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ORIGINAL ARTICLE
Year : 2015  |  Volume : 13  |  Issue : 4  |  Page : 399-404

Mapping the prevalence of deleterious oral habits among 10–16-year-old children in Karnataka: A cross-sectional study


1 Department of Pediatric Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
2 Department of Orthodontics, VS Dental College, Bengaluru, Karnataka, India

Date of Web Publication7-Dec-2015

Correspondence Address:
Srinath Krishnappa
Department of Pediatric Dentistry, Government Dental College and Research Institute, Fort, Bengaluru - 560 002, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.171192

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  Abstract 

Introduction: Deleterious oral habits are possible causes of unbalanced functional forces on the developing dentition and are factors in the development of dento-skeletal abnormalities and hence possible etiologic factors in malocclusion. Therefore, recognition and elimination of deleterious oral habits is of utmost importance. Aim: To assess and district wise map the prevalence of deleterious oral habits among 10–16-year-old children in Karnataka. Materials and Methods: A cross-sectional was conducted over a period of 2 years from January 2012 to January 2014. With 95% confidence level, the sample size of 9505 was estimated using population proportionate technique. The list of schools provided by the Karnataka Higher Primary and Secondary Education Board were stratified district wise, and then the required number of subjects was chosen by simple random sampling method. Oral habits were diagnosed using data gathered from a clinical examination of occlusion and extra-oral assessment of the face, combined with the history of habits from parents and guardians. Z-test for proportions was used to compare the prevalence between the genders. Results: The study demonstrated a low prevalence of 6% deleterious oral habits, and tongue thrusting was the most prevalent habit found in 2% of children. The highest prevalence of 12% was found in the district of Karwar. There was no significant difference of deleterious oral habits between the genders (P = 0.315). Conclusions: Highest prevalence of 12% was observed in Karwar district. Overall a low prevalence of 6% was found in Karnataka. 2% prevalence of tongue thrusting was the most prevalent habit.

Keywords: Deleterious, district, habits, mapping, prevalence


How to cite this article:
Krishnappa S, Rani M S, Gowda R. Mapping the prevalence of deleterious oral habits among 10–16-year-old children in Karnataka: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:399-404

How to cite this URL:
Krishnappa S, Rani M S, Gowda R. Mapping the prevalence of deleterious oral habits among 10–16-year-old children in Karnataka: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Apr 1];13:399-404. Available from: http://www.jiaphd.org/text.asp?2015/13/4/399/171192


  Introduction Top


The term "nonnutritive sucking habit" (NNSH) encompasses the use of pacifiers (dummies, soothers), blankets and digit sucking (finger or thumb).[1] Although the incidence of sucking habits varies considerably between different countries, these comforting habits are common in children in many populations.[1] One Swedish study looking at 60 consecutive births found the incidence of NNSH to be 82% during the first 5 months of life [2] and a US-based study reported this as 73% for a group of 130 children between 2 and 5 years of age.[3] Modeer found that 48% of 4-year-old children had a digit or dummy sucking habit.[4] Although the incidence of NNSH reduces with age, it was found in 1.9% of children as old as 12 years of age, in a Swedish population.[5]

NNSHs cause malocclusions by the pressure exerted through an object, or a digit resting on the teeth and there is evidence that children who have a history of NNSH are more likely to develop malocclusions (problems with the way the upper and lower teeth fit together) when compared with children who have no history of NNSH.[6],[7],[8],[9],[10] The longer the duration of the habit, the more severe the developing malocclusion tends to be.[5],[11],[12]

Although NNSHs do not inevitably lead to a predictable malocclusion, it has been reported that different sucking habits can produce different effects on the teeth.[12] Prolonged pacifier habits are associated with the development of posterior cross bites (the top back teeth biting inside the lower back teeth) and prolonged digit habits with increased overjet,[12],[13],[14] but both are associated with an increased prevalence of reduced overbite and anterior open bite.[12] There have also been reports of digit deformities developing as a result of prolonged digit sucking, requiring surgical correction.[15] Speech can be affected with tooth position: Laine found a significant relationship between increased overjet and distortions of the "s" sound.[16] With regard to anterior open bite, research has shown that speech is commonly defective, often presenting with a lisp.[17] A newspaper article published in October 2009 has once again brought the issue of dummy sucking, malocclusion and speech to the public attention.[18]

If these problems are not diagnosed until the patient is in the permanent dentition it can be complex, time-consuming, and costly to correct the problem and it will usually require fixed brace treatment carried out by a specialist orthodontist. In severe cases, it can even require orthognathic surgery (jaw surgery) to correct the anterior open bite.[19]

In the light of these factors, this pioneer cross-sectional epidemiological survey was conducted across the state of Karnataka with the following aims and objectives:

  • To find out the prevalence of various deleterious oral habits, and to map district wise, in children aged 10–16 years in Karnataka
  • To compare the prevalence of these habits gender-wise.



  Materials and Methods Top


Karnataka is a vast state in India constituting 30 districts. The state covers an area of 191,976 km 2 (74,122 mi 2), or 5.83% of the total geographical area of India. A cross-sectional epidemiological survey was conducted in the state of Karnataka, by obtaining prior permission from the Ministry of Higher Primary and Secondary Education Board of Karnataka and Ethical clearance from the Ethical Committee of VS Dental College, Bengaluru. The survey was carried out in selected schools in all the district headquarters. Children in the age group of 10–16 years were included in the study and constituted the study population. Population proportionate technique was employed for sample size estimation. According to the population census 2011, the total population in Karnataka was 61130704 out of which 10–16-year-old children constituted 29%.[20]

Recruitment

The study was conducted over a period of 2 years from January 2012 to January 2014. With 95% confidence level, the estimated sample size was 9505. The list of schools provided by the Karnataka Higher Primary and Secondary Education Board served as the sampling frame. This list of schools in the state was stratified geographically, with the state being subdivided into districts. The sample size for each district was specified in terms of the target number for males and females, considering the proportion of children in the district. In the first stage of sampling, three categories of schools, namely, government schools, aided schools, and private schools in each district were selected from the list of schools by simple random sampling method. In the second stage, 102 schools all over Karnataka were selected. The participation of the subjects in the study was voluntary, and written informed consent was obtained at the beginning of the study.

Eligibility criteria

All children aged 10 years and above till the age of 16 years.

Inclusion criteria

  • All children aged 10–16 years.


Exclusion criteria

  • Mentally retarded children
  • Children with developmental disabilities
  • Medically compromised children.


Training and calibration

The investigator was trained in the Department of Orthodontics, VS Dental College, Bengaluru on 10 subjects. Calibration was done on 10 subjects who were examined twice using diagnostic criteria for malocclusion, such as decreased overbite, open bite, and/or unilateral or bilateral crossbite etc., on the same day with a time interval of 1 h between the two examinations, and then the results were compared to diagnostic variability. Agreement for assessment was 90%.

Examination

The examination procedure was carried out at schools under natural light by a single investigator. The children were made to sit on a bench during the examination. The oral examination was performed according to World Health Organization guidelines for oral health surveys.[21]

The examination was carried out using sterile mouth mirrors and periodontal probes. Examination of children was undertaken to determine the prevalence of deleterious oral habits in children aged 10–16 years. The diagnosis of children with deleterious habits was done according to the history and demonstrable malocclusion present in the child. Guardians were interviewed to obtain information on the history of deleterious habits. Z-test for proportions was used to compare the prevalence of deleterious habits gender-wise.


  Results Top


The study population was composed of 9505 children ranged in age from 10 to 16 years. There were 52% (n = 4943) male children and 48% (n = 4562) female children.

Gender distribution of deleterious oral habits in subjects from various districts of Karnataka is presented in [Table 1]. Prevalence of deleterious oral habits in subjects from various districts of Karnataka is shown in [Figure 1].
Table 1: Gender distribution of deleterious oral habits in subjects from various districts of Karnataka

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Figure 1: Prevalence of deleterious oral habits in subjects from various districts of Karnataka

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It was found that 94% of children in the age group of 10–16 years were free of deleterious oral habits. The prevalence of deleterious oral habits in the age group was found to be 6%. No significant differences were found between the genders (P = 0.315). Tongue thrusting was noted to be the most prevalent deleterious oral habit with 2% in each gender. About 1% in each gender had mouth breathing habit, which was noted to be the second most prevalent habit in subjects. Thumb sucking was noted in Bengaluru rural, Chikbalapur, and Ramnagar districts, however, the prevalence was <1%. Lip biting and nail biting were also noted in a few districts. However, the prevalence was <1%.

In the district of Karwar, subjects had the highest prevalence of deleterious habits (12%), 8% showed tongue thrusting and 4% showed mouth breathing habits. Mysore ranked second among the districts with most prevalent deleterious oral habits, 11% of subjects showed the habits, with 5% having tongue thrusting, 3% having mouth breathing, and 1% of subjects demonstrating each of thumb sucking, lip biting, and nail biting. Although deleterious oral habits were noted in all the districts of Karnataka, least prevalence of 2% was noted in six districts and tongue thrusting was the most common habit in the subjects.


  Discussion Top


Much attention has been directed toward oral habits, such as NNSHs and tongue-thrust, as possible causes of unbalanced functional forces on the developing dentition.[22] Unbalanced functional forces are potential etiologic factors in the development of dento-skeletal abnormalities and hence possible etiologic factors in malocclusion.[22] This is based on the theory of craniofacial growth proposed by Moss in the 1960s in his "functional matrix theory," which holds that growth of the face occurs in response to the functional needs and effects of the soft tissues surrounding the bony structures of the maxilla and the mandible.[22] The activity of the masticatory muscles, the tongue and the muscles of the cheeks and lips play a major role in the developing occlusion and relapse of orthodontic treatment.[22] It is essential when studying the dental malocclusion related to oral habits to assess the abnormal function of different soft tissues including the tongue.

Very few studies have been reported in the literature about the prevalence of deleterious oral habits in children aged 10 years and above. The findings of the study showed that 6% of children are involved in one or more deleterious oral habits. However, a high prevalence of 38% was observed by Bhayya and Shyagali [23] in 11–13-year-old children in Gulbarga city. One of the reasons for this variation could be the sample size, which was less in their studies. Tongue thrusting and mouth breathing were the most prevalent deleterious oral habits observed in the present study, and these findings are in agreement with the results of Bhayya and Shyagali [23] in 11–13-year-old children in Gulbarga city, however, the prevalence of tongue thrusting found in the study was 18%, and that of mouth breathing was 27%. The prevalence of tongue thrusting found in the present study was 2% and this is in agreement with the findings of Shetty and Munshi,[24] who observed a 3.02% prevalence rate for tongue thrusting in Mangalore children. However, Kharbanda et al.[25] observed the occurrence of digit sucking most frequently in 50% of children.

The prevalence of lip biting and nail biting was almost zero and were observed in subjects in very few districts. In the present study, gender-wise significant differences were not observed. However, Kharbanda et al.[25] observed thumb sucking more common among girls than boys. Further Gildasya and Syarief [26] also showed slightly more prevalence of the habits among boys.

Lopes et al.[27] suggested that the longer the duration of breastfeeding the lower are the chances of developing deleterious oral habits. Further Moimaz et al.[28] suggested that children with oral habits and with low rates of breastfeeding were more susceptible to malocclusions. Ferreira et al.[29] found in a historical cohort study that NNSHs were positively associated with smoking initiation in adolescence and in early childhood, in contrast, prolonged breastfeeding was a protective factor.

Limitations of the study

The diagnosis of children with deleterious habits was done according to the history as well as demonstrable malocclusion that is, posterior cross bite, and/or anterior open bite or decreased overbite present in the child. Hence, children who had no demonstrated malocclusion were not included. Therefore, it is possible that, children though with habits, might have not been included as prevalent because they did not demonstrate malocclusion. This could be one of the contributing factors for low prevalence of deleterious habits, as the development of these features is associated with habits of at least 36 months or more duration.[30]

Prolonged breastfeeding during infancy reduces the chance of the development of abnormal dental relationships in children with habits.[31] Therefore, some children though might have had habits, may not have been recognized as having habits, in the study and could be the factor for low prevalence of deleterious habits found in the study as the protective factors delay development of malocclusion.


  Conclusions Top


The prevalence of deleterious oral habits across the state of Karnataka was 6%. The highest prevalence of 12% was observed in the district of Karwar, and tongue trusting of 2% was the most prevalent habit in the age group. The analysis of factors related to the causes of these habits is essential for planning public health policies aimed at preventing and clinically intercepting malocclusion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Singh SP, Utreja A, Chawla HS. Distribution of malocclusion types among thumb suckers seeking orthodontic treatment. J Indian Soc Pedod Prev Dent 2008;26 Suppl 3:S114-7.  Back to cited text no. 11
    
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Laine T, Jaroma M, Linnasalo AL. Relationships between interincisal occlusion and articulatory components of speech. Folia Phoniatr Logop 1987;39:78-86.  Back to cited text no. 16
    
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Bhayya DP, Shyagali TR. Prevalence of oral habits in 11-13 year-old school children in Gulbarga city, India. Virtual J Orthod 2009;8:1-4.  Back to cited text no. 23
    
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    Figures

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    Tables

  [Table 1]


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