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ORIGINAL ARTICLE
Year : 2016  |  Volume : 34  |  Issue : 3  |  Page : 249-256
 

Caries prevalence of school-going boys and girls according to cleaning methods and soft drink-taking frequency in different localities, in and around Guwahati City


1 Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
2 Department of Anthropology, Gauhati University, Guwahati, Assam, India
3 Department of Oral Pathology, Regional Dental College, Guwahati, Assam, India
4 Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India

Date of Web Publication25-Jul-2016

Correspondence Address:
Chandana Kalita
House No. 41, Dwaraka Nagar, Naboday Path, P. O. Khanapara, Guwahati - 781 022, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.186755

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   Abstract 

Background: Dental caries is a multifactorial disease, causes of which are mostly understood nowadays. This disease is not only treatable but also preventable, if detected in its initial stage. In a developing country like India, facility of dental treatment is available mostly for urban population, whereas a very common approach of dental disease treatment is still traditional for the rural people. Objective: The objective of this study was to find out the prevalence of dental caries, teeth cleaning methods, and sweet and soft drink-taking frequency among boys and girls of Guwahati City and its nearby semi-urban and rural areas. Materials and Methods: Cross sectional study was carried out among school going boys and girls of 3-17 years group, using the modified WHO oral health survey form. The number of population was 2396 from urban locality, 2370 from semi-urban, and 2467 from rural. Results: Caries prevalence is much higher in urban (62.77%), contrary to rural where 76% of the sample is caries free. Those who take sweet occasionally suffered less or almost caries free (7.93% in urban and 0% in rural) than among those who consume it more than five times a day (90.75% in urban, 100% in semi-urban, and 99.33% in rural). Discussion and Conclusion: Urban localities are two times and semi-urban areas are 1.64 times more at risk of dental caries than rural areas. The odds ratio for cleaning frequency shows that the effect of cleaning by brush on caries is less (78%, not significant) than chewing stick while the risk associated with finger and charcoal use is about 19.63 times and 7.11 times, respectively.


Keywords: Dental caries, soft drink-taking frequency, teeth cleaning methods


How to cite this article:
Kalita C, Choudhary B, Saikia AK, Sarma PC. Caries prevalence of school-going boys and girls according to cleaning methods and soft drink-taking frequency in different localities, in and around Guwahati City. J Indian Soc Pedod Prev Dent 2016;34:249-56

How to cite this URL:
Kalita C, Choudhary B, Saikia AK, Sarma PC. Caries prevalence of school-going boys and girls according to cleaning methods and soft drink-taking frequency in different localities, in and around Guwahati City. J Indian Soc Pedod Prev Dent [serial online] 2016 [cited 2019 Aug 25];34:249-56. Available from: http://www.jisppd.com/text.asp?2016/34/3/249/186755



   Introduction Top


Distribution of dental caries found throughout the world is varied. This uneven distribution of the disease presents the picture of some children having none or very few caries and others having a high number of caries. Situation is more varied in the developing country due to changes in living way of life and industrialization. Studies reveal that more than 51 million school hours are lost annually due to suffering in oral diseases.[1]

Diet plays a major role in initiation of dental caries. Prevalence of caries is more in the urban than in the rural areas due to the availability of refined food. However, risk or chances of rural children suffering from dental caries are becoming high after exposure to modern lifestyle. It is also observed that facility for dental treatment to rural population is usually not available due to shortage of dental human resources, distance to the medical facilities, financial constraints, and lack of oral health-care education.

Data on the prevalence of dental caries, oral health, and diet inhabiting different localities are of prime importance for any attempt on planning for the improvement of the oral health-care facilities in the localities.

The present study was done to assess the prevalence of dental caries, teeth cleaning aids, and frequency of taking sweets and soft drinks among school-going boys and girls inhabiting in urban and nearby semi-urban and rural areas of Guwahati City.


   Materials and Methods Top


Study area and sample size

The study area is Guwahati city and its nearby semi-urban and rural area. It is the largest city in the entire northeast region of India, serve as the hub of all socioeconomic activities. Period of the study was 5 years. The distribution of sample population according to sex, locality, and teeth cleaning aid is shown in [Table 1].
Table 1: Sex-wise distribution of sample by locality and brushing technique

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Sample selection

The presence of dental caries was assessed in good natural light using mirror and explorer, inspecting all visible surfaces. In the present study, the WHO (1977) criteria [2] for caries diagnosis were followed using the modified WHO Health Survey Assessment Form. Caries status, gender, age, locality, cleaning methods, and frequency of taking sweets and soft drinks were recorded.

For sweet-taking frequency, samples were divided into three groups according to the frequency. 1st - who never take sweets or take occasionally, 2nd - who take sweets 2–5/day, and 3rd - who take >five times a day. For soft drinks, samples were divided similarly. 1st - who never take soft drink or take it occasionally, 2nd - who take soft drink two to four times a week, and 3rd - who take soft drink > four times a week.


   Results Top


The Chi-square test shows statistically significant difference between different localities (χ2 = 744.482, df = 2, P < 0.001) with respect to the prevalence of caries [Table 2]. The Chi-square test also shows that the differences between urban and semi-urban (χ2 = 168.578, df = 1, P < 0.001), urban and rural areas (χ2 = 745.166, df = 1, P < 0.001), and semi-urban and rural (χ2 = 216.332, df = 1, P < 0.001) are statistically significant with respect to the caries prevalence.
Table 2: Locality-wise distribution of caries affected study sample

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In all the localities, the boys exhibited higher caries prevalence than the girls [Table 3].
Table 3: Sex-wise distribution of caries in different localities

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Prevalence of caries increases with age in all, except slight decrease in 15–17 years age group of urban locality [Table 4].
Table 4: Age- and locality-wise distribution of caries-affected boys and girls

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Caries prevalence according to teeth cleaning methods

The differences in caries prevalence between the users of different teeth cleaning methods are found to be statistically significant (χ2 = 11.208, df = 3, P < 0.05). Statistically, significant difference is also observed between brush and finger users (χ2 = 201.807, df = 1, P < 0.001) and brush and chewing stick users (χ2 = 68.482, df = 1, P < 0.001).

All those who use fingers are found to experience caries in the 12–14 years and 15–17 years age groups [Table 5].
Table 5: Age-wise distribution of caries according to different teeth cleaning methods

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Caries prevalence according to sweet-taking frequency

In the urban area (42.86%), it is almost three times more than the rural area (12.04%) those who take sweets more than five times a day [Table 6].
Table 6: Age- and locality-wise distribution caries-affected boys and girls according to sweet-taking frequency

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The difference in caries prevalence of boys and girls among different categories of sweet takers is found to be statistically significant in both sexes (in boys: χ2 = 1955.818, df = 2, P < 0.001 and in girls: χ2 = 1929.232, df = 2, P < 0.001).

The differences in caries prevalence according to sweet-taking frequency in different localities are found to be statistically significant as revealed from the Chi-square test (in urban: χ2 = 1059.878, df = 2, P < 0.001; semi-urban: χ2 = 1346.085, df = 2, P < 0.001; and rural: χ2 = 1360.906, df = 2, P < 0.001) [Table 8].
Table 8: Locality-wise caries distribution according to sweet-taking frequency

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Caries prevalence is 100% or close to 100% among those who take sweet >5/day, irrespective of teeth cleaning methods they use [Table 9].
Table 9: Distribution of caries according to sweet-taking frequency and teeth cleaning methods

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Caries prevalence according to soft drink-taking frequency

The differences in caries prevalence between different categories of soft drink takers in both sexes are found to be statistically significant (in boys: χ2 = 2078.634, df = 2, P < 0.001 and in girls: χ2 = 1735.531, df = 2, P < 0.001) [Table 10].
Table 10: Sex-wise distribution of caries prevalence according to soft drink-taking frequency

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Distribution of caries prevalence according to soft drink taking frequency in different locality and cleaning methods are shown in [Table 11] and [Table 12].
Table 11: Distribution of caries prevalence according to soft drink-taking frequency by locality

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Table 12: Distribution of caries according to soft drinks-taking frequency by cleaning methods

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The differences in caries prevalence between different categories of soft drinks takers are statistically significant as revealed from the Chi-square test (in urban: χ2 = 645.040, df = 2, P < 0.001; semi-urban: χ2 = 2020.568, df = 2, P < 0.001; and rural: χ2 = 920.118, df = 2, P < 0.001).

Logistic regression analysis was performed along with the associated odds ratio (Model I and Model II) to identify factors associated with locality and cleaning methods for the prevalence of dental caries [Table 13]. The subjects living in urban locality are two times more at risk of dental caries than rural community, whereas it is 1.64 times more in those residing in semi-urban areas. The association between the localities is found to be statistically significant.
Table 13: Results of binary logistic regression analysis for locality and cleaning methods on risk factors of caries

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The odds ratio for cleaning frequency shows that the effect of cleaning by brush on caries is less (0.78, not significant) than chewing stick while the risk associated with finger and charcoal use is about 19.63 times and 7.11 times, respectively.


   Discussion Top


Large variation is noted in the prevalence of dental caries among people living under different geographic and climatic conditions, with various dietary and feeding habits. The present study endeavors to present the prevalence of dental caries in the city of Guwahati and its neighboring semi-urban and rural areas [Table 1]. Prevalence of caries affected in urban area is two and half times more than in rural area [Table 2]. Urban boys showed almost three times more prevalence than the girls of rural areas [Table 3]. Linear increase of caries prevalence is observed in different age groups in all localities [Table 4]. Rapid changes of dietary habits have resulted in different health issues, including dental caries. Although not life-threatening, dental caries has a detrimental effect on quality on the life from childhood to old age.[3]

It has been observed that the prevalence of caries is highest among those who use fingers and lowest with among chewing stick users [Figure 1]. Effectiveness of cleaning is least with finger [Table 5]. Charcoal has an abrasive action and it breaks the adherence of microbes to the surface of the teeth, which may improve the cleaning efficacy. Charcoal perfectly removes halitosis and interferes with metabolism of bacteria.[4] Caries prevalence is less among the chewing stick users compared to the brush users. Preferably, during their morning walk, rural people use to a cut a stick from a tree traditionally used as herbs. They start to chew one end of the stick until the frayed end becomes soft and then start cleaning their teeth methodically and leisurely. They give sufficient time for the whole procedure. The antibacterial compounds present in the fresh chewing stick may get sufficient time to work on oral bacteria. Wu et al. (2001) suggested that antimicrobial substances that naturally protect plants against various microorganisms, may leach out into the oral cavity from the twigs and may benefit the users by protecting against cariogenic bacteria.[5] Burt and Cleaton-Jones et al. concluded that oral hygiene was the dominant variable for caries prevention.[6]
Figure 1: Distributions of caries-affected boys and girls by teeth cleaning methods

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Sucrose is the most commonly used sweetener to provide bulk, flavor, texture, and sweetness.[7] It is found in natural foods or added to food during processing. The cariogenicity of food depends on various factors such as food form, frequency of consumption, retention time, composition, the potential of the food to stimulate saliva, and salivary pH.[8],[9],[10] Increasing trend of sweet-taking frequency is observed [Table 6] more prevalence among the boys who take sweets more than five times a day. Caries is very negligible among those who occasionally take sweets or never take it [Table 7].
Table 7: Sex-wise caries distribution according to sweet-taking frequency

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In this study, the number of sweet takers is found to be the highest in the urban area and is usually in the form of chocolates, toffee, lollipops, mint, etc., However, in rural areas, sweets are mainly in the form of caramel which is sticky but with less retentive properties and are cleaned from the oral cavity faster than other form of sweets.[8] Fake chocolates and toffees available in rural shops may have less retentive capacity than the original one, which needs long process. It is observed that sweet and soft drink-taking frequency is least for people in rural areas. Unavailability of sweet item in the rural household may also form the habit of dislike or less preference to sweet food in their day-to-day life.

It has been observed that those who consume sweets more than five times a day experience caries more than those consume less sweets irrespective of their cleaning methods [Table 3], [Table 8] and [Table 9]. Sweet-eating frequency of three or more times per day is found to significantly elevate caries activity.[9] Higher caries is reported among those who consume 5.1 times a day than those who take 2.1 times a day, when the intake of sugars was averaged.[11] The intake of extrinsic sugars beyond four times a day leads to an increased risk of dental caries. There is conclusive evidence of a high correlation between the frequency and the amount of sugar intake.[12],[13],[14],[15]

Fluid consumption pattern of young people is diverse and may vary due to taste, preferences, and habits of parents and friends.[16] Sugar content of these commercially available drinks differs between them and increased content increases the risk.[17] In urban areas, canned fruit juice, in semi-urban and rural areas, locally made juices, drinks from concentrated powder form are available, where sucrose content may be more than in the commercially marketed drinks.

Consumption of large quantity of carbonated drinks leads to unhealthy diet patterns.[18] Liquid sugar in cold drinks pass through oral cavity very quickly with limited contact time; however, holding sugar for prolong period or constant sipping can influence the rate of caries.[19] Drinking fruit juice from feeding bottle during childhood, drinks consumed after meals significantly elevates levels of caries.[20] Consumption of sugared soda was consistent in demonstrating significant increases in caries.[21]

Those who take soft drinks occasionally have much lower prevalence of caries. It has been observed [Table 10] that higher intake of soft drink is more among boys which can be attributed to boys having more access to the market area than the girls. Urban boys and girls consume more soft drinks and exhibited higher caries prevalence than the others [Table 11]. High intake of carbonated soft drink is observed more among boys than girls [18] wherever in urban locality, both boys and girls exhibited higher consumption of these drinks.


   Conclusion Top


It can be concluded that locality-wise people of urban and semi-urban area are more at risk of caries than the rural areas. Children with the habit of taking sweets and soft drinks are more prone to caries than nontaker or occasional taker. All the factors are interrelated and sugar in the form of sweets and soft drinks; oral hygiene maintenance methods play a major role in causation of dental caries. Hence, developing a healthy diet pattern with proper oral health care may help to minimize dental caries in boys and girls.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Shalala DE. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General – Executive Summary. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.  Back to cited text no. 1
    
2.
World Health Organization. Basic methods. In: Oral Health Surveys. 4th ed. Geneva: World Health Organization; 1997.  Back to cited text no. 2
    
3.
Fejerskov O, Kidd E, Nyvad B, Baelum V, editors. Dental Caries. The Disease and its Clinical Management. Oxford, UK: Blackwell Muskgard, Blackwell Publishing Ltd.; 2008.  Back to cited text no. 3
    
4.
Lavrova Z. United States Patent Application Publication, No: US 2009/20090269288 Black Pearl. Brooklyn, NY (US); 2009.  Back to cited text no. 4
    
5.
Wu CD, Darout IA, Skaug N. Chewing sticks: Timeless natural toothbrushes for oral cleansing. J Periodontal Res 2001;36:275-84.  Back to cited text no. 5
    
6.
Cleaton-Jones P, Richardson BD, Sinwel R, Rantsho J, Granath L. Dental caries and sucrose intake in five South African pre-school groups. Community Dent Oral Epidemiol 1984;12:381-5.  Back to cited text no. 6
    
7.
Hough CA, Parker KJ, Vlitos AJ, editors. Developments in Sweeteners. Essex, England: Applied Science Publisher Ltd.; 1979.  Back to cited text no. 7
    
8.
Kashket S, Zhang J, Van Houte J. Accumulation of fermentable sugars and metabolic acids in food particles that become entrapped on the dentition. J Dent Res 1996;75:1885-91.  Back to cited text no. 8
    
9.
Lingström P, van Houte J, Kashket S. Food starches and dental caries. Crit Rev Oral Biol Med 2000;11:366-80.  Back to cited text no. 9
    
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Gupta P, Gupta N, Pawar AP, Birajdar SS, Natt AS, Singh HP. Role of sugar and sugar substitutes in dental caries: A review. ISRN Dent 2013;2013:519421.  Back to cited text no. 10
    
11.
Holbrook WP, Arnadóttir IB, Takazoe I, Birkhed D, Frostell G. Longitudinal study of caries, cariogenic bacteria and diet in children just before and after starting school. Eur J Oral Sci 1995;103:42-5.  Back to cited text no. 11
    
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Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines. J Dent Res 2014;93:8-18.  Back to cited text no. 12
    
13.
Rugg-Gunn AJ, Hackett AF, Appleton DR, Jenkins GN, Eastoe JE. Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent school children. Arch Oral Biol 1984;29:983-92.  Back to cited text no. 13
    
14.
Burt BA, Pai S. Sugar consumption and caries risk: A systematic review. J Dent Educ 2001;65:1017-23.  Back to cited text no. 14
    
15.
Sheiham A. Dietary effects on dental diseases. Public Health Nutr 2001;4:569-91.  Back to cited text no. 15
    
16.
Grimm GC, Harnack L, Story M. Factors associated with soft drink consumption in school-aged children. J Am Diet Assoc 2004;104:1244-9.  Back to cited text no. 16
    
17.
Putnam JJ, Allshouse JE. Food Consumption, Prices, and Expenditures, 1970-97. Washington, DC: Food and Consumers Economics Division, Economic Research Service, US Department of Agriculture; 1999.  Back to cited text no. 17
    
18.
Sohn W, Burt BA, Sowers MR. Carbonated soft drinks and dental caries in the primary dentition. J Dent Res 2006;85:262-6.  Back to cited text no. 18
    
19.
Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr 2003;78:881S-92S.  Back to cited text no. 19
    
20.
Zeng X, Luo Y, Du M, Bedi R. Dental caries experience of preschool children from different ethnic groups in Guangxi Province in China. Oral Health Prev Dent 2005;3:25-31.  Back to cited text no. 20
    
21.
Heller KE, Burt BA, Eklund SA. Sugared soda consumption and dental caries in the United States. J Dent Res 2001;80:1949‑53.  Back to cited text no. 21
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13]



 

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