Year : 2005 | Volume
: 23 | Issue : 2 | Page : 74--79
Prevalence of dental caries among 5-13-year-old children of Mangalore city
P Sudha1, S Bhasin1, RT Anegundi2,
1 Department of Pedodontics, CODS, Mangalore, India
2 Department of Pedodontics, SDM College of Dental Sciences and Hospital, Dharwad, India
Department of Pediatric Dentistry, College of Dental Sciences, Mangalore - 575 001
A study of prevalence of dental caries was undertaken in 5-13-year-old children from Mangalore city. A total of 524 children were examined. The sample consisted of 193, 160, and 171 children in the 5-7, 8-10 and 11-13 years of age group, respectively. Dental caries was examined visually and observations were recorded. Silness and L φe plaque index, L φe and Silness gingival index were used to record the periodontal status. The prevalence of dental caries was highest in 5-7-year-age group compared to 8-10 years and 11-13 years age groups. The increasing prevalence of dental caries needs dental health programmes, which target the specific segments of the population.
|How to cite this article:|
Sudha P, Bhasin S, Anegundi R T. Prevalence of dental caries among 5-13-year-old children of Mangalore city.J Indian Soc Pedod Prev Dent 2005;23:74-79
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Sudha P, Bhasin S, Anegundi R T. Prevalence of dental caries among 5-13-year-old children of Mangalore city. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2021 Sep 27 ];23:74-79
Available from: https://www.jisppd.com/text.asp?2005/23/2/74/16446
'Polarization' of caries is occurring on a worldwide basis, where the prevalence of caries is declining in developed countries, increasing in less-developed countries, and is epidemic in countries with emerging economies. This decline in caries prevalence in developed countries has been associated with a more sensible approach to sugar consumption, improved oral hygiene practices and several preventive programs. However, the side-by-side rise in caries prevalence in developing countries is mainly because the oral health care systems in these countries mostly focus on curative care, whereas community-based prevention and oral health promotion have not been systematically implemented.
Dental caries is a disease with multifactorial causes. The prevalence and incidence of dental caries in a population is influenced by a number of risk factors such as age, sex, ethnic group, dietary patterns and oral hygiene habits.
Diet has been associated with the prevalence of dental caries for centuries. In the field of research into caries etiology, diet has probably received more attention than any other subjects. The Vipeholm study (1954), perhaps, is the best known research project about diet and caries concluded that the frequency and nature of sugar intake had marked influence on caries activity.
There is no doubt that dietary and oral hygiene habits are affected by income, education, and social environment. Hunt had shown convincingly that in Western countries people, whose socio-economic status is low, tend to have more caries. In the assessment of caries risk, the reported sensitivities and specificities have been low.
Voluminous literature exists on the status of dental caries in the Indian population. Despite several attempts to cure and prevent the disease, its prevalence has increased over the last couple of decades. These changing trends in the prevalence of dental caries need continuous understanding and investigation. Thus, review of the past and prediction of the future is the need of the hour.
Thus, the present study was designed to assess the prevalence of dental caries in school children of Mangalore city in the age group of 5-13 years considering the age, ethnic group, socio-economic status, oral hygiene habits, and dietary habits.
Materials and Methods
A study of prevalence of dental caries of school going children of Mangalore was undertaken by the Department of Pedodontics and Preventive Dentistry, College of Dental Surgery, Mangalore, to evaluate prevalence of dental caries in relation to various risk factors.
The survey was conducted in 524 school children residing in Mangalore, Dakshina Kannada District, Karnataka. The schools were selected based on the socio-economic status. Children belonging to the low socio-economic groups were those studying in the government schools and the high socio-economic group comprised of children studying in aided schools. Out of the 64 schools, eight government and eight aided schools were selected for the survey. The sample was selected using a two-stage cluster sampling method.  The sample consisted of 193, 160 and 171 children in the 5-7, 8-10, and 11-13 years-age group, respectively. In each of these age groups an attempt was made to include equal number of male and female subjects. Consent for examining of the children was obtained from the respective head master. The criteria for selection of the study subjects were that the children should be permanent residents of Mangalore.
Depending on the physical conditions of the school, the exact arrangement for conducting the examination was determined. The subjects were examined on an upright chair in adequate natural light. Examination of the child was done by only one examiner to avoid interexaminer variability. Recording of data was done by a trained person who assisted throughout the study. Prior to the examination for plaque and dental caries, a questionnaire was filled by the subject to find out the personal data and oral hygiene habits. Tooth surface was dried and plaque scores were recorded first, prior to the examination of dental caries using plaque modified Silness and L φe and deft and DMFT indices respectively.
Calibration procedures were performed prior to and during the study to ensure that a consistent standard of the diagnosis was maintained. Re-examinations were carried out on approximately one in ten children selected at random to have a constant check on the interexaminer variability. Subjects' data and diet history for past 24 h were recorded on a proforma and were entered into a computer.
Parents were requested to fill this form giving details of the diet, which the subject had consumed over the past one day. The number of sugar exposures was calculated from the diet chart and it varied from 0 to 5 during a 24 hour-time period.
Results and Discussion
Caries is the most prevalent affliction of children. Despite credible scientific advances and the fact that caries is preventable, the disease continues to be a major public health problem. In developing countries, changing life-styles and dietary patterns are markedly increasing caries incidence. While mortality from the direct sequence of dental caries is very low, it contributes towards loss of productivity. The caries prevalence was related to age, sex, ethnic group, socio-economic status, dietary pattern including influence of sugar consumption, and oral hygiene habits and results were tabulated.
In the present study, the caries prevalence in the 5-7-year-age group was 94.3%. Shetty and Tandon in 1988 observed that 71.11% of children in the 5-6-year-age group were affected by caries. This may be an indication of an upward trend in the caries prevalence in developing countries. However, the area covered in the previous study, compared to this study, could be a contributory factor. Rao et al observed a caries prevalence of 75.3% whereas, Gaikwad and Indurkar  reported a low caries prevalence of 47.8% in this age group.
The caries prevalence in the present study was 82.5% in the 8-10-year-age group. Rao et al reported a similar prevalence of 82.2% in the 7-8-year-age group and a 82.6% in the 9-10-year-age group. The prevalence in the 11-13-year-age group (82.5%) was much higher than that observed by Mishra and Shee (60.41%) and Chopra et al (61.88%). Damle and Patel (79.48%) and Gauba et al observed caries prevalence of 79.48 and 87.95%, respectively.
The prevalence of caries was higher in the 5-6-year-age group when compared to the 8-10 and 11-13-year-age group. This could be due to the increase in age, there is an increased awareness of oral hygiene. The permanent teeth are also more resistant to the caries process than the primary teeth. [Figure 1]
The difference in the dmft/DMFT between the three age groups in the study was found to be highly significant. The dmft scores declined progressively as the age advanced; whereas the DMFT scores increased from 5 to 13 years. The decrease in the dmft values might be attributed to the reduction in the number of primary teeth with age due to normal exfoliation. The increase in DMFT may be coinciding with the eruption of permanent teeth [Figure 2]. Rao et al also reported a similar trend with the dmft declining from 4.52 ± 4.15 (5-6 years) to 1.81 ± 1.88 (11-12 years).
There was no statistically significant difference in the caries prevalence between the two sexes [Figure 3]. Shetty and Tandon and Jai also found no difference in caries prevalence among the two sexes. Vacher, Aukland and Bjelkaroey, and Gaikwad and Indurkar observed a higher caries experience in boys than in girls. On the contrary, girls were found to have higher caries prevalence by Mishra and Shee, Saimbi et al and Singh et al. The variation could be attributed to the different age groups and geographic locations studied in the surveys.
According to this study, the difference between the dmft values was statistically significant in ethnic groups. The dmft value was maximum for the Muslim subjects. But the differences in DMFT values were not statistically significant [Figure 4]. A larger and more detailed study with equal sample size in each group could help in getting an insight into the relationship between dental caries and ethnic groups. It is possible that real differences in caries experience may exist between ethnic groups, but even if they do, they are masked by and are of secondary importance to the social and cultural factors in the environment.
The prevalence of caries in the low socio-economic group was higher (96.2%) than the high socio-economic group (77.1%). The difference in the dmft and DMFT scores according to socio-economic status was statistically, highly significant [Figure 5] and [Figure 6]. These findings are in accordance with the observations of Singh et al and Chandra and Chawla on the contrary observed a higher caries prevalence in children belonging to the high socio-economic status. Ghandour classified children into three socio-economic groups - low, middle and high, but did not find any statistically significant difference between the caries prevalence within these groups. The grouping of subjects according to the socio-economic status encompasses the influence of income, education, and social environment. Determination of social class is complicated, especially in developing countries like India, where there are no specifically accepted criteria for the same. In spite of the clear correlation between social status and caries, in the assessment of caries risk, the reported sensitivities and specificities have been low.
The caries prevalence among vegetarians was lower. The difference in the dmft/DMFT was not found to be statistically significant between the vegetarian and mixed diet group [Figure 7] and [Figure 8]. These findings are in accordance with the observations of Srinivas and Gangwar et al. and Mishra and Shee observed 58.8 and 60.5% caries prevalence between the vegetarian and nonvegetarians, respectively. Although the relationship between sucrose and caries has been clearly established, sucrose has been described as the 'arch criminal', the value of self-reported sucrose intake seems to have little value. Both positive correlation and lack of correlation between the intake of sucrose-containing foods and caries have been reported. In the present study, the caries prevalence increased with increasing number of sugar exposures. In these groups the difference in the dmft and DMFT was highly significant [Figure 9] and [Figure 10].
The strongest correlation between sugar consumption and caries development was seen when international data are compared. A study by Sreebny using data on sugar supplied in various countries and data on caries prevalence obtained from WHO for 6-year-old children in 23 nations and 12-year olds in 47 nations, showed that the availability of less than 50 gms sugar per person per day in a country was always associated with dmft or DMFT scores of less than three. Similar findings were reported by Gustaffson et al. Winter and Rule and Shetty and Tandon. However, Mc Donald found no significant relationship between sugar consumption and caries prevalence. In this study, a highly significant relation was found between sugar consumption and socio-economic status. Similar findings were reported by Bilnkhorn et al, who stated that in deprived areas mothers were more likely to give continuous sugar to children throughout the day, increasing the daily sugar consumption.
Most of the cross-sectional epidemiological studies show a weaker correlation between sugar intake and caries than might be expected from theoretical considerations. It is evident that dietary data obtained by questionnaires, or diet history interviews, covered a period ranging from 1 day to some months, while caries data includes the total caries experience accumulated over the years. Sugar clearance is another important factor, which must be taken into consideration while studying the effect of sugar consumption on incidence of dental caries.
In this study, there was no statistically significant difference in dmft/DMFT in relation to oral hygiene habits [Figure 11]. Studies by Ainamo and Parviainen and Shetty and Tandon also were unable to demonstrate a correlation between reported frequency of tooth brushing and caries prevalence. Bellini et al reported that the relationship between caries and the amount of plaque on teeth or frequency of self-reported oral hygiene measure is vague. High sucrose consumption and poor oral hygiene are often found in the same individual, and the effect of one of these factors may vary.
In the present study, a statistically significant difference was observed between oral hygiene habits and socio-economic status. Majority of the children claimed that they rinsed their mouth following their meals. The caries prevalence was higher in children who rinsed their mouth [Figure 12]. Kapoor et al observed a minimum prevalence of caries in children rinsing with water. These differences observed may be due to the possibility that children reported rinsing following meals to please the investigator.
The mean plaque scores for 5-7, 8-7 and 11-13 years were 1.10(0.56), 1.20(0.54) and 1.11(0.57), respectively. The dmft increased with increasing plaque index score till 1.9. The dmft was seen to decline when plaque index score was between 2.0 and 3.0. The DMFT scores increased with increasing plaque scores [Figure 13]. The role of other etiological agents, which were not studied here, must also be taken into consideration. Saha and Sarkar revealed that dental caries has no direct correlation with the oral hygiene index. Mathur and Roy reported that plaque accumulation increased with increasing age. Despite various studies the role of plaque in dental caries is inconclusive.
The present study showed a high caries prevalence in school-going children of Mangalore city in both primary and permanent dentitions. Systematic approach to the control of this disease is needed. Due to scarcity of public resources for oral health care and keeping in mind the current incidence of dental caries, a national oral health policy that emphasizes prevention rather than curative care is more advantageous. The implementation of community-based oral health promotion programmes is a matter of urgency. In relation to children, such programmes could be initiated through health promoting school projects. The identification of significant caries risk factors specific to children living in Mangalore city may be quite useful in developing these preventive programmes.
The prevalence of dental caries and its relation with various risk factors was estimated in 524, 5-13-year-old school going children of Mangalore city. Following conclusions were drawn from this study.
The prevalence of dental caries was high in the 5-13-year-age group; with the highest prevalence seen in the 5-7-year-age group compared to that of 8-10 and 11-13 age group.Caries prevalence did not show any variation in relation to sex.The children belonging to the low socio-economic status had higher caries prevalence than those belonging to the high socio-economic status.Caries prevalence was lower among vegetarians.A strong correlation was seen between sugar consumption and caries, with the prevalence increasing with increasing sugar exposure.The sugar consumption was found to have a highly significant relation with the socio-economic status.
The increasing prevalence of dental caries in Mangalore city highlights the need for a dental health programme to target the specific segments of the population through systematic public and school health education programmes. Parents could also benefit from oral health education and should be advised regarding continuous dental follow-ups with dietary instructions to maintain good oral hygiene.
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