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ORIGINAL ARTICLE
Year : 2007  |  Volume : 25  |  Issue : 3  |  Page : 115-118
 

Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years


Unit of Pedodontics and Preventive Dentistry, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
A Goyal
Oral Health Sciences Center, PGIMER, Chandigarh - 160012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.36559

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   Abstract 

The prevalence of dental caries in 6, 9, 12 and 15-year-old school children of Chandigarh, selected on a randomized basis was evaluated using Moller's criteria (1966) and correlated with the various risk factors. The mean deft was found to be 4.0 3.6 in 6 year old and 4.61 3.14 in 9 year old, whereas the mean DMFT in 12 and 15 year old was found to be 3.03 2.52 and 3.82 2.85 respectively. The high prevalence of dental caries in these children was attributed to the lack of use of fluoride toothpaste (80% children), lack of knowledge about etiology of dental caries (98%) and frequency of sugar exposures up to more than five times per day (30%).


Keywords: Chandigarh, dental caries, prevalence, school children


How to cite this article:
Goyal A, Gauba K, Chawla H S, Kaur M, Kapur A. Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years. J Indian Soc Pedod Prev Dent 2007;25:115-8

How to cite this URL:
Goyal A, Gauba K, Chawla H S, Kaur M, Kapur A. Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years. J Indian Soc Pedod Prev Dent [serial online] 2007 [cited 2018 Nov 15];25:115-8. Available from: http://www.jisppd.com/text.asp?2007/25/3/115/36559



   Introduction Top


The dental caries status of school children in Chandigarh has been evaluated at an interval of 8-9 years during the last three decades. [1],[2],[3] The first cross-sectional study was carried out in 1977 followed by two more studies in 1985 and 1993 using the WHO criteria. [4],[5] The first study done in 1977 showed a mean deft + DMFT of 2.6 in 5-6-year-old-children and a mean DMFT of 4.7 in 15-year old. The subsequent study in 1985 showed almost no change in the prevalence of dental caries in the younger children over a period of 8 years, the mean deft being 2.26; although in 15-year old, a decline in dental caries was evident, the DMFT being 1.38. The re-recording of data in 1993 on a cross-sectional basis further showed a decrease in the mean DMFT to 1.12 1.35 in 15-year-old-children as compared to the mean of 4.7 in 1977. By 1993, the dental caries status of 5-6-year-old-children over a period of 16 years remained almost the same (deft 2.7 3.45). The present study was carried out nine years after the cross sectional survey of 1993 in different schools of Chandigarh using the Moller's criteria (1966) among children of the following age groups: 5-6, 9, 12 and 15 years [6] in order to record the incipient carious lesions as well.


   Materials and Methods Top


This study was carried out on a total of 1816 children of the following age groups: 5-6, 9, 12 and 15 years, stratified on the basis of age, sex and socioeconomic status. A total of eight schools were randomly selected from a list of 80 government schools obtained from the Education Department of the Union Territory of Chandigarh, representing both the middle and low socioeconomic status as per the fee structure. While selecting the schools, care was taken to include schools from all the geographical directions.

The children selected for the present study were examined for dental caries using Moller's Index (1966). Recordings were made on the Unilever dental proforma using standardized Hu-Friedy dental probes with a tip diameter of 45 microns so that any remineralization is not disturbed that could have happened with a finer tip probe, i.e., 18 microns, as used by I. J. Moller. The knowledge, attitude and practice of these school children with regard to oral health measures were also recorded on a specially designed computerized proforma to correlate the existing dental caries status with various risk factors. The recording procedure was standardized by repeated sessions of calibration between the examiner and chief supervisor before the start of the actual recording on children. All the recordings were carried out by single examiner in bright day light and the child under examination was made to sit on an ordinary chair facing away from direct sunlight. The recorded data was later punched and statistically analyzed. The distribution of sample in the various age groups is detailed in [Table - 1].


   Results and Discussion Top


The prevalence of dental caries in 459 6-year-old children was found to be 79.74% with a mean deft of 4.00 3.68 and mean defs of 8.96 11.05.

The prevalence of dental caries in the mixed dentition of 9-year-old children was found to be 92.11% with a mean deft + DMFT of 4.61 3.14 and mean defs + DMFS of 9.88 8.46 [Figure - 1]. The intraanalysis showed the mean decayed surfaces to be 9.5 8.2 [Figure - 2], which constituted 96% of the mean defs + DMFS, thereby showing a lack of awareness and motivation regarding the need for restoration of dental caries in young children. The interarch analysis revealed the mandibular arch to be more affected with dental caries in this age group; the mean deft + DMFT were 2.63 1.9 for the mandibular arch and 2.01.7 for the maxillary arch [Figure - 3]. Further analysis revealed the occlusal surfaces to be the most affected with mean defs + DMFS of 4.01 2.8 followed by smooth surfaces, i.e., buccal and lingual (3.5 3.7), and proximal surfaces (2.3 2.7) [Figure - 4].

On evaluating the permanent dentition in 12- and 15-year-old children, the prevalence of dental caries was found to range between 80-87%, the mean DMFT was found to be 3.03 2.52 and 3.82 2.85 respectively; the mean DMFS figures were 4.06 3.91and 5.12 5.12, respectively [Figure - 5]. The intraanalysis of DMFS in these age groups revealed 94% and 97%, respectively, to be constituted of the decayed component (3.96 4.88) missing and filled components being almost negligible [Figure - 6]. Hence, the young adolescents should be motivated to seek dental treatment. The interarch analysis revealed the mandibular arch to be more affected with dental caries with a mean DMFT of 1.76 1.47 and 2.38 1.62 in 12- and 15-year-old children, respectively, in comparison to 1.27 1.35 and 1.44 1.64 in the maxillary arch [Figure - 7]. In the mandibular arch, out of the entire teeth affected with dental caries, the permanent first molars were found to be involved the maximum (80%), followed by permanent second molars (48-75%) and the second bicuspids (4-5%) were the least involved. A similar trend was evident in the maxillary arch (53-68%) first molars, (25-42%) second molars and (4-5%) second bicuspids. The permanent second molars are always at a greater risk of developing dental caries and catch up with the first permanent molars in spite of a lesser period of risk in the oral cavity [7] as compared with the first permanent molars (in the present study 3 years for second molars after their eruption in comparison to 8 years for the permanent first molars).

The surface wise analysis of DMFS revealed a similar trend of involvement, as observed in 9-year-old-children, i.e., occlusal surfaces were found to be the most affected followed by buccal and lingual surfaces and the proximal surfaces were found to be the least affected [Figure - 8].

The children aged 9, 12 and 15 years ( n = 1356) were examined for knowledge, attitude and practice of oral health, thereby revealing a number of factors that possibly contributed to the high prevalence of dental caries. Although there has been an influx of fluoride-containing dentifrices in the city, 80.2% of the total children examined were found to be still using nonfluoridated toothpastes and 99% did not know the importance and effect of fluorides on teeth in spite of the regular flash of advertisements on TV regarding the importance of using a fluoridated tooth paste by the dentifrice manufacturing companies. Regarding the knowledge of sugar exposures, 48.4% had no knowledge regarding the recommended frequency of sugar exposures for the prevention of dental caries; only 4.6% had the knowledge of safe sugar exposures being three per day for the prevention of dental caries. It was seen that 30% of children consumed sweets around five times in a day and only 11.5% restricted the intake to three times in a day. Further, 62.7% children had the knowledge of brushing frequency being thrice daily and only 45% actually practiced it. The knowledge regarding the etiology of dental caries was confined to only 2%, and there was a complete lack of knowledge regarding the preventive effect of fluorides on teeth (99% children).

Chandigarh has recently shown an increase in the dental caries in spite of a high literacy rate of 82% and a favorable dentist population ratio of 1:3000. This increase shows a lack of awareness and proper motivation on the part of the parents to seek periodic preventive oral health checkups and restorative care of their children. Hence, there is an urgent requirement to implement organized preventive school oral-health programs, utilizing the services of school teachers and involving the school health scheme for educating and motivating the children on a continuous basis along with monitoring of dental caries at repeated time intervals. Low levels of fluoride in drinking water (0.3 ppm) could be another possible factor contributing to initiation and progression of dental caries; the optimum being 0.7-1.2 ppm (WHO, 1963) for the prevention of dental caries. [8] Nevertheless, the use of nonfluoride toothpaste by a high percentage of Chandigarh children is another contributing factor. Due to the marketing tactics and lack of awareness regarding the advantages of using fluoride toothpaste, nonfluoride toothpastes are being preferred. The rapid influx of cariogenic foods in the urban sector might have contributed further to this recent increase. The consumption of sugary stuffs like candies, chocolates, wafers, jellies, etc., is on the rise, mainly because of the varieties, easy availabilities in the market and attractive advertisement offers. In schools, candies are distributed generously as part of positive reinforcement and encouraged by the teachers, and celebrations in our country are considered incomplete without sugary stuff.

Trends of dental caries in Chandigarh

The present study was carried out using the Moller's criteria (1966) in comparison to previous studies that were recorded using the WHO Index. [1],[2],[3] In order to compare the results of the present study with previous studies and to deduce the trends of dental caries over the last 25 years, the deft/DMFT values of children of different age groups in 2002 were converted to numerical values as per the WHO criteria, using the conversion methodology of Sahoo et al. [9] In this study the data obtained using WHO Index and Moller's criteria were compared and a difference of 1.0 deft + DMFT and 1.5 defs + DMFS was obtained between the two recording methods, respectively. The higher values of DMFT/DMFS observed using the Moller's criteria confirms it as a more sensitive index that records different grades of carious lesions ranging from incipient to frank caries, whereas WHO criteria mainly records the open carious lesions.

A detailed analysis of the trends of dental caries in Chandigarh school children over three decades [Figure - 9] reveals an almost static trend in 5-6 year-old from 1977-1993 with a slight increase during the last decade from 2.73 3.5 in 1993 to 3.2 in 2002. In the 15-year old, initially a sharp decline in the mean DMFT was evident from 4.7 in 1977 to 1.38 in 1985 and then a gradual decline to 1.25 in 1993; however, during the last decade, a spurt in dental caries has been observed with a mean DMFT of 2.82 in 2002. The trends with regard to 12-year-old children cannot be evaluated, as the data for this age group is available only for three periods of time, viz., 1977, 1993 and 2002. An increasing trend in the dental caries is however evident in these children over the last 9 years. This increase in dental caries in 12- and 15-year-old adolescents is due to the limited use of fluoride tooth paste (12-33%), greater consumption of sugary food stuffs due to the active growth period and neglect of oral hygiene due to casual approach during this period of "identity crisis." Moreover during this age, the enamel of approximal surfaces of newly erupted posterior teeth is undergoing secondary maturation, and thus, they are more susceptible to dental caries. This age group has been labeled as "Key risk age group 3" because of the highest number of intact tooth surfaces and greatest number of surfaces at risk. [7] Children in this age group are in their active growth period and tendency to eat instant energy giving foods, viz., simple carbohydrates, places them at a higher risk of developing dental caries. It is thus essential that plaque control and fluoride measures be intensified to protect the sound tooth surfaces and remineralize the incipient lesions. The recent increase in dental caries in adolescents of Chandigarh points towards an urgent requirement to plan and implement organized school oral-health programs in the city by training the school teachers of all the schools (government and private) in primary preventive strategies of oral health. These trained and motivated school teachers can further be made responsible for implementing these programs in the schools on a regular basis. If this program is maintained throughout the secondary maturation period and the required self-care habits are maintained, there is a possibility that the sound tooth surfaces would remain intact throughout the life of the individual. Nevertheless, weekly/fortnightly fluoride mouth rinse programs should be made an integral part of each and every school of Chandigarh.

 
   References Top

1.Tewari A, Chawla HS. A study of prevalence of dental caries in an urban area of India, Chandigarh. J Indian Dent Assoc 1977;49:231-7  Back to cited text no. 1    
2.Tewari A, Goyal A, Mehta K, Gauba K. Distribution of dental caries in India and South East Asia. In : Johnson NW, editors. Risk markers for oral diseases. Dental Caries (vol-1): Markers of high and low risk groups and individuals. Cambridge Univ Press: Cambridge; 1991. p. 33-61  Back to cited text no. 2    
3.Chawla HS, Gauba K, Goyal A. Trends of dental caries in children of Chandigarh over the last sixteen years. J Indian Dent Assoc 2000;18:41-5  Back to cited text no. 3    
4.WHO Index of dental caries-criteria and method of recording of dental caries. Oral health surveys basic methods. 2 nd ed. WHO: Geneva; 1971  Back to cited text no. 4    
5.World Health Organization. Oral health surveys-basic methods. 3 rd ed. WHO: Geneva; 1983  Back to cited text no. 5    
6.Moller IJ. The clinical criteria for diagnosis of incipient caries lesions. Advance Fluoride Res 1966;4:67-72  Back to cited text no. 6    
7.Axelsson Per. Diagnosis and risk prediction of dental caries. Vol 2.2000;153-4  Back to cited text no. 7    
8.World Health Organization (1963). International standards of drinking water  Back to cited text no. 8    
9.Sahoo PK. An epidemiological study relating dental caries with specific risk factors and assessment of treatment needs in the child population of Orissa. Thesis submitted in partial fulfillment of the requirements for M.D.S. degree of Punjab University. (1986)  Back to cited text no. 9    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9]
 
 
    Tables

  [Table - 1]


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