|Year : 2012 | Volume
| Issue : 5 | Page : 579-584
|Dental caries prevalence and treatment needs among 12- and 15- Year old schoolchildren in Shimla city, Himachal Pradesh, India
Fotedar Shailee1, GM Sogi2, KR Sharma1, Pruthi Nidhi3
1 Department of Public Health Dentistry, HP Government Dental College, Shimla, Himachal Pradesh, India
2 Department of Public Health Dentistry, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India
3 Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
Click here for correspondence address and email
|Date of Submission||18-Jul-2011|
|Date of Decision||20-Dec-2011|
|Date of Acceptance||05-May-2012|
|Date of Web Publication||19-Feb-2013|
| Abstract|| |
Context: Dental caries is one of the commonest oral diseases in children. Despite this fact, not many studies have been done on this issue among school children in Shimla.
Aim: To assess the prevalence of dental caries and treatment needs among schoolchildren aged 12 years and 15 years in Shimla city, Himachal Pradesh, India. With this study we also aimed to establish reliable baseline data.
Design: Cross-sectional study.
Materials and Materials: This study was conducted among 12 - and 15 - year old schoolchildren in Shimla city, Himachal Pradesh-India. A sample of 1011 schoolchildren was selected by a two-stage cluster sampling method. Clinical recording of dental caries, was done according to WHO diagnostic criteria (1997).
Statistical Analysis: The statistical tests used were the t- test, and the Chi-square test.
Results: The prevalence of dental caries was 32.6% and 42.2% at 12 years and 15 years respectively. At 12 years of age, the mean Decayed Missing Filled Teeth was 0.62 ± 1.42 and it was 1.06 ± 2.93 at 15 years of age. Females had higher level of caries than males at both the ages. Dental caries was higher in children from government schools as compared to those from private schools. The 'decayed' component was the biggest contributor to the DMFT index. The highest treatment need at both ages was one surface restoration.
Conclusion: The caries experience of 12- and 15- year-old children was low compared to WHO - 'recommended' values. Effective oral health promotion strategies need to be implemented to further improve the dental health of school children in Shimla city.
Keywords: Dental caries, prevalence, schoolchildren, treatment needs
|How to cite this article:|
Shailee F, Sogi G M, Sharma K R, Nidhi P. Dental caries prevalence and treatment needs among 12- and 15- Year old schoolchildren in Shimla city, Himachal Pradesh, India. Indian J Dent Res 2012;23:579-84
Dental caries is the most prevalent dental affliction in humans.  Despite creditable scientific advances and the fact that caries is preventable, the disease continues to be a major public health problem predominantly affecting children.  Dental caries is often responsible for the absenteeism from school and loss of working hours. The lack of availability of dental care, postponement of treatment due to cost considerations, and under utilization of available facilities not only results in aggravation of the disease but also enhances the cost of treatment and care.Worldwide schools offer an efficient and effective way to reach children and, through them, families and community members. School age is an influential stage in people's lives, a time when lifelong sustainable oral health - related behaviors, as well as beliefs and attitudes, are being developed.  Children are particularly receptive to health messages during this period and the earlier the good habits are established, the longer lasting the impact. Moreover, the messages can be reinforced regularly throughout the school years.  Further, the social and economic factors for Dental Caries can be represented by the type of school .e. government and private schools.
|How to cite this URL:|
Shailee F, Sogi G M, Sharma K R, Nidhi P. Dental caries prevalence and treatment needs among 12- and 15- Year old schoolchildren in Shimla city, Himachal Pradesh, India. Indian J Dent Res [serial online] 2012 [cited 2019 Oct 15];23:579-84. Available from: http://www.ijdr.in/text.asp?2012/23/5/579/107330
The National Oral Health Survey and Fluoride mapping - 2003  reported that 72.5% of 12 year old children and 75.4% of 15 year old children had dental caries. As it is the most common dental disease with high prevalence among children, it is important to control the disease process by rendering required treatment and by increasing awareness regarding its preventive measures. Knowledge of dental health and treatment needs of school children is important for developing appropriate preventive approaches, anticipating utilization patterns, and planning effectively for organization and financing of dental resources.
As there have been no earlier studies on the prevalence of dental caries and treatment needs of schoolchildren in Shimla city,- this study was conducted with the following objectives:
- To assess the prevalence and severity of dental caries and the treatment needs of schoolchildren aged 12 years and 15 years in Shimla city.
- To compare the dental caries levels and treatment needs in government schools with that in and private schools.
- To establish reliable baseline data for development of national/regional oral health programs.
| Materials and Methods|| |
A cross-sectional epidemiologic study was conducted among schoolgoing children aged 12 years and 15 years in Shimla city. Ethical approval to conduct the study was obtained from the Institutional Review Board of H.P. Government Dental College and Hospital, Shimla. Written consent for the participation of the children in the study was obtained from the Principals of the concerned schools.
A two-stage cluster sampling technique was used for obtaining the required sample for the study. For the purpose of the study, Shimla city was arbitrarily divided into four geographical zones, which corresponded to the four administrative areas of the city: Shimla municipal and three Shimla Planning Areas (Dhalli, Tutu and New Shimla). Schools from each region were randomly selected to obtain the desired sample size.We ensured that there was equal representation from each of the four zones.
Under the municipal corporation of Shimla, there were 43 schools (12 Senior Secondary, 24 Secondary, and 7 Middle), where the children in age- group of 12 and 15 were available. Among the 43 schools there were 26 government and 17 private schools as per the data available from the Director of Education, Himachal Pradesh in December, 2008. The total number of school children schoolchildren in the age groups of 12 years and 15 years was 6870.
A pilot study was conducted by randomly selecting one government and one private school from the list of available schools. The results from this pilot were used to calculate the sample size (n = 985) for the main study.
For obtaining this sample size, seven government and five private schools were selected randomly with proportionate representation from each category of schools, i.e., government and private schools. A total of 1011 students from these schools were examined over a period of 3 months April -June 2009.
The inclusion criteria
The exclusion criteria
- Schoolchildren (male and female) who had completed 12 and 15 years of age
- Children present on the day of examination
Children who refused to participate were excluded. Data collection was carried out by one of the authors (SF) trained for clinical examination during several educational and clinical sessions in the Department of Public Health Dentistry, Government Dental College, Shimla. The author was assisted by an alert and co-operative recording assistant. General information about the subject and the data reagarding oral hygiene practices were obtained through interview and recorded on a modified WHO proforma  . With regard to oral hygiene practices, we collected information on type of the oral hygiene aid used (i.e. tooth- brush, finger, twig of a tree and any other aid); oral hygiene material used (tooth- paste, tooth powder, charcoal, salt or any other material); and frequency of cleaning teeth (once daily, twice daily or not even once).
The subjects were examined by type III  clinical examination in their respective schools while seated on a comfortable chair. The diagnostic criteria and treatment codes were in accordance with those recommended by WHO  . The Kappa static for intra-examiner reproducibility of caries diagnosis determined using Kappa statistic was 0.85.
A referral was forwarded to the parents of the children in need of dental care. At the conclusion of the survey, an oral health education session was conducted and correct way of brushing the teeth was demonstrated in each classroom.
The data collected was analyzed using Statistical Package for Social Sciences for Windows®, version 13 (SPSS Inc., Chicago, IL). The statistical tests used were the t- test for continuous variables and the Chi-square test for categorical data. A level of P ≤ .05 was considered statistically significant and P ≤ 0.001 was taken as highly significant.
| Results|| |
The distribution of students according to type of school and gender are given in [Table 1].
[Table 2] shows the distribution of subjects according to oral hygiene practices. All children (100%) in private schools used toothbrush and tooth paste whereas in government schools 95.4% used tooth brush and 93.6% used tooth paste. This difference was statistically significant, P < 0.001. The frequency of brushing twice a day was significantly higher in private schools as compared to government schools [Table 3].
|Table 2: Distribution of subjects according to age, sex and oral hygiene practices|
Click here to view
|Table 3: Distribution of subjects according to oral hygiene practices and school category|
Click here to view
The prevalence of dental caries at 12 years was 32.6% and at the age of 15 years it was 42.2% [Table 4]. At the age of 12 years, the mean decayed missing filled teeth was 0.62 ± 1.42 while at the age of 15 yrs it was 1.06 ± 2.93; this difference between the two age groups was statistically significant(P ≤ 0.001). In both the age groups, females showed higher mean DMFT as compared to males. The difference was statistically significant at 12 years [Table 5]. Subjects brushing their teeth once a day had higher mean DMFT as compared to those brushing twice a day; this difference was statistically significant at 12 years [Table 5]. The mean DMFT was higher in private schools as compared to government schools [Table 5]. At 12 years of age children eating vegetarian diet had significantly higher mean number of decayed teeth than children on mixed diet [Table 5].
|Table 5: Mean caries experience (DMFT) in relation to age, gender, schools, brushing frequency and Diet|
Click here to view
The largest contribution to the DMFT index was by the decayed component with 90.5% at 12 years and 84.1 % at 15 years. The mean of decayed teeth, filled teeth and missing teeth due to caries was significantly higher at 15 years as compared to 12 years. Females had higher number of mean decayed teeth (0.65) than males (0.44), and this difference was statistically significant. At both the ages, mean of decayed teeth was significantly higher in government schools as compared to private schools. Children in government schools had less number of mean filled teeth at both ages as compared to children from private schools; this difference was also statistically significant [Table 6].
At the age of 12 years, 50.1% of children required restorative and exodontic treatment and at the age of 15 years 50.6% of children required such treatment [Table 7]. The greatest need was for single surface restorations (2.3% in 12 yrs and 2.2% in 15 yrs.
| Discussion|| |
This cross-sectional study was carried out to assess the prevalence of dental caries and the treatment needs among schoolchildren in Shimla city, Himachal Pradesh,-India. Children of 12 and 15 years were chosen for this study, as these are global monitoring ages for dental caries for international comparisons and monitoring of disease trends. In the present study the sample we included schoolchildren from from both public and private schools in order to have children from all the social, economic and cultural backgrounds.
In both the age groups around 97% of population used tooth brush and tooth paste for cleaning their teeth. This clearly indicates their awareness about oral hygiene. At the age of 12 years, most of the children (64%) brushed once a day which is similar with the findings of Joshi et al. , but high as compared to findings of Harikaran et al. and Peng,  and low as compared to Peterson et al.  . The habit of brushing twice a day was more common in private schools as compared to government schools which was also reported by Mahesh Kumar et al,  Tanni et al . and Peterson et al . In the present study, as the frequency of brushing increased, the prevalence of dental caries decreased. This finding is consistent with the findings of Christina SB et al,  Wei S et al. and Sethi B et al.
In the present study, we observed that the prevalence of dental caries was higher at the age of 15 years (42.2%) than at 12 years (32.6%); this was also reported by Rodrigues, and Damle  , Singh et al . Psoter et al . Naidu et al.,  Goyal et al,  and Mustafa et al. The reason for the higher prevalence of dental caries at 15 years as compared to 12 years is that caries being a continuous and cumulative process had obviously increased over a span of 3 years; moreover, the number of teeth is more at the age of 15 years.
In the present study, the mean DMFT at 12 years and at 15 years was 0.62 and 1.06, respectively; similar values were also reported by Naidu et al. , Peterson  and Bajoma and Rudolph.  However, our values are low compared to DMFT of 2.4 reported by National Oral Health Survey in H.  Females had significantly higher mean DMFT value than males. This is in line with the findings of Al Shammery et al.,  Salapatal et al.,  Obry Musset et al.,  Dummer et al.,  Sogi and Basker.,  Singh et al.,  Mishra and Shee,  Saimbi et al.,  This finding may be due to the fact that teeth erupt earlier in females than males which means females teeth would have been exposed to oral environment for a longer period than the male of the same age.
In both the age groups there was statistically significant difference in mean decayed, filled, and missing teeth between the government and the private schools. The level of caries was higher in children attending government schools which is in line with the findings of Almedia et al.,  but in contrast to the results reported by Tanni,  Ojofeitimi et al.,.  The higher DMFT in government schools may be due to lack of availability of dental care, postponement of treatment because of cost considerations, under utilization of available facilities and lack ofawareness regarding the importance of timely dental care. Further studies are needed to assess the various barriers for utilization of services.
The mean number of filled teeth and missing teeth due to other reasons were high in private schools, which may be due to positive attitude and better dental awareness, of the parents of children in private schools which is reflected in the child's oral health maintenance. The mean number of missing teeth due to other reasons was higher in private schools probably due to orthodontic interventions in these children.("unpublished observations" with written permission from the source). 
In the present study, children having mixed diets had significantly lower mean decayed teeth than children having vegetarian diets. This has also been reported by Chandra and Chawla,  Sarvanan et al.,  and Khan et al.,.  It is suggested that persons who consume a mixed diet (protein rich food), will develop less amount of acid in their mouth and thereby be relatively protected from dental caries. This may be because proteins tend to putrify rather than ferment like carbohydrates, promoting alkalinity instead of acidity, and so no decalcification is usually observed. 
At the age of 12 years, treatment need was observed for 50.1% children, which is higher than 44.7% as reported by Abid.  At the age of 15 years, treatment need was seen for 50.6% of children.On examining the treatment needs for dental diseases among children of 12 years and 15 years, we found the greatest need was for one surface restoration followed by two-surface restorations, pulp restoration, extractions and others. This is similar to the findings of Wright et al.,  Rodrigues and Dhamle,  Kulkarniand Deshpande,  Dash JK. 
| Conclusion|| |
The mean DMFT in 12 - and 15- year-old children in Shimla city, as revealed by the study falls within the 'very low' category as per the WHO classification. To further improve the oral health of children in Shimla, we recommend the following:.
- Oral health promotion through well-structured oral health education program can create positive change in awareness for special groups like schoolchildren. Reinforcement of knowledge is necessary and this can be done by incorporating chapters on oral health and oral hygiene in school textbooks. Also, the teacher's training programs can ensure continuity of reinforcement.
- Implementation of school dental health programs, focusing on preventive programs like fluoride mouth rinse and tooth brushing programs.
- Preventive services should be given high priority and needs to be started at an early age to target the primary dentition and future caries in permanent dentition.
- Regular interval screening programs to assess the oral health and treatment needs of schoolchildren with treatment as per the need.
| References|| |
|1.||Fejerskov O, Kidd E, Edwina AM. Dental caries: The disease and its clinical management. 2 nd ed. Wiley-Blackwell; 2008. |
|2.||US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General-- Executive Summary. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000. |
|3.||World Health Organization. The Status of School Health. Report of the School health Working Group and the WHO Expert Committee on Comprehensive School Health Education and Promotion.1 Geneva: WHO; 1996. |
|4.||Petersen PE, Tores AM. Preventive oral health care and health promotion provided for children and adolescents by the Municipal Dental Health Service in Denmark. Int J Paediatr Dent 1999;9:81-91. |
|5.||National Oral Health Survey and Fluoride mapping 2002-2003. India: DCI Publication. |
|6.||World Health Organization. Oral Health Surveys. Basic Methods. 4 th ed. Geneva, 1997. |
|7.||Dunning JM. Principles of Dental Public Health. 4 th ed. Harward University Press:1986;132-133. |
|8.||Joshi N, Rajesh R. Prevalence of dental caries among schoolchildren in Kulasekharam village: A correlated prevalence survey. J Indian Soc Pedod Prev Dent 2005;23:138-40. |
|9.||Harikiran AG, Pallavi SK, Hariprakash S, Ashutosh, Nage KS. Oral health-related KAP among 11- to 12-year-old schoolchildren in a government-aided missionary school of Bangalore city. J Dent Res 2008;19:236-42. |
|10.||Peng B, Petersen PE, Fan MW, Tai BJ. Oral health status and oral health behaviour of 12-year-old urban schoolchildren in the People's Republic of China. Community Dent Health 1997;14:238-4. |
|11.||Petersen PE, Hoerup N, Poomviset N, Prommajan J, Watanapa A. Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand. Int Dent J 2001;51:95-102. |
|12.||Mahesh Kumar P, Joseph T, Varma RB, Jayanthi M. Oral health status of 5 years and 12 years school going children in Chennai city: An epidemiological study. J Indian Soc Pedod Prev Dent 2005;23: 17-22. |
|13.||Tanni DQ. Caries prevalence and periodontal treatment needs in public and private school pupils in Jordan. Int Dent J 1997;47:100-4. |
|14.||Petersen PE, Wierzbicka M, Szatko F, Dybizbanska E, Kalo I. Changing oral health status and oral health behaviour of schoolchildren in Poland. Community Dent Health 2002;19:243-50. |
|15.||Christina SB, Anna KH. Dental caries in Swedish 4 year old children. Swed Dent J 1989;13:39-44. |
|16.||Wei S, Holm AK. Dental caries and related factors in children in Hong Kong. Pediatr Dent 1993;15:116-19. |
|17.||Sethi B, Tandon S. Caries pattern in preschoolchildren . J Indian Dent Assoc 1996;67 :141-45. |
|18.||Rodrigues JS, Damle SG. Prevalence of dental caries and treatment need in 12-15 year old municipal schoolchildren school children of Mumbai. Indian Soc Pedod Prev Dent 1998;16:31-6. |
|19.||Singh AA, Singh B, Kharbanda OP, Shukla DK, Goswami K, Gupta S. A study of dental caries in schoolchildren from Rural Haryana. J Indian Soc Pedod Prev Dent 1999;17:24-8. |
|20.||Psoter WJ, Saint Jean HL, Morse DE, Prophte SE, Joseph JR, Katz RV .Dental caries in twelve- and fifteen-year-olds: results from the basic oral health survey in Haiti. J Public Health Dent 2005;65:209-14. |
|21.||Naidu R, Prevatt I, Simeon D. The oral health and treatment needs of schoolchildren in Trinidad and Tobago: findings of a national survey. Int J Paediatr Dent 2006;16:412-18. |
|22.||Goyal A, Gauba K, Chawla HS, Kaur M, Kapur A. Epidemiology of dental caries in Chandigarh schoolchildren and trends over the last 25 years. J Indian Soc Pedod Prev Dent 2007;25:115-18. |
|23.||Nurelhuda NM, Trovik TA, Ali RW and Ahmed MA. Oral health status of 12-year-old schoolchildren in Khartoum state, the Sudan; a school-based survey. BMC Oral Health 2009 15;9:15-23. |
|24.||Petersen PE, Kaka M. Oral health status of children and adults in the Republic of Niger, Africa. Int Dent J 1999;49:159-64. |
|25.||Bajoma AS, Rudolph MJ. Dental caries in 6, 12 and 15 year old venda children in South. East Afr Med J 2004;81:236-43. |
|26.||Shammery A, Guile EF. Prevalence of caries in primary schoolchildren in Saudi Arabia. Community Dent Oral Epidemiol 1990;18:320-21. |
|27.||Salapatta J, Blinkhorn AS, Attwood T. Dental health of 12 year old children in Athens. Community Dent Oral Epidemiol 1990;18:80-1. |
|28.||Obry-Musset AM, Cahen PM. Dental caries and oral hygiene in 12 year old children in Martinique. Community Dent Oral Epidemiol 1991;21:54-5. |
|29.||Dummer MH, Addy M, Hicks R, Kingdom A. The effect of social class on the prevalence of caries, plaque, gingivitis and pocketing in 11-12 year old children in South Wales. J Dent 1987;15:185-90. |
|30.||Sogi G, Bhaskar DJ. Dental caries and oral hygiene status of 13-14 year old schoolchildren of Davangere. J Indian Soc Pedod Prev Dent 2001;19:113-17. |
|31.||Mishra FM, Shee BK. Prevalence of Dental Caries in school going tribal children in Ganjam District, Orissa. J Indian Dent Assoc 1982;54:375-77. |
|32.||Saimbi CS, Mehrotra AK, Mehrotra KK, Kharbanda OP. Incidence of Dental caries in individual teeth. J Indian Dent Assoc 1993;55:23-6. |
|33.||Almeida CM, Petersen PE, André SJ, Toscano. A Changing oral health status of 6- and 12-year-old schoolchildren in Portugal. Community Dent Health 2003; 20:211-6. |
|34.||Ojofeitimi EO, Hollist NO, Banjo T, Adu Ta . Effect of cariogenic food exposure on prevalence of dental caries among fee and non fee paying Nigerian school children. Community Dent Oral Epidemiol 1984;12:274-77. |
|35.||Pruthi N. Prevalence of Malocclusion among 12 & 15 years old schoolchildren in Shimla city. MDS Thesis. Himachal. Pradesh University;2010 |
|36.||Chandra S, Chawla TN. Incidence of dental caries in Lucknow school going children. J Ind Dent Assoc 1979;51:109-10. |
|37.||Saravanan S, Anuradha KP, Bhaskar DJ. Prevalence of dental caries and treatment needs among school going children of Pondicherry, India. J Indian Soc Pedod Prev Dent 2003;21:1-12. |
|38.||Khan AA, Jain SK, Shrivastav A. Prevalence of Dental Caries among the Population of Gwalior (India) in Relation of Different Associated Factors. Euro Dent 2008;2:81-5. |
|39.||Abid A. Oral health in Tunisia. Int Dent J 2004;54 (6 Suppl 1):389-94. |
|40.||Wright FAC, Deng H, Shi ST. The dental health status of 6 and 12 year old Beijing schoolchildren in 1987. Community Dent Health 1989;6:121-30. |
|41.||Kulkarni SS, Deshpande SD. Caries prevalence and treatment needs in 11-15 year old children of Belgaum city. J Indian Soc Pedod Prev Dent 2002;20:12-5. |
|42.||Dash JK, Sahoo PK, Bhuyan SK, Sahoo SK. Prevalence of dental caries and treatment needs among children of Cuttack (Orissa). J Indian Soc Pedod Prev Dent 2002;20:139-43. |
Department of Public Health Dentistry, HP Government Dental College, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
|This article has been cited by|
||dental caries status among children aged 12-14 years in urban and rural areas of lasbella district, balochistan
| ||khail, a.a.k. and baloch, h.n. and hammad, j. and kurd, s.a. and baloch, m.u.r. |
| ||medical forum monthly. 2013; 24(7): 103-106 |
| Article Access Statistics|
| Viewed||6453 |
| Printed||105 |
| Emailed||4 |
| PDF Downloaded||427 |
| Comments ||[Add] |
| Cited by others ||1 |