|Year : 2014 | Volume
| Issue : 3 | Page : 231-237
The oral health status of institutionalized children that is, Juvenile home and orphanage home run by Gujarat state Government, in Vadodara city with that of normal school children
Ankita Gaur1, Sunanda Gul Sujan2, Vishal Katna3
1 Department of Pedodontics and Preventive Dentistry, Himachal Dental College and Hospital, Sunder Nagar, Mandi, Himachal Pradesh, India
2 Department of Pedodontics and Preventive Dentistry, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Pipariya, Vadodara, Gujarat, India
3 Department of Prosthodontics, Himachal Dental College and Hospital, Sunder Nagar, Mandi, Himachal Pradesh, India
|Date of Web Publication||2-Jul-2014|
Department of Pedodontics and Preventive Dentistry, Himachal Dental College and Hospital, Sunder Nagar, Mandi - 175 002, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Dental Caries and Periodontal Diseases are widespread and virtually everybody suffers from them, and in global scenario dental caries are the most prevalent oral diseases among children. Observation home serve as temporary holding facilities of juvenile and orphans who are arrested by police or found to be living in neglected. Aim: The aim of the study was to evaluate oral health status (caries prevalence, dmft, DMF, OHI index) of the institutionalized children that is, juvenile home, orphanage home run by Gujarat Government in Vadodara city with that of normal school children. Design: Cross-sectional study was conducted among the 166 children residing in juvenile and orphanage home with 384 school children. Results: The prevalence of dental caries was higher among the school going children (62.12%) with juvenile group having (52.4%) but the oral hygiene was poor among the juvenile group children with respect to those of school going group. Conclusion: It is concluded from the present study that juvenile group children had lower caries prevalence but poor oral hygiene status in contrast to school going children.
Keywords: Dental caries, institutionalized children, Juvenile home, oral health, orphanage home
|How to cite this article:|
Gaur A, Sujan SG, Katna V. The oral health status of institutionalized children that is, Juvenile home and orphanage home run by Gujarat state Government, in Vadodara city with that of normal school children. J Indian Soc Pedod Prev Dent 2014;32:231-7
|How to cite this URL:|
Gaur A, Sujan SG, Katna V. The oral health status of institutionalized children that is, Juvenile home and orphanage home run by Gujarat state Government, in Vadodara city with that of normal school children. J Indian Soc Pedod Prev Dent [serial online] 2014 [cited 2019 Feb 21];32:231-7. Available from: http://www.jisppd.com/text.asp?2014/32/3/231/135833
| Introduction|| |
Good oral health is an integral component of good general health. Although enjoying good oral health includes more than just having healthy teeth, many children have inadequate oral and general health because of active and uncontrolled caries.  Dental caries and periodontal diseases are widespread and virtually everybody suffer from them. Dental caries is the most prevalent disease among children in the global scenario. According to World Health Organization (WHO) it is next to the common cold in children. Several studies undertaken in different parts of the country show that dental caries has been consistently increasing in its prevalence and severity.  Oral health and general wellbeing are inextricably bound to each other. If the oral health of children develops unfavorably, they should be considered a risk group demanding special attention for planning of Dental Health Program.
The Indian Juvenile Justice system, the Juvenile Justice Act (Care and Protection of Children), approved in 2000 to reform the 1986 Act, is designed as a comprehensive legal framework by which the Indian government has pledged to alleviate the devastating impact that underdevelopment, poverty, and crime have on children. The act spells out the government's responsibilities in the care, the protection, and the development of neglected children, but also tackles issues-related to crime prevention and the rehabilitation of Juvenile delinquents. 
The provisions contained in the Juvenile Justice Act apply to two categories of children: Those defined "in conflict with the law" and those considered as "in need of care and protection." The act sanctioned the establishment of new institutions charged with the care of neglected and delinquent children. Observation homes serve as temporary holding facilities for Juveniles who were arrested by the police or found to be living in neglect. The Juvenile Justice Act invests the government with the responsibility to care, protect, and work for the development and Rehabilitation of Neglected and Delinquent Juveniles. Every observation home to which a Juvenile is sent under the act shall not only provide the child with accommodation, maintenance, and medical assistance, but also provide him/her with facilities for useful occupation. 
The aim of this survey was to determine and compare "the oral health status of institutionalized children that is, Juvenile home and orphanage home run by Gujarat state Government, in Vadodara city with that of normal school children."
| Aims and Objectives|| |
The groups in the most oral health survey conducted worldwide have consisted primarily of children, adolescents, and adults from the general population. Among the disadvantaged groups, the health of the prisoners is of great concern particularly because the number of the persons under jurisdictions of corrections systems, including those on probation or parole, continues to increase dramatically. It is generally acknowledged from extensive research that correctional population are more vulnerable to a wide range of health problems, commonly being infectious disease, chronic disease, mental illness, psychosocial and psychiatric problems. Currently, one under-researched area has been the oral health status and dental epidemiological investigations of the Juvenile in the prison environment but such studies are important in order to expand the level of knowledge.
Aim of the study
- To evaluate the oral health status of institutionalized children that is, Juvenile home and orphanage home run by Gujarat state Government, in Vadodara city with that of normal school children.
Objectives of the study
- To determine the caries prevalence among the institutionalized children and that of the normal school going children and to correlate the findings
- To calculate the decayed, missing, filled teeth (dmft), DMFT and the oral hygiene index (OHI)-index among the groups
- To determine the frequency of snacking, brushing habit on oral health of the groups.
| Materials and Methods|| |
Instrument and supplies
The following instruments and supplies in sufficient number were used:
- Plain mouth mirrors
- Community periodontal index (CPI) probe
- Kidney trays
- Gloves and mouth masks
- Cotton rolls
- Cloth hand towels
- Savlon solution (chlorhexidine solution i.p. 1.5% v/v and strong cetrimide solution b.p. equivalent to i.p. 3.0% v/w, colors: Tetrazine and Sunset Yellow FCF)
Details of examination
The clinical examination of all Juvenile, orphanage and school children was entirely done by a single investigator. Before conducting the survey, the investigator was calibrated at Department of Pedodontics and Preventive Dentistry under the guidance of a professor in order to limit examiner variability. A recording clerk was trained to assist in the recording procedure throughout the study.
Method of sampling
To assume homogeneity of the sample the map of Vadodara city was procured and the city was arbitrarily divided into five zones that is, North, East, West, South and Central zone. The education Department of Municipal Corporation was approached to collect the information of schools functioning in each zone. Permission was obtained from the concerned authorities like, Headmaster, Research and Ethical Committee of Sumandeep Vidyapeeth University, Pipariya, Vadodara, Gujarat, India before examining of children. Thus out of five zones a total of 384 school going children were examined (double the sample of children residing in Juvenile and orphanage home), which constituted the representative sample for the study.
Method of examination
American Dental Association (ADA) type III examination technique  was used:
Each child was examined on an ordinary upright chair with the help of mouth mirror and CPI probe in an adequate natural light. Prior to examination, the child was asked to rinse the mouth thoroughly. The teeth were then cleaned and dried with cotton roll to eliminate confusing effects of food debris and saliva. The examination was done by one examiner only to eliminate error. It was carried out in the uniform manner, starting from the most posterior tooth in maxillary right quadrant and then in a clockwise direction.
Recording criteria for dental caries
The dental caries was assessed as per the WHO criteria (1997) and dmft, decayed, missing, filled surfaces index (dmfs) for primary teeth and DMFT, DMFS for permanent teeth were calculated based on same. The data was recorded on modified WHO oral health assessment form (1997).  25-30 children were examined every day.
- dmft and dmfs for primary dentition
- DMFT and DMFS for permanent dentition.
Information can be calculated from the information of WHO dentition status and treatment needs. The d-component includes all teeth with codes 1 (B) or 2 (C). The m-component compromises teeth coded 4 (E) that is, missing due to caries the f-component includes teeth with code 3 (D) filled with no decay.
Recording criteria for oral hygiene index-index
The OHI was developed in 1960 by John C. Greene and Jack R. Vermillion to classify and assess oral hygiene status. Even though, the OHI was determined to be simple and sensitive, it was time consuming and required more decision making. Hence, an effort was made to develop a more simplified version with equal sensitivity.
The simplified OHI (OHI-S) differs from OHI in:
- The number of tooth surfaces recorded (6 rather than 12)
- The method of selecting the surface to be scored
- The scores, which can be obtained.
However, the criteria and scoring for the tooth surface, remain the same.
Surface and teeth to be examined:
- 16, upper right first molar, buccal
- 11, upper right central incisor, labial
- 26, upper left first molar, buccal
- 36, lower left first molar, lingual
- 31, lower left first central incisor, labial
- 46, lower right first molar, lingual.
Examination method and scoring system
The surface area of the debris is examined by running the side of explorer or probe along the tooth surface being examined. The occlusal or incisal extent of debris is noted as it is removed.
Calculation of DI = Total score/number of surfaces examined
The oral hygiene examination and scoring for DI always should precede the oral examination and scoring for calculus index (CI).
There are basically two main types of dental calculus, which are differentiated primarily by location on the tooth in relation to free gingival margin.
- Supra-gingival calculus
- Sub-gingival calculus.
Calculation of CI = Total score/number of surfaces examined
Calculation of simplified oral hygiene index
Once the debris index-simplified ( DI-S) and CI-simplified (CI-S) are calculated separately then, they are added together to get the OHI-S score.
OHI-S = DI-S + CI-S
The following methods of statistical analysis have been used in this study. Data were entered in Microsoft excel spreadsheet and analyzed using IBM SPSS (version 12). Qualitative data were presented as frequency and percentages.
The Chi-square test was applied to study the association of the prevalence of dental caries with various risk factors.
For all tests, the level of significance was set at P ≤ 0.05.
| Discussion|| |
Voluminous literature exists on the status of dental caries in the Indian school children by different investigators e.g., Misra and Shee,  El_Qaderi SS and Quteish Ta'ani D  and Al-Haddad KA et al. etc. Currently, one under-researched area has been the oral health status and dental epidemiological investigations of the Juvenile in the prison environment. Such studies are important in order to expand the level of knowledge. 
The prevalence percentages of this study along with those of previous studies conducted in India for the school going children has come out to be more or less similar. However, as each study was conducted and reported differently, it is not possible to compare all the results as here we have compared the oral health status of the Juvenile and orphanage children with the school going children of Vadodara city.
The present study showed caries prevalence of 62.12% with higher prevalence among the boys (64.34%) and girls (59.04%) in 6-14 years old school going children which is lower than the study done by Retnakumari N (68.50%) [7 ] and Rao et al. (76.9%), [10 ] and higher than Kapoor et al. (49.1%),  Misra and Shee (60.4%), [ 5 ] and Dhar et al. (46.75%). 
Age and sex
In this study, boys showed higher caries prevalence (54.5%) than girls (45.7%). Similar findings were reported by Rao et al. (77.4% and 76.5%, respectively)  and Dhar et al. (48.18% and 45.16%, respectively).  The increased prevalence in boys confirms the view that there is a marked preference for male child regardless of the socioeconomic class, which manifests itself in the better feeding to them compared with female child. It also may be due to their habits of taking soft drinks and other sweetened snacks during their longer stay outside. These results are in contrast to Misra and Shee  as they found higher prevalence in girls (65%) than in boys (58.7%).
The caries prevalence in this study increased as the age increased from 6 years (52.3%) to 10 years (6.9%) and then decreased with lowest being at age of 12 years (1.1%). The results are similar to that of Misra and Shee  and Rao et al. This is because of longer exposure of primary molars to the food habits in the age group of 8-10 years. Another reason is improper cleaning of teeth in early childhood and frequent intake of sweet and sticky food. These findings are contradictory to the study done by Retnakumari N. 
The caries prevalence was found to be higher among the children of school group in comparison to the children of Juvenile group. In the Juvenile group, boys had less caries in both the deciduous dentition (17.6%) as well as permanent dentition (13.6%), whereas boys in school group had more caries in both the deciduous dentition (38.7%) as well as permanent dentition (26.1%). A similar trend of lower caries was observed among the girls in Juvenile group in both deciduous (16.3%) and permanent dentition (13.2%), whereas increased caries prevalence was seen among the girls of school group, with higher caries prevalence in the deciduous (29.4%), and lowered caries in permanent dentition (13.0%). The difference of caries prevalence among the two groups was observed mainly because of the lack of in availability of sugars, carbohydrate rich sticky foods to the Juvenile group children.
Frequency of brushing
In this study, most of the Juvenile group children (99.4%) brushed their teeth only once, while very small percentage (0.6%) brushed twice whereas, among the school group children (72.7%) brushed once and (27.3%) brushed twice a day. These findings were highly significant in relation to oral hygiene. This may be due to nonavailability of brushing aids (toothbrush and toothpaste) regularly and lack of guidance, assistance during brushing.
Frequency of snacking
This study revealed least habit of snacking between meals in Juvenile group, whereas frequent habit was observed among the school children. This finding was highly significant in relation to dental caries, as caries was more prevalent among the school children than in Juvenile group.
The food habits play an important role in the causation of dental caries. The introduction of refined sugar (sucrose) into the modern diet has been associated with the increased caries prevalence. Since the time of early Greek philosophers diet has been suspected of influencing the etiology of caries. The direct relation of frequency of sweet, sticky snacks and dental caries incidence has been proved by Gustafsson et al.  in the Vipeholm dental caries study.
Oral hygiene index
Children of Juvenile group had much poor oral hygiene in comparison to the school going children. The boys of the Juvenile group had a poor OHI (61.36%) with girls having comparatively better (58.97%). Among the school group children, both boys and girls had a fair oral hygiene with the index value of 56% and 54.89%, respectively.
In both groups, boys exhibited poor oral hygiene when compared with the girls.
Children of Juvenile group had a poor oral hygiene when compared with the school going children since there was no one to guide them for the maintenance of proper oral hygiene and even because of lack of availability of material to be provided by the authorities on time.
| Results|| |
The data obtained from the study were subjected to statistical analysis. The results are presented under the headings of various parameters considered for the study.
A total of 166 Juvenile and orphanage home children were examined and compared with 384 school going children from the age between 6 and 12 years [Table 1] and [Figure 1].
The samples were asked for their frequency of brushing habit (once or twice) [Table 2] and [Figure 2].
The samples were questioned for their habit of snacking in between the meals as occasionally, moderately and frequently [Table 3] and [Figure 3].
Total caries prevalence in the study was found to be different among both the groups. Juvenile home boys had a caries prevalence of (54.5%) and girls (50.7%), whereas among the school group the boys had a higher caries prevalence of (64.34%) and girls (59.04%). In the Juvenile group, boys had less caries in both the deciduous dentition (17.6%) as well as permanent dentition (13.6%), whereas boys in school group had more caries in both the deciduous dentition (38.7%) as well as permanent dentition (26.1%). A similar trend of lower caries was observed among the girls in Juvenile group in both deciduous (16.3%) and permanent dentition (13.2%), whereas increased caries prevalence was seen among the girls of school group, with higher caries prevalence in the deciduous (29.4%), and lowered caries in permanent dentition (13.0%) [Table 4] and [Figure 4]. The caries prevalence for boys and girls in the juvenile group showed an increasing trend, with boy
s of 12 years age group and girls those of 11 years respectively showed maximum dental decay [Table 5] and [Figure 5].
|Figure 5: Distribution of sample according to age and gender with respect to prevalence of dental caries among the Juvenile group children|
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|Table 4: Distribution of sample according to age and gender with respect to prevalence of dental caries among the school group children|
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|Figure 4: Distribution of sample according to age and gender with respect to prevalence of dental caries among the school group children|
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|Table 5: Distribution of sample according to age and gender with respect to prevalence of dental caries among the Juvenile group children|
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Declining trend of dental caries was observed for both the permanent and deciduous set of dentition among both the juvenile and school going children group [Table 6] and [Figure 6], [Table 7] and [Figure 7].
|Table 6: Distribution of sample for decayed permanent dentition based upon the age among the two groups (Juvenile and school going children)|
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|Table 7: Distribution of sample for decayed deciduous dentition based upon the age among the two groups (Juvenile and school group children)|
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|Figure 6: Distribution of sample for decayed permanent dentition based upon the age among the two groups (Juvenile and school children group)|
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|Figure 7: Distribution of sample for decayed deciduous dentition based upon the age among the two groups (Juvenile and school group children)|
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| Summary and Conclusion|| |
The following were the conclusions made from the present study:
- The prevalence of dental caries among the Juvenile and orphanage group was lower (52.4%) than that of school going children (62.12%)
- The percentages of decayed component in deciduous as well as permanent dentition among the boys of school group children was higher (38.7% and 26.1%, respectively) than that of the girls of same group (29.4% and 13.0%, respectively)
- Similar trend was observed in both boys and girls of Juvenile group, with boys showing higher prevalence in both deciduous and permanent dentition (17.6% and 13.6%, respectively), when compared to girls of same group (16.3% and 13.2%, respectively)
- There was a significant correlation between the frequency of brushing, with dental caries and oral hygiene
- A definite positive correlation was established between the frequency and consumption of sweets and dental caries. The study revealed an important result that the children of Juvenile home did not have the habit of frequently snacking in between the meals because of nonavailability of sweets and snacks, whereas the school children had frequent habit of snacking in between meals
- Another important fact revealed from the study was the oral hygiene of the two groups. Children of Juvenile group (both boys and girls) had a poor OHI, when compared with the school group children (both boys and girls). This observation is attributed to irregular supply of cleansing aids (toothbrushes and toothpaste) to the Juvenile group and also due to the lack of assistance while brushing.
| Conclusion|| |
From this study, it is concluded that Juvenile group of children had lower caries prevalence, but poor oral hygiene status in contrast to school going children. Thus, there is a need for frequent dental health checkup camps in both places so as to improve dental health.
| Acknowledgments|| |
Thanks to the superintendent of the Juvenile home Vadodara and the principals of the school for giving permission to examine the children.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]