|Year : 2016 | Volume
| Issue : 2 | Page : 160-163
Risk factors for predicting early childhood caries in Anganwadi children in Bangalore city: A cross-sectional study
KB Shilpashree1, C Manjunath1, T Ramakrishna2
1 Department of Public Health Dentistry, The Oxford Dental College, Bengaluru, Karnataka, India
2 Department of Maxillofacial and Oral Surgery, The Oxford Dental College, Bengaluru, Karnataka, India
|Date of Web Publication||10-Jun-2016|
Department of Public Health Dentistry, The Oxford Dental College, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Preschool oral health is an overlooked aspect of childhood health and well-being. Early childhood caries (ECC) is an infectious and multifactorial disease of the childhood. Several factors play a role in the etiology of disease. Aim: To predict the risk factors for occurrence of ECC in children aged 3–6 years of Anganwadi centers. Materials and Methods: A cross-sectional descriptive study consisting of 3009 children aged 3–6 years attending Anganwadi centers of Bangalore South. Required and relevant information regarding feeding practices and oral hygiene practices were obtained. Multivariate regression analysis was performed for statistical analysis. Results: The prevalence of ECC was 31.4% with mean decayed, missing, and filled teeth (DMFT) of study population is 1.15 ± 2.28. Mean DMFT among males and females were 1.31 ± 2.48 and 1.01 ± 2.07, respectively. Habit of bottle feeding in the night (P < 0.001 and odds ratio [OR] of 1.32), in between meal, snacks (P < 0.001 and OR of 1.24) were the risk factors for caries in this study. Conclusions: The present study provides an insight regarding the risk factors involved in predicting ECC in children.
Keywords: Early childhood caries, regression analysis, risk factors
|How to cite this article:|
Shilpashree K B, Manjunath C, Ramakrishna T. Risk factors for predicting early childhood caries in Anganwadi children in Bangalore city: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:160-3
|How to cite this URL:|
Shilpashree K B, Manjunath C, Ramakrishna T. Risk factors for predicting early childhood caries in Anganwadi children in Bangalore city: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 May 25];14:160-3. Available from: http://www.jiaphd.org/text.asp?2016/14/2/160/183802
| Introduction|| |
Dental caries is widely recognized as a multifactorial disease. Even after 100 years of research since Miller's time, the most definitive causal model for caries is yet to be described. Dental caries, especially among young children defined as early childhood caries (ECC) is a serious public health problem in both developing and industrialized countries. ECC, also known as baby bottle caries, is a disease characterized by severe decay in the teeth of infants or young children and a very common bacterial infection. It is a unique form of rampant caries that develops in the primary dentition at a very young age. ECC can manifest itself in severe pain, infection, abscesses, chewing difficulty, malnutrition, and gastrointestinal disorders. Further decay of primary teeth can affect children's growth, lead to malocclusion by adversely affecting the correct guidance of the permanent dentition, and cause poor speech articulation and low self-esteem. Although it is not life threatening, it may contribute to suboptimal health and failure to thrive.
The typical causative triad for caries consists of cariogenic micro-organisms, fermentable carbohydrates, and a susceptible host. However, a multitude of risk factors are involved in ECC development: A child's nap time use of a bottle containing juice, milk formula, or any other liquid sweetened with fermentable carbohydrates increases the risk of severe dental caries due to prolonged contact between cariogenic bacteria and sugar in the liquid on the susceptible tooth surface.,, Associated risk factors are of course pregnancy or instrumental delivery, demographic characteristics, oral hygiene practices, parental attitudes, educational status of mother, social status, malnutrition, temperament of the child, mouth breathers, siblings, pacifiers dipped in honey, children with chronic illnesses or special health care needs, and other feeding habits.,
Finally, ECC has a complex etiology and there are still several unexplained interactions among factors such as infection with mutans streptococci, education status of mothers, dental knowledge, stress, self-esteem, social status, family structure, and social networks, and the use of baby bottles or nursing on demand. Hence, the study was conducted with an objective to predict the risk factors for occurrence of ECCs in children aged 3–6 years of Anganwadis.
| Materials and Methods|| |
A cross-sectional study was conducted in children aged 3–6 years attending Anganwadis of Bangalore South from January to June 2007. Ethical clearance was obtained from Ethical committee. Voluntary written informed consent was obtained from parents of the children participating in the study before the clinical examination. A pilot study was carried out on 10% (300 children) of the study population to check the feasibility and relevance of proforma, to have prior idea regarding the estimate of the time taken to examine each subject and the survey was planned accordingly.
Bangalore city was divided into North and South Zone. Using lottery method, south zone was selected. All the children who were present on the day of examination of all the 109 centers of Bangalore south were included in the study. The mothers and caregivers of the children were interviewed at Anganwadis and children were examined subsequently. A detailed weekly and monthly schedule was prepared well in advance by informing and obtaining consent from authorities of respective study areas.
A specially prepared and pretested proforma was used for recording the data. The proforma included questions regarding personal data: Child's feeding habits and oral hygiene practices associated with the occurrence of ECC. This questionnaire in English script was translated into Kannada script (local language), so that it could be used conveniently during field work. The investigator was trained and calibrated to conduct the interview and examination with intra-examiner kappa value of 0.83. On an average, 35 subjects were examined and their mothers parents were interviewed in any given day during the survey period excluding Sunday. Caries experience was recorded using decayed, missing, and filled teeth (DMFT) index by Grubell in 1944.
The mean DMFT of different groups was compared using ANOVA. Multivariate logistic regression analysis was performed to assess the risk factors for occurrence of ECC using SPSS for windows version 15.0; SPSS Inc., Chicago, IL, USA. The P < 0.05 was considered to be statistically significant.
| Results|| |
The study population comprised 3009 children, out of whom, 1429 (47.4%) were males and 1580 (52.6%) were females with 1897 (63%) children in the age group of 3–4 years, 888 (29.5%) children.
The caries prevalence in the study population was 31.4%; 33.8% of the males and 29.1% of the females had caries with mandibular first molars being most affected (10.7%), followed by mandibular second molars (9.13%), maxillary second molars (8.12%), maxillary central incisors (7.79%), and least affected were mandibular lateral incisors (0.06%). Caries was significantly higher in children who were bottle fed only (mean DMFT of 1.92 ± 0.64) when compared to children who were breast fed only (mean DMFT of 1.43 ± 0.2). Children who were bottle fed at night had higher caries prevalence with mean DMFT of 2.14 compared to the children who were not bottle fed at night with a mean DMFT of 1.67. Children who consumed snacks and sticky type of food had higher caries prevalence with a mean DMFT of 1.39 and 3.21, respectively. Children who frequently (more than once) consumed snacks in between meals had a mean DMFT of 1.50. Children aged 3–4 years who brushed their teeth themselves had more caries (1.08) compared to children who brushed their teeth under the supervision of the parents (0.82) and care takers (0.25) [Table 1].
Among the study population, children in the age group of 5–6 years (n = 88, 39.28%) had caries followed by children in 4–5 year (n = 324, 36.4%) and then age group 3–4 years (n = 533, 28%) had caries.
The results of multivariate logistic regression analysis after considering 16 independent variables simultaneously, the risk factors for caries in children were the habit of bottle feeding in the night (odds ratio [OR] of 1.32 P < 0.001) and children who consumed snacks in between meals had a higher ECC prevalence with a P < 0.001 and OR of 1.24, children who did use tooth brush for brushing had less caries prevalence with a P < 0.006 and OR of 1.38, and children who brushed twice or more daily with P < 0.006 and OR of 1.83 [Table 2].
|Table 2: Multivariate logistic regression analysis of risk factors for predicting caries in children|
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Other factors such as duration of breast feeding, frequency of breast feeding, drinking from cup, semi-solid consumption, age at which the child started brushing, and person responsible for brushing were not statistically significant.
| Discussion|| |
Dental caries is widely recognized as an infectious disease. The main players in the etiology of the disease are cariogenic bacteria, fermentable carbohydrates, a susceptible tooth, host and in addition, a sufficient period of time. The answer to the question “what causes caries in children?” is an important and a complex one.
The influence of infant feeding per se on ECC remains a complex and some what a controversial issue. In this study, the association between children who were bottle fed at night and the prevalence of dental caries was statistically significant (P = 0.001, OR = 1.32). This was similar to the study by Hallet and Rourke , and Dini et al. In this study, children who were bottle fed only had more caries (mean DMFT of 1.92 ± 2.14) than children who were exclusively breast fed only (mean DMFT of 1.43 ± 2.00). This was similar to the results by Bian and Champion of China among bottle fed (DMFT 2.16 ± 12.89) and children who were breast fed only (DMFT 1.12 ± 1.96) and Oulis et al. who observed that children who fall asleep with the nursing bottle have a significantly greater chance of developing caries than children discarding the bottle, before they fall asleep with a mean DMFT of 2.4 and 3.1, respectively. This observation is in agreement with the findings of other studies by Jin et al.
Ripa proposed a mechanism in 1988 that initiation, development, and pattern of the clinical appearance of the caries is while the child is awake, salivary secretion, and swallowing allow for clearance of the fermentable carbohydrates. However, as the child grown drowsier, the salivary flow and swallowing rate are decreased, allowing carbohydrates to remain in the mouth and pool around the teeth initiating the caries process. In addition to this maternal lactation failure, these children turned to alternatives such as bottle feeding, milk-based substitutes, and solid foods very early in their life which might have contributed to the above findings in the present study.
Even though the multifactorial aspect of the etiology of ECC is now well established, the question of why its risk of occurrence is highest among some groups is unanswered. Giving of sweets, snacks frequently as a reward to the children is a common practice predominantly culturally based. Children with caries generally report a high frequency of sugar consumption, especially sticky foods or snacks. In this study, children who consumed more in between meal snacks had a higher ECC prevalence (OR of 1.24) which suggests a positive association between the occurrence of caries and frequency of snacking between meals. This was also supported by the study done by Jin et al. who reported caries in 87.9% of the children who consumed in between meal snacks. The relationship between meal snacking and caries status in this study showed statistically significant association (P< 0.001: OR = 0.24). This was supported by Jin et al.
Children aged 3–4 years who brushed their teeth themselves had more caries compared to children who brushed their teeth under the supervision of the parents and care takers with a mean DMFT of 1.08 ± 2.14, 0.82 ± 1.19, and 0.12 ± 1.00, respectively. This was similarly reported by Hallet and Rourke, who reported a similar trend in the prevalence of caries in children who brushed unsupervised by parents with a mean DMFT of 2.3 and 1.8 for those children who were supervised while brushing. However, no such relationship was reported in Australian sample and the United States by Benjamin et al.
The sample in this study comes from low socioeconomic background and therefore it is not always possible to generalize the results from thi s study. Other risk factors such as Streptococcus mutans count, education status of mother, socioeconomic status, malnutrition, mouth breathers, siblings, children with chronic illness, deleterious habits should be considered in further studies.
| Conclusion|| |
ECCs is a health problem that warrants the attention and resources of the community. The present study provides an insight regarding the risk factors involved in predicting ECC in children. Efforts to increase the awareness of the public on the prevalence, severity, and impact of ECC on overall health, growth, and development of children should be undertaken.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ramos-Gomez FJ, Tomar SL, Ellison J, Artiga N, Sintes J, Vicuna G. Assessment of early childhood caries and dietary habits in a population of migrant Hispanic children in Stockton, California. ASDC J Dent Child 1999;66:395-403, 366.
Dini EL, Holt RD, Bedi R. Caries and its association with infant feeding and oral health-related behaviours in 3-4-year-old Brazilian children. Community Dent Oral Epidemiol 2000;28:241-8.
Rodrigues CS, Sheiham A. The relationships between dietary guidelines, sugar intake and caries in primary teeth in low income Brazilian 3-year-olds: A longitudinal study. Int J Paediatr Dent 2000;10:47-55.
Petti S, Cairella G, Tarsitani G. Rampant early childhood dental decay: An example from Italy. J Public Health Dent 2000;60:159-66.
Schroth RJ, Moore P, Brothwell DJ. Prevalence of early childhood caries in 4 Manitoba communities. J Can Dent Assoc 2005;71:567.
Peretz B, Ram D, Azo E, Efrat Y. Preschool caries as an indicator of future caries: A longitudinal study. Pediatr Dent 2003;25:114-8.
Bian MD, Guo L, Holt R, Champion J, Bedi R. Caries patterns and their relationship to infant feeding and socio-economic status in 2-4 year old Chinese children. Int J Paediatr Dent 2000;50:385-9.
Hallett KB, O'Rourke PK. Social and behavioural determinants of early childhood caries. Aust Dent J 2003;48:27-33.
Hallett KB, O'Rourke PK. Early childhood caries and infant feeding practice. Community Dent Health 2002;19:237-42.
Gopinath VK, Barathi VK, Kannan A. Assessment and treatment of dental caries in semi-urban school children of Tamilnadu (India). J Indian Soc Pedod Prev Dent 1999;17:9-12.
Gibson S, Williams S. Dental caries in pre-school children: Associations with social class, toothbrushing habit and consumption of sugars and sugar-containing foods. Further analysis of data from the National Diet and Nutrition Survey of children aged 1.5-4.5 years. Caries Res 1999;33:101-13.
Peretz B, Ram D, Azo E, Efrat Y. Preschool caries as an indicator of future caries: A longitudinal study. Pediatric Dentistry 2003;25:114-8.
[Table 1], [Table 2]