Caries Prevalence And Risk Assessment – A Survey

INTRODUCTION

           Dental caries and its consequences together constitute a very real and personal problem for almost every man, woman and child.1 However "Polarization" of caries is occurring on a worldwide basis, where the prevalence of caries is declining in developed countries, is 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, fluorides in toothpaste, topical fluoride application, fluoride rinsing and water fluoridation. However, the sideby- 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.²

Dental caries is a multifactorial disease. The prevalence and incidence of dental caries in a population is influenced by a number of risk factors like age, sex, dietary patterns and oral hygiene habits.

           The prevention of disease has always been known to be the most perfect form of practice. Prevention of the disease rests on knowledge of the disease etiology as well as an understanding of the occurrence and distribution of related factors and conditions. Information on caries prevalence and severity forms the basis for the magnitude and quality of caries prevention programs and treatment needs in a population. Therefore, a continuous need remains to field caries prevalence and severity information.²

           The present study was undertaken to study the prevalence of dental caries in school children 6-12 years of age and association of caries with factors like age, sex, diet, sweet consumption, mode of tooth cleaning and oral cleanliness.

MATERIALS AND METHODS

           The present cross-sectional study was carried out among 2,314 primary school children of 6-12 years of age from Shirur village of Udupi District. Shirur is a village in Kundapur taluk and all schools in Shirurpanchayath limits (9 Government and 2 Unaided schools.) were included in this study. The study was cleared by the ethical committee of the Yenepoya Dental College, Mangalore.

           Consent from the concerned competent authority was obtained prior to the commencement of the study. A single examiner conducted the oral examination to avoid inter examiner variability and he was assisted by a recording clerk.

           The survey was carried out using a specific proforma which consisted of two parts.

           First part consists of a questionnaire to collect information of the schoolchildren's demographic data, oral hygiene practices, dietary habits andsource of drinking water at school.

The second part consisted of the clinical examination.

Clinical examination - Caries was recorded as per WHO criteria(1997)³

Oral hygiene status was assessed using OHI-S (Greene and Vermillion1964) .⁴

RESULTS

The division of the sample of 2,314 children by age and sex is provided in Table 1

           In the deciduous dentition, 8 year old shows a highest prevalence of 86.1% (Mean dmft 3.84) and the lowest prevalence of 22.7% in the 12 year age group (Mean dmft 0.51) (Table 2).

           In the permanent dentition, 12 year old children showed a highest prevalence of 29.9% (Mean DMF 0.527) and the lowest prevalence of 4.2% in the 6 year age group (Mean DMF 0.054) (Table 3)

           The variables considered for risk assessment were age, gender, source of drinking water, brushing frequency, mode of tooth cleaning, sweet consumption, oral cleanliness, oral hygiene status, family income and mothers' employment status (Table 4).

DISCUSSION

           In the deciduous dentition, 8 year olds showed highest caries prevalence of 86.1% (Mean dmft 3.84) and the lowest prevalence of 22.7% was recorded in the 12 year old group(Mean dmft 0.51%) The prevalence of caries for 6 years was 78.6%. Shetty and Tandon⁵ observed a prevalence of 71.11% whereas Gaikwad and Indurkar⁶ reported a low prevalence of 47.8%. The prevalence of caries in the 11 year age group was 47.4%, which was much lower compared to studies by Gaubaet al⁷ and Damle and Patel⁸. The relation of age with caries prevalence in the primary dentition was very highly significant.

           In the permanent dentition, 12 year old children showed the highest prevalence of 29.9% (Mean DMF 0.527) and the lowest prevalence of 4.2% in the 6 year old group(Mean DMF 0.054) The relation of age with caries prevalence in the permanent dentition was very highly significant. The DMF scores increased progressively from 6 years (0.054) to 12 years (0.527).This could be attributed to the irreversible nature of DMF index.

           Logistic regression was done to estimate the magnitude of association between exposure and outcome for risk assessment. The variables considered were sex, gender, source of drinking water, brushing frequency, sweet consumption, oral cleanliness, oral hygiene status, family income and mothers employment status.

           In the present study, females are at a greater risk for caries (RR 1.180) compared to males. However the results are not statistically significant.

           The association between severity of dental caries and frequency of tooth brushing was evaluated. The sample consisted of children who brushed once daily, twice daily and after every meal. The results were very highly significant for this category. However in a study by Kuriakose S1, there was no association in brushing frequency and caries prevalence or severity. These results are in accordance with a study conducted by Retnakumari N.⁹

           Relative risk for children using toothpowder and tooth brush was lower (RR 0.735) when compared to children using tooth paste and toothbrush. However the results were not statistically significant(p=0.706). These results are in accordance with a study conducted by Retnakumari N.⁹

           When frequency of sweet consumption was considered, relative risk for moderate sweet consumption (RR 0.782) and High sweet consumption (0.886) was lower than that for the reference category (low RR=1). These results are in contradiction to a study by Retnakumari N.⁹ where the RR for moderate and high sweet consumption was higher than the low sweet consumption category.

           Oral Cleanliness was based on the debris index. Poor oral hygiene is widely considered as a caries risk factor. The results are very highly significant (p value<0.001). Hence an association of oral cleanliness with caries is established. Results from the present study identify well with studies conducted by Retnakumari N⁹ and Tinanoff. ¹⁰ However Yee¹¹ et al demonstrated an inverse relationship between oral cleanliness and dental caries .

           Oral hygiene status was based on OHI-S scores. The relative risk for students scoring fair was 2.369compared to the good category and these results are very highly significant (p<0.001).

           The association between severity of dental caries and mothers' employment status was evaluated. The relative risk of caries for children of employed mothers was higher (3.082) when compared to those children whose mothers were house wives. This was statistically highly significant (p=0.006)

CONCLUSION

The data from the present study provides valuable information on the caries prevalence and association of specific risk factors in the above mentioned population. This will enable public health authorities to plan and implement interventions to improve the oral health of this population. With limited resources availability, the need for prevention cannot be over emphasized.