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ORIGINAL ARTICLE
Year : 2014  |  Volume : 32  |  Issue : 1  |  Page : 3-8
 

Oral health status of 5 years and 12 years old school going children in rural Gurgaon, India: An epidemiological study


1 ESIC Dental College, New Delhi, India
2 SGT Dental College, Haryana, India
3 Max Hospital, Gurgaon, Haryana, India

Date of Web Publication15-Feb-2014

Correspondence Address:
Meenu Mittal
A-29, Ground Floor, Hauz Khas, New Delhi - 110 016
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.127039

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   Abstract 

Background and Aims: Oral health is an essential component of health throughout life. Hardly any information is available on the oral health status of children in Gurgaon. Thus, the present study was conducted among 5-year-old and 12-years-old children in schools in rural Gurgaon. Materials and Methods: A total of 1003 children were examined of which 619 were in 5 years age group and 384 in 12 years group. The prevalence of dental caries was studied using dentition status and treatment needs index. For dental calculus criteria of Community Periodontal and for dental fluorosis Dean's index was used. Results: In 5 years age group prevalence of dental caries was 68.5%, dental fluorosis was 22.5% and treatment needs were 63.7%. In 12 year age group prevalence of dental caries was 37.5%, dental fluorosis was 76.04%, highest community periodontal index score was 2, seen in 80.2% and overall treatment needs were 44.3%. Conclusion: Preventive approaches seem to be a viable alternative to tackle the overwhelming problem of dental caries and other oral diseases. Provision of oral health education in schools and school based preventive programs are important for improvement of this situation.


Keywords: Community periodontal index, dental caries, dental fluorosis, Gurgaon, treatment needs


How to cite this article:
Mittal M, Chaudhary P, Chopra R, Khattar V. Oral health status of 5 years and 12 years old school going children in rural Gurgaon, India: An epidemiological study. J Indian Soc Pedod Prev Dent 2014;32:3-8

How to cite this URL:
Mittal M, Chaudhary P, Chopra R, Khattar V. Oral health status of 5 years and 12 years old school going children in rural Gurgaon, India: An epidemiological study. J Indian Soc Pedod Prev Dent [serial online] 2014 [cited 2018 Nov 17];32:3-8. Available from: http://www.jisppd.com/text.asp?2014/32/1/3/127039



   Introduction Top


Oral health has always been an inseparable part of general health and affects the total wellbeing of individuals. The unique characteristic of oral and dental diseases is that they are universally prevalent and do not undergo remission or termination if untreated and require technically demanding expertise and time consuming professional treatment. [1] However millions of individuals suffer from dental caries and periodontal disease resulting in unnecessary pain, difficulty in chewing, swallowing and speaking and increased medical costs. [2] Among oral diseases, dental caries is an important dental public problem in India and is predominantly a disease of childhood. [3] Dental caries remains a major public health problem in most industrialized countries especially for those countries where preventive programs have not been established. [4]

Periodontal disease has been accepted as one of the most widespread diseases of mankind by World Health Organization (WHO). [5] If untreated, can release bacteria in the blood stream and worsen the condition of patients suffering from heart disease and other similar ailments. Dental fluorosis occurs as a result of disruption in enamel development and is seen as opacities in enamel.

Assessment of oral health is important in deciding a treatment plan or dental public health program. Though 85% of India's population reside in rural areas, limited specific studies have been carried out to study the incidence of dental diseases in the rural population. To counter the ever present threat of dental caries and other oral diseases, prompted us to study the prevalence of dental fluorosis, caries and periodontal disease in rural Gurgaon, Haryana, India from where no previous data was available. The data collected can help the oral health planners to plan and execute appropriate preventive and curative measures for dental diseases.


   Materials and Methods Top


The present study was conducted in schools of rural Gurgaon. Necessary approval from school authorities was taken. Children in the age group of 5-6 (categorized as 5 year age group) and 12-13 (categorized as 12 years group) who were present on the day of examination were examined. A total of 1003 children were examined of which 619 were in 5 years age group and 384 were in 12 years group. The clinical examination was performed on simple, straight chairs, using plane mouth mirrors and community periodontal index (CPI) probe under natural day light. Three examiners examined the children. The recording procedures were standardized by repeated session of calibration between the examiners. Teeth were cleaned using cotton with a tweezer if debris was present. Instruments were sterilized at the end of the day after single use. Simplified basic oral health survey (WHO form 1997) was used to collect the data. Dental caries was assessed by dentition status and treatment needs (WHO 1997). CPI was used to record periodontal status, whereas dean index was used to assess dental fluorosis. Oral health education was given to the school children in each school. Data obtained was statistically analyzed using Chi-square tests and student t-test.


   Results Top


A total number of 1003 school going children in the age group of 5 years and 12 years were examined. Of the 619 children examined in 5 year age group, 304 (49%) were males and 315 (51%) were females [Table 1]. In 12 year age group, total children were 384, of which 228 (59%) were males and 156 (41%) were females [Graph 1]. [Table 2] shows the dental caries assessment of 5 and 12 year age groups. In the 5 year group prevalence of dental caries was 68.5% with 69.4% in males and 67.62% in females. In the 12 year age group, overall caries prevalence was 37.5% with 41% in males and 33% in females [Graph 2]. There was no statistical significant difference in caries prevalence between males and females in both age groups (P > 0.05).





In the 5 year age group [Table 2], overall mean decayed missing and filled teeth (dmft) score was 1.93 ± 0.43 (1.95 ± 0.45 in males and 1.92 ± 0.60 in females) [Graph 3]. The difference in dmft scores between males and females was not statistically significant (P > 0.05, t-test). Of the 1195 dmft teeth in 5 year group, total number of decayed teeth was 1064 (89.03%), missing were 91 (7.62%) and filled were 40 (3.35%) [Graph 4].

In the 12 year age group [Table 2], overall mean DMFT score was 1.0 ± 1.48, with 1.04 ± 1.43 in males and 0.93 ± 1.56 in females [Graph 3]. The difference between DMFT scores of males and females was not statistically significant (P > 0.05, t-test). Of the 384 DMFT teeth in 12 year age group, decayed were 320 (83.3%), missing were 6 (1.88%) and filled were 58 (15.1%) [Graph 4]. Comparing a range of DMFT/dmft scores [Table 3], the differences in DMFT/dmft ranges of 0, 1-3 and more than 3 was not statistically significant between males and females in both the age groups (P > 0.05, Chi-square test). [Table 4] shows prevalence of dental fluorosis. In 5 year age group, overall prevalence of fluorosis was 22.5%; with 26.3% of males affected and 18.7% of females affected. In 12 year age group, overall prevalence was 76.04%; with 79.39% of males affected and 71.15% of females affected [Graph 2]. The difference between males and females in 5 year group was statistically significant (P < 0.05, Chi-square test) and non-significant in 12 year group.
Table 1: Age and sex distribution of subjects

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Table 2: Dental caries assessment in 5- and 12-year-old

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Table 3: DMFT/dmft score range for 5- and 12-year-old

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Table 4: Prevalence of dental fluorosis in 5 years and 12 years

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Considering the severity of dental fluorosis [Table 5], no statistically significant difference in severity was found between males and females in both the groups (Chi-square P > 0.05). Highest fluorosis value was 3 in 5 year age group, which was seen in 1.3% of cases. The highest fluorosis value in 12 year group was 5, which was seen in 15.9% of cases. [Table 6] shows CPI scores in 12 year age group. CPI score 0 was seen in 8.07% children, of which 4.82% were males and 12.8% were females. CPI score 1 was seen in 11.7% children, of which 10.52% were males and 13.5% were females. Overall CPI score 2 was seen in 80.2% with 84.7% males and 73.7% females [Graph 2]. Males were affected more than females showing statistical significance (P < 0.05).
Table 5: Severity of dental fluorosis

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Table 6: Gingival and periodontal assessment by using CPI scores (12 years)

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As can be seen in [Table 7], total number of children requiring treatment was 564 (56.23%), out of which number of children requiring treatment was 394 (63.7%) in 5 year old group while it was 170 (44.3%) in 12 year old group [Graph 5]. This difference in treatment needs between two age groups was highly significant (P < 0.05).
Table 7: Distribution of subjects according to type of treatment needs

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In 5 year age group treatment needs were, one surface restoration 13.1%, two or more surface restoration 26.7%, crown 4.2% and veneer/laminate 6.3%, pulp care restoration 7.1%, extraction 1.1% and other care 5.2%. In 12 year age group treatment needs were, one surface restoration 34.4%, two surface restoration 9.4%, crown 0.5%, veneer/laminate 0.5%, pulp care restoration 3.4%, extraction 1.8% and other care (radiographs, crown and bridge work) 5.2% [Graph 5].


   Discussion Top


The WHO oral health goals advocated for year 2010 of DMFT in 12 year old was below one and for 2000 it was below three. For 5-6 year old the goal for 2000 was 50% of 5-6 year old will be caries free. This study showed that our population has reached none of these targets.

5-6 years (combined as 5 year age group) and 12-13 years (called as 12 year age group) as age groups were chosen as these are the global monitoring age for dental caries and for international comparisons and monitoring of disease trends. The study was targeted at school going children because of the ease of accessibility.

All studies reported by other authors cannot be compared with present investigation as these authors have not used WHO index excepting a few.

A low caries experience was seen in 12 year age group when compared to 5 year age group. Similar findings, i.e., caries decrease from 5 to 12 years age group have been reported by many studies. [2],[3],[6],[7],[8] Dash et al. [9] observed a pattern in which carries was increasing from 5 years to 8 years and subsequently decreased at 11 and 15 years. In a study by Grewal et al. [10] reported that child population exhibited caries prevalence of more than 60% until the age of 11 years and showed a decline to 36% at the age of 12 years. Ratnakumari [11] reported in her study that there was no increase in prevalence of caries as age increases (prevalence at 6 years was 67.5% and at 12 years 67.2%). Though some authors have also reported increased caries incidence with an increase in age. [12],[13] Reason behind this high caries in 5 years could be that thickness of enamel in the deciduous teeth is less than that of permanent teeth being 1 mm and 2.5 mm respectively. [6] Thinner enamel layer combined with a set of other factors, such as a diet higher in sugars and/or the inability of a younger child to properly brush their teeth on their own [14] cumulates the effect. Lower calcium content of deciduous teeth and structural differences [3],[15] may increase caries susceptibility in deciduous teeth [3] along with lack of preventive measures. [15] Another reason could be that WHO index does not record incipient caries but records only when the caries involves dentin, resulting in slight underestimation of caries in 12 year group.

In both the groups, the decayed teeth accounted for the greatest %age of total DMFT/dmft value. This is in accordance with Kulkami and Deshpande, [13] Saravanan et al., [3] Rodrigues and Damle, [12] Mandal et al., [6] Mahesh Kumar et al. [16] This may be attributed to lack of awareness, neglect, lack of motivation, the lack of availability of dental facilities or may be due to economic constraints.

An evaluation of treatment needs revealed that the greatest need was for restorations (one surface or two or more surface). Greatest need for restorations indicates a lack of restorative treatment, preventive oral care facility and awareness among the population. Two surface restoration requirements was more than one surface in 5 year age group, though reverse was the case in 12 year age group. Reason could be that there are more chances of occlusal caries in permanent teeth as they have deeper pits and fissures when compared to deciduous teeth.

Prevalence of dental fluorosis was very high, 22.5% in 5 year age group and 76.04% in 12 year group. This further proves that Gurgaon belongs to endemic zone of fluorosis. High prevalence of fluorosis could be due to the presence of fluoride in ground water as most of the population in the rural area use ground water for drinking, may be due to tradition/belief or non-availability of central pipe water supply.

CPI score of 2 was seen in 80.2% children in 12 year age group and score 1 in 11.7% children. This could be due to mixed dentition period, shedding of primary teeth, ineffective maintenance of oral hygiene and pubertal changes. [16],[17] Other reason could be lack of dental health education and motivational programs. Similar high level of CPI have been reported by Mahesh Kumar et al., [16] Alexander et al. [17] Males were affected more than females. This can be explained on the basis that girls usually exhibit better oral hygiene levels and report more frequent and regular tooth brushing than boys. [18],[19] Preventive approaches seem to be a viable alternative to tackle the overwhelming problem of dental caries and other oral diseases. Screening for dental caries and its sequelae should be included in school health program. The school health program involving volunteers and school teachers since they are easily accessible, accepted and aware of local traditions, taboos and health attitudes; needs to be developed as part of primary health care facility. [17]

 
   References Top

1.Jose A, Joseph MR. Prevalence of dental health problems among school going children in rural Kerala. J Indian Soc Pedod Prev Dent 2003;21:147-51.  Back to cited text no. 1
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15.Dukiæ W, Delija B, Luliæ Dukiæ O. Caries prevalence among schoolchildren in Zagreb, Croatia. Croat Med J 2011;52:665-71.  Back to cited text no. 15
    
16.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 Pedod Prev Dent 2005;23:17-22.  Back to cited text no. 16
    
17.Alexander S, Hegde S, Sudha P. Prevalence of malocclusion and periodontal status in Tibetan school children of Kushalnagar, Mysore district. J Indian Soc Pedod Prev Dent 1997;15:114-7.  Back to cited text no. 17
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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