oral health is an integral part of general health . with the life expectancy increasing to 66.8 years1 among the indian population ,
the role oral health plays in improving the quality of a person s life can not be overstated . over the last five decades , there has been a steady increase both in the prevalence and in the severity of dental caries in india .
it is evident from the literature that 30% of children suffer from mal - aligned teeth and jaws diminishing the potential of dentofacial apparatus to function properly.2 oral cancer constitutes 35 - 40% of total body cancers which could be attributed to the wide usage of tobacco , betel nuts , quid , pan masala etc.3 the health care delivery system in india embodies a public sector , a private sector , and an unofficial nexus of health care providers operating within an unchecked environment , with no supervision on the services provided with respect to the provider , way of provision of services , costs involved , and there is no standardization in measuring the quality of care .
this impromptu health care system has created a wide disparity in access to dental care , with the frivolous and lackadaisical public health system rubbing salt into the wound . for most indians , a visit to a dental office
is considered an extraordinary and an unexpected event . according to the concept given by bhore committee in 1946 , a primary health center ( phc )
is supposed to be a basic health unit that provides curative and preventive health care services in an integrated manner to the rural population emphasizing on the preventive and promotive genres of health care , situated as close to the people as possible .
the national health plan ( 1983 ) recommended reconstitution of phcs at a ratio of one phc for every 30,000 rural population in the plains .
this ratio is 1:20,000 in hilly , tribal , and backward areas to render comprehensive coverage.4 though the national oral health policy had recommended dentists to be recruited in all phcs , it is unfortunate that this policy has not been implemented till date and there are no dentists appointed in phcs in some states .
there are nine clusters under the phc with a population coverage of 41,650.5 the main objective of any oral health care system was to maintain and improve oral health care , which depends on the willingness of the individuals to seek care . in many developing countries ,
utilization is measured as the number of visits per year or the number of people with at least one visit during the previous year , and utilization studies serve as an important tool in designing and modifying oral health policies.6 with this background a study is planned to know the dental services utilization among the rural population under the phc , with the following objectives : 
 to know the normative needs among the rural population.to know the factors determining utilization of dental services . 
  to know the normative needs among the rural population . to know the factors determining utilization of dental services .
the study was carried out in clusters under the primary health center situated 30 km from guntur , andhra pradesh , india .
a cross - sectional house to house survey was conducted in the field practice area of a phc in southern india .
three clusters were randomly selected for data collection from a total of nine clusters that are covered under the phc .
the list of houses was obtained from the respective rural administrative authorities . from each cluster ,
questionnaires were distributed to adults residing in the selected houses to assess their dental care utilization , followed by screening for existing oral diseases .
demographic profile includes details regarding name , age , sex , education , occupation , income ( kuppuswamy s socio - economic status [ ses ] scale - updating for 2007).7 each respondent was asked a series of questions on dental health attitudes , last dental visit , treatments underwent and factors influencing utilization .
responses to the questionnaire were analyzed using chi - square test to assess the association between demographic characteristics .
a significant relationship was assumed to exist between the groups if the p value was found to be < 0.05 .
ethical clearance was obtained from the ethical committee of sibar institute of dental sciences and prior permission was taken from local authorities .
subjects who were available on the day of examination and permanent residents of the study area .
a cross - sectional house to house survey was conducted in the field practice area of a phc in southern india .
three clusters were randomly selected for data collection from a total of nine clusters that are covered under the phc .
the list of houses was obtained from the respective rural administrative authorities . from each cluster ,
questionnaires were distributed to adults residing in the selected houses to assess their dental care utilization , followed by screening for existing oral diseases .
demographic profile includes details regarding name , age , sex , education , occupation , income ( kuppuswamy s socio - economic status [ ses ] scale - updating for 2007).7 each respondent was asked a series of questions on dental health attitudes , last dental visit , treatments underwent and factors influencing utilization .
responses to the questionnaire were analyzed using chi - square test to assess the association between demographic characteristics .
a significant relationship was assumed to exist between the groups if the p value was found to be < 0.05 .
ethical clearance was obtained from the ethical committee of sibar institute of dental sciences and prior permission was taken from local authorities .
subjects who were available on the day of examination and permanent residents of the study area .
of the 385 study subjects , 190 ( 49.4% ) were male and 195 ( 50.6% ) were female with majority of them belonging to the age group of 35 - 44 years ( 22.08% ) .
principal number ( 46.23% ) of the study subjects belonged to upper lower ( ul ) ses and very few subjects ( 1.31% ) belonged to upper ses .
4.41% study subjects belonged to lower ses , 40% of study subjects belonged to lower middle ( lm ) ses , and 8.05% study subjects belonged to upper middle ( um ) ses .
table 1 shows the distribution of study subjects according to the  felt need . 
major dental problem experienced by the study subjects was toothache which constituted around 68.85% , of which 51.37% study subjects belonged to lm socio economic group .
difference in proportions is statistically significant as analyzed by chi - square test ( p = 0.00 ) .
majority of study subjects have undergone an extraction which constituted about 50.27% of which 37.17% study subjects belonged to lm socio economic group .
the percentage of subjects who underwent restorations and prosthetic treatments constitute 5.46% and 3.28% , respectively . influenced by various factors 31.15% of the subjects with one - third of them belonging to lower ses , availed no treatment despite having dental problems .
difference in proportions is statistically significant as analyzed by chi - square test ( p = 0.00 ) .
most of the study subjects ( 68.25% ) preferred private dental clinics over government dental hospital ( 75.08% ) in pursuing their dental needs .
difference in proportions is statistically significant as analyzed by chi - square test ( p = 0.00 ) .
table 4 shows the distribution of study subjects according to factors influencing for not utilization of dental services .
impenitent attitude of the patient stands out as prime reason ( 50.88% ) for not visiting the dentist and is followed by the reasons like  lack of awareness  ( 14.03% ) and notions like  dental treatments are expensive  ( 14.03% ) .
upper ses group reported reason for not visiting a dentist was  lack of time . 
distribution of study subjects according to factors influencing for not utilization of dental services even though they have perceived the problem .
table 5 shows the distribution of study subjects according to the reason for taking treatment in a particular center .
much of the study subjects ( 45.24% ) stated proximity of dental clinics as influencing factor in choosing a center to avail dental treatments and only 13.49% of the subjects underwent treatment in a particular center as they provide better quality treatment .
difference in proportions is statistically significant as analyzed by chi - square test ( p = 0.00 ) .
table 6 shows the distribution of normative needs according to gender . majority ( 49.78% ) study subjects were observed with the presence of multiple problems , 27.1% were observed with calculus and 8.05% were observed with decayed teeth . among the study subjects , 9.68% of the um socio economic group presented with decayed teeth .
5.9% of the lower socio economic group had missing teeth . however , the difference observed was statistically not significant ( p = 0.407 ) .
utilization is not just the willingness of people to seek care , but the actual attendance at the site of delivery of health care services to receive care .
the present study was conducted with a sample of 385 subjects , who were the permanent residents of a phc area . the sample comprised of 190 males ( 49.35% ) and 195 females ( 50.65% ) . in the present study , maximum ( 22.27% ) number of subjects belonged to the 35 - 44 years age group and a minimum of 5.44% subjects belonged to the age group of 0 - 14 years . in our study , it was observed that toothache was the ubiquitous problem , which being an emergency condition should logically have forced them to visit a dentist . but
nearly 30% of people having toothache had not visited a dentist , whereas a study conducted by poudyal et al .
it was identified from the current study that not giving much importance to dental care was the major factor negatively influencing the utilization of dental care accounting for 50.88% of the total influencing factors .
( 2010),8 where a majority of people opined that they had no dental problems , recognized that the mismatch between normative need and perceived need was the major factor affecting utilization of dental care .
in our study , it was observed that fear was not a major reason for non - utilization of dental care , constituting for a mere 3.5% of all the reasons given for non - utilization
. nonetheless , these results are not in accordance with a study done by kakatkar et al .
( 2011)9 and tong and tong ( 2005)10 where fear was recognized as the major reason for not utilizing the dental care .
this study did not show significant difference between the dental visit history among males and females ; and similar results were observed in a study done by poudyal et al .
( 2010).8 dissimilar results were observed in a study done by liddell and locker ( 1997),11 kakatkar et al .
( 2011).9 most preferred treatment centers by the study subjects were private dental hospitals ( 24.7% ) , and the reason identified was accessibility which constituted ( 15.1% ) of all the reasons given .
 utilization of oral healthcare services  has long been used as an indicator of oral health related behavior .
the iterated reason for not visiting the dentist was  did not think it was important ,  which shows the laxity of indian population towards oral health .
the only health service available for the rural population is phc , but there is no dentist in it to provide dental care .
the need of the hour is to improve the oral health knowledge and awareness among people .
motivating them towards availing oral health care is a prime requisite to provide them a socially and economically productive life .
recruitment of dentists in primary health centers and providing the necessary infrastructure is the only possible way to abolish the malady of  apathy toward procuring oral health care .
 background : the oral disease burden in india is showing a steady increase in the recent years . 
 utilization of dental care being the major factor affecting the oral health status of the population is used as an important tool in oral health policy decision - making and is measured in terms of the number of dental visits per annum.materials and methods : a cross - sectional house to house questionnaire survey was conducted in three rural clusters which were randomly selected from a total of eight clusters served by a primary health center . 
 simple random sampling was used to select 100 houses from each cluster . 
 screening was done to examine the existing oral diseases . 
 a total of 385 completed questionnaires were collected from 300 houses.results:of 385 study subjects , 183 have experienced previous dental problems . major dental problem experienced by the study subjects was toothache ( 68.85% ) and the treatment underwent was extraction ( 50.27% ) . 
 most preferred treatment centers by the study subjects were private dental hospital ( 68.25% ) and reason identified was accessibility which constituted ( 45.24% ) of all the reasons given . 
 negative attitude toward dental care is one of the important barriers ; 50.8% of the non - utilizers felt dental treatment is not much important.conclusion:persons attitude , lack of awareness , and affordability remain the barriers for utilization of dental services . 
 effective methods have to be exercised to breach such barriers . 
Introduction
Materials and Methods
Study population and sampling procedure
Questionnaire
Ethical clearance
Inclusion criteria
Exclusion criteria
Results
Discussion
Conclusion