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Caries experience in the permanentdentition of 12 year old schoolchildren

of Bhimavaram town, IndiaMohammad Shahul Hameed,* Santosh Kumar, Suresh S , MohammadShafiulla, Jyothi Tadakamadla,||*Assistant Professor, Department of Maxillofacial Surgery & Diagnostic Sciences, King Khalid University,

Abha, KSA. Senior lecturer, Professor & Head, Department of Public Health Dentistry. ||Senior lecturer,

Department of Oral Medicine & Radiology, Vishnu Dental College, Bhimavaram, India.

Senior lecturer,Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, India.

Abstract

Aims: To assess the dental caries experience of 12 year old schoolchildren of Bhimavaram town and to evaluate its relation to gender,occupation of father and tooth brushing habits. Methods: The studypopulation for the present cross-sectional study comprised of 574school children of 12 years age attending the schools in Bhimavaramtown, Andhra Pradesh, India. Each subject was assessed for cariesusing decayed, missing and filled teeth index (DMFT). In addition,each subject was interviewed for socio-demographic data (age, gender,occupation of father) and oral hygiene behavior (method of cleaningteeth and frequency of cleaning teeth). Results: The overall cariesprevalence in the study population accounted to 76.5% and there was a

significant difference between the genders for caries experience. Themean DMFT of 2.39 in boys was significantly greater than 2.14 amongthe girls. Similarly, decayed and filled components of DMFT weresignificantly greater in males than girls. Though there was a gradualincrease in the caries experience as the level of occupationdeteriorated, the increase was insignificant. Subjects using tooth brushand tooth paste and those cleaning twice or more per day experiencedlesser caries than their counterparts, however this was insignificant.Conclusions: Boys had greater caries experience than girls.Occupation of the father, oral hygiene method and frequency of toothcleaning failed to influence dental caries experience.Key words: Caries; DMFT; School children; Tooth brushing.

*Author for correspondence: Dr Santosh Kumar Tadakamadla, Department ofPublic Health Dentistry, Vishnu Dental College, Bhimavaram, India. 534202.Tel: +91-9701925025E-mail: [email protected]

Original Article


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Caries in school children

125Journal of Oral Health Research, Volume 1, Issue 3, September 2010

IntroductionOral diseases such as dental caries,

periodontal disease, tooth loss, oral mucosallesions, oropharyngeal cancers, human

immunodeficiency virus/acquiredimmunodeficiency syndrome (HIV/AIDS) related oral disease and orodental trauma aremajor public health problems worldwide.

Among these, dental caries is still a majorhealth problem in most countries as it affects60-90% of school-age children and a vastmajority of adults. (1)

Furthermore, the prevalence of dentalcaries has been found to be high in many ofthe industrialized countries while low carieslevels have been observed in developing

countries (2). However, the last three decadeshas seen massive improvements in childdental health in most industrialized countries(3). The reasons for this development arecomplex but may be ascribed to a moresensible approach to sugar consumption,improved oral hygiene practices, fluorides intoothpaste, topical fluoride application, andfluoride rinsing (4). Thus, it has beensuggested that dental caries tend to be lessprevalent in societies with traditional diets

and low sugar consumption (5).It is well documented that dentalcaries is a multifactorial disease; in addition tooral hygiene practices and diet, it has beenconcluded from a systematic review that thereexists an inverse relationship between socioeconomic status and the prevalence of cariesamong children less than twelve years of age(6). While there have been contradictoryreports regarding the influence of oral hygienebehavior on dental caries status, it has beenestablished from a systematic review that a

weak evidence that tooth-brushing preventsdental caries (6).

The age group of 12 years oldhas always been considered as a globalmonitoring age for dental caries, as it isgenerally the age at which children leaveprimary school, and thus in most countries, is

the last age at which a reliable sample may beobtained easily through the school system (7).

In Asia, the prevalence ofdental caries in children is reported to be lowto moderate (8). Furthermore, the prevalenceof dental caries in India has been found to be53.8%, which is considered to be low (9).However, there is no data available on dentalcaries status of 12 year old children from thepresent study region which would aid inplanning oral health services. Hence, thisstudy intended to assess the dental cariesexperience of 12 year old school children ofBhimavaram town and to evaluate its relationto gender, occupation of father and toothbrushing habits.

Material and methodsThe target population of the present

cross-sectional study was children in the ageof 12 years attending the schools inBhimavaram town, Andhra Pradesh, India. Arepresentative sample of 574 school children

was extracted from the target population bystratified random sampling procedure. Firstly,Bhimavaram town was stratified into fourgeographic regions and two schools were

randomly selected from each region. From theselected schools, all the 12 year old childrenwere included.

Students present during the days ofthe survey were considered for inclusion whilethose children whose parents did not give theconsent were excluded. Ethical approval wasobtained from the institutional ethicalcommittee.

Each subject was assessed for cariesusing decayed, missing and filled teeth index(DMFT) (10). The criterion for cariesassessment was according to the WorldHealth Organisation (WHO) Guidelines, 1997(7). Clinical examination for dental caries wasdone by a single examiner with mouth mirrorand community periodontal index (CPI) probeunder adequate illumination. The intra-examiner consistency for dental cares


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assessment was 89.6% calculated using kappastatistic.

In addition to clinical examination,each subject was interviewed for socio-demographic data (age, gender, occupation offather) and oral hygiene behavior (method ofcleaning teeth and frequency of cleaningteeth). Occupation status of the parents wasclassified according to the occupationcomponent of Kuppuswamy scale (11).Statistical analysis

Statistical Data collected was subjectedto statistical analysis using Statistical Packagefor Social Sciences (SPSS), version 17.0.Unpaired t test and one way analysis of

variance (ANOVA) were used for evaluatingthe significance of difference between the

means of two groups and more than twogroups respectively. A probability value of lessthan 0.05 was considered significant.

ResultsThe overall caries prevalence in the

study population accounted to 76.5%. It isevident from table 1 that there was asignificant difference between the genders forcaries experience. The mean DMFT of 2.39 inboys was significantly greater than 2.14 among

the girls. Similarly, decayed and filledcomponents of DMFT were significantlygreater in males than girls.

Table 1: DMFT and its components in thestudy population in relation to gender

Males(366)

Females(208)

Total(574)

Decayed* 2.342.28 2.101.84 2.262.13Missing 0.040.19 0.030.16 0.030.18Filled* 0.010.10 0.000.00 0.010.083DMFT* 2.392.34 2.141.88 2.302.19Unpaired t test, *p


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could be attributed to the reason that thepresent study population is representative ofthe children of Bhimavaram town while thenational survey consisted of childrenrepresentative of the whole nation. The otherprobable reason might be due to the reductionin dental caries occurrence since 2002.

Boys had significantly greater cariesexperience than girls. A well-documentedfinding is that females take preventive oralhealth actions more often, and consumesugary products less often than their malecounterparts (12, 13) which might be a reasonfor boys exhibiting greater caries experiencethan girls.

Past studies have reported that inaddition to gender, various social influences

appear to be important predictors for dentalcaries. Past literature provides substantialevidence for the poorer oral health of lower-socioeconomic status (SES) groups compared

with their higher SES counterparts (14-16).In the present study, we tried to assess

the influence of SES on dental caries but havetaken only fathers occupation intoconsideration as the other components of SESlike education and annual income could notbe retrieved either from the school records or

by the subject interviews. Furthermore, theoccupation of the mother was not taken intoconsideration as all of them were housewives.It was observed that there was a gradualincrease in the caries experience as the level ofoccupation deteriorated but the increase wasinsignificant. Occupation merely is a measureof prestige, responsibility, physical activityand work exposures (17). A study concludedthat higher education may be the best SESpredictor for good health than income andoccupation (17). This could be a probablereason why dental caries was not related tooccupation of the father. However, this is incontrast to previous studies, where parentaloccupation significantly influenced dentalcaries levels (18, 19).

In agreement with some earlier studies(8, 20-22), oral hygiene methods andfrequency of cleaning were not found to be

significantly related to caries occurrence inthis study. This is in contrast to a previousstudy (23) where frequency of tooth brushing

was observed to affect caries prevalence.The reason for dental caries being

uninfluenced by tooth cleaning frequencymight be due to the reason that it is thequality of tooth brushing which is moreimportant than the frequency. Santos et al.,(24) observed that oral hygiene frequency wasnot associated to oral hygiene quality and theyhave recommended that further studiesconcerning the relation between theocurrence of dental caries and oral hygienehabits should consider not only the frequencyof toothbrushing but also the quality of toothcleanliness.

In conclusion, boys had greater cariesexperience than girls. Occupation of thefather, oral hygiene method and frequency oftooth cleaning failed to influence dental cariesexperience.

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