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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 1  |  Page : 1-7

Prevalence of dental caries among 6–12 years school children of Mahbubnagar District, Telangana State, India: A cross-sectional study


1 Department of Pedodontics and Preventive Dentistry, Mamata Dental College, Khammam, Telangana, India
2 Department of Public Health Dentistry, Mamata Dental College, Khammam, Telangana, India
3 Department of Pedodontics and Preventive Dentistry, SVS Dental College, Mahbubnagar, Telangana, India

Date of Web Publication6-Mar-2017

Correspondence Address:
Kola Srikanth Reddy
Department of Pedodontics and Preventive Dentistry, Mamata Dental College, Khammam, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-4003.201641

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  Abstract 

Background: Dental caries is one of the most common oral problems affecting children globally involving the people of all region and society. It can be seen in all age groups of children involving both deciduous and permanent teeth. Dental caries is a lifetime disease, and the highest priority risk group is between 6 and 12 years of age. Aims: The aim of the study was to evaluate the prevalence of dental caries in both primary and permanent dentition among the school-going children in Mahbubnagar district. Materials and Methods: A cross-sectional study was carried out in 2000 children in different areas of Mahbubnagar district in age group 6–12 years. The dental caries status was assessed by decayed, missing, and filled teeth (DMFT)/dmft index using the World Health Organization criteria 1997. Statistical Analysis: Collected data from each patient is subjected to statistical analysis to know the prevalence of dental caries. Results: Dental caries in both primary dentition and permanent dentition was 64.2% and 26.6%, respectively. The prevalence of dental caries in primary dentition was more in 7–8-year-old children and less in 11–12-year-old children (P > 0.05). Overall, mean dmft score of both males and females is 1.49 ± 1.56, the overall mean DMFT score of both males and females is 0.57 ± 1.23. Conclusion: The present study showed that the frequency of caries was found to be a higher in the Northern region of Mahbubnagar district. The dental caries was more in 7–8 years and less in 11–12 years children, whereas less in local villages of Mahbubnagar.

Keywords: Children, dental caries, India, prevalence, schools


How to cite this article:
Reddy KS, Reddy S, Ravindhar P, Balaji K, Reddy H, Reddy A. Prevalence of dental caries among 6–12 years school children of Mahbubnagar District, Telangana State, India: A cross-sectional study. Indian J Dent Sci 2017;9:1-7

How to cite this URL:
Reddy KS, Reddy S, Ravindhar P, Balaji K, Reddy H, Reddy A. Prevalence of dental caries among 6–12 years school children of Mahbubnagar District, Telangana State, India: A cross-sectional study. Indian J Dent Sci [serial online] 2017 [cited 2019 May 20];9:1-7. Available from: http://www.ijds.in/text.asp?2017/9/1/1/201641


  Introduction Top


Dental caries is an important dental public health problem and is also the most prevalent oral disease among children and adults in the world. The prevalence of dental caries was of great interest for long and is a principal subject of many epidemiological researches being carried out worldwide. This significant but a preventable public health problem interferes with normal food intake, speech, self–esteem, and routine activities affecting overall health status of the children. Dental caries is a multifactorial infectious microbial disease of the teeth that results in localized dissolution and destruction of the calcified tissues often resulting in cavitation.[1]

Dental caries is still a smoldering disease in the developing countries like India that has engrossed its tentacles deep into the regions where the resources are inadequate for dental treatment, lack of public awareness, and motivation with increased intake of carbohydrates.[2],[3] Low income, poor oral hygiene, mother's schooling and fluorosis, enamel defects, various measures of low socioeconomic status, low level of parental education and cariogenic diet, all affect caries risk.[4],[5]

The oral health of children 12-year-old is the object of several epidemiological studies conducted around the world.[6] According to the World Health Organization (WHO, 2013),[7] the importance given to this age group is because it is the age that children leave primary school. Thus, in many countries, it is the last age at which data can be easily obtained through a reliable sample of the school system. Moreover, it is possible that at this age, all the permanent teeth except third molars have already erupted. Thus, the age of 12 was determined as the age of global monitoring of caries for international comparisons and monitoring of disease trends.

There is a high prevalence of dental caries worldwide involving the people of all region and society,[8] voluminous literature exists about dental caries levels in Indian population.[9]

Geographical location plays a great role in caries prevalence; it varies with the change in location. According to the National Oral Health Survey Report 2004.[10] Caries prevalence in India was 51.9%, 53.8%, and 63.1% at ages 5, 12, and 15 years, respectively, in different parts of India. Available literature from 1940 to 1960, the prevalence of dental caries in India showed a varied picture.[11],[12],[13] In spite of conflicting reports, it has been observed that during 1940, the prevalence of dental caries in India [14] was 55.5% and during 1960, it was reported to be 68.4%.

Mahbubnagar district is a geographical area located in Telangana state at the border between Telangana and Karnataka. Majority of the people staying here belong to lower socioeconomic status. Telangana state has many areas which have high fluoride levels in drinking water and Mahbubnagar district is one among them, where people are affected with dental and skeletal fluorosis. No study showing the prevalence of dental caries has been carried out so far in this region; hence, a study was carried out with an aim to assess the prevalence of dental caries in school-going children of Mahbubnagar district.

The objectives of study were to know the prevalence of dental caries in both primary and permanent dentition according to different age groups of children and also to suggest suitable preventive programs for the prevention of dental caries in this population.


  Materials and Methods Top


Study design

A cross-sectional study was carried out in Mahbubnagar district to assess the prevalence of dental caries among school children in the age group of 6–12 years.

Study area

Mahbubnagar district is lies between 15° 55' and 17° 29' North latitude and between 77° 15' and 79° 15' East longitudes. The district covers spread over 18,432 km 2, It lies at an average 498 from the sea level with a population of 4,042,191, the annual average temperature is 32°. It contains about 4 revenue divisions, 64 mandals, villages 1541, municipalities 4 and 4689 schools of which 3133 were primary schools, 889 were upper primary schools and 658 were high schools, and 9 were higher secondary schools.[15]

Sampling

The sampling procedure involved multistage stratified sampling [16] where whole Mahbubnagar district is divided into five strata, namely, and Mahbubnagar Central, Southern, Northern, Eastern, and Western. In each strata, following areas were selected.

  • Mahbubnagar Central: Boyapalli, Jainallipur, Ramaiahbowli, Mettugadda
  • Mahbubnagar Southern part: Kollapur, Utkoor, Bijinapalli, Wanaparthy
  • Mahbubnagar Eastern part: Kalwakurthy, Thadoor, Uppununthala, Kollur
  • Mahbubnagar Northern part: Kottur, Badepalli, Balanagar, Nawabpet
  • Mahbubnagar Western part: Kosghi, Narayanpet, Bomaraspet, Makthal.


In each area, one school was selected by simple random sampling (lottery) method, and on the whole about twenty schools were selected from above-mentioned areas. Eligible children were selected randomly from a list obtained from school records. Age eligibility requires that the children fall into the appropriate age at the time of sampling.

Inclusion criteria

The tooth was considered carious (d component) if there was visible evidence of a cavity, including untreated dental caries. The missing (m component) included teeth with indications for extractions or teeth extracted due to caries. The filled (f component) included filled teeth.

Exclusion criteria

  1. Early stages of dental caries and questionable lesions were excluded and considered sound
  2. Children with systemic diseases and on antibiotic therapy in the previous 6 months were excluded from the study.


Sample size determination

A pilot study was conducted on a convenient sample fifty, the prevalence of dental caries was assessed, and it was found to 49.71%. Based on this, the sample size was decided with n = 1849 with consideration of 3% precision and 99% confidence level. The final sample was rounded to 2000.

Note: Expected proportion = 0.4971, precision (%) = 3, desired confidence level (%) = 99, sample size (n) = 1849 should be taken.



Where Z: Standard normal value (Z value) = 2.58,

d: Precision = 3% (0.03),

P = 0.4971,

q = 1 − p.

A total of 2000 school-going children from rural and urban areas of 6–12 years old were enrolled in this study.

Ethical clearance and permission

Before starting the study, ethical clearance was taken from the Ethical Committee of Institution, Mahbubnagar. An official permission was obtained from the district educational officer Mahbubnagar. Informed consent was obtained from the respective school headmasters and parents of the children.

Training and calibration

The clinical examination (American dental association type 111) was done by three dentists; they were assisted by three dental assistants over a period of 1 year for recording data. All six persons were trained prior, and recording procedure was standardized by repeated sections of calibration between the examiner and chief supervisor in the Department of Pedodontics and Preventive Dentistry, in the Institution, Mahbubnagar, before starting the actual recording on children.

Clinical examination of dental caries

Standard infection control guidelines were applied. All the recordings were carried out in the daylight, and the child was made to sit in ordinary chair facing away from a direct sunlight.[17]

The oral examination of the study subjects was conducted in respective schools using, a plane mouth mirror under natural light and a community periodontal index (CPI) probe, as indicated by the WHO, CPI probes (“ball point”) are used, especially in epidemiologic surveys to remove debris over tooth, thus improving the visualization [10] The components of the decayed, missing, and filled teeth (DMFT)/dmft index have been defined as follows: D = tooth requiring treatment because of caries, lost or fractured filling; M = tooth missed because of caries, and F = filled or crowned tooth, no need of treatment. The total number of caries-free (CF) schoolchildren was also recorded.

Sociodemoghraphic information

During the examination of school children, a questionnaire was used to fill out personal data such as name, age, gender, and occupation and income status of the parent, permanent address, source of water for consumption, oral hygiene methods, and diet chart. The draft of the questionnaire was reviewed by the panel of experts which included faculty members from pedodontics and preventive dentistry, public health dentistry, school teachers and headmasters, and then finalized.

Data analysis

All data were entered into an SPSS (18) program (IBM Corporation, Chicago, USA) both descriptive and analytic approaches were used in the data analysis. Frequency tables were computed. The association between prevalence of caries and gender was tested using the Chi-square test. The t-test was used to test the mean dmft and decayed, missing, and filled surfaces (dmfs) difference between groups. P < 0.05 was considered statistically significant.


  Results Top


Sample distribution according to age

[Table 1] shows that the age group of the population ranges from 6 to 12 years with mean age of 9.45 ± 2.0 years. Among a total population of 2000 children, 332 of them belonged to age group 6–7 years, 286 of them belong to age group 9–10 years age group. Out of the population, 1021 were males and 979 are females.
Table 1: Sample distribution according to the age and gender

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Sample distribution according to region

[Table 2] shows the distribution of sample according to the region wise and Mahbubnagar distributed into five regions, namely, Central, Eastern, Western, Southern, and Northern from each region 400 sample were selected.
Table 2: Sample distribution according to region

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Overall prevalence of dental caries in primary, permanent dentition based on age and gender

[Table 3] indicates that from one to other age group the caries prevalence is dissimilar. The total caries prevalence in primary dentition was in males is 63.6%, in females is 65.1%. The CF in males is 36.4%, and females is 34.8%. The total caries % in all gender is 64.2%.
Table 3: Percentage of children with caries and caries-free

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The caries prevalence in permanent dentition was in males is 26.2%, in females is 73.5%. The total caries prevalence in both males and females is 26.6%. The total CF prevalence in both males and females is 73.5%. From one to other age group, the caries prevalence rate is dissimilar, statistically it is significant (P value is 0.00) (<0.01).

Prevalence of dental caries in primary dentition based on gender

The overall decayed, extracted, and filled teeth (deft) value for both males and females were 1.49 ± 1.56 and decayed, extracted, and filled surface value 1.9% ± 2.65%. The differences between males and females are statistically it is not significant. The total no of males mean deft values are 1.51 ± 1.57, the mean deft values are 1.47 ± 1.54 [Graph 1].



Prevalence of dental caries in permanent dentition based on gender

The overall mean DMFT and DMFS values for both males and females were 0.57 ± 1.235, 0.65. ± 1.47. The difference between males and females were statistically significant. The total mean DMFT values in males are 0.610 ± 1.50, in females are 0.57 ± 1.28 [Graph 2].



Correlation of socioeconomic status with caries prevalence in primary dentition

[Table 4] indicates that higher deft values (1.49, 64.2%) were found in daily labor due to increased exposure of teeth to poor oral hygiene conditions.
Table 4: Correlation of socioeconomic status with caries prevalence in primary dentition

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Correlation of socioeconomic status with caries prevalence in permanent dentition

[Table 5] indicates that the mean DMFT was found 0.57 (26.6%).
Table 5: Correlation of socioeconomic status with caries prevalence in permanent dentition

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The total average number of sugar exposures with age-wise distribution

[Table 6] indicates that total average no of sugar exposures with age-wise distribution. It is statistically significant with all age group. Except 8–9 years, it is not statistically significant. The total mean for both males and females is 1.60 ± 1.50. The total mean values for sugar exposures in males are 1.50 ± 0.82, the total mean values for sugar exposure in females are 1.70 ± 0.84.
Table 6: Total average number of sugar exposures

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  Discussion Top


Many studies have been conducted to identify the prevalence of caries in different parts of India.[1],[2],[8],[9] However, there has been relatively very few data reported in literature concerning the prevalence of dental caries among Mahbubnagar district children, particularly in mixed dentition period, so the present study was conducted in school children of 6–12 years.

In the present study, the prevalence of dental caries was higher in primary dentition (mean deft 1.49, 64.2%) when compared to permanent dentition (mean DMFT 0.57, 26.6%), respectively. This is similar to the reports of some other studies.[18],[19] This could be attributed to the fact permanent teeth have a lower susceptibility to dental caries. It may also be because children of 12 years of age had just finished to change dentition. It could also be due to the lower calcium content of deciduous teeth and structural differences that may increase caries susceptibility in deciduous teeth.[20]

However, a cross-sectional study conducted in Bundelkhand region, India,[21] reported a much higher prevalence of dental caries (82.62%) in 3–14 years old group as compared to the present study. The prevalence of caries in our study was higher in boys than girls. Similar findings were reported by Moses et al., Joshi et al.[22],[23] The increased prevalence of caries in the boys may be due to the marked preference for the sons, which manifest in preferential feeding compared to daughters and due to snacking habit among boys during the longer outside stay.[22]

In permanent dentition, 11–12 years old were having more caries (mean DMFT 1.32, mean DMFS 1.43) and less caries was found in age group of 6–7 years (mean dmft 0.27, mean dmfs 0.34). The reason behind this is the presence of less number of permanent teeth at age group of 6–7 years when compared to age group of 11–12 years.

These results are correlating with study done by Mahesh Kumar et al.,[24] who conducted a study in oral health status of 5–12 years school-going children in Chennai city population.

In the present study, the prevalence of dental caries was high in the low socioeconomic status because of their poor oral hygiene practice, lack of awareness, improper food intake, and family status. This finding is similar to the study conducted by Moses et al.[22] Recent studies from Europe demonstrate a significant inverse association between social class and oral health status in young children. The North Brisbane study supports these findings by confirming that preschool children from a lower socioeconomic background also more active decay and more missing teeth from the previous disease compared with children from higher socioeconomic status levels.

The strongest correlation between sugar consumption and caries development was seen when international data are compared. A study by Sreebny [25] data on sugar supplied in various countries and data on caries prevalence obtained from the WHO for 6-year-old children in 23 nations and 12-year-old in 47 nations, showed that the availability of <50 g sugar per persons per day in a country was always associated with dmft or DMFT scores of <3.

Similar findings were reported by Gustafsson et al.,[26] Winter et al.,[27] and Shetty and Tandon et al.[28] However, McDonald found no significant relationship between sugar consumption and caries prevalence. In this study, a highly significant relation was found between sugar consumption and socioeconomic status. Similar findings were reported by Blinkhorn et al.,[29] who stated that in deposited areas mothers were more likely to give continuous sugar to children throughout that day, increasing the daily sugar consumption.

This present study was similar to the prevalence of dental caries in school-going children of Vidarbha region in Central India was found to be 65.70%. High prevalence of dental caries in school-going children of the study and in the current literature could possibly be due known issues of socioeconomics, immigration, lack of preventive efforts, and dietary changes.[30]

However, a cross-sectional study, conducted in Bundelkhand region of India,[31] reported a much higher prevalence of dental caries (82.62%) in 3–14 years old group when compared to the present study. Ramachandran Karunakaran et al.[8] conducted a similar study in 460 male school-going children of Namakkal district of Tamil Nadu and found the prevalence of dental caries to be 69.57% with the mean dmft score of 2.89. Datta and Datta et al.[32] conducted similar study in school children of Sunderban district and found 68.8% male children of 13 and 14 years affected with dental caries.

The present study reported the mean DMFT/dmft of 3.2 which is much higher than the WHO (oral health goals 2010) target of mean DMFT/dmft of 1.5.[33] The high mean DMFT/dmft reported could be the reflection of low economic status in rural region of Mahbubnagar district.


  Conclusion Top


Our data shows a high prevalence of dental caries among 7–8-year-old school children from low socioeconomic status background in both urban and rural areas of Mahbubnagar district. This data may be of importance in the evaluation of the past and planning of future oral health prevention and treatment programs targeting young children in primary schools. A comprehensive community-focused oral health-care intervention that includes oral health education in elementary schools and homes are recommended to increase general oral health awareness.

Limitations

As this study is cross-sectional, it measures cause and effect at the same point in time, introducing the problem of temporal ambiguity, and inability in establishing a causal relationship. Risk factors for dental caries, socioeconomic status, and oral hygiene behaviors should be assessed along with the prevalence of dental caries.

Recommendation

  • Implementation of preventive school dental health programs
  • Mobile dental clinic services can be implemented to the residential school children
  • These trained and motivated school teachers can further be made responsible for implementing these programs in the schools on a regular basis
  • The government should provide oral health through primary health-care system appointment dental surgeons up to primary health center level in this region.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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