in all the prisons. To ensure reliability of the data, prior intra-examiner calibration was undertaken by examining 30 adults and then re-examining them four days later. The result of this calibration was 94 percent of diagnostic concordance, with a Kappa statistical value of 0.91, thus representing a satisfactory level of concordance (WHO, 1997). The data were recorded with the help of a recorder who was also part of the team. The data were analyzed using Statistical Package for Social Sciences version 13.0 for Windows. x 2 analysis was used to analyze the significance of the qualitative variables. Student-t test (unpaired) and analysis of variance were used to find the significance of the cross tabulation of a variable with the mean of dentition status and treatment needs. The p-value was stated to be statistically significant when equal to or lower than 0.05.
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Results The subjects’ mean age was 35.26 years ^ 12.29. A total of 8.26 percent (115) of females and 91.74 percent (1,278) of males were examined. A high percentage of subjects (27.5 percent) were illiterate. Nearly 1/3 (32.1 percent) of subjects examined had been in prison for less than one year. Many prison subjects examined belonged to a class IV/partly skilled occupation before entry into prison and their mean monthly per capita income was 1,626 ^ 1,426 Indian national rupees. As the subjects differed vastly in the length of imprisonment passed, and the CPI differs every year, their socioeconomic status could not be drawn for comparison. A subjective assessment of the need for dental treatment indicated that 80.0 percent (1,115) of the subjects were in need of one or more dental interventions. Of those in need, 62.8 percent had required dental treatment for a time period ranging from one month to one year. Many subjects (46.2 percent) reported toothache while 12.3 percent reported a cavity in their tooth/teeth. Also, 65.5 percent (912) subjects had never visited a dentist in their lifetime. Of the total study subjects, 63 percent (877) had a habit of using tobacco. Oral hygiene measures Regarding oral hygiene measures, 4.1 percent (57) subjects reported that they did not use any aid to maintain their oral hygiene. About 79.6 percent (1,109) subjects used some kind of oral hygiene aid, but not daily. About 73.1 percent subjects used a tooth brush while 3.9 percent subjects used a tree stick to maintain their oral hygiene. Tooth powder was being provided free of cost to the prisoners but only 21.2 percent subjects used it. Dentition status The prevalence of decayed teeth was 72.7 percent (Table I). The mean number of decayed teeth per person was 2.32 ^ 2.47. Amongst all the subjects, there were only 279 teeth with a restoration (mean ¼ 0.20 ^ 0.35) out of which 91 had recurrent decay (mean ¼ 0.07 ^ 0.30). The mean number of teeth in need of one and two surface fillings was 1.46 ^ 2.11 and 0. 31 ^ 0.68, respectively. Around one (0.96 ^ 1.88) tooth per person was in need of extraction. In other words, 3.01 percent of the total teeth needed extraction (Table II). The tooth most commonly found to be decayed was mandibular left 2nd molar. The mean numbers of teeth missing due to caries (1.12 ^ 2.11) and due to other reasons (1.85 ^ 5.39) were in subjects imprisoned for more than five years ( p . 0.05) (Table III). The need for two or more surface filling (0.39 ^ 0.74) and extraction (1.00 ^ 2.07) was also highest in these subjects, although none of these associations were statistically significant. Subjects who had visited a dentist at all in their lifetime had 8.51 ^ 5.34 mean number of decayed teeth and 2.32 ^ 2.81 mean number of missing teeth while those who had not visited a dentist ever had 7.92 ^ 4.23 mean decayed teeth and 1.86 ^ 2.34 mean missing teeth ( p , 0.05). Subjects who did not use any oral hygiene measures had a significantly higher mean number of decayed crowns (2.67 ^ 2.79) as well as roots (0.23 ^ 0.98) than those who used them (2.33 ^ 2.54; 0.03 ^ 0.31) ( p , 0.05). Teeth missing due to caries (1.26 ^ 3.85) and due to other reasons (8.93 ^ 12.48) and teeth needing extraction (2.37 ^ 3.34) were significantly higher while filled teeth were lower in these subjects (0.02 ^ 0.13). The mean number of teeth decayed and missing due to caries was highest in subjects with no or only primary education ( p , 0.05). Teeth missing due to caries increased steadily from the youngest Table I Showing prevalence of dentition status components Filled with Filled without decaya decaya Decayeda Crown Root Crown Root Crown Root Count Percentage of subjects
1,013 72.7
28 2.0
74 5.3
1 0.1
106 7.6
1 0.1
Missing due to cariesa Crown 438 31.4
Missing due to other reasona Crown 283 20.3
Traumaa Crown
Bridge abutmenta Crown
Obscured by calculusa Root
113 8.1
5 0.4
315 22.6
Note: aNumber of subjects having at least one tooth related to this component has been taken
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Table II Showing dentition status
Crown status Sound Decayed Filled with decay Filled without decay Missing due to caries Missing due to other reason Trauma Bridge abutment Unerupted Root status Sound Decayed Filled with decay Filled without decay Root obscured due to calculus Treatment needs No treatment One surface filling Two surface filling Crown Coronoplasty Pulp therapy Extraction
Min
Max
Suma
Mean
SD
Percentage of total teethb
0 0 0 0 0 0 0 0 0
32 19 4 7 32 32 9 5 8
36,744 3,233 91 188 1,159 1,923 159 14 1,052
26.38 2.32 0.07 0.13 0.83 1.38 0.11 0.01 0.76
5.449 2.475 0.304 0.566 2.134 4.609 0.479 0.189 1.213
82.43 7.25 0.20 0.42 2.60 4.31 0.36 0.03 2.36
0 0 0 0 0
32 7 2 2 28
39,137 66 2 2 1,227
28.10 0.05 0.00 0.00 0.88
5.554 0.418 0.054 0.054 2.380
87.80 0.15 0.004 0.004 2.75
0 0 0 0 0 0 0
32 21 7 3 11 6 17
35,948 2,040 434 29 58 589 1,343
25.81 1.46 0.31 0.02 0.04 0.42 0.96
6.118 2.118 0.682 0.186 0.448 0.767 1.883
80.64 4.58 0.97 0.07 0.13 1.32 3.01
Notes: aSum of teeth in all 1,393 subjects; bnumber of total teeth ¼ 44,576; Min, minimum; Max, maximum no. of teeth per person; SD, standard deviation; number of subjects ¼ 1,393; Crown & Root status along with treatment needs
Table III Showing comparison of length of imprisonment with Crown & Root (dentition) status Length of imprisonment 0.5 to 1 yr .1-2 yrs .2-5 yrs .5 yrs Total Significant ( p)
Decayed
Filled with decay
Filled without decay
Missing due to Missing due to caries other reason
Obscured by calculus
n
Crown
Root
Crown
Crown
Crown
Crown
Root
447
2.46 2.528 2.27 2.485 2.22 2.296 2.28 2.633 2.32 2.475 0.518
0.03 0.340 0.04 0.456 0.04 0.390 0.09 0.521 0.05 0.418 0.361
0.05 0.262 0.05 0.298 0.08 0.319 0.08 0.353 0.07 0.304 0.362
0.15 0.607 0.10 0.509 0.16 0.597 0.11 0.505 0.13 0.566 0.515
0.69 1.474 0.83 2.932 0.80 2.079 1.12 2.117 0.83 2.134 0.076
1.26 4.075 1.46 5.142 1.15 4.177 1.85 5.399 1.38 4.609 0.245
0.94 2.505 0.91 2.870 0.77 1.902 0.92 2.224 0.88 2.380 0.752
Mean SD 287 Mean SD 397 Mean SD 262 Mean SD 1,393 Mean SD
Notes: SD, standard deviation; n ¼ number of subjects
age group and were highest in subjects aged 55-64 years. The need for tooth extraction increased with increasing age while the need for pulp therapy decreased with increasing age. Both these associations were statistically significant (Table IV). The mean decayed, missing and filled teeth (DMFT) for age groups 35-44 and 65-74 years was 3.36 ^ 3.32 and 3.61 ^ 3.91, respectively. The mean number of 1.83 and 0.81 teeth needed a filling while 1.01 and 2.23 teeth needed extraction in the 35-44 and 65-74 year age group, respectively. A medical officer was posted in all the prisons while a full time/part time dentist was posted only in a quarter (5) of the prisons even though these prisons lacked basic equipment for
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Table IV Showing comparison of age with Crown & Root (dentition) status
Age
n
#24
279
25-34 35-44 45-54 55-64 65-74 $75 Total Significance ( p)
Mean SD 465 Mean SD 351 Mean SD 172 Mean SD 85 Mean SD 31 Mean SD 10 Mean SD 1,393 Mean SD
Decayed Crown Root 2.33 2.415 2.48 2.513 2.23 2.349 2.17 2.423 2.11 2.673 2.26 3.255 2.80 3.293 2.32 2.475 0.672
0.00 0.000 0.03 0.390 0.01 0.130 0.15 0.684 0.16 0.738 0.03 0.180 0.60 1.897 0.05 0.418
Filled with decay Crown 0.09 0.396 0.07 0.307 0.05 0.257 0.02 0.151 0.06 0.237 0.13 0.499 0.20 0.422 0.07 0.304 0.134
Filled without decay Crown 0.13 0.534 0.16 0.619 0.15 0.644 0.09 0.372 0.09 0.479 0.00 0.000 0.00 0.000 0.13 0.566 0.485
Missing due to caries Crown 0.19 0.686 0.65 1.243 0.92 2.256 1.54 3.205 1.94 3.914 1.19 2.482 1.50 4.089 0.83 2.134 0.000
Missing due to other Obscured by reason calculus Crown Root 0.05 0.284 0.23 0.954 0.92 3.134 3.37 6.674 5.84 8.236 9.10 12.563 12.40 10.721 1.38 4.609 0.000
0.28 1.032 0.66 1.993 1.08 2.299 1.52 3.256 1.85 4.196 1.42 3.170 0.10 0.316 0.88 2.380 0.000
Notes: SD, standard deviation; n ¼ number of subjects
providing dental treatment. In all prisons there was provision for taking prisoners outside the prison to government hospitals for medical and dental treatment.
Discussion This was the first study of its kind of covering all (19) the prisons of an entire state; other studies consulted had been conducted in only one or a few prisons. No study investigating oral health in the prisons of Haryana state, or even in India, was encountered so the results of this study were compared with the prison populations of other countries and the general population of Haryana. The mean age of the study population in our investigation was similar to other studies on the prison population (Jones et al., 2004; Mixson et al., 1990; Osborn et al., 2003; Salive et al., 1989). Male to female ratio was similar to other studies (Cropsey et al., 2006; Jones et al., 2004; Osborn et al., 2003) while most studies were conducted only on male prisoners (Cunningham et al., 1985; Lunn et al., 2003; McGrath, 2002; Mixson et al., 1990; Nobile et al., 2007; Salive et al., 1989). This is because most of the prisoners were male and many prisons did not have facilities to accommodate female prisoners. Around one-third of the study subjects had no, or only elementary education, similar to that reported by (Nobile et al., 2007). A high number of prisoners were unemployed before imprisonment, similar to other studies (Moller et al., 2007). The high percentage of subjects with low education and no employment before imprisonment could be because such individuals experience fewer job opportunities and can resort to illegal activities leading to imprisonment. Overall literacy rate was similar to other studies (Sajid et al., 2006). The long-standing self-reported dental need of the great majority of prisoners is indicative of the dire need for provision of dental treatment to the subjects. Two thirds of the subjects had not visited a dentist in their lifetime, while more than 4/5th of the subjects did not use oral hygiene measures regularly, or did not use them at all. It is interesting to note that the availability of low cost oral hygiene aids for the general public and the provision of free tooth powder in the prisons override the consideration of socioeconomic conditions as the reason for not being able to make regular use of oral hygiene aids. Although the paucity of dental surgeons in rural India has often been a topic of much debate, the state of Haryana has 528 government posts for dental surgeons out of which 384 posts are occupied. It should be mentioned that the majority of treatments in government occupancies are provided at no or little cost (Health Department, Haryana, n.d.). This indicated that oral health was given low priority by the prisoners.
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This was contrary to other studies (Jones et al., 2004; Nobile et al., 2007) which reported a high use of oral hygiene measures on a regular basis in the prisons and a high use of dental health services by the prisoners. As a word of caution, the statements on availability of dental manpower need to be scrutinized with great care as India is a developing nation. A large number of instances of public dispensing may be visible and seen to be adequately working on paper, but their actual functioning needs to be practically assessed. The presence of adequate manpower without adequate infrastructure might be of little or no use. The number of decayed teeth per person was lower than most of the studies (Cunningham et al., 1985; Jones et al., 2005; Lunn et al., 2003; Osborn et al., 2003) while few studies (Jones et al., 2004; Nobile et al., 2007) found a similar number. The mean number of filled teeth was found to be quite low as compared to other studies (Cunningham et al., 1985; Jones et al., 2004, 2005; Lunn et al., 2003; Osborn et al., 2003; Nobile et al., 2007). This is consistent with our finding that the number of subjects who had never visited a dentist in their lifetime was very high; hence the mean number of restored teeth shall be low. DMFTwas found to be lower in both the 35-44 and 65-74 year age groups when compared to the general population of Haryana (Mathur et al., 2004). Osborn et al. (2003) reported the DMFT to be quite high in these age groups in their study population. The need for a filling was less while need for tooth extraction was quite high in the present study as compared to the population of Haryana (Mathur et al., 2004). This shows that the teeth of a high number of prisoners were so badly decayed that they were not restorable. The mean number of decayed teeth decreased while missing teeth increased with increasing length of incarceration. This could be because the subjects in need of dental treatment are taken outside of the prison to a government hospital in cases of dental emergency and single sitting procedures for the extraction of teeth would be the treatment of choice in these cases leading to greater tooth mortality. Subjects, who had visited a dentist sometime in their lifetime, had a higher number of decayed and missing teeth. This can be because of a trend to visit a dentist only when in utmost need; hence only those subjects who already have teeth in poor condition visit a dentist. There was higher number of teeth missing due to other reasons as compared to teeth missing due to caries. This can be due to several reasons including periodontal disease, traumatic injuries due to assaults, etc. There was an inverse relation between education and mean number of decayed and missing teeth. Pain is the most common reason for seeking dental treatment, yet many subjects in the prisons reported suffering from dental pain for a long time. The high demand of dental treatment requires the provision of dental treatment within the prison itself. Such huge demands cannot be catered for by taking all the prisoners out to a hospital, as this involves many security issues. Hence, the posting of dental surgeons in the prisons along with infrastructure adequate for them to carry out dental treatments, is of utmost importance. Not many subjects reported using the tooth powder supplied free of cost to the prisoners. Additionally, as the use of tooth brushes and tooth paste is widely accepted, consideration should be given to the provision of free tooth brushes and tooth paste to prisoners. As the reported need for dental treatment is high and also most of the subjects do not maintain their oral hygiene on a regular basis, the provision of treatment to the subjects calls for an oral hygiene checkup prior to provision of any treatment (except that of emergency nature). This suggestion is reinforced by the fact that those subjects who did not use any oral hygiene measures had a higher number of decayed as well as missing teeth along with a higher need for tooth extraction while the number of filled teeth was lower. Oral health was found to be given low priority by the prisoners and consideration should be given to education programmes to address this. In India, publicly funded oral health care service is limited and the primary oral health care service is based on private dental health care providers, who are out of reach of the study group owing to their restrained freedom of movement. The majority of prisons lacked dental manpower and, where it existed, equipment for oral health care delivery was either sparse or outdated.
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It is the responsibility of the government to take care of prisoner health. Although the dental health of the prisoners was found to be similar or marginally better than the general population of Haryana, the non-availability of resources and the situation of imprisonment call for immediate attention to the prisoners’ oral health care needs by the government. A question that arises here is: are there any potential barriers to government implementation of more expansive policies? This requires an in-depth study and suggestions to be put forward advocating alternative methods to address prisoners’ oral health care needs.
References Bansal, V., Sogi, G.M. and Veeresha, K.L. (2010), ‘‘Assessment of oral health status and treatment needs of elders associated with elders’ homes of Ambala division, Haryana India’’, Indian Journal of Dental Research, Vol. 21 No. 2, pp. 244-7. Cropsey, K.L., Crews, K.M. and Silberman, S.L. (2006), ‘‘Relationship between smoking status and oral health in a prison population’’, Journal of Correctional Health Care, Vol. 12 No. 4, pp. 240-7. Cunningham, M.A., Glenn, R.E. and Field, H.M. (1985), ‘‘Dental disease prevalence in a prison population’’, Journal of Public Health Dentistry, Vol. 45 No. 1, pp. 49-52. Dahiya, M. and Croucher, R. (2010), ‘‘Male prisoner tobacco use and oral cancer knowledge: a case study of a local prison in India’’, International Dentistry Journal, Vol. 60 No. 2, pp. 135-8. Health Department, Haryana (n.d.), ‘‘Note of oral health services’’, available at: www.haryanahealth.nic.in Jones, C.M., McCann, M. and Nugent, Z. (2004), Scottish Prisons’ Dental Health Survey 2002, Scottish Executive, Edinburgh. Jones, C.M., Woods, K. and Neville, J. (2005), ‘‘Dental health of prisoners in the north west of England in 2000: literature review and dental health survey results’’, Community Dental Health, Vol. 22 No. 2, pp. 113-7. Kumar, A., Mukhopadhyay, P.K. and Raut, D.K. (2006), Central Bureau of Health Intelligence: National Health Profile 2006, Directorate General of Health Services, Ministry of Health & Family Welfare, New Delhi. Kumar, A., Virdi, M., Veeresha, K.L. and Bansal, V. (2010), ‘‘Oral health status and treatment needs of rural population of Ambala, Haryana, India’’, The Internet Journal of Epidemiology, Vol. 8 No. 2. Lunn, H., Morris, J., Jacob, A. and Grummitt, C. (2003), ‘‘The oral health of a group of prison inmates’’, Dental Update, Vol. 30 No. 3, pp. 135-8. McGrath, C. (2002), ‘‘Oral health behind bars: a study of oral disease and its impact on the life quality of an older prison population’’, Gerodontology, Vol. 19 No. 2, pp. 109-14. Mathur, V.B., Talwar, P.P. and Chanana, H.B. (2004), National Oral Health Survey and Fluoride Mapping 2002-2003 – Haryana, Dental Council of India, New Delhi. Mixson, J.M., Eplee, H.C., Fell, P.H., Jones, J.J. and Rico, M. (1990), ‘‘Oral health status of a federal prison population’’, Journal of Public Health Dentistry, Vol. 50 No. 4, pp. 257-61. Moller, L., Stover, H., Jurgens, R., Gatherer, A. and Nikogosian, H. (2007), Health in Prisons – A WHO Guide to the Essentials in Prison Health, World Health Organization Regional Office for Europe, Copenhagen. Nobile, C.G., Fortunato, L., Pavia, M. and Angelillo, I. (2007), ‘‘Oral health status of male prisoners in Italy’’, International Dental Journal, Vol. 57 No. 1, pp. 27-35. Osborn, M., Butler, T. and Barnard, P.D. (2003), ‘‘Oral health status of prison inmates – New South Wales, Australia’’, Australian Dental Journal, Vol. 48 No. 1, pp. 34-8. Raban, M.Z., Dandona, R., Kumar, G.A. and Dadona, L. (2010), ‘‘Inequitable coverage of non-communicable diseases and injury interventions in India’’, National Medical Journal of India, Vol. 23 No. 5, pp. 267-73. Sajid, A., Nalini, S. and Elizabeth, D. (2006), ‘‘Prevalence and socio-demographic factors associated with tobacco smoking among adult males in rural Sindh, Pakistan’’, Southeast Asian Journal of Tropical Medicine & Public Health, Vol. 37 No. 5, pp. 1054-60. Salive, M.E., Carolla, J.M. and Brewer, T.F. (1989), ‘‘Dental health of male inmates in a state prison system’’, Journal of Public Health Dentistry, Vol. 49 No. 2, pp. 83-6.
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Treadwell, H.M., Northridge, M.E. and Bethea, T.N. (2007), ‘‘Building the case for oral health care for prisoners: presenting the evidence and calling for justice’’, in Greifinger, R.B. (Ed.), Public Health Behind Bars: From Prisons to Communities, Springer, New York, NY, pp. 203-12. World Health Organization (1997), Oral Health Surveys, Basic Methods, 4th ed., World Health Organization, Geneva.
About the authors Dr Vikram Bansal is working as a Senior Lecturer at the Dental College, M.M. University, Mullana. He is actively involved in research work. He is also engaged in teaching the skills of public health dentistry to undergraduate and post graduate students. He has several publications to his credit in various journals. Vikram Bansal is the corresponding author and can be contacted at: [email protected] Dr G.M. Sogi is working as a Professor at the Dental College, M.M. University, Mullana. He is actively involved in research work. He has several publications to his credit in various journals. He is on the board of various universities in India as an examiner for undergraduate and postgraduate studies. Dr K.L. Veeresha is the Professor and Head of the Department of Public Health Dentistry at the Dental College, M.M. University, Mullana. He monitors the research work being carried under his supervision. He is also engaged in teaching the skills of public health dentistry to postgraduate students. He is on the board of various universities in India is an examiner and paper setter for undergraduate and postgraduate studies. Dr Adarsh Kumar is an Assistant Professor at the Government Dental College, Rohtak. He is actively involved in research work and also is engaged in teaching public health dentistry to students. He also monitors various government initiatives on oral health for the general public of the state of Haryana. Dr Shelly Bansal is a Lecturer at the Dental College, M.M. University, Mullana. She is actively involved in various research projects. She is also involved in teaching the skills of dentistry to undergraduate students.
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Vikram Bansal is Senior Lecturer, G.M. Sogi is Professor, K.L. Veeresha is Professor and Head of the Department of Public Health Dentistry, all in the Department of Public Health Dentistry, M.M. College of Dental Sciences and Research, Mullana, India. Adarsh Kumar is Assistant Professor, Department of Public Health Dentistry, Government Dental College, Rohtak, India. Shelly Bansal is a Lecturer in the Department of Conservative Dentistry, M.M. College of Dental Sciences and Research, Mullana, India.
Abstract Purpose – This paper aims to explore prisoner dental health in Haryana, India. Design/methodology/approach – The authors assessed the prevalence of dental caries and the treatment needs of prisoners in all 19 prisons in Haryana. The results were compared with the prison populations of other countries and the general population of Haryana. Findings – The mean age of 1,393 subjects examined was 35.26 ^ 12.29 years. A large number of the subjects reported to be in need of dental treatment. The number of decayed teeth was found to be similar to the general population of Haryana but the number of filled teeth was quite low. The number of teeth missing and the need for tooth extraction was high. Social implications – Long-standing prisoner dental problems indicated a need for dental treatment in prisons. Originality/value – This is the first study of its kind covering all 19 prisons in Haryana, India. The results indicate that the government needs to further consider and address the oral health needs of prisoners. Keywords Dental caries, Dentition, Tooth extraction, Oral hygiene, Prisoners, Health services, Health care, India Paper type Research paper
Introduction Prisoners are a psychologically, socially and morally affected group who are disproportionately from a low socioeconomic background (Cunningham et al., 1985). Such socio-demographic factors are closely associated with poor health in the community, which gets worse when they are incarcerated. Admission to correctional institutions, increases stress factors – the loss of freedom of movement, isolation from family members, overcrowding, and little or no recreational facilities are all factors that can compound extant health problems and lead to depression and loss of health. While prisoners are incarcerated, it becomes the total responsibility of the government to provide health services (Moller et al., 2007). The problem is that since India is facing economic, material and manpower stringency to deliver health care for the general public (Raban et al., 2010) good oral health care for prisoners is a secondary priority. Haryana is one of the 29 states of India and is situated in the sub Himalayan plateau of North India. It consists of 21 districts with a population of 21,144,564 and a density of 478 persons/km2 (Kumar et al., 2006). The literacy rate in Haryana is 67.91 percent, which is more than India’s average literacy rate while unemployment rate is 3.7 percent (Kumar et al., 2006), which is lower than the national unemployment rate. In Haryana, the prevalence of dental caries in the 35-44 year old age group is 77.2 percent (Mathur et al., 2004). A study reported 69.5 percent prevalence of dental caries in the rural population of the Ambala district (Kumar et al., 2010). Another study reported that out of 152 study subjects of the Ambala division aged 60 years and above, 36.8 percent had never visited a dental surgeon in their life time (Bansal et al., 2010). Prevalence of tobacco consumption amongst prisoners was reported to be 68.5 percent in India (Dahiya and Croucher, 2010). The burden of oral diseases and conditions is disproportionately
DOI 10.1108/17449201211268264
VOL. 8 NO. 1 2012, pp. 27-34, Q Emerald Group Publishing Limited, ISSN 1744-9200
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borne by those of lower social standing at each stage of life. Poor nutrition, lack of preventive oral health care, violence leading to facial trauma, and tobacco and alcohol use affect teeth and their supporting structures which leads to dental caries, periodontal diseases and tooth loss and oral and pharyngeal cancers (Treadwell et al., 2007). A thorough search of the literature did not yield any survey regarding dental caries or oral health of prisoners in Haryana. This study was undertaken because there were no study reports on the oral health status and treatment needs of prisoners and oral health care facilities in Haryana prisons. This paper reports a part of the findings of the larger study aiming to assess the oral health status and treatment needs of prisoners. The aim of this paper was to assess the dental caries status and treatment needs of the prisoners of Haryana state.
Method Permission and ethical clearance The study was conducted after obtaining written permission from the Director General of Prisons, Haryana state, and clearance from the institutional ethical committee, M.M.C.D.S. and R., Mullana. The study was conducted between September 2007 and June 2008. The pilot study was conducted at the District jail Kurukshetra to assess the feasibility and practical difficulties. Inclusion criteria The study population consisted of prisoners in all of the 19 Haryana prisons. The inclusion criterion for the study was incarceration for at least six months. It did not matter if the prisoner had been convicted or was currently on trial or had a history of imprisonment. Researchers were prohibited from entering the cells that housed the prisoners and access to prisoner records was also prohibited. The random allocation of the subjects for the study, therefore, was left to the prison authorities. In each prison, one police official was assigned to randomly pick the prisoners from each cell and ask them to participate. The sample size was calculated using the formula n¼4( pq/L 2) where p¼ population proportion of positive character, q ¼ 1 2 p and L ¼ allowable error. For this study L was presumed to be 2 percent giving a power of (1 2 L), i.e. 98 percent to study. The p-value was 85 percent (prevalence of dental caries), as obtained from pilot study. The required sample size was 1,275 subjects. The total number of prisoners in Haryana prisons was approximately 12,000. Based on the required sample size 10.63 percent of the subjects were required. To give an adequate representation to subjects from each prison, the sample was targeted to cover at least 5 percent of the prison population of each prison. A total number of 1,393 subjects were examined and the data collected. Data collection Subjects were interviewed regarding information on demographic and health details. Dentition status and treatment needs were taken from the World Health Organization (WHO) (1997) format for oral health status and treatment needs. The details of the existing health and oral health care facilities were collected from the prison authorities. The subjects were made to sit on a stool/chair available and a type III examination was conducted using mouth mirrors and a consumer price index (CPI) probe under adequate illumination. A single examiner (Vikram Bansal) conducted the examinations in all the prisons. To ensure reliability of the data, prior intra-examiner calibration was undertaken by examining 30 adults and then re-examining them four days later. The result of this calibration was 94 percent of diagnostic concordance, with a Kappa statistical value of 0.91, thus representing a satisfactory level of concordance (WHO, 1997). The data were recorded with the help of a recorder who was also part of the team. The data were analyzed using Statistical Package for Social Sciences version 13.0 for Windows. x 2 analysis was used to analyze the significance of the qualitative variables. Student-t test (unpaired) and analysis of variance were used to find the significance of the cross tabulation of a variable with the mean of dentition status and treatment needs. The p-value was stated to be statistically significant when equal to or lower than 0.05.
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Results The subjects’ mean age was 35.26 years ^ 12.29. A total of 8.26 percent (115) of females and 91.74 percent (1,278) of males were examined. A high percentage of subjects (27.5 percent) were illiterate. Nearly 1/3 (32.1 percent) of subjects examined had been in prison for less than one year. Many prison subjects examined belonged to a class IV/partly skilled occupation before entry into prison and their mean monthly per capita income was 1,626 ^ 1,426 Indian national rupees. As the subjects differed vastly in the length of imprisonment passed, and the CPI differs every year, their socioeconomic status could not be drawn for comparison. A subjective assessment of the need for dental treatment indicated that 80.0 percent (1,115) of the subjects were in need of one or more dental interventions. Of those in need, 62.8 percent had required dental treatment for a time period ranging from one month to one year. Many subjects (46.2 percent) reported toothache while 12.3 percent reported a cavity in their tooth/teeth. Also, 65.5 percent (912) subjects had never visited a dentist in their lifetime. Of the total study subjects, 63 percent (877) had a habit of using tobacco. Oral hygiene measures Regarding oral hygiene measures, 4.1 percent (57) subjects reported that they did not use any aid to maintain their oral hygiene. About 79.6 percent (1,109) subjects used some kind of oral hygiene aid, but not daily. About 73.1 percent subjects used a tooth brush while 3.9 percent subjects used a tree stick to maintain their oral hygiene. Tooth powder was being provided free of cost to the prisoners but only 21.2 percent subjects used it. Dentition status The prevalence of decayed teeth was 72.7 percent (Table I). The mean number of decayed teeth per person was 2.32 ^ 2.47. Amongst all the subjects, there were only 279 teeth with a restoration (mean ¼ 0.20 ^ 0.35) out of which 91 had recurrent decay (mean ¼ 0.07 ^ 0.30). The mean number of teeth in need of one and two surface fillings was 1.46 ^ 2.11 and 0. 31 ^ 0.68, respectively. Around one (0.96 ^ 1.88) tooth per person was in need of extraction. In other words, 3.01 percent of the total teeth needed extraction (Table II). The tooth most commonly found to be decayed was mandibular left 2nd molar. The mean numbers of teeth missing due to caries (1.12 ^ 2.11) and due to other reasons (1.85 ^ 5.39) were in subjects imprisoned for more than five years ( p . 0.05) (Table III). The need for two or more surface filling (0.39 ^ 0.74) and extraction (1.00 ^ 2.07) was also highest in these subjects, although none of these associations were statistically significant. Subjects who had visited a dentist at all in their lifetime had 8.51 ^ 5.34 mean number of decayed teeth and 2.32 ^ 2.81 mean number of missing teeth while those who had not visited a dentist ever had 7.92 ^ 4.23 mean decayed teeth and 1.86 ^ 2.34 mean missing teeth ( p , 0.05). Subjects who did not use any oral hygiene measures had a significantly higher mean number of decayed crowns (2.67 ^ 2.79) as well as roots (0.23 ^ 0.98) than those who used them (2.33 ^ 2.54; 0.03 ^ 0.31) ( p , 0.05). Teeth missing due to caries (1.26 ^ 3.85) and due to other reasons (8.93 ^ 12.48) and teeth needing extraction (2.37 ^ 3.34) were significantly higher while filled teeth were lower in these subjects (0.02 ^ 0.13). The mean number of teeth decayed and missing due to caries was highest in subjects with no or only primary education ( p , 0.05). Teeth missing due to caries increased steadily from the youngest Table I Showing prevalence of dentition status components Filled with Filled without decaya decaya Decayeda Crown Root Crown Root Crown Root Count Percentage of subjects
1,013 72.7
28 2.0
74 5.3
1 0.1
106 7.6
1 0.1
Missing due to cariesa Crown 438 31.4
Missing due to other reasona Crown 283 20.3
Traumaa Crown
Bridge abutmenta Crown
Obscured by calculusa Root
113 8.1
5 0.4
315 22.6
Note: aNumber of subjects having at least one tooth related to this component has been taken
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Table II Showing dentition status
Crown status Sound Decayed Filled with decay Filled without decay Missing due to caries Missing due to other reason Trauma Bridge abutment Unerupted Root status Sound Decayed Filled with decay Filled without decay Root obscured due to calculus Treatment needs No treatment One surface filling Two surface filling Crown Coronoplasty Pulp therapy Extraction
Min
Max
Suma
Mean
SD
Percentage of total teethb
0 0 0 0 0 0 0 0 0
32 19 4 7 32 32 9 5 8
36,744 3,233 91 188 1,159 1,923 159 14 1,052
26.38 2.32 0.07 0.13 0.83 1.38 0.11 0.01 0.76
5.449 2.475 0.304 0.566 2.134 4.609 0.479 0.189 1.213
82.43 7.25 0.20 0.42 2.60 4.31 0.36 0.03 2.36
0 0 0 0 0
32 7 2 2 28
39,137 66 2 2 1,227
28.10 0.05 0.00 0.00 0.88
5.554 0.418 0.054 0.054 2.380
87.80 0.15 0.004 0.004 2.75
0 0 0 0 0 0 0
32 21 7 3 11 6 17
35,948 2,040 434 29 58 589 1,343
25.81 1.46 0.31 0.02 0.04 0.42 0.96
6.118 2.118 0.682 0.186 0.448 0.767 1.883
80.64 4.58 0.97 0.07 0.13 1.32 3.01
Notes: aSum of teeth in all 1,393 subjects; bnumber of total teeth ¼ 44,576; Min, minimum; Max, maximum no. of teeth per person; SD, standard deviation; number of subjects ¼ 1,393; Crown & Root status along with treatment needs
Table III Showing comparison of length of imprisonment with Crown & Root (dentition) status Length of imprisonment 0.5 to 1 yr .1-2 yrs .2-5 yrs .5 yrs Total Significant ( p)
Decayed
Filled with decay
Filled without decay
Missing due to Missing due to caries other reason
Obscured by calculus
n
Crown
Root
Crown
Crown
Crown
Crown
Root
447
2.46 2.528 2.27 2.485 2.22 2.296 2.28 2.633 2.32 2.475 0.518
0.03 0.340 0.04 0.456 0.04 0.390 0.09 0.521 0.05 0.418 0.361
0.05 0.262 0.05 0.298 0.08 0.319 0.08 0.353 0.07 0.304 0.362
0.15 0.607 0.10 0.509 0.16 0.597 0.11 0.505 0.13 0.566 0.515
0.69 1.474 0.83 2.932 0.80 2.079 1.12 2.117 0.83 2.134 0.076
1.26 4.075 1.46 5.142 1.15 4.177 1.85 5.399 1.38 4.609 0.245
0.94 2.505 0.91 2.870 0.77 1.902 0.92 2.224 0.88 2.380 0.752
Mean SD 287 Mean SD 397 Mean SD 262 Mean SD 1,393 Mean SD
Notes: SD, standard deviation; n ¼ number of subjects
age group and were highest in subjects aged 55-64 years. The need for tooth extraction increased with increasing age while the need for pulp therapy decreased with increasing age. Both these associations were statistically significant (Table IV). The mean decayed, missing and filled teeth (DMFT) for age groups 35-44 and 65-74 years was 3.36 ^ 3.32 and 3.61 ^ 3.91, respectively. The mean number of 1.83 and 0.81 teeth needed a filling while 1.01 and 2.23 teeth needed extraction in the 35-44 and 65-74 year age group, respectively. A medical officer was posted in all the prisons while a full time/part time dentist was posted only in a quarter (5) of the prisons even though these prisons lacked basic equipment for
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Table IV Showing comparison of age with Crown & Root (dentition) status
Age
n
#24
279
25-34 35-44 45-54 55-64 65-74 $75 Total Significance ( p)
Mean SD 465 Mean SD 351 Mean SD 172 Mean SD 85 Mean SD 31 Mean SD 10 Mean SD 1,393 Mean SD
Decayed Crown Root 2.33 2.415 2.48 2.513 2.23 2.349 2.17 2.423 2.11 2.673 2.26 3.255 2.80 3.293 2.32 2.475 0.672
0.00 0.000 0.03 0.390 0.01 0.130 0.15 0.684 0.16 0.738 0.03 0.180 0.60 1.897 0.05 0.418
Filled with decay Crown 0.09 0.396 0.07 0.307 0.05 0.257 0.02 0.151 0.06 0.237 0.13 0.499 0.20 0.422 0.07 0.304 0.134
Filled without decay Crown 0.13 0.534 0.16 0.619 0.15 0.644 0.09 0.372 0.09 0.479 0.00 0.000 0.00 0.000 0.13 0.566 0.485
Missing due to caries Crown 0.19 0.686 0.65 1.243 0.92 2.256 1.54 3.205 1.94 3.914 1.19 2.482 1.50 4.089 0.83 2.134 0.000
Missing due to other Obscured by reason calculus Crown Root 0.05 0.284 0.23 0.954 0.92 3.134 3.37 6.674 5.84 8.236 9.10 12.563 12.40 10.721 1.38 4.609 0.000
0.28 1.032 0.66 1.993 1.08 2.299 1.52 3.256 1.85 4.196 1.42 3.170 0.10 0.316 0.88 2.380 0.000
Notes: SD, standard deviation; n ¼ number of subjects
providing dental treatment. In all prisons there was provision for taking prisoners outside the prison to government hospitals for medical and dental treatment.
Discussion This was the first study of its kind of covering all (19) the prisons of an entire state; other studies consulted had been conducted in only one or a few prisons. No study investigating oral health in the prisons of Haryana state, or even in India, was encountered so the results of this study were compared with the prison populations of other countries and the general population of Haryana. The mean age of the study population in our investigation was similar to other studies on the prison population (Jones et al., 2004; Mixson et al., 1990; Osborn et al., 2003; Salive et al., 1989). Male to female ratio was similar to other studies (Cropsey et al., 2006; Jones et al., 2004; Osborn et al., 2003) while most studies were conducted only on male prisoners (Cunningham et al., 1985; Lunn et al., 2003; McGrath, 2002; Mixson et al., 1990; Nobile et al., 2007; Salive et al., 1989). This is because most of the prisoners were male and many prisons did not have facilities to accommodate female prisoners. Around one-third of the study subjects had no, or only elementary education, similar to that reported by (Nobile et al., 2007). A high number of prisoners were unemployed before imprisonment, similar to other studies (Moller et al., 2007). The high percentage of subjects with low education and no employment before imprisonment could be because such individuals experience fewer job opportunities and can resort to illegal activities leading to imprisonment. Overall literacy rate was similar to other studies (Sajid et al., 2006). The long-standing self-reported dental need of the great majority of prisoners is indicative of the dire need for provision of dental treatment to the subjects. Two thirds of the subjects had not visited a dentist in their lifetime, while more than 4/5th of the subjects did not use oral hygiene measures regularly, or did not use them at all. It is interesting to note that the availability of low cost oral hygiene aids for the general public and the provision of free tooth powder in the prisons override the consideration of socioeconomic conditions as the reason for not being able to make regular use of oral hygiene aids. Although the paucity of dental surgeons in rural India has often been a topic of much debate, the state of Haryana has 528 government posts for dental surgeons out of which 384 posts are occupied. It should be mentioned that the majority of treatments in government occupancies are provided at no or little cost (Health Department, Haryana, n.d.). This indicated that oral health was given low priority by the prisoners.
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This was contrary to other studies (Jones et al., 2004; Nobile et al., 2007) which reported a high use of oral hygiene measures on a regular basis in the prisons and a high use of dental health services by the prisoners. As a word of caution, the statements on availability of dental manpower need to be scrutinized with great care as India is a developing nation. A large number of instances of public dispensing may be visible and seen to be adequately working on paper, but their actual functioning needs to be practically assessed. The presence of adequate manpower without adequate infrastructure might be of little or no use. The number of decayed teeth per person was lower than most of the studies (Cunningham et al., 1985; Jones et al., 2005; Lunn et al., 2003; Osborn et al., 2003) while few studies (Jones et al., 2004; Nobile et al., 2007) found a similar number. The mean number of filled teeth was found to be quite low as compared to other studies (Cunningham et al., 1985; Jones et al., 2004, 2005; Lunn et al., 2003; Osborn et al., 2003; Nobile et al., 2007). This is consistent with our finding that the number of subjects who had never visited a dentist in their lifetime was very high; hence the mean number of restored teeth shall be low. DMFTwas found to be lower in both the 35-44 and 65-74 year age groups when compared to the general population of Haryana (Mathur et al., 2004). Osborn et al. (2003) reported the DMFT to be quite high in these age groups in their study population. The need for a filling was less while need for tooth extraction was quite high in the present study as compared to the population of Haryana (Mathur et al., 2004). This shows that the teeth of a high number of prisoners were so badly decayed that they were not restorable. The mean number of decayed teeth decreased while missing teeth increased with increasing length of incarceration. This could be because the subjects in need of dental treatment are taken outside of the prison to a government hospital in cases of dental emergency and single sitting procedures for the extraction of teeth would be the treatment of choice in these cases leading to greater tooth mortality. Subjects, who had visited a dentist sometime in their lifetime, had a higher number of decayed and missing teeth. This can be because of a trend to visit a dentist only when in utmost need; hence only those subjects who already have teeth in poor condition visit a dentist. There was higher number of teeth missing due to other reasons as compared to teeth missing due to caries. This can be due to several reasons including periodontal disease, traumatic injuries due to assaults, etc. There was an inverse relation between education and mean number of decayed and missing teeth. Pain is the most common reason for seeking dental treatment, yet many subjects in the prisons reported suffering from dental pain for a long time. The high demand of dental treatment requires the provision of dental treatment within the prison itself. Such huge demands cannot be catered for by taking all the prisoners out to a hospital, as this involves many security issues. Hence, the posting of dental surgeons in the prisons along with infrastructure adequate for them to carry out dental treatments, is of utmost importance. Not many subjects reported using the tooth powder supplied free of cost to the prisoners. Additionally, as the use of tooth brushes and tooth paste is widely accepted, consideration should be given to the provision of free tooth brushes and tooth paste to prisoners. As the reported need for dental treatment is high and also most of the subjects do not maintain their oral hygiene on a regular basis, the provision of treatment to the subjects calls for an oral hygiene checkup prior to provision of any treatment (except that of emergency nature). This suggestion is reinforced by the fact that those subjects who did not use any oral hygiene measures had a higher number of decayed as well as missing teeth along with a higher need for tooth extraction while the number of filled teeth was lower. Oral health was found to be given low priority by the prisoners and consideration should be given to education programmes to address this. In India, publicly funded oral health care service is limited and the primary oral health care service is based on private dental health care providers, who are out of reach of the study group owing to their restrained freedom of movement. The majority of prisons lacked dental manpower and, where it existed, equipment for oral health care delivery was either sparse or outdated.
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It is the responsibility of the government to take care of prisoner health. Although the dental health of the prisoners was found to be similar or marginally better than the general population of Haryana, the non-availability of resources and the situation of imprisonment call for immediate attention to the prisoners’ oral health care needs by the government. A question that arises here is: are there any potential barriers to government implementation of more expansive policies? This requires an in-depth study and suggestions to be put forward advocating alternative methods to address prisoners’ oral health care needs.
References Bansal, V., Sogi, G.M. and Veeresha, K.L. (2010), ‘‘Assessment of oral health status and treatment needs of elders associated with elders’ homes of Ambala division, Haryana India’’, Indian Journal of Dental Research, Vol. 21 No. 2, pp. 244-7. Cropsey, K.L., Crews, K.M. and Silberman, S.L. (2006), ‘‘Relationship between smoking status and oral health in a prison population’’, Journal of Correctional Health Care, Vol. 12 No. 4, pp. 240-7. Cunningham, M.A., Glenn, R.E. and Field, H.M. (1985), ‘‘Dental disease prevalence in a prison population’’, Journal of Public Health Dentistry, Vol. 45 No. 1, pp. 49-52. Dahiya, M. and Croucher, R. (2010), ‘‘Male prisoner tobacco use and oral cancer knowledge: a case study of a local prison in India’’, International Dentistry Journal, Vol. 60 No. 2, pp. 135-8. Health Department, Haryana (n.d.), ‘‘Note of oral health services’’, available at: www.haryanahealth.nic.in Jones, C.M., McCann, M. and Nugent, Z. (2004), Scottish Prisons’ Dental Health Survey 2002, Scottish Executive, Edinburgh. Jones, C.M., Woods, K. and Neville, J. (2005), ‘‘Dental health of prisoners in the north west of England in 2000: literature review and dental health survey results’’, Community Dental Health, Vol. 22 No. 2, pp. 113-7. Kumar, A., Mukhopadhyay, P.K. and Raut, D.K. (2006), Central Bureau of Health Intelligence: National Health Profile 2006, Directorate General of Health Services, Ministry of Health & Family Welfare, New Delhi. Kumar, A., Virdi, M., Veeresha, K.L. and Bansal, V. (2010), ‘‘Oral health status and treatment needs of rural population of Ambala, Haryana, India’’, The Internet Journal of Epidemiology, Vol. 8 No. 2. Lunn, H., Morris, J., Jacob, A. and Grummitt, C. (2003), ‘‘The oral health of a group of prison inmates’’, Dental Update, Vol. 30 No. 3, pp. 135-8. McGrath, C. (2002), ‘‘Oral health behind bars: a study of oral disease and its impact on the life quality of an older prison population’’, Gerodontology, Vol. 19 No. 2, pp. 109-14. Mathur, V.B., Talwar, P.P. and Chanana, H.B. (2004), National Oral Health Survey and Fluoride Mapping 2002-2003 – Haryana, Dental Council of India, New Delhi. Mixson, J.M., Eplee, H.C., Fell, P.H., Jones, J.J. and Rico, M. (1990), ‘‘Oral health status of a federal prison population’’, Journal of Public Health Dentistry, Vol. 50 No. 4, pp. 257-61. Moller, L., Stover, H., Jurgens, R., Gatherer, A. and Nikogosian, H. (2007), Health in Prisons – A WHO Guide to the Essentials in Prison Health, World Health Organization Regional Office for Europe, Copenhagen. Nobile, C.G., Fortunato, L., Pavia, M. and Angelillo, I. (2007), ‘‘Oral health status of male prisoners in Italy’’, International Dental Journal, Vol. 57 No. 1, pp. 27-35. Osborn, M., Butler, T. and Barnard, P.D. (2003), ‘‘Oral health status of prison inmates – New South Wales, Australia’’, Australian Dental Journal, Vol. 48 No. 1, pp. 34-8. Raban, M.Z., Dandona, R., Kumar, G.A. and Dadona, L. (2010), ‘‘Inequitable coverage of non-communicable diseases and injury interventions in India’’, National Medical Journal of India, Vol. 23 No. 5, pp. 267-73. Sajid, A., Nalini, S. and Elizabeth, D. (2006), ‘‘Prevalence and socio-demographic factors associated with tobacco smoking among adult males in rural Sindh, Pakistan’’, Southeast Asian Journal of Tropical Medicine & Public Health, Vol. 37 No. 5, pp. 1054-60. Salive, M.E., Carolla, J.M. and Brewer, T.F. (1989), ‘‘Dental health of male inmates in a state prison system’’, Journal of Public Health Dentistry, Vol. 49 No. 2, pp. 83-6.
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Treadwell, H.M., Northridge, M.E. and Bethea, T.N. (2007), ‘‘Building the case for oral health care for prisoners: presenting the evidence and calling for justice’’, in Greifinger, R.B. (Ed.), Public Health Behind Bars: From Prisons to Communities, Springer, New York, NY, pp. 203-12. World Health Organization (1997), Oral Health Surveys, Basic Methods, 4th ed., World Health Organization, Geneva.
About the authors Dr Vikram Bansal is working as a Senior Lecturer at the Dental College, M.M. University, Mullana. He is actively involved in research work. He is also engaged in teaching the skills of public health dentistry to undergraduate and post graduate students. He has several publications to his credit in various journals. Vikram Bansal is the corresponding author and can be contacted at: [email protected] Dr G.M. Sogi is working as a Professor at the Dental College, M.M. University, Mullana. He is actively involved in research work. He has several publications to his credit in various journals. He is on the board of various universities in India as an examiner for undergraduate and postgraduate studies. Dr K.L. Veeresha is the Professor and Head of the Department of Public Health Dentistry at the Dental College, M.M. University, Mullana. He monitors the research work being carried under his supervision. He is also engaged in teaching the skills of public health dentistry to postgraduate students. He is on the board of various universities in India is an examiner and paper setter for undergraduate and postgraduate studies. Dr Adarsh Kumar is an Assistant Professor at the Government Dental College, Rohtak. He is actively involved in research work and also is engaged in teaching public health dentistry to students. He also monitors various government initiatives on oral health for the general public of the state of Haryana. Dr Shelly Bansal is a Lecturer at the Dental College, M.M. University, Mullana. She is actively involved in various research projects. She is also involved in teaching the skills of dentistry to undergraduate students.
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