|Year : 2022 | Volume
| Issue : 1 | Page : 1-5
Prevalence of gingivitis and correlation between frequency of brushing and gingivitis in 3- to 15-year-old school children in rural parts of Barabanki District, Uttar Pradesh, India
Vertika Gupta, Prerna Vishwanath, Nalini Tripathi
Department of Dentistry, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
|Date of Submission||28-May-2020|
|Date of Acceptance||02-Apr-2021|
|Date of Web Publication||31-Dec-2021|
Sector 25, House No. 28, Near Power House, Indra Nagar, Lucknow - 226 016, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: In India, the majority population lives in rural areas where there is less awareness on the maintenance of oral health. At the rural level, less work has been done among children to determine the incidence of gingival disease and its relation to the cleaning rate. Hence, it is necessary to evaluate the prevalence of gingivitis among these masses. Aims and Objectives: The goal of the study was to determine the prevalence of gingivitis and its relation to the frequency of tooth brushing among school-going children between 3 and 15 years of age group in rural areas of Barabanki district, India. Materials and Methods: The study was done on a sample size of 1200 school-going children, in which 611 boys and 589 girls are there, from rural schools of Barabanki. The sample consisted of four age groups of children from 3 to 5 years, 6–9 years, 10–12 years, and 13–15 years of age. Gingival Index given by Loe and Silness was used to determine the severity of gingivitis. The data were evaluated using the Chi-square test. Results: The overall prevalence of gingivitis obtained was 86.17% and it was highly significant in relation to age groups. On comparing the frequency of brushing and gingivitis in all age groups it was revealed that twice daily brushing was significantly related to healthy gingiva. Conclusions: The study revealed a high prevalence rate of gingivitis among children in these age groups indicating oral health program is highly recommended for both parents and school children in rural areas to maintain oral hygiene.
Keywords: Barabanki, brushing, children, gingivitis, prevalence
|How to cite this article:|
Gupta V, Vishwanath P, Tripathi N. Prevalence of gingivitis and correlation between frequency of brushing and gingivitis in 3- to 15-year-old school children in rural parts of Barabanki District, Uttar Pradesh, India. Indian J Dent Sci 2022;14:1-5
|How to cite this URL:|
Gupta V, Vishwanath P, Tripathi N. Prevalence of gingivitis and correlation between frequency of brushing and gingivitis in 3- to 15-year-old school children in rural parts of Barabanki District, Uttar Pradesh, India. Indian J Dent Sci [serial online] 2022 [cited 2022 May 22];14:1-5. Available from: http://www.ijds.in/text.asp?2022/14/1/1/334526
| Introduction|| |
Gingivitis is one of the most common dental diseases in children of all age groups which have an early onset. It is inflammation of gingival characterized by the presence of redness, swelling in gums, and bleeding on probing. Gingivitis is a reversible condition if treatment is done on time. If left untreated it may become destructive involving both hard and soft tissues together leading to tooth loss, this condition is known as periodontitis. It can be prevented by sufficient removal of plaque and maintaining oral hygiene on a daily basis. Toothbrushing is the most common and efficient way to remove plaque. Toothbrushing and other positive oral health practices if included in children's life at an early age, oral well-being can be achieved, and disease can be put to halt in its primordium.
Although gingival diseases are preventable, an increase in gingivitis had been seen in developing countries like India where the majority of the population is concentrated more in rural parts. Studies have shown an increasing trend of gingivitis in rural parts of India, especially among children Dhar et al. and Bhayya and Shyagali. Various studies to evaluate the prevalence of gingivitis in children had been conducted in different parts of India, but Barabanki district lacks sufficient data on this disease.
Hence, this survey was planned with the aim of to study and determine the prevalence of gingival disease among the children of 3–15-year age group and the correlation with frequency of brushing and gingivitis among school-going children in rural areas of Barabanki.
| Materials and Methods|| |
The present study was carried out on a sample size of 1200 school children from three schools belonging to 3–15 years age in rural parts of Barabanki district, Uttar Pradesh. The study was conducted from October 2019 to January 2020. The schools were randomly selected using computer-generated list, and the students were examined on predetermined dates in the school. The students present on the following day of the survey were only considered for examination. Written permissions were obtained from the school authorities, and informed consent was obtained from the parents before scheduling the survey. Ethical clearance was obtained from our institutional ethical board. The inclusion criteria included children who were residents of that area and with no chronic diseases. The children with special health-care needs were excluded from the study. The study sample was divided into four age groups consisting of children from 3 to 5 years of age, 6–9 years, 10–12 years, and 13–15 years of age.
The recording was done in two sections, the first section was on demographic details and oral health practices of children consisting of age, gender, personal history, medical history, frequency of brushing, type of agent used for cleaning teeth, type of material used for toothbrushing, and second was for recording clinical examination by gingival index. The first section was prefilled by the examiner before commencing the second section that was clinical examination and recording. The first part which was the questionnaire was preevaluated by the dentist and public health expert. The information for the first section of the questionnaire for the age group from 6 years and above was directly interviewed and recorded. For age groups from 3 to 5 years, the part one of the questionnaire which was also prepared in Hindi language for the rural areas to compensate for any linguistic barrier was sent by the school authorities to the parents, which was later returned and collected by the school teachers and handed back to the examiner.
The participants were clinically examined by a trained examiner in broad daylight by seating them on a simple chair. Single examiner trained to record the WHO oral health assessment form examined all the children to avoid interexaminer variability. Intraoral examination was done using sterile mouth mirrors and probes. Multiple sets of sterile instrument were used while recording the findings. The Gingival index by Loe and Silness was used for recording the gingival status. The data were compiled and subjected to statistical analysis using SPSS version 20 (Chicago, IL, USA). The Chi-square test was used, and P < 0.05 and P < 0.01 were considered statistically significant.
| Results|| |
A total of 1200 students were examined in the schools for the survey. Among this total, 611 (50.9%) were boys and 589 (49.0%) girls. Out of them, 267 (22.25%) children belonged to 3–5 years age group, 281 (23.42%) children belonged to 6–9 years age group, and 314 (26.17%) and 388 (28.17%) children to the age groups of 10–12 years and 13–15 years, respectively [Table 1].
|Table 1: Demographic representation of study subjects according to age group|
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In 3–5 years old, the overall prevalence of gingivitis was 76.4%. A total of 267 children were examined in this age group, of which 63 (23.6%) had healthy gingiva, 177 (66.29%) had mild gingivitis, 25 (9.36%) had moderate gingivitis, and 2 (0.75%) suffered from severe gingivitis [Table 2].
In 6–9 years old, 281 students were examined in total, out of which 250 children were affected by the disease. The overall prevalence of gingivitis for this age group was 88.97%. Mild gingivitis was seen in 181 (64.41%) children, moderate gingivitis and severe gingivitis were seen in 60 (21.35%) and 9 (3.2%) patients, respectively [Table 2].
In 10–12 years old, a total of 314 students were surveyed; it was observed that 280 children were affected by gingivitis. Mild, moderate, and severe gingivitis was seen in 194 (61.78%), 74 (23.57%), and12 (3.82%) children, respectively. The overall prevalence of gingivitis was seen as 89.17% [Table 2].
In 13–15 years old, 338 children were examined and 300 were affected by the disease. The overall prevalence of gingivitis was 88.76%. Mild gingivitis was seen in 205 (60.65%) children, moderate gingivitis in 80 (23.57%) children, and severe gingivitis in 15 (4.4%) children [Table 2].
Out of 1200 students, 1034 were suffering from gingivitis with the overall prevalence of 86.17% (mild gingivitis 70.33%, moderate gingivitis 13.75%, and severe gingivitis 2.08%) [Table 2].
On comparing the age groups, the age-wise difference was found highly significant [Table 2].
A total of 515 (84.29%) boys and 519 (88.12%) girls were affected by gingivitis. The difference between boys and girls was not significant (P < 0.05) [Table 3]. On comparing the relationship between frequency of brushing and gingivitis, the data revealed that, in all the age groups, twice-daily brushing was significantly related to healthy gingival (P < 0.01) [Table 4].
|Table 4: Prevalence of gingivitis in relation with frequency of brushing|
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| Discussion|| |
India is the second largest populated country in the world after China, with more than 2 billion population. Most of the population is lives in rural parts, i.e. 78% and urban part constitute 28% of the total. The ratio of dentist to the population in rural parts is less as compared to urban areas. The high prevalence rate in dental diseases has been reported from time to time from different parts of India. Gingivitis is seen as the most prevalent dental diseases. Epidemiological trials to evaluate the prevalence of disease are a prerequisite in planning and implementation of oral health programs so that such diseases can be eradicated.
The existence of oral diseases correlates with the understanding of oral hygiene practices and oral well-being in a population. Even though the majority of the population in India resides in rural areas, the oral hygiene maintenance had been neglected over the years due to a lack of education and financial constraints.
Various studies to evaluate the prevalence of gingivitis in children had been conducted in different parts of India, but Barabanki district lacks sufficient data on this disease. A study by Singh et al. in 2011 is the only epidemiological study conducted so far in Barabanki which assessed the prevalence of gingivitis, fluorosis, and malocclusion, and after this, no data are available for this region. Moreover, no study had been done to assess the prevalence of gingivitis and the relationship between frequency of brushing and gingivitis.
The present study is the foremost research to determine the oral hygiene practices and prevalence of gingivitis in school children from age 3 to 15 years in rural areas of Barabanki district of Uttar Pradesh. Gingival index by Loe and Silness was chosen in our study to assess the severity of gingivitis as it had been used extensively in various epidemiological studies. This index is easy to use in the field with minimal training, highly reproducible, and the criterion used helps in quick examination of subjects.
The total prevalence of gingivitis among school children in our study was 86.17% which also increased with age is high and is in accordance with the findings of Dhar et al. in 2007, who reported 84.3% overall prevalence in school going children of rural areas of Udaipur district. Another study was done by Singh et al. in rural parts of Barabanki district on school-going children reported the overall prevalence of 78.35% which was also high. Various other studies also reported a high prevalence of gingivitis among school-going children of rural areas in India.,,
The results of our survey showed that most of the children aged 3–15 suffered from mild-to-moderate gingivitis. In our study, no significant difference was found in the prevalence of gingivitis between male and females which were in contrast to the finding of Singh et al. who reported high prevalence of gingivitis among girls of the rural schools in Barabanki. Several other studies done by Dhar et al., Shah and Jeevanandan showed more prevalence in females than males. This could be due to hormonal changes during puberty, lack of oral hygiene practices in rural areas, and more priority of boys over girls in rural parts. However, few studies done by Das et al., Mahesh Kumar et al., and Bhayya and Shyagali reported a high prevalence in males probably because oral hygiene habits have a gender relation and personal hygiene is more of concern in girls than boys.
The distribution of prevalence in gingivitis was assessed with respect to the age groups; it was observed in this study that gingivitis shows an increasing trend as age advances similar to the results reported by Jose and Joseph and Mahesh Kumar et al. In 3–5 years of school-going children, mild gingivitis was more prevalent in our study which is similar to the results of Dhar et al. who reported mild gingivitis in the same age group of school-going children of rural areas. This could be explained due to various food habits, improper feeding habits, and lack of awareness of parents of rural areas on oral health practices. The oral hygiene practices in this age group are dependent mainly on parents due to the limited dexterity of the child, therefore, the lack of awareness on oral health among them could be the main reason influencing the disease process.
The age group from 6 to 9 years our study showed that most children were affected by mild and moderate gingivitis with a slight increase in the prevalence of moderate gingivitis in rural schools which is in accordance with the survey done by Singh in Lucknow on school children aged 8–10 suffered gingivitis of mostly mild-to-moderate severity. This could be due to mixed dentition, shedding of primary teeth, various deleterious oral habits, increase in intake of sugar, parental behavior and attitude, and socioeconomic factors in rural areas.
Among school children of 10–15 years of age, an increase in prevalence toward moderate and severe gingivitis was seen in this study which is similar to the study reported by Bhayya and Shyagali among 10–12-year age group and Baiju et al. among 15–18 years old. The prepubertal and pubertal changes influenced by hormones, crowding of teeth due to newly erupted permanent teeth leading to malocclusion, unsupervised brushing habits, unavailability of toothbrush and toothpaste due to economic constrains, less education, awareness, and motivation about oral health hygiene and habits such as tobacco consumption in rural areas can be the reason for this result in our study. A peak in the severity in 9–14 years old had been documented extensively.,
A shift in severity of gingivitis from infancy to adolescence can be due to the increase in the number of site at risk, plaque accumulation, changes in microflora, inflammatory changes associated with tooth eruption and exfoliation, hormonal influence, and habits like mouth breathing which is common in adolescence.
Although a slight decline in the overall prevalence of gingivitis in the age group of 13–15 years was seen in our study and could reflect an increased social awareness leading to improvement in oral hygiene.
Most of the children in all the age groups (86.58%) brushed their teeth once daily which is similar to the results of Sharva et al. but high in comparison to Harikiran et al. and Shailee et al. In our study, very few children (5.75%) who brushed their teeth twice a day and 7.67% of children who brushed occasionally this is similar to the results by Sharva et al. which reported a less number of students brushed their teeth twice daily. This could be due to fact that all the children examined in our study belonged to rural areas and belong to low socioeconomic families, the low literacy rates in these areas among parents, low level of knowledge, and less medical facilities. The increased frequency of brushing decrease in the prevalence of gingivitis was evident in our study which is similar to the results of other studies as well. This shows that there is a definite relation between retention of plaque and inflammation of gingival. In the present study 84% of children used toothbrush and toothpaste for cleaning teeth, but the level of gingivitis present reflected irregular methods of brushing, inadequate brushing time and/or techniques. Some of the children might not even be brushing as they claim. Data collected through questionnaire/interviewing may not always give correct results.
About 9% of children in our study reported using finger as cleaning aid for brushing and 7% used neem stick (datoon). The custom of using fingers and neem stick is still being practiced in rural India. It is evident from our study that there is a lack of awareness and attitude among the parents of rural areas in Barabanki district about oral health. As to improve the oral health of children in rural parts of Barabanki, more efforts are needed to initiate changes among masses which could be achieved by conducting various oral health programs. Oral health programs can be scheduled for children at school where positive attitudes can be instilled along with the education of school teachers and parents. Reinforcement of oral health can be done by various teaching methods in schools and regular screening and various preventive programs on toothbrushing programs among parents school teaches and children can reduce the disease burden for a better health future of children.
The information provided in our study can be used as preliminary data, and large-scale epidemiological study can be undertaken in future to collect the burden of dental diseases in rural areas.
| Conclusions|| |
Within the limitation of our study, we concluded that the prevalence of gingivitis is high among the children of rural areas of Barabanki district. Immediate attention is required toward these children from underprivileged areas for eradication of the dental diseases and promotion of oral health.
We would like to extend our thanks to dental technician and ward staff for their help.
Informed consent was obtained from the parents and concerned authorities. Ethical clearance was obtained from the institutional review board.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]