|Year : 2016 | Volume
| Issue : 2 | Page : 124-127
Assessment of social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending Anganwadis of Hingna, Nagpur
Shweta Suresh Bhayade, Rakesh Mittal, Shweta Chandak, Ashish Bhondey
Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
|Date of Web Publication||14-Apr-2016|
Dr. Shweta Suresh Bhayade
Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: In developing countries, dental caries is the most common disease of the early childhood. Its increased prevalence in younger age group have been predictive of oral health problems in future, affecting oral health and development leading to several morbid conditions of oral and general health. Prevalence and incidence of dental caries is highly influenced by a number of risk factors such as gender, age, socioeconomic status, dietary patterns, and oral hygiene habits. Aim: To assess social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending Anganwadis of Hingna, Nagpur. Materials and Methodology: A cross sectional study in 27 Anganwadis of Hingna, Nagpur was carried out over a period of two months and a total of 324 subjects attending the Anganwadis were enrolled. Social, demographic and oral hygiene practices in relation to dental caries were assessed in the study population. Results: Out of 324 subjects, 206 had dental caries and 38 were found to be malnourished. A significant association was found among age, malnutrition, parent's educational status, oral hygiene practices, total number of siblings, and dental caries. Conclusion: Anganwadis should be addressed routinely on effective oral and general health promoting strategies which must include education of parents, oral and general health issues, risk factors for dental caries, and malnutrition in children below 5 years of age.
Keywords: Anganwadis, dental caries, malnutrition, prevalence
|How to cite this article:|
Bhayade SS, Mittal R, Chandak S, Bhondey A. Assessment of social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending Anganwadis of Hingna, Nagpur. J Indian Soc Pedod Prev Dent 2016;34:124-7
|How to cite this URL:|
Bhayade SS, Mittal R, Chandak S, Bhondey A. Assessment of social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending Anganwadis of Hingna, Nagpur. J Indian Soc Pedod Prev Dent [serial online] 2016 [cited 2019 Jul 17];34:124-7. Available from: http://www.jisppd.com/text.asp?2016/34/2/124/180415
| Introduction|| |
"Courtyard Shelter" in India is also called as Anganwadi. It was established in 1975 by the Government of India as a part of the Integrated Child Development Services Program to combat child hunger and malnutrition. Anganwadi is a part of Indian public health care system. It caters for children up to 6 years of age. It provides supplementary nutrition, immunization, nutrition and health education, nonformal preschool education, preschool activities, and health check-ups. Anganwadi centers also provide basic health care in Indian villages. 
Dental caries is progressive destruction of teeth by bacteria. Caries at a younger age group leads to several morbid conditions of the oral cavity and also other systems of the human body.  It varies with age, sex, socioeconomic conditions, ethnicity, diet, oral hygiene practices, and medical conditions of the patient.  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. 
Children attending Anganwadis mostly belong to rural and urban slum areas with marked lower level of socioeconomic strata, poor feeding practice and dietary patterns, lower levels of education of parents, poor health awareness, and oral hygiene ultimately leading to increase in the incidence of dental caries. 
Malnutrition affects the development of the oral cavity and the progression of the oral diseases through an altered tissue homeostasis, which causes reduced resistance to the microbial bio-films leading to reduced tissue repair capacity. 
| Materials and Methods|| |
A cross-sectional study was carried out in 27 Anganwadis of Hingna, Nagpur, over a period of 2 months. Ethical clearance was obtained from the institution. Informed consent was obtained from the parents and head of all the Anganwadis. Out of 324 subjects, 213 were males and 111 were females. Intraoral examination was carried out by a single calibrated dentist using diagnostic instruments under all aseptic precautions and nature day light. Subjects below 5 years were included in the study. Handicapped and children with major debilitating illness were excluded. Data collection was done according to name, age, gender, nutritional status, education of parents, oral hygiene practices, and number of siblings which was obtained from the heads of Anganwadis by means of a predesigned questionnaire. Dental caries were noted using "decayed, missing, and filled teeth" index (WHO 1997). The collected data were subjected to suitable statistical analysis.
| Results|| |
Out of 324 subjects 206 had dental caries, i.e., the prevalence rate was 63.58% in the present study [Table 1]. However, out of total sample, males were affected more than females [Table 2]. Significant prevalence of dental caries in subjects of 2-4 years of age was found [Table 3]. A strong association between caries prevalence was seen in all the subjects suffering from malnutrition and with low parents' education level [Table 4] and [Table 5]. Caries prevalence was also highly significant in subjects with poor oral hygiene practices and in subjects who had started cleaning their teeth by the age of 24 months. It was found to be less in subjects who had started cleaning their teeth by the age of 6 months [Table 6]a. Caries prevalence was found to be more in subjects who were cleaning their teeth using a toothpowder and finger [Table 6]b. [Table 7] represents that caries prevalence was more in study subjects who were having more than one sibling. All the variables in the study were compared using a cross-tabulation procedure and the relative proportions were analyzed using the Chi-square test.
| Discussion|| |
The aim of the present study was to assess social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending Anganwadis. The caries prevalence was 63.58% in the present study which was similar to a study reporting prevalence rate of caries in Udupi which was 65.5% in 2-5 years of age group.  It was found that occurrence of dental caries was more in the age group between 2 and 4 years. This may be due to inappropriate dietary habits and lack of development of motor co-ordination at this age preventing the child from brushing the teeth. In the present study, dental caries prevalence was significantly higher in the males than females. This difference could be due to the diet pattern, and cultural differences seen in Indian society where males are given priority.  This was similar to a study carried out in Karnataka.  A strong predilection was found between caries prevalence and subjects suffering from malnutrition. In previous studies, presence of malnutrition have demonstrated increased caries levels with both pre- and post-natal nutritional deficiencies. ,, For the maintenance of a healthy oral cavity, normal functioning of the salivary gland is important. Hypo-functioning of the salivary glands has been reported with malnutrition, which results in a decreased salivary flow rate, buffering capacity, and decreased salivary proteins. All these factors attribute to increase demineralization of the inorganic part of the tooth structure causing dental caries.  A significant association was found between dental caries prevalence and parents' low education level. It may be due to the fact that parents themselves are not aware of good oral hygiene practices due to lack of proper education. This finding was in line with the observation made by Prabhu et al. in Karnataka  and by Holan et al. in an Arab community in Israel.  Subjects with low levels of parents' education had more dental caries. It has been reported earlier that parental education have a direct impact on child's oral health. , Parents with low-educational level and low income tends to pay less attention on dental health and preventive visits to a dentist, ultimately resulting in the development of dental caries in children at early age.  It was observed that the subjects who do not clean their teeth and who have started cleaning teeth at the age of 24 months had significantly more caries. These findings were similar to a study carried out in 2013.  Finger and toothpowder was the method of cleaning mostly used by the study subjects. This suggests that the initiation of brushing habit is late and there is lack of awareness on brushing habits and methods among parents and Anganwadi workers. Dental caries prevalence was significant in children with poor oral hygiene practices and subjects suffering from malnutrition attending Anganwadis of Hingna, Nagpur. It was also found that initiation of oral hygiene practices was late in the subjects, which may be due to lack of awareness about oral health, oral diseases due to poor hygiene, and low level of parents' education. Subjects having more than one sibling had higher caries prevalence as compared to subjects with one sibling, which is in line to a study carried out in 2013. 
| Conclusion|| |
Anganwadis in India should be addressed routinely on effective oral and general health promoting strategies which must include, monitoring and intervening of subjects below 5 years with malnutrition, generating awareness about health issues and risk factors for dental caries, and promoting education of parents. Complex preventive programs regarding oral health maintenance at primary levels should be planned, emphasized, and implemented at Anganwadis. Children from lower socioeconomic strata should be targeted. Public funding should be started for more effective health promoting programs on oral and general health focusing children, their oral hygiene and dietary habits. The Anganwadi workers should be additionally updated on oral health awareness and they should be trained for the same. An initiative has been taken at our institutional level to educate and motivate children, parents, and the Anganwadi workers about good oral hygiene practices and preventive measures have been instituted.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Prabhu P, Rajajee KT, Sudheer KA, Jesudass G. Assessment of caries prevalence among children below 5 years old. J Int Soc Prev Community Dent 2014;4:40-3.
Ingle NA, Dubey HV, Kaur N, Gupta R. Prevalence of dental caries among school children of Bharatpur city, India. J Int Soc Prev Community Dent 2014;4:52-5.
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.
WHO. Oral Health Survey: Basic Methods. 4 th
ed. Geneva: WHO; 1997.
Ehizele AO, Ojehanon PI, Akhionbare O. Nutrition and Oral health. J Postgrad Med 2009;11:76-82.
Vargas CM, Ronzio CR. Disparities in early childhood caries. BMC Oral Health 2006;6 Suppl 1:S3.
Mahejabeen R, Sudha P, Kulkarni SS, Anegundi R. Dental caries prevalence among preschool children of Hubli: Dharwad city. J Indian Soc Pedod Prev Dent 2006;24:19-22.
Menaker L, Navia JM. Effect of undernutrition during the perinatal period on caries development in the rat 11. Caries susceptibility in underfed rats supplemented with protein or caloric additions during the suckling period. J Dent Res 1973;52:680-7.
Harris SS, Navia JM. Vitamin A deficiency and caries susceptibility of rat molars. Arch Oral Biol 1980;25: 415-21.
Johansson I, Ericson T, Bowen W, Cole M. The effect of malnutrition on caries development and saliva composition in the rat. J Dent Res 1985;64:37-43.
Sheetal A, Hiremath VK, Patil AG, Sajjansetty S, Kumar SR. Malnutrition and its oral outcome - A review. J Clin Diagn Res 2013;7:178-80.
Holan G, Iyad N, Chosack A. Dental caries experience of 5-year-old children related to their parents′ education levels: A study in an Arab community in Israel. Int J Paediatr Dent 1991;1:83-7.
Pizzo G, Piscopo MR, Matranga D, Luparello M, Pizzo I, Giuliana G. Prevalence and socio-behavioral determinants of dental caries in Sicilian schoolchildren. Med Sci Monit 2010;16:PH83-9.
Källestål C, Wall S. Socio-economic effect on caries. Incidence data among Swedish 12-14-year-olds. Community Dent Oral Epidemiol 2002;30:108-14.
Costa SM, Martins CC, Bonfim Mde L, Zina LG, Paiva SM, Pordeus IA, et al.
A systematic review of socioeconomic indicators and dental caries in adults. Int J Environ Res Public Health 2012;9:3540-74.
Datta P, Datta PP. Prevalence of Dental Caries among School Children in Sundarban, India. Epidemiol Open Access Journal 2013;3:135.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]