|Year : 2015 | Volume
| Issue : 2 | Page : 144-147
Dental caries experience among 8-9-year-old school children in a South Indian City: A cross-sectional study
P Poornima, Patil Disha, Suryakanth M Pai, NB Nagaveni, NM Roshan, IE Neena
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
|Date of Web Publication||18-Jun-2015|
Department of Pedodontics and Preventive Dentistry College of Dental Sciences, Davangere - 577004
Source of Support: None, Conflict of Interest: None
Introduction: Dental caries is the most common dental disease and knowledge of a population's epidemiological situation is vital for planning and providing prevention and treatment services. There is minimal data available in the literature with regard to the prevalence of dental caries in mixed dentition. Aim: The aim was to assess dental caries experience in 8-9 years old children in Davanagere, Karnataka. Materials and Methods:A descriptive cross-sectional study of 8-9 years old children in government and private schools was conducted. Total of 800 school children (both males and females) were randomly selected for the study. Dental caries status was recorded by means of deft for primary dentition and decayed, missing, and filled teeth (DMFT) for permanent dentition. The statistical tests used were t-test and Chi-square test. Results: Caries experience among the subjects for permanent teeth was 13.8% and for primary teeth was 60.1%. Mean deft and DMFT score were 2.77 and 0.26, respectively. Conclusion: Dental caries status for the sample of Indian children aged 8-9 years of Davangere city showed a declining trend.
Keywords: Dental caries, mixed dentition, prevalence
|How to cite this article:|
Poornima P, Disha P, Pai SM, Nagaveni N B, Roshan N M, Neena I E. Dental caries experience among 8-9-year-old school children in a South Indian City: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:144-7
|How to cite this URL:|
Poornima P, Disha P, Pai SM, Nagaveni N B, Roshan N M, Neena I E. Dental caries experience among 8-9-year-old school children in a South Indian City: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jan 18];13:144-7. Available from: http://www.jiaphd.org/text.asp?2015/13/2/144/159050
| Introduction|| |
Dental caries is the most common oral disease affecting children and adolescents, though it can effectively be prevented.  Since its etiology is complex and there are several unexplained interactions among unknown confounders and traditional risk factors, it is the most prevalent oral health problem worldwide. 
The reported prevalence of dental caries in India ranges from 31.5% to 89%. ,,,,,, As dental caries is the most common dental disease with high prevalence, it is crucial to control the disease process by assessing and rendering the treatment required along with spreading awareness regarding its prevention. However, for developing appropriate preventive approaches, anticipating utilization patterns, and planning effectively for organization and financing of dental resources, the knowledge of oral health status and treatment needs of populations with different characteristics is important. 
Although several studies have been conducted on children, but few studies in the Indian population approach with any degree of clarity as to the prevalence of dental caries in the mixed dentition. The prevalence pattern of dental caries varies within the oral cavity, apart from age, sex, socio-economic status, and oral hygiene practices. Therefore, to know the relative susceptibility of teeth in the maxilla and mandible is of interest. The main objective of the investigation was to assess the dental caries experience in mixed dentition among 8-9 years old school children.
| Materials and methods|| |
A descriptive cross-sectional study was conducted among 8-9 years old school children in Davanagere city, South India. By using the sampling formula, a minimal sample size of 600 was chosen. An additional 200 children were added to further offset any losses. Thus, 800 children were randomly selected and stratified according to age and school. Before beginning the study, an ethical clearance was obtained from the Ethical Clearance Committee of the Institution. An official permission was obtained from the Officer of the Deputy Director of Public Instructions office. The study was conducted over a period of 4 months between June and September 2014.
Training and calibration
Training in the epidemiologic/clinical methodology and calibration of the examiner was performed prior to the study. The calibration of examiner was done in the Department Of Pedodontics And Preventive Dentistry, College of Dental Sciences, Davangere. The examiner and supervisor jointly examined the subjects and discussed the findings, according to the diagnostic criteria. The examiner was a postgraduate student and the supervisor was a professor (principal investigator), department of pedodontics and preventive dentistry. This process continued until reliability was achieved. A duplicate examination of 20 children during the survey yielded an intraexaminer kappa value of 0.8.
Two stage sampling procedure was adopted to select the sample. Among 350 primary and higher primary schools in the north and south zones of Davanagere City, 10 schools (equal numbers of private and government schools) were selected by using simple random sampling procedures in the first stage. Among the ten schools, the study subjects were selected by using systematic random sampling procedures. Males and females were selected proportionately and 80 school children were examined in each selected school. Twenty subjects were being examined daily for a minimum of 10 days in a month, keeping in mind holidays and test/examinations of school children. The children were examined by a single examiner under natural light (Type III examination) as suggested by the American Dental Association, 1970.  The examination of a single study subject took 3-4 min. Those children who refused to participate were excluded. Prior to the clinical examination, parents and subjects were informed about the procedure and informed parental consents were obtained.
A survey proforma was developed to gather data from the sample.
Criteria for each assessment were defined as follows:
- Teeth affected by dental caries and teeth restored/extracted as a sequelae of dental caries using decayed, missing, and filled teeth (DMFT) index (Henry Klein, Carrole E. Palmer, and Knutson J.W., 1938)  for permanent teeth
- The "def" index by Gruebbel in 1944  as an equivalent index to DMF for measuring dental caries in the primary dentition
- Plain mouth mirror and probe were used for examination. Sufficient number of autoclaved instruments was carried to the examination site to avoid the interruption during the study. After each day of examination, the entire instruments were autoclaved.
The data recorded was transferred from survey proforma to an MS-Excel sheet in a computer.
The response obtained was tabulated and the results were expressed as frequency distributions and computed in percentage using SPSS Software - version 19 (Statistical Package for Social Sciences, Chicago, Il, USA). The observations were analyzed using the Chi-square test for categorical data, Student's unpaired t-test for quantitative mean difference. P < 0.05 was considered for statistical significance.
| Results|| |
The experience of dental caries was found to be 60.1% in primary teeth and 13.8% in permanent teeth. Caries experience among government school subjects was significantly more than private school [Table 1]. Caries experience among the study subjects according to gender did not show a significant difference [Table 2]. Mean deft and DMFT were 2.7788 ± 3.3322 and 0.2625 ± 0.8151, respectively [Table 3]. The most commonly affected surface was the occlusal surface in both the dentitions [Table 4] and mandibular molars were seen to be affected more than maxillary in both primary and permanent teeth [Table 5].
|Table 1: Caries experience among the study subjects according on school type|
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|Table 4: Caries experience in primary and permanent dentition according to surface affected|
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|Table 5: Jaw wise most common cariously affected molars in primary and permanent dentition|
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| Discussion|| |
Among the government school subjects, 18.2% experienced caries in permanent teeth as compared to 9.2% of the private school subjects which was statistically significant (P < 0.001). This may be due to lack of oral health care awareness, affordability, or the underutilization of dental care facilities by the children in the government schools.  Hence, further studies are needed to assess the various barriers for utilization of services.
Among the primary teeth, 65.0% of the government school subjects experienced caries as compared to 55.2% of the private school subjects which was statistically significant (P = 0.005). Overall caries experience among the subjects for permanent teeth was 13.8% when compared to primary teeth, which was 60.1%. This could be due to increased resistance to caries process in permanent teeth than primary teeth  and implementation of oral hygiene practices is not satisfactory in younger children.
There was no significant difference in caries experience between gender for both in permanent and primary teeth [Graph 1]. These results coincide with previous Indian studies. ,,,,,, Although a slightly higher prevalence was noticed in females (16%) in permanent dentition when compared to males (11.5%). Similar findings were observed in a study by Subedi et al.  and Shailee et al.  where females had a significantly higher mean DMFT value than males. This may be due to the fact that teeth erupt earlier in females than males which lead to prolonged exposure of the teeth to the oral environment in females.  Caries prevalence similar to that of the current study in primary teeth among 9-year-old children was found to be 61.11% by Grewal et al. in Urban Delhi children.  Whereas, Sudha demonstrated a very high prevalence of dental caries in the 8-10 year age group (82.5%) when compared to our study. 
Further, in the present study mean DMFT and DMFT score were 2.78 and 0.26, respectively. Basha 2012 study in Davanagere City reported the mean DMFT and DMFT score among 6 and 13-year-old children as 3.2 and 1.4, respectively. In both the dentition mean, DT and DT scores dominated over filled component, which was a consistent finding in the present study.  Subedi et al. suggested that in developing countries like Nepal, a large proportion of the dental disease is in the form of untreated caries, which may be due to the increasing sugar consumption, low exposure to fluorides, and poor access to oral health care which could be the Indian scenario as well. 
Caries experience in primary and permanent dentition when analyzed according to the surface affected, occlusal surface was more frequently affected, and lingual/palatal surface was rare. Similar results were found in the study by Basha and Swamy 2012.  The reason could be due to the occlusal anatomy being more retentive for plaque.
It also seems that the sequence of caries attack follows a specific pattern in primary dentition: Mandibular molars, maxillary molars, and maxillary anterior teeth were predominantly affected by caries, whereas the mandibular anterior teeth were least affected, which is similar to the caries pattern described by Saravanan et al. 
When most common cariously affected teeth in primary and permanent dentition were studied, in the primary dentition most affected teeth were mandibular second molars (28.4%), followed by mandibular first molars (28.3%), maxillary second molars (23.6%), and maxillary first molars (19.7%). In the permanent dentition, mandibular first molars were most frequently affected by decay as compared to maxillary first molars. These findings were consistent with the findings of Basha and Swamy  In the primary dentition, lower second molars were most frequently affected by decay, compared to upper second molars. Primary first molars in both the arches were less susceptible to caries than the primary second molars, even though the former erupts at an earlier date. Similar results were found with Basha and Swamy  and Saravanan et al.  This suggests that in the primary dentition, the second molar is the tooth with highest caries experience. This difference in individual tooth susceptibility is due to the fissure topography of molars. The pits and fissures in second primary molars are deeper and less completely coalesced.
| Limitations and recommendations|| |
There are limitations to generalizing the findings and the data collected from the examination. Since our study did not include risk indicators and behavioral determinants of dental caries, further studies are needed which include other variables. Furthermore, the study was conducted in an urban city, which lack reflection of semi-urban and rural areas. A longitudinal study needs to be undertaken in this population, to confirm these results.
With the results of the present study, emphasis should be on planning for oral health promotion in schools, as early as a mixed dentition stage. Furthermore, teachers and parents should be made aware of dental caries and encourage healthy lifestyles. In a country like India, which lacks public resources for oral health care, a national oral health policy that emphasizes on prevention would be beneficial.
| Conclusion|| |
Dental caries experience for the sample of Indian children aged 8-10 years in this study was less compared to the other previous studies. However, dental caries still remains a serious problem in India because of its high prevalence and incidence.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]