|Year : 2015 | Volume
| Issue : 1 | Page : 30-32
Utility of pediatric cariogenicity index among preschoolers of the western part of Maharashtra: A cross-sectional study
Siddhi Pancholi1, Snehal Patil2, KM Shivakumar2, Neelima Malik3, Renuka Pawar4, KV Suresh5, Vidya Kadshetti1
1 Oral Pathology, Microbiology and Forensic Odontology, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
2 Department of Public Health Dentistry, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
3 Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
4 Department of Orthodontics and Dentofacial Orthopedics, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
5 Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
|Date of Web Publication||19-Mar-2015|
Dr. K M Shivakumar
Department of Public Health Dentistry, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad - 415 110, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Early childhood caries (ECC) is a multifactorial infectious disease occurring on one or more decayed, missing or ﬁlled tooth surfaces in a child from birth to 6 years of age. ECC results from the interaction of behavioral and biological factors including fermentable carbohydrate, plaque, and dietary patterns. Diet is a major modiﬁable risk factor in the initiation of ECC. Aim: The aim was to assess the utility of pediatric cariogenicity index among the Indian population. Materials and Methods: A cross-sectional study was conducted with sample size of 400 preschool children of Satara district, western Maharashtra. Data regarding the diet were obtained from caregivers and cariogenicity indices were used to score dietary data using a food frequency questionnaire. The 24 h dietary recall was taken. Preschool children were subjected to type 3 dental examinations. Solid and liquid cariogenicity scores were assessed by Statistical analysis - SPSS v 17.0. Results: The mean deft was 1.44 (±1.20) for the subjects. Similarly, according to the calculation using 24 h recall, mean solid cariogenicity score was 2.3 (±0.9) and mean liquid cariogenicity score 4.37 (±1.5). The correlation between deft and the solid cariogenicity score was not significant (r = −0.074). The correlation between deft and liquid cariogenicity scores was significant and positive (r = 0.671). Conclusions: There was definite positive correlation of liquid cariogenic food intake with the ECC experience among the preschool children of western part of Maharashtra.
Keywords: Caries, cariogenic index, paediatric dentistry, preschool children
|How to cite this article:|
Pancholi S, Patil S, Shivakumar K M, Malik N, Pawar R, Suresh K V, Kadshetti V. Utility of pediatric cariogenicity index among preschoolers of the western part of Maharashtra: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:30-2
|How to cite this URL:|
Pancholi S, Patil S, Shivakumar K M, Malik N, Pawar R, Suresh K V, Kadshetti V. Utility of pediatric cariogenicity index among preschoolers of the western part of Maharashtra: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jan 17];13:30-2. Available from: http://www.jiaphd.org/text.asp?2015/13/1/30/153564
| Introduction|| |
Caries is a common, complex, chronic disease resulting from an imbalance of multiple risk factors. Early childhood caries (ECC) is the most common chronic infectious disease in childhood and is a serious public health problem in both developing and industrialized countries. ECC has been considered to be at epidemic proportions in the developing countries.  Its consequences can affect the immediate and long-term quality of life of the child's family and can have significant social and economic consequences on family. ECC begins early in life, progresses rapidly in those who are at high risk, and often goes untreated. Evidence suggests that threat for ECC is increased by specific eating behaviors. Frequent consumption of cariogenic foods and bacterial infection are risk factors for ECC.  The prevalence of ECC is estimated to range from 1% to 12% in infants from developed countries.  Previous Published studies show higher prevalence for 3-year-old, which ranges from 36% to 85%. , In East Asia region, the prevalence of caries among 8-48 months old is reported to be 44%.  Studies conducted in the Middle East have shown that the prevalence of dental caries in 3-year-old is between 22% and 61% and in Africa it is between 38% and 45%. 
Primary maxillary incisors are generally affected earlier than the four maxillary anterior teeth which are often involved concurrently. Carious lesions may be found on either the labial or lingual surfaces of the teeth and in some cases, on both.  Streptococcus mutans and Streptococcus sobrinus are the main cariogenic micro-organisms. Most of the investigations have shown that in children with ECC, S. mutans has regularly exceeded 30% of the cultivable plaque flora. Inappropriate use of baby bottle has a central role in the etiology and severity of ECC. The rationale is the prolonged bedtime use of bottles with sweet content, especially lactose.  ECC is initially recognized as a dull, white band of de-mineralized enamel that quickly advances to obvious decay along the gingival margin. 
Currently, however, few tools are available to researchers and clinicians to assess children's diet, as it relates to caries risk, and demonstrate how it can be successfully modiﬁed to reduce caries risk. Palmer et al. evaluated ﬁve food categories based on potential cariogenic risk and found it to be associated with Severe ECC (S-ECC). They found that children with S-ECC consumed signiﬁcantly more liquid and solid putative cariogenic foods as compared with caries-free children. 
Pediatric cariogenicity index developed by Evans et al. is one such tools developed to assess the cariogenicity of the Childs diet.  There is a need to assess the utility of pediatric cariogenicity index to identify modifiable dietary risk factors among the Indian population especially among the preschool children. The results of our study will help the caregivers to implement preventive practices that can decrease a child's risks of developing this devastating disease. Hence, this study was conducted with an aim to assess the utility of pediatric cariogenicity index among the children of western part of Maharashtra.
| Materials and Methods|| |
A cross-sectional study was conducted among 2-6 years old school children attending government schools of Satara district, western part of Maharashtra, India. Before starting the study official permission was obtained from all the concerned authorities. Informed Consent was obtained from caregivers and Ethical approval was obtained from Institutional Ethics Committee. A Pilot study was conducted to assess the feasibility of the study. The study was conducted from May 2014 to October 2014.
A sample of 400 students were included of which 223 were girls and 177 were boys. Children were selected by simple random sampling technique. Preschool children who were co-operative for clinical examination and whose parental consent was obtained were included in the study. Preschool children with systemic diseases and under medication were excluded from the study.
The school children were allowed to sit on a chair or stool, where sufficient natural daylight was available. A survey form was prepared and the children were examined according to the Dentition status WHO oral health assessment 1997.  Children were subjected to type III clinical examinations. All teeth were examined in a systematic manner using international FDI two-digit nomenclature to identify each primary tooth and standard dental terminology to identify each surface. An average number of 40 school children were examined per day. Complete dentition examinations were carried out by the investigator; in the subjects own surroundings, that is, the school. A recording clerk (Trained Dental Surgeon) was involved to enter the codes on the survey form. Previous invasive dental procedures such as restorative care or extractions recorded. Children in need of emergency treatment were referred to dental hospital.
Following variables were assessed like education of parents, socio economic status, primary caregiver, child age and gender, size of family. A 24 h dietary recall was used as tool by the trained investigator to carry out the dietary assessment. Based on the food frequency the daily average intake was calculated. The pediatric cariogenicity index - liquid and solid cariogenicity scores were calculated based on the procedure explained by Evans et al. 2013. 
Data were analyzed using SPSS version 17.0 (SPSS Inc., Chicago, IL, U.S.A), with statistical signiﬁcance set at P < 0.05. To test the utility of indices, summary food and liquid cariogenicity scores for each participant using each dietary assessment method was calculated. Pearson correlation was used to assess the relation between the deft and cariogenicity scores of the study participants.
| Results|| |
[Table 1] shows the distribution of the participants according to the demographic variables. The mean deft was 1.44 (±1.20) for the subjects. Similarly according to the calculation using 24 h recall, mean solid cariogenicity score was 2.3 (±0.9) and Mean liquid cariogenicity score 4.37 (±1.5).
The correlation between deft and the solid cariogenicity score was not significant (r = −0.074, P > 0.137, S). The correlation between deft and liquid cariogenicity scores was significant and positive (r = 0.671, P < 0.001) [Table 2].
|Table 1: Distribution of the participants according to the demographic variables, deft, cariogenicity scores |
Click here to view
|Table 2: Correlation between mean deft and solid and liquid cariogenicity scores |
Click here to view
| Discussion|| |
This study was conducted to assess the utility and correlation of the pediatric cariogenicity index among Indian population. We hypothesized that the index will be positively correlated with the dental caries levels among the preschool children. Pediatric cariogenicity index developed by Evans et al.  is one of the first indices developed which discriminate the liquid and solid foods to better understand the effect on ECC. The liquid cariogenicity index scores beverages are based on their sugar content and acidity. Similarly the food cariogenicity scores are dependent on the sugar and starch contents of the foods.
Our results reveal the moderate correlation of deft values with the liquid cariogenicity scores and these findings are consistent with the results obtained by Evans et al.  The food cariogenicity scores were not significantly correlated with the dental caries levels of the children similar to the study by Evans et al.  Interesting finding was that there was negative correlation of food cariogenicity score though not significant one with the dental caries. This might be the case as the duration and length of eating occasions or the amount of time the teeth were exposed to a given food or that the bacterial plaque levels were not considered in 24 h recall.
In our study, we used only 24 h recall rather than food frequency questionnaire as it has not been developed for the preschool children in India. In this study the socio demographic variables were not correlated with the caries status of the children which can be considered as a limitation. The children were not divided into groups based on caries status which can be done in future studies.
Further studies need to be conducted in which the food frequency questionnaire for this population is developed and tested with the cariogenicity index used in this study. This will help overcome the limitations of the 24 h recall. Hence results of this study should be interpreted with caution due to the bias which can be introduced in 24 h recall.
It can be concluded that there was definite positive correlation of liquid cariogenic food intake with the ECC experience among the preschool children of western part of Maharashtra. Pediatric cariogenicity index can be used as a predictor for the ECC among the preschoolers and it will help in early intervention to prevent dental caries initiation and progression.
| References|| |
Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med 2013;4:29-38.
Berkowitz RJ. Causes, treatment and prevention of early childhood caries: A microbiologic perspective. J Can Dent Assoc 2003;69:304-7.
Burt BA, Eklund SA. Dentistry, Dental Practice, and the Community. 5 th
ed. Philadelphia: Saunders; 1999.
Tsai AI, Chen CY, Li LA, Hsiang CL, Hsu KH. Risk indicators for early childhood caries in Taiwan. Community Dent Oral Epidemiol 2006;34:437-45.
Jin BH, Ma DS, Moon HS, Paik DI, Hahn SH, Horowitz AM. Early childhood caries: Prevalence and risk factors in Seoul, Korea. J Public Health Dent 2003;63:183-8.
Jose B, King NM. Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent 2003;25:594-600.
van Houte J, Gibbs G, Butera C. Oral flora of children with "nursing bottle caries". J Dent Res 1982;61:382-5.
Cariño KM, Shinada K, Kawaguchi Y. Early childhood caries in northern Philippines. Community Dent Oral Epidemiol 2003;31:81-9.
Palmer CA, Kent R Jr, Loo CY, Hughes CV, Stutius E, Pradhan N, et al.
Diet and caries-associated bacteria in severe early childhood caries. J Dent Res 2010;89:1224-9.
Evans EW, Hayes C, Palmer CA, Bermudez OI, Naumova EN, Cohen SA, et al.
Development of a pediatric cariogenicity index. J Public Health Dent 2013;73:179-86.
World Health Organization. Oral Health Surveys-Basic Methods. 4 th
ed. Geneva: World Health Organization; 1997.
[Table 1], [Table 2]