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Table of Contents   
ORIGINAL RESEARCH  
Year : 2020  |  Volume : 31  |  Issue : 2  |  Page : 180-185
Caries experience, clinical consequences of untreated dental caries and associated factors among school going children - A cross-sectional study


1 Department of Public Health Dentistry, Karpaga Vinayaga Institute of Dental Sciences, Maduranthagam, Tamil Nadu, India
2 Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu, India
3 School of Population and Global Health, University of Western Australia, Perth, Australia
4 Department of Oral Medicine and Radiology, College of Dentistry, Mustaqbal University, Kingdom of Saudi Arabia

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Date of Submission07-Feb-2019
Date of Decision05-Aug-2019
Date of Acceptance28-Oct-2019
Date of Web Publication19-May-2020
 

   Abstract 


Objective: To assess the dental caries experience, clinical consequences of untreated dental caries, and associated factors among 6–13 years school going children in Tiruvallur taluk of Tiruvallur district, Tamil Nadu. Materials and Methods: The study population included a sample of 1,060 study subjects, aged 6–13 years from both government and private schools. The subjects were interviewed regarding oral hygiene practices, diet, dental visits, body mass index, income of the parents using a closed-ended questionnaire. Caries experience was assessed by recording the Pulpitis, Ulceration, Fistula, Abscess (DMFT)/dmft score and untreated carious lesion was assessed using Pulpitis, Ulceration, Fistula, Abscess (PUFA)/pufa index. Pearson's Chi-square test, independent sample t-test, Kendal tau correlation and binary logistic regression were performed to determine the relationship between DMFT, dmft, PUFA, pufa scores, and various independent factors. Result: Among the study subjects, the mean DMFT and dmft scores were 0.12 ± 0.45 and 0.79 ± 0.15, respectively. The mean PUFA and pufa scores were 0.02 ± 0.150 and 0.14 ± 0.55, respectively. Subjects who never visited the dentist and who belonged to underweight group had significantly 2.2 times and 2.3 times, respectively, increased chances for caries experience in deciduous dentition. Subjects who never visited the dentist and who belong to underweight group had significantly 1.8 times and 1.7 times respectively, increased chances for odontogenic infection in deciduous dentition. Conclusion: Dental caries experience and odontogenic infections were found to be higher in the primary dentition compared to permanent dentition. The habit of not visiting the dentist had increased the chances of developing dental caries and odontogenic infection in primary dentition.

Keywords: BMI and oral health behaviors, dental caries, socioeconomic status, untreated dental caries

How to cite this article:
Habib F, Chaly PE, Junaid M, Musthafa H M. Caries experience, clinical consequences of untreated dental caries and associated factors among school going children - A cross-sectional study. Indian J Dent Res 2020;31:180-5

How to cite this URL:
Habib F, Chaly PE, Junaid M, Musthafa H M. Caries experience, clinical consequences of untreated dental caries and associated factors among school going children - A cross-sectional study. Indian J Dent Res [serial online] 2020 [cited 2020 May 30];31:180-5. Available from: http://www.ijdr.in/text.asp?2020/31/2/180/284565



   Introduction Top


Dental caries is still a major global public health problem.[1] It is also the major oral health problem in developing countries, affecting 60–90% of the school children.[2] The relationship between nutrition and dental caries is complex because it is a multifactorial disease.[3] Childhood obesity and caries may share some common factors: biological/genetic, social/cultural, dietary/feeding, and environmental/lifestyle.[4] Hence, this study was designed to assess the caries experience, clinical consequences of untreated dental caries, and associated factors among school going children in Tiruvallur taluk, Tiruvallur district, Tamil Nadu.


   Methods Top


A descriptive cross-sectional study was carried out among 6–13 years old school going children in both government and private schools in Tiruvallur taluk of Tiruvallur district, Tamil Nadu. The survey includes a questionnaire and clinical examination. The subjects presents on the day of examination were included. Tooth with pulpal involvement due to trauma or fracture, ulceration of oral mucosa caused by other than root fragments, children undergoing orthodontic treatment and unable to open the mouth, children with congenital deformities like cleft lip and cleft palate and physically challenged were excluded.

Ethical approval was obtained from the Ethics Committee in 2015. Prior permission was obtained from the school authorities to conduct the study. The intra-examiner agreement was found to be 85%. The questionnaire was translated into Tamil. Internal consistency reliability of the questionnaire was checked using Cronbach's alpha, which was found to be 0.9. A pilot study was carried out. Using SPSS Software Version with 90% power and alpha error at 5%, using G-power analysis, the sample size was calculated based on the “Untreated PUFA Ratio” obtained from the pilot study.

Cluster sampling methodology was followed. Classes from I to VIII standard formed the clusters for the study. Random selection was done till the required sample size is reached.

Data collection included a questionnaire on oral hygiene practices, diet, dental visits, income, and body mass index (BMI). Socioeconomic classification was done on the basis of Modified B.G. Prasad Classification.[5],[6]

All children were examined by a single examiner, seated on a chair under natural light using standardized instruments. Oral examinations were conducted using an illuminated mouth mirror and a CPI probe. Caries experience was recorded according to WHO criteria (2013)[7] for dental caries and untreated carious lesion was also recorded using PUFA/pufa index.[1]

The data obtained was analyzed using SPSS V.17. Descriptive statistics were presented as numbers and percentages. The quantitative data were expressed as mean and standard deviation. A Chi-squared test and Fisher's exact test was used for comparison between two attributes. Intergroup comparison of parametric data was analyzed using independent sample t-test and for non-parametric data using Mann–Whitney test. The significance level was set at P < 0.05.


   Results Top


Among 1,060 school children, 502 (47.4%) children were from the government school and 558 (52.6%) were from the private schools [Table 1]. The mean dmft was found to be highest in lower class being (1.22 ± 2.01) and lowest in middle class being 0.33 ± 0.70. [Table 2]. The mean dmft was found to be highest in underweight being 1.73 ± 2.03 and lowest in obese being 0.21 ± 0.79. The differences noted were found to be statistically very highly significant (P = 0.0001). [Table 2]. The “P” component was found to be higher among all the other components in both the dentitions [Table 3]. Binary logistic regression results showed that children who belonged to underweight group (P = 0.0001) have 2.3 times increased chance for dmft and 0.54 times less chance for DMFT [Table 4]. Children who never visited the dentists have significance (P < 0.05) 1.8 times increased chance for pufa and those who changed their brush once a month have 0.4 times less chance for pufa [Table 4]. The underweight group have significantly 1.7 times increased odds for pufa [Table 5].
Table 1: Sociodemographic details of the study participants

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Table 2: Mean caries experience based on BMI and Socioeconomic status

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Table 3: Mean consequences of untreated caries experience

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Table 4: Binary logistic regression between caries experience and oral health behavioural factors among 10-13 year children

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Table 5: Binary logistic regression between consequences of untreated caries and oral health behavioural factors among 10-13 year children

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The prevalence of caries experience in permanent and primary dentition was 8.5% and 30.6%, respectively. Decayed component was found to be higher among both the dentitions [Graph 1]. The mean dmft and DMFT score was 0.79 ± 0.153 and 0.12 ± 0.457, respectively [Graph 2].




   Discussion Top


In our sample, the overall mean dmft score was higher compared to mean DMFT which was similar to a study conducted by Elangovan A, et al. (2015),[8] where the overall mean score of deft was higher compared to DMFT,[9],[10] among children in India. Thus, the present study is in line with other studies which show that the experience is more in deciduous dentition compared to permanent dentition.

In the present study among the components of dmft, the “d” component was the highest score. These findings are comparable to the study conducted by Shanbhog et al. (2013)[11] among orphanage children in Mysore district, India, where “d” component of dmft was the highest score. The overall prevalence of dental caries was 36.6%. In a study conducted by Mishu et al. (2013)[12] among the children in Bangladesh, the overall prevalence of dental caries was 61%. This difference could be due to the maintenance of better oral health by the present study population compared to low-income developing countries like Bangladesh. The mean dmft scores was higher among underweight group whereas in a study conducted by Elangovan A, et al. (2015) 8 among school going children in Chennai city, the mean deft scores was higher among obese group. Compared to the present study with children belonging to low socioeconomic status, the study subjects of Chennai city have a higher affordability with better access to confectionary items which would have increased the dmft in obese group. The mean dmft score was found to be highest in lower class followed by upper class, lower middle class, upper middle class, and middle class. This was in line with a study conducted by Jerkovic et al. (2009),[13] where prevalence of dental caries was 10% higher in low socioeconomic classes compared to high socioeconomic class.

The untreated caries PUFA ratio in the current study was 9.4%, which was less comparing to the study conducted by Shanbhog et al. (2013)[11] among orphanage children in Mysore district, India where the untreated caries PUFA ratio is 21%. The increase in PUFA ratio among orphanage children could be due to the neglect of oral health in the absence of caretaker. In our study, “P” component of PUFA score was the highest score. Similar results were yielded in a study conducted by Shanbhog et al. (2013)[11] and Jain K, et al. (2014)[10],[14] among school children in India where the mean “P” component (0.28 ± 0.65) was the highest score. The “P” component of pufa was found to be higher among all other components. This was in line with a study conducted by Jain K, et al. (2014)[10] among school children in India. The results of the present study is in line with other studies with regard to clinical consequences of untreated dental caries which is found to be more in deciduous dentition compared to permanent dentition. In our study, the highest mean pufa score (0.47 ± 1.37) was found among underweight children and highest mean PUFA score (0.03 ± 0.15) was found among normal weight children. Similarly in a study conducted by Dua et al. (2014)[15] among the children in rural India where the highest mean pufa score (1.72 ± 1.28) was found among underweight children and highest mean PUFA score (0.47 ± 0.88) was found among normal weight children. The clinical consequences of untreated dental caries seem to be more in children with underweight and normal weight. In the present study, the highest mean pufa score (0.24 ± 0.76) and highest mean PUFA score (0.03 ± 0.22) was found to be similar as study conducted by Dua et al. (2014)[14] among the children in rural India where the highest mean pufa score (2.25 ± 1.25) was found among poor class and highest mean PUFA score (0.56 ± 0.75) was found among lower middle class.

In the present study, 98.8% of children were using tooth paste and 92.7% of children never visited the dentist. In a study conducted by Tadakamadla et al. (2012)[15] among children in Udaipur district, 54.3% were using toothpaste and 93.3% had never visited a dentists, respectively. This difference could be because a difference in geographic location. Significantly, the higher percentage of government school children had described the health of their teeth as poor, had never undergone any dental treatment, not regular with rinsing, had the habit of snacking more than three times a day, eating more of sweets, biscuits, and sweetened soft drinks every day, drinking tea, coffee with sugar every day, avoidance of smiling every day, experience of other children making fun of their teeth, toothache forcing them to miss school and difficulty in chewing compared to private school children. This difference could be because of the improved socioeconomic status and awareness of these private school children which enables them toward practicing better oral health habits compared to government school children which enables them to afford dental aids and practice better oral health habits.

The relationship noted between oral health behaviors and clinical consequences of untreated dental caries among the study subjects were found to be almost similar to that of dental caries with oral health behaviors. This suggests that the occurrence of dental caries and clinical consequences of untreated dental caries whether in permanent or primary dentition all related to the practices of unhealthy oral health behaviors are all interlinked, reconfirming the fact that dental caries and its untreated clinical consequences have multifactorial causation.

Though not statistically significant relation was observed between PUFA and oral health behavioral factors, there was a 4.5 times and 1.4 times increased chance for developing PUFA among those who brush once a day and had tea/coffee with sugar, respectively, which suggest that improper oral behavioral factors have tendency to increase the occurrence of PUFA in the absence of appropriate treatment. The limitations of this study was that the participants may tend to give socially desirable responses by over reporting, study subjects were not equally distributed in different social classes and conducted only in one taluk of Tiruvallur district, therefore the results are not generalizable. More longitudinal studies are needed to confirm the association. There is a need for continuous monitoring and implementing preventive and restorative programs. The attention of healthcare providers and government agencies should be drawn to the PUFA/pufa score rather than the DMFT/dmft scores for planning, monitoring, allocation of health resources, evaluating access to emergency treatment, and exposure to fluoride as components of the Basic Package of Oral Care (BPOC). Physicians and dentists treating young children should consider that deviation from weight is a risk marker for childhood caries. Furthermore, longitudinal studies are needed to explore the triangular association of BMI, dental caries, and sweet consumption. It is also necessary to create a system of food and nutrition surveillance for school going children and preventive programs should focus on intake of sugars to avoid overweight/obesity and caries.


   Conclusion Top


To conclude, the study showed that the prevalence of dental caries and clinical consequences of untreated dental caries experience was found to be higher in the primary dentition and the factors related to increased caries experience were frequency of brushing less than twice a day, snacking in between meals, eating snacks more than thrice daily, underweight and low socioeconomic class.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Dr. Faizunisa Habib
Department of Public Health Dentistry, Karpaga Vinayaga Institute of Dental Sciences, Maduranthagam - 600 054, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_120_19

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