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| Year : 2013 | Volume
: 24
| Issue : 2 | Page : 199-205 |
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| Prevalence and determinant of early childhood caries among the children attending the Anganwadis of Wardha district, India |
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Abhay M Gaidhane1, Manoj Patil1, Nazli Khatib2, Sanjay Zodpey3, Quazi Syed Zahiruddin1
1 Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
2 Department of Physiology, Datta Meghe Institute Medical Sciences, Wardha, Maharashtra, India
3 Public Health Foundation India, New Delhi, India
Click here for correspondence address and email
| Date of Submission | 30-Oct-2009 |
| Date of Decision | 22-Oct-2010 |
| Date of Acceptance | 04-Mar-2011 |
| Date of Web Publication | 20-Aug-2013 |
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 Abstract | | |
Background: Dental caries is one of the most common chronic diseases of early childhood. Dental problems in early childhood have been shown to be predictive of future dental problems, growth and development by interfering with comfort, nutrition, concentration, and school participation.
Aim: To find out the prevalence of Early childhood caries (ECC) among the children attending the Anganwadis of Wardha district, to determine the feeding habits and their relationship to early childhood caries.
Materials and Methods: Community-based cross-sectional study among the selected Anganwadis children of 2-5 years of Wardha district.
Result: A total 330 subjects, 105 children were found to be having ECC, 47 (30.92%) males and 58 (32.58%) females. Total 215 children belonged to 43-60 months age group. Out of these, 72 (33.48%) children were having ECC. A significant association was found between the history of bottle-feeding and ECC (P = 0.0218). Prevalence of ECC was more among those who were bottle-fed than those who were not bottle-fed.
Conclusion: Future health promotion and education programs in Anganwadis should include oral health issues and the risk factors for ECC, and its consequences should be addressed. Public-funded oral health program should be started and targeted at children from lower socioeconomic status. Effective strategies should be developed to promote use of brush and paste for cleaning teeth and discouraging inappropriate bottle-feeding, discouraging on demand consumption of chocolates and sugars. Keywords: Children, determinant, early childhood caries, prevalence
How to cite this article:
Gaidhane AM, Patil M, Khatib N, Zodpey S, Zahiruddin QS. Prevalence and determinant of early childhood caries among the children attending the Anganwadis of Wardha district, India. Indian J Dent Res 2013;24:199-205 |
How to cite this URL:
Gaidhane AM, Patil M, Khatib N, Zodpey S, Zahiruddin QS. Prevalence and determinant of early childhood caries among the children attending the Anganwadis of Wardha district, India. Indian J Dent Res [serial online] 2013 [cited 2023 Jun 2];24:199-205. Available from: https://www.ijdr.in/text.asp?2013/24/2/199/116677 |
Dental caries is one of the most common chronic diseases of early childhood. [1] Dental caries in young children frequently leads to pain and infection necessitating hospitalization for dental extractions, sometimes under general anesthesia. [2] Dental problems in early childhood have been shown to be predictive of future dental problems, growth and development by interfering with comfort, nutrition, concentration, and school participation. [3]
Early childhood caries (ECC) is a serious public health problem in both, developed and developing countries. It affects infants and toddlers worldwide. ECC prevalence varies from population to population; but, children of disadvantaged populations have been found to be most vulnerable. [3]
The prevalence of ECC in these developing countries are reported to be as high as 70%. [4] Some of the studies that reflect the significantly high burden of ECC among the under five children in India. [5]
The children in Anganwadis mostly belong to the rural and urban slum areas with a marked lower level of socioeconomic status, poor-feeding conditions and dietary patterns, lower levels of education and health awareness among the parents, limited utilization of healthcare facilities. [6] Therefore, the burden of ECC is definitely high in this population. Unfortunately, very few studies have been conducted on ECC in this region and this population group; and that too are hospital-based studies. [6] Therefore, a community-based study is essential to reveal the true picture of this problem in this population and to find out the associated factors for this problem. So, this study was conducted with an aim to find out the prevalence of ECC, to determine the feeding habits and their relationship to ECC, to know the oral hygiene practices in ECC among the children attending the Anganwadis of Wardha district.
| Materials and Methods | |  |
Study setting
The study was conducted in selected Anganwadis of Wardha district.
Study design
It was a community-based cross-sectional study.
Institutional ethical committee
Prior to going for the study, a synopsis of the study was designed and submitted to the Institutional Ethical committee for approval. The permission was obtained from the Institutional Ethical Committee of J.N.M.C. Sawangi (M), Wardha. A written permission of the Project officer, ICDS, Wardha was obtained. An informed written consent of the parent/caretaker of the child was taken for intraoral examination.
Participants
Children belonging to 2-5-year old age group attending the selected Anganwadis of Wardha district. Anganwadi is a government sponsored child-care and mother-care center in India. It caters to children in the 0-6 age group. [7] Mostly, children come in the age of more than 2 years and are available for the dental check up.
Inclusion criteria
Children between 2 and 5-year old age group enrolled in various Anganwadis of Wardha district.
Exclusion criteria
Handicapped children; children with major debilitating illnesses.
Calculation of sample size
With reference to the previous studies on caries among the children in India, the average prevalence of caries was found to be 65%. From this figure, the sample size was calculated which came to be 215 at 95% confidence level by using the formula.
Sampling technique
This is a community-based cross-sectional study. ICDS project of Wardha district consists of eight blocks having 970 Anganwadis. All eight blocks, of Wardha district were selected and a list of all the Anganwadis in each block was obtained from the office of the CDPO, Wardha. All the Anganwadis in each block were serially numbered. Small chits of paper were prepared and a number was noted on each chit. These chits were placed in eight different boxes, each corresponding to one block. After shuffling the box properly, two chits were picked-up from each box and the name of the Anganwadi corresponding to the number on the chit was noted under the name of the corresponding block. Thus, by simple random sampling (lottery method), total 16 Anganwadis were selected for study. Children in the age group of 2-5 years (24-60 months) from the selected Anganwadis were enrolled for this study. From the list of children present on the day of intraoral examination, every second child was selected and included in the study group.
Data collection
Information regarding socio-demographic factors, feeding habits of child, oral hygiene practices of child, was obtained by a structured interview with mother/caretaker of child at their home using a pretested questionnaire.
The American Academy of Pediatrics Dentistry defined ECC as the presence of one or more decayed (non-cavitated or cavitated), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger. [4]
In accordance with this criterion, intraoral examinations were carried out using mouth mirror and No. 23 explorer for assessing ''deft'' index. For this WHO Oral Health Assessment Form 1997 was used [5] and intrarater repliability was found to be high (k = 0.94). Intraoral examination was done in natural daylight and artificial light using a torch where needed. 0.2% (w/v) chlorhexidine gluconate solution was used as an antiseptic in between patients.
Duration of study
The study was carried out over a period of 8 months including period for data collection, statistical analysis, and writing the dissertation report.
Predictor variables
Age, gender, birth order of child, income of the family, Mother's education level, mother's occupation, infant feeding habits.
Main output variables
Deft index score, prevalence of ECC, association of high deft score with socio-demographic factors, Association of high deft score with type and duration of feeding habit, association of high deft score with oral hygiene practices.
Data analysis
After initial analysis, the clinical and questionnaire data were analyzed further using SPSS-8.0 (Statistical Programme for Social Sciences). All the information collected was grouped into following categories: socio-demographic information, infant feeding practices, oral health behaviors.
Initially, the percentage of children with ECC and the children without ECC within each variable category were compared using a cross-tabulation procedure and the relative proportions in each group were analyzed using the Chi-squared test of association at 5% level of significance.
| Observation and Results | | |
In [Table 1], total 105 children were found to be having ECC, 47 (30.92%) males and 58 (32.58%) females. The overall prevalence of ECC was found to be 31.81%.
In [Table 2], 33 (28.69%) children were having ECC. Birth order of total 159 children was one, 53 (33.33%) were having ECC. No difference was found between the birth order of the child and ECC. Mothers of total 23 children were illiterate, 7 (30.43%) children were having ECC. No difference was found between mother's education and ECC.
No difference was found between mother's occupation and ECC.
No difference was found between the social class of the family and ECC.
[Table 3] shows that all study subjects were having the history of breastfeeding. So, no association could be established. Out of seven children were breastfed for less than 3 months, three (42.86%) were having ECC. No difference was found between the duration of breastfeeding and ECC. Total 26 children were having history of bottle-feeding. Out of these, 14 (53.85%) were having ECC. Total 304 children were not bottle-fed. Out of these, 91 (29.93%) were having ECC. A significant association was found between the history of bottle-feeding and ECC (P = 0.0218). Prevalence of ECC was more among those who were bottle-fed than those who were not bottle-fed. No difference was found between the duration of bottle-feeding and ECC. No difference was found between the frequency of bottle-feeding and ECC. No difference was found between the contents of feeding bottle and ECC. No difference was found between the history of bottle-feeding to sleep at night and ECC. No difference was found between the frequency of intermittent snacking per day and ECC. Seventy eight children were used to eat chocolates once-a-day. Out of these, 17 (21.79%) were having ECC. Forty seven children were used to eat chocolates twice-a-day. Out of these, 24 (51.06%) were having ECC. Thirty five children were used to eat chocolates thrice-a-day. Out of these, 17 (48.57%) were having ECC. Fifty two children were used to eat chocolates on demand. Out of these, 22 (42.31%) were having ECC. One hundred seventeen children were used to eat chocolates occasionally. Out of these, 25 (21.37%) were having ECC. Highly significant association was found between the frequency of eating sweets, chocolates, etc., per day and ECC (P < 0.0001). Prevalence of ECC was very high among the children eating chocolates on demand.
[Table 4] shows that three children had not yet started cleaning teeth. Out of these, two were having ECC. One child had started cleaning teeth at the age of 6 months and he was caries-free. Two hundred twenty nine children had started cleaning teeth at the age of 12 months. Out of these, 68 (29.69%) were having ECC. Seventy-five children had started cleaning teeth at the age of 18 months. Out of these, 26 (34.67%) were having ECC. Twenty two children had started cleaning teeth at the age of 24 months. Out of these, 10 (45.45%) were having ECC No difference was found between ECC and the age at which cleaning of teeth was started. Seventy one children used to clean their teeth with finger and paste. Out of these, 26 (36.62%) were having ECC. One hundred ninety seven children used to clean their teeth with brush and paste. Out of these, 56 (28.43%) were having ECC. Thirty five children used to clean their teeth with finger and lal manjan. Out of these, 15 (42.86%) were having ECC. Two children used to clean their teeth with brush and tooth powder. None of them was having ECC. Twenty three children used to clean their teeth with finger and paste. Out of these, eight (34.78%) were having ECC. No difference was found between ECC and the method of cleaning teeth.
| Discussion | | |
The aim of this study was to find out what proportion of 2-5-year old children having the problem of ECC and recognize the factors that are associated for the problem. As compared with the previous studies in India, prevalence of ECC among the children in Anganwadis of Wardha district in 2-5 years age group is found to be much less. Sethi and Tandon found that Prevalence rate of caries in Udupi was 65.5% in 2-5 years age group. [3] Whereas in this study, the prevalence is 31.81%. This difference might be due to the selection of specific population group, i.e. children belonging to Anganwadis where children get non-formal education, regular health check ups and supplementary nutrition. The children attending regularly are abstained, to some extent, from at will feeding and habit of eating chocolates, sweets and other cariogenic substances as compared with those who do not attend the Anganwadi. Also, they are given some tips for general and oral hygiene and may get some oral healthcare as a part of general healthcare. Seeding of good habits in children such as brushing the teeth, washing hands, etc., is also done by Anganwadi Sevika.
In this study, no significant association was found between the age of the child and ECC. This finding does not coincide with the findings by Wendt L.K. in Sweden, [8] Khristine Marie G. in Philippines, [9] and Seval Olmez in Turkey. [10] They found that higher age is associated with higher prevalence of ECC among the children.
Prevalence of ECC was found to be more among the boys than girls by Peressini et al. in Manitoulin, Ontario. [10] However, in this study, no significant association was found between the sex of the child and ECC. The prevalence of ECC among the males (31.37%) and females (32.20%) was nearly equal.
Children with birth order 1 and 2 showed higher prevalence of ECC than children with subsequent birth orders. However, no significant association was found between the birth order of the child and ECC when compared with subsequent birth orders.
No significant association was found between the social class of the family and ECC. The finding that lower family income is associated with higher prevalence of ECC were given by Jose B. in Kerala, [11] South India, and Ercillia Dini in Brazil [12] and Thangchai in Thailand [13] This may be attributed to the improved nutrition and health care these children receive in Anganwadis. This, to a more or less extent, covers the deficiencies in nutrition and health-care of the children belonging to lower socioeconomic classes.
No significant association was found between the duration of breastfeeding and ECC in this study. Association of decreased prevalence of ECC with longer duration of breastfeeding was significant in the studies by K.B. Hallet and Rourke in Brisbane. [14]
A significant association was found between the history of bottle-feeding and ECC (P = 0.0218). Prevalence of ECC was more among those who were bottle-fed than those who were not bottle-fed. Similar findings were reported by Ghanim in Riyadh, [15] Creedon in Ireland, [16] Seval Olmez among Turkish children, [17] and K.B. Hallet in Brisbane. [18] This can be attributed to the length of time the fermentable contents of bottle remain in contact with teeth.
Association of duration and frequency of bottle-feeding and history of bottle-feeding to sleep at night with prevalence of ECC was not significant as opposed to the findings reported by Ghanim in Riyadh, [15] Creedon in Ireland, [16] Seval Olmez among Turkish children, [17] and K.B. Hallet in Brisbane. [18] This may be due to very less number of subjects having the history of bottle-feeding.
The highly significant role of sweets, chocolates, sugars, candies, and wafers in higher prevalence of ECC is evident from the findings of this study which are supportive to the findings by Ghanim, [15] Jose B. Kerala, [11] Rosenblatt, [19] and Bankel. [20]
Findings such as method of cleaning teeth did not show significant relationship in this study, though these play a very important role. This can be attributed to the highly abrasive nature of dentifrices used in Maharashtra like lal manjan, ash, coal, neem datoon, which have a marked effect on tooth-enamel surface. Further research is needed in this respect.
| Conclusions and Recommendations | | |
Risk assessment for ECC is very complex and the presence or absence of disease is dependent on the balance between the virulence of the attacking agent, the factors of host resistance such as structure and integrity of primary tooth enamel, flow and consistency of saliva, and salivary defense factors like salivary IgA; the living environment including demographic, cultural, social, economic and behavioral circumstances. Oral healthcare providers should be aware of these factors, which influence the initiation and progression of ECC in their community.
The risk of developing ECC can be significantly reduced by adopting infant feeding habits such as breastfeeding for an appropriate length of time at least up to 12 months if possible, avoiding the use of feeding bottle to sleep at night, reducing the frequency of eating sugary items such as chocolates and close monitoring of the child by parents regarding cleaning of teeth. The habit of cleaning teeth after each meal should be instilled in children from the beginning.
Future health promotion and education programs in Anganwadis should include oral health issues and the risk factors for ECC, and its consequences should be addressed. Public funded oral health programs should be started and should be targeted at the children from lower socioeconomic status. Effective strategies should be developed to promote the use of brush and paste for cleaning teeth and discouraging inappropriate bottle-feeding, discouraging on demand consumption of chocolates and sugars. Non-sugar-based chocolates and candies should be introduced in the market and promoted among the children.
Limitations
Dental caries is a very complex disease involving a number of different variables. In this study, many variables were untouched like parent's attitude towards the child's oral health, parent's supervision of the child's oral health practices and feeding habits when the child is outdoors, which may have a marked effect on the prevalence of ECC.
Also, many variables which were found to be significantly associated with ECC by other researchers have shown no significance in this study. This may be due to less number of subjects studied and lack of variation in the socioeconomic and behavioral aspects of the study population.
This study is unable to focus light on the complex interrelationship of various factors in the present picture of ECC and point out the exact culprit for ECC. Further research is needed to uncover the hidden factors in this aspect.
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Correspondence Address:
Nazli Khatib
Department of Physiology, Datta Meghe Institute Medical Sciences, Wardha, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.116677
[Table 1], [Table 2], [Table 3], [Table 4] |
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