|Year : 2014 | Volume
| Issue : 3 | Page : 167-172
Dental caries and oral health behavior in 12-year-old schoolchildren in Moradabad city, Uttar Pradesh, India
Soumik Kabasi1, Pradeep Tangade2, Sumit Pal2, Aasim Farooq Shah3
1 Department of Public Health Dentistry, Institute of Dental Sciences, Bhubaneswar, Odisha, India
2 Department of Public Health Dentistry, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
3 Department of Public Health Dentistry, Government Dental College and Research Centre, Srinagar, Kashmir, India
|Date of Web Publication||15-Nov-2014|
Department of Public Health Dentistry, Institute of Dental Sciences and Hospital, Sector 8, Kalinga Nagar, Bhubaneswar 751 003, Odisha
Source of Support: None, Conflict of Interest: None
Introduction: Oral health is an essential component of health throughout life. It is important to organize community-oriented oral health promotion programs, so that information on oral health status and oral health behavior can be obtained. Aim: To investigate the caries experienced and oral health behavior in 12-year-old schoolchildren in Moradabad city, Uttar Pradesh, India. Materials and Methods: Five hundred and twelve schoolchildren (256 private and 256 government) 12 year old schoolchildren were selected through multistage random sampling procedure. Dental caries was recorded using Decayed, Missing, Filled Teeth (DMFT)/Decayed, Missing, Filled Surface (DMFS) index. Data on oral health knowledge, attitude, and behavioral practices were collected by means of a self-administered questionnaire. Results: The mean DMFT/DMFS among private schoolchildren (1.90 ± 1.46/3.24 ± 3.18) was significantly higher than the government schoolchildren (1.54 ± 1.34/2.22 ± 2.42). The survey found that 26.95% of the private and 19.53% of the government schoolchildren brushed their teeth regularly (twice a day) with toothbrush and toothpaste. The study participants also reported having hidden sugar at least once a day: Sweets (34.77% of the private schoolchildren and 25% of the government schoolchildren) and tea/coffee with sugar (61.33% of the private schoolchildren and 54.29% of the government schoolchildren). Dental visits of both private and government schoolchildren were poor. Conclusion: The difference in oral health behavior among the private and government schoolchildren may have influenced the DMFT/DMFS values and provided knowledge about the disease experience. In addition to preventing oral disease and promoting oral health, the local health authorities should give priority to school-based community-oriented oral healthcare services.
Keywords: Caries, children, oral health behavior
|How to cite this article:|
Kabasi S, Tangade P, Pal S, Shah AF. Dental caries and oral health behavior in 12-year-old schoolchildren in Moradabad city, Uttar Pradesh, India. J Indian Assoc Public Health Dent 2014;12:167-72
|How to cite this URL:|
Kabasi S, Tangade P, Pal S, Shah AF. Dental caries and oral health behavior in 12-year-old schoolchildren in Moradabad city, Uttar Pradesh, India. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2019 Nov 17];12:167-72. Available from: http://www.jiaphd.org/text.asp?2014/12/3/167/144787
| Introduction|| |
Health is multifactorial, influenced by factors like genetics, lifestyle, environment, socioeconomic status (SES), and much others.  Oral health is an integral part of the general health, rather oral cavity can rightly be called gateway of the body. Poor oral health has a detrimental effect on children's performance in school and their success in later life. Children who suffer from poor oral health are more likely to have restricted activity days, including missing school. 
India, a developing country, faces many challenges in rendering oral health needs. Despite credible scientific advances and the fact that caries is preventable, the disease continues to be a major public health problem. In India, dental caries has been consistently increasing both in prevalence and severity for last 5 decades. About 80% of children and 60% of adults suffer from dental caries. 
The increase in the prevalence of dental caries has been attributed to factors such as high sugar consumption, a shift to a westernized diet, poor SES, and the rate of urbanization.  Many industrialized countries have experienced a dramatic decline in dental caries which has been attributed to improved socio-economic conditions, changing lifestyles, self-care practices, use of fluorides, and effective use of preventive oral health services. 
Behavioral practices feature prominently in the oral health literature reflecting the fact that much of the dental disease is preventable. Petersen  has observed that at the population level, oral health outcomes are related to distal socio-environmental factors and characteristics of the oral health services available. Over the past decades, a large number of research reports have shown that dental caries is linked to social and behavioral factors. 
In order to control the growing burden of oral diseases, a number of developing countries have introduced school-based oral health education and preventive programs which aim at improving oral health behavior and status of the child population. The initial evaluations from such health projects conducted in Indonesia, Brazil, Madagascar, and China have disclosed some encouraging results. 
In a developing country like India, information on studies of caries and oral behavior in 12-year-old schoolchildren is sparse. The purpose of this study was to investigate the caries experienced and oral health behaviors in 12-year-old schoolchildren in Moradabad city, Uttar Pradesh, India.
| Materials and Methods|| |
The study was carried out in Moradabad city, Uttar Pradesh, India scheduled over a period of 3 months from February 2012 to April 2012. Twelve-year-old children, attending private and government schools in Moradabad city were chosen by the principle of representative sample regarding social, economical, and cultural communities; in order to attain a realistic view of the condition of oral health of the target group.
A list of all the schools, with the children aged 12 years, situated in Moradabad city was obtained from District Inspector of Schools and a map of Moradabad city was obtained from Moradabad Development Authority office. In order to collect the representative sample, a multistage sampling procedure was executed. At first stage, the city was divided into four zones: North, south, east, and west. Later at second stage, four largest schools were selected randomly from each zone. At third stage, cluster of sixth standard students were selected from each of the selected schools. Subsequently, all the 512 (256 private and 256 government) 12-year-old schoolchildren who were present in the schools on the day of examination, constituted the sample for the present study.
Prior to the start of the study, informed consent was obtained from the parents of the selected 12-year-old children in the schools. Only children whose parent gave their consent were included in the study. None of the children refused to participate. The calibration of the examiners was undertaken by means of a pilot study of 50 children during a 1-week period. The method of examination and scoring was standardized in the Department of Public Health Dentistry until inter- and intraexaminer reliability of 85% was achieved.
Before the dental examination, questionnaires were administered to assess the oral health knowledge, attitudes, and behavior of the children. The structured questionnaires were translated into local language, pretested on 100 children of Moradabad city in order to assess the validity of the questionnaire. Only those children were examined who filled the questionnaire completely. Questionnaires were administered in the classrooms by the examiner and the questions were read aloud giving time for children to fill in the questionnaires. The participants were encouraged to approach the examiner whenever they needed clarification at any point. School staff was placed under an obligation not to enter the classrooms where the children filled the questionnaire, as children tend to answer the questionnaire in favor of socially acceptable behavior. The children were also informed that their teachers would not look at the scripts and they would be processed away from the school.
One class period (approximately 45 minutes) was provided to fill the questionnaire. Students were assured that the information they provided would remain confidential and thus were encouraged to be truthful in their responses. They were informed that their participation was completely voluntary and they could quit at any time. A reference number was given to each questionnaire.
The questionnaire included 16 items designed to evaluate the oral health knowledge through the effects of regular dental visits, brushing, and consumption of sugary food stuff along with fluoride usage on the dentition. Items that assessed participant's dental attitudes included questions on effect of tooth decay on appearance and importance of natural teeth. A question on sources of dental health information was also included. Assessment of participant's oral health behavior included brushing frequency, use of oral hygiene aids, and usage of toothpaste. Dietary practices were also included to assess the oral health behavior for which frequency of consumption of various sugary foods (fresh fruits and sweets) and sugary drinks (soft drinks and tea/coffee and milk with sugar) were considered.
Data were collected in the school premises by means of clinical examination and questionnaires. One calibrated researcher, assisted by a recorder examined all the 512 children under artificial light using plane mouth mirrors. Clinical conditions recorded were caries, using Decayed, Missing, Filled Teeth (DMFT)/Decayed, Missing, Filled Surface (DMFS) index.  The names of children who needed dental treatment were given to the class teacher who informed the parents. All children who needed dental treatment were referred to the Kothiwal Dental College and Research Centre, for treatment. Oral health education and correct toothbrushing technique was taught to all the children examined.
Processing and analysis of data were carried out by means of the Statistical Package for Social Sciences (SPSS - PC version 18, Statistical Analysis Software). t-test was used for the comparison of means. The level of significance was set at P < 0.05.
| Results|| |
All the 512, 12-year-old children from the private and government schools were examined. The mean DMFT in private schoolchildren was found to be 1.90 ± 1.46, while in government schoolchildren it was 1.54 ± 1.34. The difference was found to be statistically significant (P = 0.0039). Furthermore, the mean DMFS in private schoolchildren (3.24 ± 3.18) was found to be higher than the government schoolchildren (2.22 ± 2.42) [Table 1].
|Table 1: Mean dental caries experienced by 12-year-old schoolchildren according to school type |
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It is evident from [Table 2] that 67.58% of the private schoolchildren agreed that "regular visits to the dentist keep away dental problems"; whereas, 54.69% of the government schoolchildren agreed to the same. Moreover, 73.83% of the private schoolchildren were aware that, "brushing their teeth can prevent tooth decay"; whereas, 68.75% of the government schoolchildren were aware about it. [Table 3] depicts that most of the subjects (N = 270) received information about dental health from their parents, out of which 139 subjects (54.3%) were from the private schools and 131 subjects (51.2%) were from the government schools.
|Table 2: Distribution of 12-year-old school children according to their answers to questionnaire in relation to school type |
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|Table 3: Distribution of 12-year-old schoolchildren according to source of dental health information in relation to school type |
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Private schoolchildren consumed sweets (34.77%) and tea/coffee with sugar (61.33%) more than the government schoolchildren (sweets (25%) and tea/coffee with sugar (54.29%)) [Table 4].Children from both government (19.53%) and private schools (26.95%) brushed their teeth regularly (twice a day) with toothbrush and toothpaste. Dental visit behavior among both government and private schoolchildren were poor. Over 80% of the children had never visited the dentist [Table 5].
|Table 4: Distribution of 12-year-old school children according to frequency of sugary foods consumption in relation to school type |
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|Table 5: Distribution of 12-year-old schoolchildren according to various oral health practices in relation to school type |
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| Discussion|| |
The present study provides information on dental caries experience and oral health behavior in a representative sample (n = 512) of 12-year-old private and government schoolchildren from Moradabad city, Uttar Pradesh, India. In Moradabad city, schools are classified as either private or government depending on the source of their funding.
School-going children of 12 years were considered because of many reasons. This is the age at which the deciduous dentition would have been replaced by permanent dentition. At this age of adolescence, the child identifies oneself; self-awareness in the child becomes intensified and results in a push for independence with less family supervision. As a result, appropriate data on oral health behavior could be collected. Moreover, according to World Health Organization, 12 years is the age at which children leave primary school and is the last age at which a reliable sample can be obtained easily through the school system and ease of availability of the particular age group children.
The present study showed that the probability of having caries experienced was significantly associated with the type of school. A previous study showed that dental caries was higher in children attending fee-paying schools than non-fee-paying schools,  which is in agreement with the present study. The major reason for the difference in caries experience of private and government schoolchildren was due to the fact that children from private schools were financially empowered than government schoolchildren.
The data was collected by means of self-administered questionnaires and due to school-based approach a high response rate was obtained. Meanwhile, the data collection method chosen may have certain limitations. With regard to attitudes towards dental care, oral hygiene habits, frequency of dental visits, and consumption of fresh fruits, overreporting has to be assumed; whereas, the consumption of sugary foods and drinks has probably been under-reported.  In addition, recall bias should be considered with respect to consumption of food items. 
The present survey provides an overview of oral health behavior and attitudes of the 12-year-old private and government schoolchildren. A major proportion of the respondents were not aware of the benefits of fluorides for prevention of dental caries; while the positive attitude towards the importance of toothbrushing was widespread, which is in agreement with previous studies among schoolchildren of Bangalore city, India  and Burkina Faso, Africa. 
This survey demonstrated that parents represent the primary source of information about oral health followed by school teachers, in concurrence with previous studies; , while in contrast to studies done by Harikiran et al.,  and Jamjoum  , where children received oral health information primarily from television. Hence, future health education programs should be targeted towards parents and school teachers who can significantly influence children's oral health behavior.
Substantial proportions of private schoolchildren of Moradabad city performed regular oral hygiene; in particular oral hygiene practices were infrequent in government schoolchildren. This variation in oral hygiene practices according to school type has been observed in many of the previous studies. ,,
The present study showed that majority of the 12-year-old schoolchildren claimed to brush their teeth regularly with a toothbrush and toothpaste. , Toothbrushing without appropriate instructions and regular supervision of the children will not prevent dental caries.  Brushing the teeth may be done very fast and with a technique greatly reduced in quality,  which could be the reason for the dental caries experienced in the present study.
The consumption of sweets and sugary drinks in the present survey was relatively high when compared to similar surveys from other regions, , while it is lower than the consumption frequency among previous studies. ,,, It has been reported that, access to money had direct influence on sweet snacking.  Regular consumption of sweets amongst schoolchildren attending private schools was found to be higher (34.77%) than those in government schools (25.00%). This finding is in support of previous Nigerian studies on increase in sugar consumption among this age group and higher dental caries in children attending fee-paying schools.  The majority of children attending the government school is from low-income families and may not have access to extra money to buy sweets.
Thus, in the present study, the levels of oral health knowledge and attitudes were rather low government schoolchildren of Moradabad city and the oral hygiene behavior varied with school type.
| Conclusion|| |
The differences in oral health behavior among the private and government schoolchildren may have influenced the DMFT/DMFS values and provided knowledge about the disease experience. Thus, the information obtained from the study can be used for the planning of oral health program for children.
As parents and school teachers are important informants in oral health, their involvement should be considered in oral health education program for children. The school may also serve as an effective platform for promotion of oral health in relation to children as well as families. In addition, to preventing oral disease and promoting oral health, the local health authorities should give priority to school-based community-oriented oral healthcare services.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]