Prevalence Of Dental Caries, Socio-Economic Status And Treatment Needs Among 5 To 15 Year Old School Going Children Of Chidambaram
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Dr. Joyson Moses MDS
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Introduction: Dental caries is a disease with multifactorial causes. The prevalence and incidence of dental caries in a population is influenced by a number of risk factor such as sex, age, socioeconomic status, dietary patterns and oral hygiene habits. Thus the present study was designed to assess the prevalence of dental caries in school children in Chidambaram between 5-15 age groups.
Materials and methods: The study population consisted of 2362 children, 1258 were boys and 1104 were girls. A total of 7 schools were selected. Trained Dental Surgeon was involved in the examining and the children were examined according to the Dentition status and Treatment Needs, WHO oral health assessment 1987.
Results: Off all the three groups, group II (9-11yrs old) had high percentage of caries. In total, dental caries were observed in 1484(63.83%) of study population. The mean (Â±SD) value of dmft/DMFT of all groups, the decayed teeth accounted for the greatest percentage. In all 80.4%of the student belong to low socio-economic group and showed dental caries .Restoration was the most required treatment in all three groups which was follow by pulp therapy.
Conclusion: The result of this study is a pointer to the fact that there still exist a large segment of the population who continue to remain ignorant about the detriment effects of poor oral health and the multiple benefits enjoyed from good oral health.
Prevalence, Dental Caries, School Children, Treatment Need
Dental caries is the most prevalent oral disease. Itâ€™s very high morbidity potential has brought this disease into the main focus of the dental health profession. There is practically no geographic area in the world whose inhabitant does not exhibit some evidence of dental caries. It affects both the sexes, all races, all socio-economic status and all age groups (1). It not only causes pain and discomfort, but also in addition, places a financial burden on the parent. The prevention of dental caries has long been considered as an important task for the health profession. Scientific research continues to make progress in identifying the best practices for diagnosing, treating, and preventing dental caries. Traditional approaches for treating carious lesions in a surgical manner are being replaced by newer strategies that emphasize disease prevention and conservation of tooth structure.
Voluminous literature exists on the status of the dental caries in the Indian population. In the year 1997, 22.7% of Indian population was estimated to be 5-14 yrs. This being such a high proportion of the population, the prevelance of dental disease among this age group needs to be assessed. It has been observed that during 1940 the prevalence of dental caries in India was 55.5%, during 1960 it was reported to be 68%. Overall the general impression is that dental caries has increased in prevalence and severity in urban and cosmopolitan population over the last couples of decades. However there is no definite picture as yet regarding the disease status in rural and backward areas of country in the comparison where 80% of the population inhabits (2).
A very extensive and comprehensive National Health Survey (3) conducted in 2004 throughout India has shown dental caries in 51.9% in 5 year-old children, 53.8% in 12 year-old children and 63.1% in 15 year-old teenagers. The report concluded that a preventive dentistry program, such as water fluoridation, should be initiated to address this national crisis in dental caries.
In order to assess the magnitude of the preventive task it is necessary to know the extent and severity of the disease. Schools are the best center for effectively implementing the comprehensive health care programme, as children are easily accessible at school. The process of improving oral health in a population involves components such as
1. Collection of information about oral diseases.
2. Evaluation of the data helps to understand the need of the community.
3. Identification of the high risk group.
4. Plan the treatment and preventive strategies for community.
Not many studies have been done in Chidambaram school children to assess the dental caries and oral hygiene status. Hence the current study was planned to provide the base line data of prevalence of dental caries and the treatment needs for dental caries along with their socioeconomic status among 5 to 15 year old school going children of Chidambaram.
The study was conducted between October (2002) to March (2003). The study population consisted of children aged 5 to 15 year who were attending the school in Chidambaram. The study sample comprised of 2362 children, 1258 were boys and 1104 were girls.
(Table/Fig 1): The Total Number Subject
The lists of school were prepared according to the information supplied by directorate of education, Chidambaram. Schools were selected randomly. There are 17 schools in Chidambaram, of which only 7 school were selected for the study, out of which 4 government and 3 private school. The age groups of 5 to 15years were selected to screen the primary dentition, mixed dentition and permanent dentition except the third molar and the early status of dental caries that could not be diagnosed positively were excluded. Before starting the study official permission was obtained from all the concerned authorities. Each school principal was informed about the study aims and objectives and invited to participate in the project by a letter of explanation. An initial training and calibration exercise was conducted to provide practical experience in the study methodology and the coding system for the dental examiner prior to the main survey. All children enrolled at the preschool were given a parent introduction letter with an attached consent form. Visit to the school was made on predecided dates and all the students present on the day were examined. Children with the consent to participate in the survey were examined within their school, usually in the school corridor. Oral examinations were conducted using a disposable illuminated mouth mirror (Denlite, Welch Allyn Ltd, Navan, Co Meath, Ireland) and a blunt ball-ended probe (Diagnostic Probe, Hu-Freidy Dental, Chicago, Illinois, USA) with an end diameter of 0.5mm. All teeth were examined in a systematic manner using international FDI two-digit nomenclature to identify each primary tooth and standard dental terminology to identify each surface. An average number of 50 school children were examined per day.
A survey form was prepared and the children were examined according to the Dentition status and Treatment Needs WHO oral health assessment 1987 (4). All the examinations were carried out by the investigator, in the subjects own surroundings i.e. the school. A recording clerk (Trained Dental Surgeon) was involved to enter the codes on the survey form. The present and past health status of each tooth was recorded in terms of the presence or absence of disease or a dental restoration. Only definite cavitations of the tooth surface were recorded as dental caries to reduce examiner confusion regarding diagnosis and exclusion of intact demineralized (white spot) lesions.
The instruments were kept in Dettol solution, for disinfections and sterilization. Dettol was diluted by adding potable water in the ratio of 1:9 dilutions. The school children were allowed to sit on a chair or stool, where sufficient natural daylight was available. The children were asked to rinse mouth thoroughly before examination, then the teeth were dried with cotton swab and the dental caries were recorded. Immediate care was given and referral was made as and when required. All the children were referred to Department of Pedodontics and Preventive Dentistry, R. M. D. C & H, Chidambaram. Survey findings were reported to respective school authorities on the spot.
Children belonging to 5-8 years were classified under group I, 9-11 years under group II and 12 â€“ 15 years under group III. The statistical software SPSS PC (statistical package for social science, version 4.01) was used for statistical analysis.
Epidemiological survey was conducted for 2362 school children; belong to the age group of 5 -15 years. Out of the study population 544(23%) belong to the age group I, 764(32%) belong to age group II and 1054 (45%) belong to the age group III (Table/Fig 1).
196(68.05%) males and 160 (62.5%) females belong to age group I showed prevalence of dental caries. 280(69.4%) males and 214 (63.7%) females belong to age group II showed prevalence of dental caries. 330(61%) males and 304 (59.4%) females belong to age group III showed prevalence of dental caries. in total, dental caries were observed in 1484(63.83%) of study population.
(Table/Fig 2): Comparison of proportion of affected cases among males and females
Caries experience according to socio economic status in group I, the low socio-economic showed high percentage of caries experience males (81.2%) and females (77%). In group II, the low socio-economic showed high percentage of caries experience males (71.3%) and females (77.8%). In group III, the low socio-economic showed high percentage of caries experience males (82.7%) and females (92.3%).In all 80.4%of the student belongs low socio-economic group has showed dental caries.
(Table/Fig 3): Caries experience according the socio-economic status
This table shows that in all groups the decayed teeth accounted for the greatest percentage of the total decay, missed and filled teeth. The mean (+SD) value of dmft/DMFT for group I males were 1.91Â±2.75 and females 3.36Â±3.25, group II males were 2.57Â±3.12 and females 2.52Â±2.95, group III males were 1.67Â±1.99 and females 1.95Â±1.99.
(Table/Fig 4): Distribution on dmft/dmft component according to age and sex
(Table/Fig 5): The mean Â± (sd) of dmft/dmft component according to age and sex
A total of 62.83% children required treatment, out of all groups, groups I 68% males required treatment. Among the different types of treatment required, there was no big difference between boys and girls. More cases required restoration followed by pulp care, Extraction, fissure sealant and preventive.
(Table/Fig 6): Treatment needs according to the age and sex
Untreated oral diseases in children frequently lead to serious general health, significant pain, and interference with eating and lost school time. One of the factors to be considered when planning for the required growth in dental care facilities is the prevalence of dental diseases and their treatment need in the population. A World Health Organization (WHO) estimation of global DMFT for 12 year-old children reported that in the 188 countries included in their database, that on a global basis, 200,335,280 teeth were decayed, filled or missing among just that age group. This was based on the data available in 2004 from the WHO Oral Health Database, Country/Area Profile Program (CAPP)(5). This is why WHO continues to advocate that efforts to improve the overall situation are still highly indicated (Table 2) (6),(7).
The 12-13 year age group were chosen for the study as it is the global monitoring age for dental caries, for international comparisons and monitoring of disease trends.(Aggeryd 1983) (8). It was observed that the caries prevalence of group III age group was lower as compared to the group II and I. This show as age advances, the prevalence of dental caries decreases. This finding corresponds with the study conducted by Misra F.M (1979) (9) among 6-16 year old children in urban area of South Orissa. He observed an increase in caries level between 5 to 12 year (56% to 81%) and a decrease in caries level in 13-15year (41.4%).Similarly in the study conducted by Peterson P.E,et al (1991) (10), Retna Kumari N (1999) (11), Dash J.K (2002) (12), Saravanan S,.et al (2003) (13), Mahesh Kumar P(2005) (14). The increased prevalence of caries in boys compared to girls confirms the view that there is a marked preference for sons regardless of the socio-economic class, which manifests itself in the longer feeding of sons compared to daughters Jain M (2001) (15). A cross sectional study19 with 3,048 children aged 6-12 years in Mexico was reported in 2006. Mean age was determined to be 8.81 years with a primary dentition caries prevalence of 90.2%. In the permanent dentition, Caries prevalence was reported to be 82%. The majority of the children (81.1%) needed restorations of at least two toothsurfaces. Caries incidence increased with age (16).
The prevalence of dental caries was high in the low socio-economic status because of their poor oral hygiene practice, lack of awareness, improper food intake and family status. This finding is similar to the study conducted by Sogi G and Baskar D.J (2001) (17). Recent studies from Europe 4, 522 demonstrate a significant inverse association between social class and oral health status in young children. The north Brisbane study supports these findings by confirming that preschool children from a lower socio-economic background also more active decay and more missing teeth from previous disease compared with children from higher SES levels.In the present study, the decay teeth accounted for the greatest percentage 92%of the dmft/DMFT component, finding is similar to the studies of Olojugba O.O, et al (1987) (18) and Prodrigues J.S.L & Damle S.G(1998) (19).
On assessment of treatment needs, among the III groups, group I aged 5-8yrs old were high treatment needed, similar to the study done by Dhar V., Jain A.,Van Dyke T.E., Kohli A(2007) (20) and Dhar V, Bhatnagar M (2009) (21). The highest need I all III groups were of restoration followed by pulp care. Between the two sexes, boys showed a decline in treatment needs .This could suggest that boys were getting a preference for receiving dental treatment compared to girls. Rao A, Sequeira SP, Peter S (1999) (22)
The result of this study is a pointer to the fact that there still exist a large segment of the population who continue to remain ignorant about the detriment effects of poor oral health and the multiple benefits enjoyed from good oral health. One of the oral health goals advocated by WHO for 2000 AD (23) was that 50% of 5-6 year olds should be free from dental caries. In the present study it was observed that 57.2% of children in 6 year age group were affected by dental caries indicating a high prevalence of the disease in children.
P.S: The above studies are an accumulation of dental caries studies over a period of 20 years (from 1990-2010) and involving the age group 5-17 years.
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