Health Seeking and Oral Health behaviour of the Tribes of Rajasthan: A Review

ABSTRACT

The cultural patterns and the life style of the tribes vary a lot, and so does their health seeking behavior. The study of health, disease and treatment vary according to the culture of a particular area. Moreover, the culture of tribal area is guided by traditionally laid down customs and each member of the culture is ideally expected to conform to it. In every culture there is repository of values and belief systems built around important life experiences i.e. birth, disease and death. Tribes constituted separate socio-cultural groups having distinct customs, traditions and living largely in agricultural and pre-agricultural level of technology.

Oral Health remains to be the ignored part. The tribal population is relying upon the traditional system of medicine to relieve toothache and other oral problems. The present review provides with the insight of the indigenous oral health practices of the tribes.

Keywords: Tribes, Oral Health, Traditional Medicine.

INTRODUCTION

Mankind is proceeding towards greater and greater homogeneity racially, culturally and linguistically. Oldest cultures are dying or being exterminated. In such a broad category comes a great segment of primitive, tribal, indigenous, native people. Some major characteristics of these groups have been simple pre-machine economy, unsophisticated rituals and social customs, lack of a script for their speech which itself is not developed, small local community organization and homogeneity.1,2

A tribe is a collection of families bearing a common name, speaking a common dialect, occupying a common territory and is not usually endogamous, though originally it might have been so.3

TRIBES IN INDIA: CLASSIFICATION

Tribes in India can be classified on the basis of their 4:

a)Territorial/Geographical distribution

b)Linguistic affiliation

c)Physical and Racial characteristics

d)Occupation or Economy

e)Cultural contact

f)Religious beliefs

Territorial/Geographical Distribution

Indian tribes are classified into 3 zones

The north and north-eastern zone

The central or the middle zone

The southern zone

The inhabitants of Andaman and Nicobar Islands are not included in the above classification, but they may be said to constitute a fourth zone. The main tribes living in this area are the Jarawa, Onge, Andanmanese and Nicobari.3

Linguistic Classification

Tribal people of India may be classified into 3 speech families:

  1. Dravidian
  2. Austric
  3. Tibeto-chinese

Racial Classification

Classification by Sir Herbert Risely(1915):

  1. Turko- Iranian
  2. Indo-Aryan
  3. Scytho-Dravidian
  4. Aryo-Dravidian
  5. Mongolo-Dravidian
  6. Mongoloid
  7. Dravidian

These seven types may be reduced to 3 basic types:

  1. Dravidian
  2. Mongolian
  3. Indo-Aryan

Economic Classification(Thurnwald)

  1. Homogenous communities of men as hunters and trappers, women as collectors- Kadar, Chenchu, Kharia and Korwa are some of the Indian tribes falling in this category.
  2. Homogenous communities of hunters, trappers and agriculturists- the Kamar, Baiga and Birhor are examples of this group.
  3. Graded society of hunters,trappers, agriculturists and artisans- most of the tribes fall under this category. Eg. The Chero, Agariya
  4. The herdsmen- Toda and Bhils fall under this category
  5. Ethnically stratified cattle breeders and traders- the bhotiyas of sub-Himalayan regions.
  6. Socially graded herdsmen with hunting, agricultural and artisan population.3

Classification according to culture contact:

  1. Most primitive tribes, lives a joint communal life
  2. Attached to solitude and ancient traditions, are more individualistic.
  3. Those who are under external influence and are already on the way out by the loss of their tribal culture, religion and social organization.
  4. The tribes like Bhils and Naga, who are said to be the representatives of the old aristocracy and retain, much of their original tribal life.

Classification based on Religious Beliefs:

  1. Hinduism
  2. Christianity
  3. Buddhism
  4. Islam
  5. Jainism
  6. Other religions

TRIBES OF RAJASTHAN- AN OVERVIEW

BHILS are said to be the oldest inhabitants of the country they are – “Adivasi” the original settlers. They have been living in hills and forests. Items like spirits, ghosts, gods, goddesses, ill-health and cure practices based on supernatural considerations, are rampant in the Bhil society. They are very superstitious and wear charms and amulets on the forearm to keep evil spirits at a distance.4MINA forms about 49% of the population of schedulded tribes in the state, except in Ajmer district where minas are not included in the schedulded tribes. They account for 99 - 99.8 per cent of all ST population in the five districts namely Dhaulpur, Bharatpur, SawaiMadhopur, Karauli, & Dausa. GARASIA constitute the third largest tribal group of the state of Rajasthan. Garasia are primitive and neglected tribe of Rajasthan. SAHARIYA are primitive group. They constitute 0.99% of the total tribal population of the state. In view of the primitive character of these groups, greater emphasis is given to education, agriculture and health care.GADIA LOHAR is the tribal nomadic communities and it means “blacksmith in vehicle.” They were assigned the job of making weapons. The people of this tribe spent most of their time in bullock-cart.The other tribal groups include Damors, Kathodi, rabari, bishnois.5

ORAL HEALTH BEHAVIOUR AMONG TRIBALS

Every culture has its own concepts of health, sickness and health promotion depicting values, beliefs, knowledge and practices shared by its people.2Alike all health problems, dental and oral diseases are a product of economic, Socio-cultural status, environmental and behavioural factors. Poor hygiene, poor nutrition and smoking contribute to dental and oral problems. In such matters learned behaviour is of utmost importance, which in turn is linked to environmental and socio-economic conditions. There are no traditional or advanced/ improved methods of oral hygiene as such which form a part of tribe’s health behaviour for the maintenance of oral health and prevention of oral diseases. They do not brush their teeth. They clean their teeth with mouthful of water. They are in habit of smoking bidis, chillum and chewing tobacco and paan(beetle), which results in staining of the teeth.6

Dental caries is one of the most common oral health problems among tribes. Like caries; the frequency of periodontal disease of the oral cavity is high. Periodontal disease is disease of teeth itself and it afflicts the supporting structure of the teeth, especially the gingival, the alveolar bone, the periodontal ligament and the cementum. These four structures constitute a single functional unit called the periodontium, which is responsible for the healthy maintenance of the tooth in its alveolus. Diseases in the tooth are characterized by modifications in the colour, bleeding and ulceration or sloughing of the gums.7

Dental diseases are caused by malnutrition, unhygienic habits, bacterial infections, and betel chewing, smoking and chewing of tobacco. The negligence of oral hygiene assists in the accumulation of dental plaque that produces anaerobic organisms, which cause inflammation. Inflammatory conditions spread to deeper structures of the periodontium and finally lead to exfoliation of teeth. As a consequence of dietary deficiency, several oral diseases, for example- Glossitis, Vitamin B deficiency; Mottled enamel; Angular stomatitis and spongy to bleeding gums are observed among tribals.7,8,9

Alike all health problems, dental and oral diseases are a product of economic, social, cultural, environmental and behavioural factors. Poor nutrition, poor hygiene and smoking habits contribute to dental and oral problems. Like other health problems even the dental problems are related to spirit intervention. Different spirit and deities are associated with various dental diseases. All deities have their own respective departments and areas of influence. For example, Garasias believe that Dantio Veer causes toothache and gum diseases. To appease Dantio veer they perform pooja with seven type of grains mixed with seven types of colours.10,11,12

TRADITIONAL METHODS OF DENTAL CARE AMONG TRIBALS

There are no improved or advanced methods of oral hygiene among the tribal communities which form a part of tribal health behaviour for the maintenance of oral health and prevention of oral diseases. Health education can be effectively incorporated in development programmes in promoting the prevention of diseases and dental care. Methods and techniques of dental care among tribals comprise use of local materials. These are as follows:

1. For cleaning teeth

(a) Baked clay from the earth.

(b) Twigs of rattan jot (Jatrophacurcas)

(c) Twigs of Jhatbor(Ziziphusnummularia) as tooth brush.

2. For loose teeth

(a) Local application of latex of tuar (Euphorbia neriifolia) with cotton.

3. For teeth and jaw aches

(a) They chew roots of kanthar (Capparissepiaria);

(b) Local application of crushed paste of roots of rattan-jot

(c) In case of toothache they brush their teeth with roots of chltravar (PlumbagoZeylanica )

(d) In case of jaw ache they chew seeds ofGularias well as inhale vapours of fumigated Gulari (Solanumsurattenc) seeds;

(e) For toothache they chew the stem of bajdanti, a

(f) In case of toothache they apply clove oil (laung ka tel) or the juice of the leaves of the climbing bean (sem- ki- phalli )

4. For swelling of gums

(a) They wash their mouth with solution ofchilbaithafruit boiled in water. They also use solution of bark of kachnavar tree boiled in water is as mouthwash. The twigs of Kachnavar are used for brushing the teeth.

6. For dental caries

They use gum of the babool (Acacia nilotica) to fill the cavity.

7. For relieving pain

They burn the crust of a coconut and a plate is inverted on it to collect heat and smoke in a boll of cotton. This cotton is placed in cavity for relieving pain.10

MUTILATION OF TEETH

Tooth related and oral soft tissue mutilations are well recognized forms of mutilation. Knowledge of these practices is important for the valuable insights they provide into the cultural beliefs and traditions of the people who practise them. Tooth mutilation practices includes non-therapeutic tooth extraction(avulsion); the breaking off tooth crowns; alterations in shape of the tooth crowns by filling and chipping; dental inlay work; lacquering and staining of teeth; and placement of gold crowns for adornment purposes. Beliefs and associations ascribed to the practice of tooth mutilations are:

  • Tribal identification
  • Sign of bravery
  • Sign of ceremonial rebirth
  • Aesthetics and adornment
  • Cultural mimicry
  • Local superstition

The use of decorative inlays and crowns for adornment purposes is a very popular practice among the tribes. It is usually carried out for the purpose of beautification or to signify some event. The nature of inlay materials used is jade, pyrite, gold. This is usually done in the labial surface of upper central incisors, seen in both males and females. Small holes are drilled into the labial surface of maxillary teeth and place pieces of gold, copper etc. in such defects.11,13

CONCLUSION

Isolation of tribes has kept them from the benefits of modern facilities.. In the ordinary course of life the tribals hardly understand the nature of disease and they tend to associate the recovery of patient with the superstitions practices either through the Bhopa or the observation of several rituals. The tribals are ignorant of the intricate nature of disease. Treatment of disease is primarily based on the indigenous sources.Traditional health care system have been prevalent among the tribal of Rajasthan in one form or other based on medicinal herbs, roots and tubers and healing practices. The psychological and emotional dimension in this care system has also been equally important in the healing practice. The tribal people living closest to nature are influenced more by socio-cultural and environmental dimensions in their healing practices. Since tribal belief relates sickness, death and good health to the curse or goodwill of the deities worshipped by the concerned tribes, appeasement of God as well as destruction of evil spirits, forms a major part of psychosomatic healing or health care system.

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  4. S.C.Dube. Tribal studies of India. Antiquity to modernity in tribal India continuity and change among Indian tribes. Inter-India Publications. New Delhi, 1998
  5. Robin B. Tribhuwan. Health of Primitive tribes. New Delhi: Discovery Publication House; 2004
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