Year : 2008 | Volume
: 19 | Issue : 3 | Page : 186--190
Caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, South India
S Saravanan1, V Kalyani1, MP Vijayarani1, P Jayakodi1, JWA Felix2, P Arunmozhi3, V Krishnan3, P Sampath Kumar1,
1 Division of Community Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Tamilnadu, India
2 Division of Community Medicine, Rajah Muthiah Dental College and Hospital, Annamalai University, Tamilnadu, India
3 Division of Periodontology, Rajah Muthiah Dental College and Hospital, Annamalai University, Tamilnadu, India
Division of Community Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Tamilnadu
Objective: To obtain information on caries prevalence and treatment needs of children aged 5-10 years to plan appropriate dental care services in rural areas.
Materials and Methods: Children studying in all the primary schools (six schools) in the field practice area of the Rural Health Centre of the Faculty of Medicine, Annamalai University, Chidambaram, were surveyed. Each child was clinically examined in the schools by calibrated examiners. Dental caries was assessed using diagnostic criteria recommended by WHO (1997). The chi-square test and two-way analysis of variance were used for statistical analysis.
Results: Five hundred and eight 5-10 year-old school children (247 boys and 261 girls) were surveyed. Caries prevalence was 71.7 and 26.5% in primary and permanent dentition, respectively. The mean dmft and decayed missing filled tooth (DMFT) scores were 3.00 and 0.42 respectively. The mean dmft decreased with age ( P < 0.01) whereas the mean DMFT increased with age ( P < 0.001). Although the mean dmft scores were not statistically significant different for the two sexes, the mean DMFT score was found to be higher among girls than among boys ( P < 0.02). The entire dmft/DMFT value represented the «SQ»decay«SQ» component only. There was a strong need for single surface restorations (60.6%). In the WHO index age (5-6 years), the caries prevalence was 70.2% (29.8% caries-free) with a mean dmft value of 3.54 ± 3.71.
Conclusion: Dental caries is a significant public health problem in this population. An extensive system to provide primary oral health care has to be developed in the rural areas of India.
|How to cite this article:|
Saravanan S, Kalyani V, Vijayarani M P, Jayakodi P, Felix J, Arunmozhi P, Krishnan V, Sampath Kumar P. Caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, South India.Indian J Dent Res 2008;19:186-190
|How to cite this URL:|
Saravanan S, Kalyani V, Vijayarani M P, Jayakodi P, Felix J, Arunmozhi P, Krishnan V, Sampath Kumar P. Caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, South India. Indian J Dent Res [serial online] 2008 [cited 2020 Jul 5 ];19:186-190
Available from: http://www.ijdr.in/text.asp?2008/19/3/186/42948
Voluminous dental literature exists about caries levels in the Indian population. These data have been obtained from the major cities and cosmopolitan areas. The overall impression is that dental caries has increased in prevalence and severity in the urban and cosmopolitan population over the last couple of decades. However, there is no definite picture as yet regarding the dental caries status in the rural areas of our country, where 72.2%  of the population live. 
Oral health care in rural areas is limited due to shortage of dental manpower, financial constraints and the lack of perceived need for dental care among rural masses. One of the most important factors to be considered when planning for the improvement in dental care facilities in rural India is the baseline data for dental diseases and the treatment needs of the population. The present study aims at assessing the dental caries status in the rural population in Chidambaram Taluk, Cuddalore district of Tamil Nadu, where hardly any data on the status of dental caries exists.
Thus, the objectives of the study were:
To assess the prevalence of dental caries and treatment needs in rural school childrenTo calculate the dmft/DMFT indices andTo provide information to health authorities to plan appropriate preventive and curative programs for schools in rural areas
Materials and Methods
This cross-sectional study was conducted on 508 primary school children aged 5-10 years in the rural areas of the Chidambaram Taluk.
The field practice area of the Rural Health Centre of Rajah Muthiah Medical College and Hospital (RMMC and H), Annamalai University, Chidambaram, forms the study area. The Rural Health Centre is located at South Pichavaram, 12 kms to the east of the town of Chidambaram and 4-6 kms from the sea coast (Bay of Bengal). The villages covered by the service area are: 1) South Pichavaram, 2) Kanagarapattu, 3) T.S. Pettai, 4) North Pichavaram, 5) Keezhaperambai and 6) Senjicherry. These villages form part of the Chidambaram Taluk in the Cuddalore district of the state of Tamil Nadu, South India.
The study site has a land area of 16.4 km 2 with a total population of 6089 inhabitants. Agriculture is the major occupation except for one village (T.S. Pettai), where fishing is also one of the occupations. On an average, the annual income for a family in the study area is Rs. 12,000 (US $260) except for the village of T.S. Pettai, where the income level ranges from Rs. 12,000 to Rs. 18,000 (US $260-391). There were six primary schools and one high school in the study area. Ninety-nine per cent of the children in the age group of 5-10 years and around 85% of the children in the age group of 11-16 years were in enrolled in the schools.
Study population and procedures
A review of the literature shows that caries prevalence varies from 40 to 80% in rural India. ,,, Considering the prevalence rate of dental caries to be 50% with a type I error of 5% and the power of the study to be 90%, the sample size was calculated to be 390 children.
There were six primary schools (Classes I-V for the children aged 5-10 years) and one high school (classes VI-X for the children aged 11-16 years) in the study area. The study focused on only the children in primary schools as there was only one primary school in each village and 99% of 5-10 year-old children in the study area were enrolled in the schools. Although the required sample size was 390 children, all the 531 children studying in the six primary schools in six villages were included in the study to avoid embarrassment among the school children and their parents. Of these 531 children, six children were chronic absentees and were out of the study area. There were seventeen 11-12 year-olds in the study population who were excluded from the group analysis. Thus, the study population consisted of 508 5-10 year-olds comprising of 247 (48.6%) boys and 261 (51.4%) girls.
As such, the data obtained is a census of the 5-10 year-olds in the study area, which was chosen as a research setting due to accessibility and convenience. Hence, these six villages that comprise the study area may not be a true representation of rural India. This may be a limitation of this study. However, the study population (508 children) represents 2.1% of the children of similar age in the rural Chidambaram Taluk. Indeed, the study population exceeded the statistically required number (390) and was adequate for the purposes of the study. Hence, it is likely to be representative of the same age group of children of the rural Chidambaram Taluk in the Cuddalore district of Tamil Nadu.
The survey was conducted from July 2003 to March 2004. Approval from the concerned school authorities and informed consent from the parents were obtained. Children were examined in the school premises in suitable places with the subjects seated in ordinary chairs. Natural day light was used for illumination and direct sunlight was avoided. Oral examination was performed by three trained and calibrated dentists (SS, CK and MPV). Caries was diagnosed according to the criteria set by the World Health Organization  using a mouth mirror and a community periodontal index (CPI) probe. The scribes were seated close enough to the examiners so that the instructions and codes could be easily heard and the examiners could verify the correct entry of the findings.
Training and calibration of examiners
Before the survey, all the examiners and scribes participated in a two-day training and clinical calibration exercise. Following this training, 52 school children were examined by each of the three investigators to assess interexaminer reliability. The interexaminer calibration for caries experience between SS and CK, SS and MPV and CK and MPV resulted in Kappa values of 0.80 (P Statistical analysis
Means and standard deviations were calculated to express the dmft/DMFT values. The chi-square test was applied to study the association of the prevalence of dental caries with gender and age. Two-way analysis of variance was applied to compare caries in primary and permanent dentition by age and gender.
A total of 508 5-10 year-old children were surveyed, among whom there were 247 (48.6%) boys and 261 (51.4%) girls. The children belonged to mixed dentition periods [Table 1].
As shown in [Table 2], the prevalence of caries in primary and permanent dentition was 71.7 and 26.5% respectively. The prevalence of caries increases significantly with age in permanent dentition (P  In the present study, the prevalence of caries in the primary dentition of five to six year-olds was 70.2%. The reported prevalence rates for caries are much higher compared to those for rural parts of western India  and Uganda.  Also, our study shows that the prevalence of caries is higher than the WHO-formulated world target of 50% caries-free 5-6 year-olds by the year 2000 A.D. The overall prevalence of caries in permanent dentition was 26.5%, which is lower than caries levels reported in rural school children in the Southwestern part of Germany. 
The mean dmft was 3.00 ± 3.03 for the whole study population. In accordance with other studies, , the present study reports a decrease in caries with increasing age, a trend also seen within the same sex. Similar observations were also found in rural Calcutta.  The exfoliation of deciduous teeth in the older age group might explain why the mean dmft score is lower for 9-10 year-olds.  Boys recorded higher mean dmft scores than girls. These findings are in agreement with the results of several studies on caries. ,, 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. ,,
The mean DMFT score was 0.42 ± 0.84 for the entire study population. Studies conducted on caries in rural Punjab  (Northern India) and rural Karnataka  (Southern India) reported an increase in mean DMFT scores with increasing age. The present study also showed a positive correlation of mean DMFT scores with age, being highest in the 9-10 year-olds. The mean DMFT score was higher (0.50) in girls than in boys (0.35), again in accordance with earlier studies. , Differences between the sexes may be largely attributed to the fact that girls' teeth erupt at an earlier age than boys' teeth. 
The caries experience was lower in permanent dentition (0.42) than in primary dentition (3.00). This high caries experience in primary teeth could be attributed to the fact that permanent teeth have a lower susceptibility to dental caries.  It may also be due to the structural differences that may increase caries susceptibility in deciduous teeth. 
Studies conducted on caries in rural areas of Mozambique,  Uganda  and Southwestern China  showed that decayed teeth accounted for the greatest percentage of total dmft/DMFT. Similar findings were reported in rural areas of Punjab,  Maharashatra  and Karnataka  in India. In the present study, the total dmft or DMFT represented only untreated decay and not the missing or filled components. This indicates that rural children do not have access to restorative or any other dental treatment due to the nonexistence of professional dental care in rural India and no access to government dental services in the surrounding region. Also, the nonutilization of services provided by the dental faculty in Annamalai University (private), which is located around 15 kms from the study area, clearly reflects their inability to afford dental care.
The high caries prevalence as seen in the current study, may largely be attributed to factors like family income; parental education; parents' dental knowledge, attitude and behaviour; the child's dietary and oral hygiene habits; and place of residence. Further support regarding the positive correlation of dental caries with the above mentioned factors comes from studies conducted in Greece,  Hong Kong, , the UAE  and China.  Clarification of these risk markers for caries would be interesting and useful but it is beyond the scope of this study.
Conclusion and Recommendations
The results of this baseline study indicate that dental caries is a major public health problem in this region and an active and effective program of dental care is necessary for the child population.
In view of the close relationship between poverty, quality of life and oral health; and the fact that 72.2%  of the Indian population lives in rural areas, the government of Tamil Nadu should implement the concept of appointing dental surgeons in Primary Health Centres (PHCs) and provide oral care through the Primary Health Care system.
Concepts such as:
Middle-level dentists , to provide simple restorations and extractionsOral health examiners to record the oral health statusOral health educators to give instructions and to promote an awareness of the importance of oral hygiene andVillage scalers to perform superficial tooth scaling can also be implemented 
These primary oral health care workers should be trained in PHCs under the dental surgeons.
As most of the decay in the study population can be treated with simple one-surface fillings, the Atraumatic Restorative Treatment (ART) approach seems very appropriate.  Combining ART with other preventive measures will definitely improve the oral health status of most children in the present study area.
|1||Chandramouli C, Provisional Population totals, series-34, Tamil Nadu, Census of India 2001.|
|2||Saha S, Sarkar S. Prevalence and severity of dental caries and oral hygiene status in rural and urban areas of Calcutta. J Indian Soc Pedod Prev Dent 1996;14:17-20.|
|3||Khera N, Tewari A, Chawla HS. Inter-comparision of prevalence and severity of dental caries in urban and rural areas of Northern India. J Indian Soc Pedod Prev Dent 1984;2:19-25.|
|4||Gangwar SK, Idris MZ, Bhushan V, Nirupam S, Saimbi CS, Jain VC. Bio-social correlates of dental caries in rural areas of Lucknow. J Indian Dent Assoc 1990;61:93-7.|
|5||Chatufale JD, Goyal RC. A cross-sectional study of factors related to oral health in rural areas of Loni, Western Maharashatra. Indian J Community Med 2002;27:74-6,96.|
|6||World Health Organization. Oral health surveys-basic methods. 4 th ed. Geneva: WHO; 1997.|
|7||Zerfowski M, Koch MJ, Niekusch U, Staehle HJ. Caries prevalence and treatment needs of 7-to 10-year-old school children in Southwestern Germany. Community Dent Oral Epidemiol 1997;25:348-51.|
|8||Nalweyiso N, Busingye J, Whitworth J, Robinson PG. Dental treatment needs of children in a rural subcounty of Uganda. Int J Pediatr Dent 2004;14:27-33.|
|9||Rao A, Sequeira SP, Peter S. Prevalence of dental caries among school children of Moodbidri. J Indian Soc Pedod Prev Dent 1999;17:45-8.|
|10||Tewari S, Tewari S. Caries experience in 3-7 years old children in Haryana (India). J Indian Soc Pedod Prev Dent 2001;19:52-6.|
|11||Jain M. Save our future mothers. Indian J Prev Soc Med 2001;32:89-90.|
|12||Kusum MS. Atrocities against women. Yojana 1991;35:19.|
|13||Ghosh S. Discrimination begins at birth. Indian Pediatr 1986;23:9-15.|
|14||Gauba K, Tiwari A, Chawla HS. Frequency distribution of children according to dental caries status in rural areas of northern India (Punjab). J Indian Dent Assoc 1986;58:505-12.|
|15||Megas BF, Athanassouli TN. Dental caries prevalence in the permanent teeth in Greek school children related to age, sex, urbanization and social status. Community Dent Health 1989;6:131-7.|
|16||Mandal KP, Tewari A, Chawla HS, Gauba K. Prevalence and severity of dental caries and treatment needs among population in the eastern states of India. J Indian Soc Pedod Prev Dent 2001;19:85-91.|
|17||Olsson B, Segura-Bernal F, Tanda A. Dental caries in urban and rural areas in Mozambique. Community Dent Health 1989;6:139-45.|
|18||Lo EC, Holmgren CJ, Hu DY, Wan HC. Dental caries status and treatment needs of 12-13 year-old children in Sichuan Province, Southwestern China. Community Dent Health 1999;16:114-6.|
|19||Bhowate RR, Borle SR, Chinchkhede DH, Gondhalekar RV. Dental health amongst 11-15 year old children in Sevagram, Maharashatra. Indian J Dent Res 1994;5:65-8.|
|20||Wei SHY, Holm AK, Odont LS, Yuen SW. Dental caries prevalence and related factors in 5-year-old children in Hong Kong. Pediatr Dent 1993;15:116-9.|
|21||Evans RW, Lo EC, Darvell BW. Determinants of variation in dental caries experience in primary teeth of Hong Kong children aged 6-8 years. Community Dent Oral Epidemiol 1993; 21:1-3.|
|22||Hashim R, Thomson WM, Ayers KM, Lewsey JD, Awad M. Dental caries experience and use of dental services among preschool children in Ajman, UAE. Int J Pediatr Dent 2006;16:257-62.|
|23||Zhu L, Petersen PE, Wang HY, Bian JY, Zhang BX. Oral health knowledge, attitudes and behaviour of adults in China. Int Dent J 2005; 55:231-41.|
|24||Lo EC, Jin LJ, Zee KY, Keung Leung W, Corbet EF. Oral health status and treatment need of 11-13 year-old-urban children in Tibet, China. Community Dent Health 2000;17:161-4.|
|25||Songpaisan Y, Davies GN. Dental caries experience in the Chiangmai/ Lamp hun provinces of Thailand. Community Dent Oral Epidemiol 1989;17:131-5.|
|26||Frencken JE, Makoni F, Sithole WD. ART restorations and glass ionomer sealants in Zimbabwe: Survival after 3 years. Community Dent Oral Epidemiol 1998;26:372-81.|