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Table of Contents   
ORIGINAL RESEARCH  
Year : 2018  |  Volume : 29  |  Issue : 3  |  Page : 323-328
Trends in dental caries in Indian children for the past 25 years


Department of Public Health Dentistry, Faculty of Dentistry, Jamia Millia Islamia University, New Delhi, India

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Date of Web Publication13-Jun-2018
 

   Abstract 

Background: The economic liberalization which was started 25 years back in India has led to a rising gross domestic product and per capita income and a decline in poverty. There has been an improvement in various health status indicators in the Indian population. As oral health is an integral part of general health, a retrospective study was designed to assess the effect of economic liberalization on dental caries experience in Indian children. Materials and Methods: A systematic literature search was conducted to find studies done on dental caries prevalence in children in India from the year 1992–2016. Mesh and free text terms “child,” “dental caries,” and “India” were searched in databases – PubMed and PubMed Central. A total of 1468 titles were screened, out of which 191 articles were shortlisted for further inspection. Finally, 69 studies were found suitable for final analysis. Results: The pooled caries prevalence was between 50.84% and 62.41% at 5-year interval. There was a decline in caries prevalence in 2–5 and 11–15 years of age group. The overall weighed mean of 2.4, 2.7, and 1.9 was observed in three different age groups. Significant caries index (SiC) of more than 3 was observed in all the age groups. Conclusion: The present review suggests that more than half of Indian children have been affected by dental caries. High SIC index score suggests a skewed distribution of caries among Indian children. This data may aid in planning further exploratory research and oral health care services for children by the stakeholders.

Keywords: Children, dental caries, DMF/dmf index, India, significant caries index

How to cite this article:
Mehta A. Trends in dental caries in Indian children for the past 25 years. Indian J Dent Res 2018;29:323-8

How to cite this URL:
Mehta A. Trends in dental caries in Indian children for the past 25 years. Indian J Dent Res [serial online] 2018 [cited 2019 Dec 5];29:323-8. Available from: http://www.ijdr.in/text.asp?2018/29/3/323/234361

   Introduction Top


As stated by the World Health Organization in their oral health report of 2003,[1] dental caries and periodontal diseases are pandemic diseases affecting all population irrespective of gender, age, or socioeconomic status. This situation is more alarming in developing countries due to lack of access to oral health care services and preventive measures like fluorides.

India is a developing mixed economy country of 1.3 billion. It initiated economic liberalization in late 1991, before that the growth rate of India was 3%–4%, but currently, it is one of the fastest growing and the 5th largest (in terms of the gross domestic product [GDP]) economies in the world.[2] The total expenditure on healthcare as a proportion of GDP in 2014 was 4.7%. India was declared Polio-free in 2014 and maternal and neonatal tetanus free in 2015.[3] It has a dentist population ratio of 1:10,271, but there is a disparity between urban and rural areas as urban centers attracting more dental workforce.[4] Last National Oral Health Survey conducted in 2002–2003 stated that DMFT index score for Indian children was around 2 and caries prevalence was increasing with age from 51.9% to 63.1% in 5–15 years of age group, respectively.[5]

Keeping these facts in mind, a retrospective study was planned with a rationale that as oral health is considered to be an integral part of general health, it is expected that there shall be an improvement in oral diseases morbidity indicators among the children who are born in the era economic liberalization in India. The main purpose of this study was to assess the trend in caries prevalence and mean decayed, missing, filled/Decayed, Missing, Filled (dmf/DMF) index score among Indian children for the past 25 years.


   Materials and Methods Top


Search strategy

An electronic literature search was conducted in PubMed and PubMed Central databases for the following Mesh and free text terms – “child,” “dental caries,” and “India.” The search period was from January 1, 1992 to December 31, 2016. Articles in English language only were included in this search. Terms searched by PubMed and PMC were-(“dental caries” [MeSH Terms]) OR (“dental” [All Fields] AND “caries” [All Fields]) OR “dental caries” [All Fields]) AND (“child” [MeSH Terms] OR “child” [All Fields] OR “children” [All Fields]) AND (“India” [MeSH Terms] OR “India” [All Fields]).

The initial search in databases found 3440 hits. After removal of duplicates, 1468 articles remained for initial screening, out of these 191 articles were selected for detail inspection. Based on the predecided inclusion criteria, 69 studies were found eligible for participation in this study [Flow Chart 1]. Full text of the included studies was retrieved by electronic and manual search from the library.



Inclusion criteria

Studies satisfying the following criteria were included in this review:

  • Studies done on children less than or equal to 15 years of age
  • Studies published between 1992 and 2016 in PubMed and PubMed central databases
  • Studies mentioned average DMF/dmf score with a measure of variance and/or caries prevalence in percentage.


Exclusion criteria

Studies which were done on children suffering from any systemic conditions such as asthma, leukemia, diabetes, obesity, and physical or mental disabilities were excluded from this review. Comparison or correlation studies, for example, studies done to find an association between diet or obesity or body mass index and dental caries experience or where the assessment of caries risk was done were excluded from this review. Studies done on children of Indian origin living outside India were not included in this review.

Data extraction

A template was prepared in Excel spreadsheet to extract the following data from the articles-year of the study/publication, age, study region, mean dmf/DMF value with standard deviation (SD), and total prevalence of dental caries. Following groups were prepared for further analysis: different age groups (2–5, 6–10 and 11–15 years), 5-year interval (1992–1996, 1997–2001, 2002–2006, 2007–2011 and 2012–2016) and different regions of India (North, East, West, and South). Those groups in which 2 or <2 articles were present and they were excluded from further analysis. “dmf” index was considered for analysis in 0–5 and 6–10 years group, whereas “DMF” was considered for 11– 15-year group. If articles have mentioned the year of a survey conducted, that was used; otherwise, year of publication was considered.

Statistical analysis

Average proportion, standard error (SE), confidence interval, weighted mean, and significant caries index (SiC) value were found for each group using the following formulas:[6]

  1. Average proportion = p1 × n1 + p2 × n2+------pn × nn/n1 + n2+---nn
  2. Weighted mean (W) = m1 × n1 + m2 × n2+----mn × nn/n1 + n2+---nn
  3. Combined SD = Sum of SD12 × n1 + SD22 × n2+----SDn2 × nn/n1 + n2+------nn
  4. SE calculation in case of mean DMFT/dmft = SD/Square root of n
  5. SE calculation in case of prevalence of dental caries = Square root of average proportion (1-average proportion)/total sample
  6. C. I = Weighted Mean ± (1.96 × S. E)
  7. SIC value = m1 × n1 + m2 × n2+-----mn × nn/n1 + n2+---nn (1/3rd of the population with a higher DMFT score in each group)[7]


Where P is proportion, m is mean, SD is the standard deviation, SE is standard error, and n is the total sample.


   Results Top


In total 69 studies were included in this review. When the number of studies was divided according to 5-year interval group, it was observed that there are 4, 15, 8, 18, and 24 studies in 1992–1996, 1997–2001, 2002–2006, 2007–2011, and 2012–2016 group, respectively [Table 1]. Average pooled caries prevalence was 56.7% with a range of 50.8%–62.4% [Table 2]. Caries prevalence was 48.9%, 69.1%, and 52.1% for 2–5, 6–10, and 11–15 year, of age group, respectively. There was a decline in caries prevalence in the youngest and eldest age group children [Graph 1] and [Graph 2], whereas middle age group (6–10 years) showed an upward trend [Graph 3].
Table 1: Total number of studies included-year wise

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Table 2: Trend in caries prevalence at 5 year interval

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Overall weighed mean caries experience was 2.3. [Table 3] describes the weight mean dmf/DMF score in different year groups along with SD, SE and confidence interval. Mean dmf/DMF in different age groups ranged from 1.9 to 2.7 as shown in [Table 4]. Region-wise distribution of dental caries shows more caries prevalence in the southern and western part of India as compared to the northern and eastern part of India. The weighed mean dmf/DMF was also higher for these two regions [Table 5]. SIC values are showing an overall decline from 3.8 to 2.7 over the past 25 years [Graph 4].
Table 3: Weighed mean Decayed, Missing, and Filled Teeth/decayed, missing, and filled teeth in 5-year interval group

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Table 4: Weighed mean Decayed, Missing, and Filled Teeth/decayed, missing, and filled teeth in different age group

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Table 5: Region wise distribution of caries in India

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   Discussion Top


Principal findings

This review shows that pooled prevalence of dental caries in Indian children is more than 50% and average dmf/DMF values are between 2 and 3 in all the age groups. These figures are quite similar to those reported by the World Health Organization,[1] Dental Council of India,[5] Moreira R [76] and Kundu et al.[6] for Indian children. Caries experience was found less in the northern and eastern part of India as compared to southern and western parts, this is contrary to findings by Kundu et al. where they found children of north India having higher caries experience as compared to other parts of the country. India despite being a developing country has less caries experience in comparison to other developing countries.[1],[77] High SiC values suggest a skewed distribution of dental caries in Indian children and are comparable to its neighboring countries but less than the developed world.[78]

In India, the magnitude and impact of oral diseases, especially caries and periodontal diseases are unknown. There is no nationwide comprehensive disease surveillance in place, and hence, recent epidemiological data are not available to make a strong case about the oral diseases burden. Moreover, there is no national oral health research agenda to coordinate and prioritize research according to national needs. Thus, the indicators commonly used to assess oral health status do not provide clear or easily understandable information about burden or severity.[79] A set of guidelines should be established in our country, especially regarding the way an oral health survey is to be carried out as a part of postgraduate dissertation or faculty research; this will help in maintaining uniformity and creating a national oral health data bank.

Strengths of the study

The biggest strengths of this study are first, higher of (69) studies were found eligible for final data analysis. This helps to increase the sample size and confidence level for further observations and comparisons. Second, studies which were published in PubMed and PubMed Central indexed journals were included in this review. These two databases provide reasonably good quality and comprehensive search of scientific articles related to the field of medicine and dentistry.

Unanswered questions

This review has described certain trends and values such as the decline of caries in certain age groups, region-wise variations in caries prevalence, but these observations are based on pooling of data from descriptive surveys; therefore, no particular reasons can be assigned for such trends. Further exploratory studies are required in this regard.


   Conclusions and Recommendations Top


The present review suggests one out of two children in India is affected by dental caries and there is an increase in caries burden in deciduous dentition. Signs of decline in caries should be treated with caution because the current oral health-care services are inadequate to sustain this gain and it does not mean that dental caries is not a public health problem in India. This study has shown that all the regions and age groups are affected by caries. Therefore, efforts should be directed to improve access to fluorides, dental sealants, and other established methods of caries control such as proper oral hygiene advice and dietary counseling for our future generations. Furthermore, a database of the international standard must be established in India for surveillance of dental caries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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Correspondence Address:
Dr. Abhishek Mehta
Faculty of Dentistry, Jamia Millia Islamia University, New Delhi - 110 025
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_615_17

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