Year : 2009 | Volume
: 20 | Issue : 3 | Page : 256--260
Dental caries and treatment needs of children (6-10 years) in rural Udaipur, Rajasthan
Vineet Dhar1, Maheep Bhatnagar2,
1 Departments of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
2 Faculty of Science, M.L.Sukhadia University, Udaipur, Rajasthan, India
Departments of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan
Objective : This study was done to examine caries prevalence and corresponding treatment needs in school children of rural areas of Udaipur, Rajasthan.
Materials and Methods : A total of 750 children of rural areas in the age group of 6-10 years were examined, using WHO index, to record the prevalence of dental caries and treatment needs. The results were subjected to statistical analysis using chi square test.
Results : Dental caries was found in 63.20% children, and 85.07% children needed dental treatment. The highest need was of one surface filling (85.73%) followed by sealant (51.20%).
Conclusion : Dental caries showed to be a significant health issue in the rural population requiring immediate attention.
|How to cite this article:|
Dhar V, Bhatnagar M. Dental caries and treatment needs of children (6-10 years) in rural Udaipur, Rajasthan.Indian J Dent Res 2009;20:256-260
|How to cite this URL:|
Dhar V, Bhatnagar M. Dental caries and treatment needs of children (6-10 years) in rural Udaipur, Rajasthan. Indian J Dent Res [serial online] 2009 [cited 2020 Aug 14 ];20:256-260
Available from: http://www.ijdr.in/text.asp?2009/20/3/256/57352
Dental caries is one of the commonest dental problems affecting children. It can be seen in all age groups of children involving both primary and permanent teeth. The quest to control or eradicate dental caries has been on for a long time. Treatment of dental caries involves restorative or pulp therapy which is not only expensive but also painful and demanding for the child. Considering these factors prevention of caries seems to the most acceptable and desirable option. It is important that prevalence of caries in a given population is assessed at regular intervals of time to ascertain the spread of disease and need of preventive and restorative care. Such studies would help in planning the preventive steps needed to keep the population disease free. Various prevalence studies on dental caries and treatment needs of different populations in urban regions of India have been done and reported. However, not enough work has been done in rural areas where majority of the Indian population lives. An major cause of limited oral care in rural areas is lack of manpower, inadequate planning of resources and unavailability of baseline data of dental diseases and treatment needs. In many rural regions of Rajasthan inadequate research work has been conducted leading to lack of scientific data indicating prevalence of dental diseases and treatment needs. Even in rural areas of Udaipur, so far, very little work has been done on prevalence of dental caries and corresponding treatment needs in children especially in the age group of 6-10 years.
The purpose of this cross-sectional study was to assess the prevalence of dental caries and corresponding treatment needs in school children of age group 6-10 years in the rural areas of Udaipur district, Rajasthan.
Materials and Methods
This study was carried out at the Dental Care Center, Bapna House, Hospital Road, Udaipur, in coordination with Faculty of Science, M.L.Sukhadia University, Udaipur, Rajasthan, India.
A sample size of 750 village children were examined over a time span of one year (August, 2007 to July, 2008) from schools in rural areas of Udaipur. This study was cleared by the Institutional Ethics Committee of D.Y.Patil Dental College, Pune, Maharastra, India. Five rural areas- Loyara, Kavita, Thoor, Bedla and Dangio ka Guda were randomly taken up. All the children taken for this study were contacted at their schools. After parents', teachers' consent, children from these regions were brought regularly to the hospital for examination and given free dental treatment. In this manner all the 750 children from rural areas in the age group of 6-10 years were examined. All these children had mixed dentition, that is, both primary and permanent teeth were present. To avoid inter-examiner variability the children were examined by a single examiner who was trained to record World Health Organization (WHO) oral health assessment  form. The WHO indices were used to record caries and treatment needs. The assessment involved recording of scores for status of permanent and primary teeth and treatment needs. Status was recorded using the following criteria:
For assessing treatment needs, criteria and their scores are given as follows:
0 = none, 1 = caries arresting or sealant care, 2 = one surface filling, 3 = two or more surface filling, 4 = crown or bridge abutment, 5 = bridge element, 6 = pulp care, 7 = extraction, 8 = need for other care, 9 = specify.
Teeth which were decayed or filled with decay were counted as carious and in case of missing teeth only those missing due to caries were considered. The data was recorded for each patient separately and that gave the number of decayed (d), missing (m) and filled (f) teeth and the details of type of treatment care needed for that patient. The dmft (d+m+f) was calculated for each patient individually. Children were divided into different groups according to sex (boys and girls) and age groups (6-7 and 8-10 years). For each child the overall caries experience and treatment needs of both primary and permanent teeth combined were calculated. All the data was compiled and subjected to statistical analysis using chi square test for deriving the results.
In total, 750 children were examined - 396 boys and 354 girls. In the age group six to seven years there were 163 children including 87 boys and 76 girls and in the age group 8-10 years there were 587 children including 309 boys and 278 girls [Table 1].
Overall, caries prevalence in the total sample was recorded to be 63.20% (dmft 2.60 ± 2.05). Caries prevalence in the boys group was 66.91% (dmft 2.82 ± 2.01), and girls group was 59.03% (dmft 2.37 ± 2.05). The difference between both the groups was statistically significant. Among different age groups, total caries prevalence in the age group 6-7 years was 51.53% as compared to 66.44% in the age group 8-10years. The difference between the two age groups was highly significant statistically.
In the 6-7 age group caries prevalence among boys and girls was found to be statistically significant but within the age group 8-10 years the difference was non-significant. [Table 2] and [Table 3].
On assessment of decayed, missing and filled teeth in the total sample, 69.94% were decayed, 14.70% were missing and 15.36% were filled. Overall dmft in boys was 2.82 ± 2.01 and in girls it was 2.37 ± 2.09.
Among the different age groups, higher dmft was seen in age group 8-10 years compared to 6-7 years and the difference was statistically significant. A higher percentage of decayed teeth was seen in girls of both age groups compared to boys. Also, boys of both age groups showed a higher percentage of filled and missing teeth compared to girls indicating that more boys had undergone dental treatment in the form of fillings or extractions [Table 3].
On assessment of treatment needs it was seen that 85.07% of the total children needed treatment. On comparison between two sexes, 87.63% of boys and 82.20% of girls needed treatment and the difference was significant statistically. Both the age groups, 6-7 years and 8-10 years, had high treatment needs though the difference between them was not statistically significant.
In the age group 6-7 years, 95.40% boys and 78.95% girls needed treatment and the difference between them was highly significant; in the age group 8-10 years, 85.44% boys and 83.09% girls needed treatment but the difference between them was insignificant statistically.
Among boys, the 6-7 years age group showed higher treatment needs (95.04%) than the group 8-10 years (85.44%) group. The difference was statistically significant here while among girls of different age groups the difference was statistically insignificant [Table 4].
Among the total children, 85.07% needed treatment and it was further calculated that out of the total children 51.20% children needed sealants, 85.73% needed one surface filling, 4.00% needed two or more surface filling, 5.20% children needed pulp care and crown, 4.13% children needed extractions and 19.87% children needed other care which in these cases was mostly veneers, preventive and interceptive orthodontics.
Overall, a similar trend of treatment needs was recorded for both boys and girls. The highest need in both groups was of one surface filling followed by sealants. A comparison of the two age groups, showed a higher need for preventive care like sealants for the 6-7 years age group while the 8-10 years group showed higher need for one surface filling with significant reduction in need for sealant care. This indicated that probably the permanent first molars had developed caries by this age.
Boys in the age group of 6-7 years showed a high need of preventive procedures like sealant (91.95%) compared to boys in the age group 8-10 years (38.19%); and more boys in age group 8-10 years needed fillings compared to age group 6-7 years. A similar trend was seen among girls where 71.05% children in the 6-7 years age group and 47.48% in the 8-10 years age group showed a need for sealants; and girls in the 8-10 years age group showed higher need for fillings than the age group 6-7 years.
Comparing the 6-7 group and 8-10 age group; in the former group, boys showed higher need for sealants, one and two or more surface fillings and other care whereas girls showed slightly higher need for pulp care, extractions and crowns. In the latter group, boys showed higher needs for all types of treatment except for sealants which was needed more in girls [Table 4].
Treatment needs were also calculated on the basis of total teeth needing treatment. Among the different varieties of treatment required there was no significant statistical difference between different age groups. Among boys, 56.70% of teeth required treatment compared to 43.30% in girls. In the variety of treatment requirements, there was need for one surface filling (51.37%) followed by sealant care (33.15%), other care, two or more surface fillings, crowns, pulp care and extractions in that order [Table 5].
It has always been a challenge for epidemiological studies to obtain the appropriate representation of the target population. School going children of the concerned regions have always been considered a good sample source for conducting such work in children. This study was conducted in rural areas and targeted at school going children because of the ease of accessibility and adequate representation of the target population.  The children were divided in age groups of 6-7 years and 8-10 years because the first age group corresponds to the eruption of permanent first molars and after eruption they are known to be most prone to develop dental caries which was observed in the other age group.
Overall caries was found to be 63.20% in this study which was comparative to various prevalence studies done in rural India. ,,, Boys showed higher caries prevalence than girls; and age group 8-10 years showed higher caries than age group 6-7 years. Higher caries prevalence in boys could be attributed to overfeeding of boys compared to girls; this could be done by parents exhibiting preferential behavior towards boys. Similar observations, of preference for over-feeding of sons, leading to higher decay has been noted in rural areas of India in previous studies also. ,
In dmft values it was seen that boys had higher overall dmft, but girls within their dmft values had a much higher percentage of decayed teeth than missing or filled teeth when compared to boys suggesting that more boys had received treatment than girls.
Among the two age groups, dmft was significantly higher in 8-10 years and especially decayed teeth formed the highest component of dmft, suggesting high prevalence of disease and lack of dental care in rural areas, this finding was also noted in a study done in Chidambaram Taluk, Tamil Nadu 
Various studies done nationally in Punjab,  Maharashtra,  Karnataka,  Tamil Nadu  and internationally in Southwestern China  and Uganda  have showed that decayed teeth account for the highest percentage of total dmft as was observed in rural Udaipur also. This suggests that there are sufficient contributing factors for decay to occur and progress but the children are not undergoing treatment either due to lack of facilities or lack of awareness.
This study showed a positive co-relation between dmft and age as also seen in various previous studies done in rural areas of northern and southern India. , This could be justified by increased exposure of the child to risk factors causing caries with time.
On assessment of treatment needs, among the two groups, boys needed more treatment than girls; and among age groups, the children of age group 8-10 years required more treatment compared to children of 6-7 years. In age group 8-10 years there was a higher need of one surface filling and in the age group 6-7 years there was a higher need of sealants. This suggested that by the age 8-10 years most likely the permanent molars also had developed caries thus increasing the need for filling. Therefore, early use of preventive methods could protect caries and subsequent need of restorations in later years.
Between the two sexes, boys showed a decline in treatment needs from age group 6-7 years to 8-10 years and girls showed increased treatment needs with age. This could suggest that boys were getting a preference for receiving dental treatment compared to girls. This is also supported by the finding that in dmft values, boys had higher number of missing and filled teeth indicating more treatment received. Similar preference for sons in receiving health care was also noted in other studies in rural areas of India. ,
The calculation of treatment needs was also done as per total number of teeth affected. This method was also used by Mahesh et al. in 2005.  This method also gave similar findings as compared to number of children needing treatment.
There was high need for other care which mainly included space management and composite veneers as a treatment of fluorosis in anterior teeth. This study gives an insight into existing caries and treatment needs among school children of Udaipur and would definitely help in implementing programs to achieve optimal health for children.
|1||World Health Organization, Oral Health Survey, Basic Methods. 4 th ed. Geneva: WHO; 1999.|
|2||Holm AK. Caries in preschool children-international trends. J Dent 1990;18:291-5.|
|3||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.|
|4||Khera N, Tewari A, Chawla HS. Inter-comparison 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.|
|5||Gangwar SK, Idris MZ, Bhushan V, Nirupam S, Saimb CS, Jain VC. Bio- social correlates of dental caries in rural areas of Lucknow. J Indian Dent Assoc 1990;61:93-7.|
|6||Chatufale JD, Goyal RC. A cross sectional study of factors related to oral health in rural areas of Loni, Western Maharastra. Indian J Community Med 2002;27:74-6, 96.|
|7||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.|
|8||Saravanan S, Kalyani V, Vijayarani MP, Jayakodi P, Felix JW, Arunmozhi P, et al. Caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, South India. Indian J Dent Res 2008;19:186-90.|
|9||Bhowate RR, Borle SR, Chinchkhede DH, Gondhalekar RV. Dental health amongst 11-15 year old children in Sevagram, Maharashtra. Indian J Dent Res 1994;5:65-8.|
|10||Lo LC, Holmgren CJ, Hu DY, Wan HC. Dental caries status and treatment needs of 12-13 year-old children in Siachuan Province, Southwetern China. Community Dent Health 1999;16:114-6.|
|11||Nalweyiso N, Busingye J, Whitworth J, Robinson PG. Dental treatment needs of children in rural subcounty of Uganda. Int J Pediatr Dent 2004;14:27-33.|
|12||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.|
|13||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 Pedo Prev Dent 2005;2317-22.|