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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 2  |  Page : 122-126

Oral health status and treatment needs of asthmatic children aged 6 – 12 Years in Lucknow


1 Department of Periodontics and Community Dentistry, Dr. Z. A. Dental College, AMU, Aligarh, Uttar Pradesh, India
2 Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
3 Department of Pedodontics and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India

Date of Web Publication13-Jun-2017

Correspondence Address:
Pramod Kumar Yadav
Department of Periodontics and Community Dentistry, Dr. Z A Dental College, AMU, Aligarh - 226 025, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_136_16

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  Abstract 

Introduction: Asthma is a growing public health problem affecting over 300 million people worldwide. Asthmatic children have an altered immune response and a high tendency to mouth breathing especially during an episode of rhinitis or an attack thus predisposing them to serious oral health problems. Aim: This study aims to assess oral health status of asthmatic children aged 6–12. Materials and Methods: A cross-sectional study was conducted among 450 asthmatic children aged 6–12 years in Lucknow, asthmatic children were chosen from pediatric department of major hospitals. Gingival index (GI), oral hygiene index-simplified (OHI-S), and dentition status and treatment need of World Health Organization oral health survey pro forma (1997) were used to assess oral health status. ANOVA, Chi-square test, and descriptive statistics were carried out. SPSS 16 was used for the data analysis. Results: Mean dynamical mean-field theory (DMFT) was 2.98 ± 1.52 and 3.05 ± 1.60, mean GI score was 1.55 ± 0.52 and 1.53 ± 0.42 and mean OHI-S was 2.59 ± 0.68 and 2.48 ± 0.77 among the male and female asthmatic children. Conclusion: Female asthmatic children had higher mean DMFT score, but lower mean GI score and oral hygiene score than male children in comparison and also they had a compromised oral hygiene status.

Keywords: Asthma, dental caries, periodontal disease, treatment-needs


How to cite this article:
Yadav PK, Saha S, Singh S, Gupta N D, Agrawal N, Bharti K. Oral health status and treatment needs of asthmatic children aged 6 – 12 Years in Lucknow. J Indian Assoc Public Health Dent 2017;15:122-6

How to cite this URL:
Yadav PK, Saha S, Singh S, Gupta N D, Agrawal N, Bharti K. Oral health status and treatment needs of asthmatic children aged 6 – 12 Years in Lucknow. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2017 Dec 17];15:122-6. Available from: http://www.jiaphd.org/text.asp?2017/15/2/122/207911


  Introduction Top


Asthma has become one of the most common chronic diseases in industrialized countries, and its prevalence is increasing throughout the world.[1] Asthma affects all age groups and is often persistent, accounting for a large proportion of health care spending and loss of work.[2],[3],[4],[5] Asthma is a chronic inflammatory disorder of the airways characterized by attacks of bronchoconstriction causing shortness of breath, coughing, chest tightness, and rapid breathing. The severity of asthma can be classified as mild, moderate, or severe.[1] It presents an increased prevalence in preschool children and one out of every ten preschool-age children has asthma disorder.[6]

Asthma is a growing public health problem affecting over 300 million people worldwide. It is estimated that an additional 100 million may be diagnosed with asthma by 2025.[7] In India, about 15–20 million people are suffering from bronchial asthma.[8] Several studies have been done to investigate the effect of asthma on oral health. In spite of the confounding results, the majority of the studies conclude that children with asthma have higher caries prevalence than their nonasthmatic counterparts.[9]

Saliva plays a major role in the health of the oral cavity and any changes in the amount or quality of saliva may alter the oral health status.[10] Saliva contains several defense systems aiming to protect dental enamel and oral mucous membranes. Their effects on the mechanisms of action of various antimicrobial systems and bacterial, fungal, and viral species present in human saliva have been extensively studied in vitro.[11],[12] However, little is known of their possible significance in vivo, and in particular with respect to systemic medication or systemic disease.[13],[14],[15] Asthmatic children have an altered immune response and a high tendency to mouth breathing especially during an episode of rhinitis or an attack thus predisposing them to serious oral health problems.[16]

Relatively, few studies exist on the oral health of asthmatic patients. Findings, indicating an increased risk of oral diseases in asthmatic patients are mainly obtained from studies on children and adolescents. According to most published reports, young asthmatic patients suffer more from caries and/or periodontal diseases than nonasthmatic individuals.[16],[17],[18],[19],[20],[21],[22] These findings were mainly obtained from small-scale studies, and there are two recently published studies that found no association between dental caries and childhood asthma,[23] or association over time between asthma and caries increment.[24] In their reports, Ryberg et al. linked the increased incidence of dental caries to the regular use of inhaled beta-2-agonists used in the treatment of asthma. However, during the 1990s, the treatment modalities of asthma has changed dramatically.[25] Haahtela et al. have shown that the regular use of inhaled beta-2-agonists is not efficient and the early introduction of inhaled steroids is an internationally approved approach to the treatment of asthma.[26],[27],[28],[29] Ryberg et al. have also reported differences in salivary flow rate and saliva composition between asthmatic and nonasthmatic children. They concluded that asthmatic patients treated with beta-2-adrenoceptor agonists have increased caries susceptibility due to an impaired saliva secretion caused by the use of beta-adrenergic agonists.[19],[25]

The two most common oral diseases dental caries and periodontal disease are preventable to some extent, and early recognition of populations at high risk may help to focus dental health-care resources more effectively on the prevention of these diseases. Sometimes, asthma patients are concerned about the potential adverse effects of inhaled medications used as anti-asthmatic on patients' mouth.

Aim and objectives

  • To estimate dental caries, gingivitis, and oral hygiene status among 6–12-year-old asthmatic children
  • To assess the association of oral health in asthmatic children in relation to the form and route of medications being taken and duration of the disease.



  Materials and Methods Top


A cross-sectional study was conducted among asthmatic children aged 6–12 years in Lucknow between February and October 2012. Asthmatic children aged between 6 and 12 years (male and female) visiting the Pediatric Department of selected four government administered hospitals in Lucknow, India, were included the study. Ethical clearance was obtained from the Institutional Ethical Committee to conduct the study. Written permission was taken from head of each hospital and informed consent from the parents of the asthmatic children. Before the start of the survey, the research guide calibrated the investigator regarding the World Health Organization (WHO) criteria for dentition status and treatment needs in the department. The recorder in the study was also trained in the department regarding the contents of the pro forma, and the method of recording total of 25 participants were selected and examined who possessed collectively the full range of conditions expected to assess in the survey. Participants were re-examined on successive days using the same clinical criteria. Intra-examiner reliability was found to be 0.86, using kappa statistics.

Inclusion criteria

  • Asthmatic children diagnosed as bronchial asthma and confirmed by a pediatrician aged between 6 and 12 years
  • Only those children who were suffering from asthma since 1 year or more and had taken medication for the treatment of asthma for at least 30 days in the previous year.


Exclusion criteria

  • Presence of other chronic diseases such as malnutrition and juvenile diabetes.
  • Patients who were uncooperative and not willing to participate.


Pilot study was conducted on 25 asthmatic children from Government Hospitals to assess the operational feasibility of the study using gingival index (GI) (Loe and Silness, 1963),[30] oral hygiene index-simplified (OHI-S),[31] and Dentition status and treatment need of the WHO Oral Health Survey proforma (1997).[32] This was also done for the determination of sample size. The formula for determining the size of the sample is:

n = z2 (p [1 − p])/e2

Where, n = size of the sample; z = critical value at a specified level of confidence = 1.96

p = sample (0.50); e = difference between sample proportion and population proportion = 0.05

Sample size calculated using the formula and it was found sample size to be 442. For the convenience of calculation, it was rounded off to 450.

Data collection was done using the pro forma. Demographic information, oral hygiene practices, dietary habits, and history regarding their asthmatic medication (frequency, dose, type) were recorded. Clinical assessment was done using GI (Loe and Silness, 1963), OHI-S and dentition status and treatment need of WHO oral health survey pro forma (1997).[30],[31],[32]

The examiner visited the hospital on the scheduled dates with one recording clerk. The children were allowed to sit on a chair, and a total of 5–7 children were examined per day. Type III examination was done using the WHO Probe, Shepherd crook, and plane mouth mirror, under the adequate natural light in hospital premises.[32]

A duplicate examination was carried out on 10 asthmatic children at regular interval on four different occasions, to ensure reliability of the examiner in the accurate collection of data.

All the collected data were entered into Microsoft word excel sheet, version 2007, and processed using SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc. Statistical analysis was done using descriptive analysis, ANOVA, Chi-square test (P ≤ 0.05 was considered as statistically significant).


  Results Top


In the present study, 450 participants were included, female (55.7%:251) individuals were more in number than male (44.2%:199). The participants were broadly divided into three age groups. The majority of participants were belonging to 6–8 years age group (49.7%:224) [Table 1].
Table 1: Age- and gender-wise distribution of asthmatic children

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Decayed component was more in males (2.74 ± 1.77) than females (2.72 ± 1.80). Overall mean dynamical mean-field theory (DMFT) score was more in females (3.05 ± 1.60) than males (2.98 ± 1.52). Mean DMFT score was more in the age group 8–10 years (3.08 ± 1.62; 3.05 ± 1.78). There was no statistically significant difference in mean DMFT score among different age group [Table 2].
Table 2: Age- and gender-wise mean decayed, missing, filled teeth of asthmatic children

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Males had more mean OHI-S score than females. In age-wise distribution 8–10 years group male (2.59 ± 0.69) and female (2.48 ± 0.77) individuals were more than the age group 6–8 and 10–12 age group [Table 3].
Table 3: Age- and gender-wise mean simplified oral hygiene index of asthmatic children

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There was no significant difference in mean GI score between various age groups. The highest mean OHI-S scores were found in males and females of 8–10 years [Table 4].
Table 4: Age- and gender-wise mean gingival index of asthmatic children

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It was observed that among all age groups, significantly higher proportion (P = 0.004) of participants (78.6%) were using beta-2 adrenoreceptor agonist followed by both (18.8%) and steroids (2.6%). Gender-wise distribution shows that both males and females (80.4%) used beta-2 adrenoreceptor agonist in higher proportion than other drugs [Table 5].
Table 5: Age- and gender-wise distribution of asthmatic children related to type of medication

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In age- and gender-wise distribution of treatment needs was found to be in higher proportion of participants including males were in need of pit and fissure sealants treatment and was decreased with increasing age range among age groups. Females required more one or two surface fillings than males. The treatment need for crown was more in males than females, but it was not statistically significant. More females than males needed pulp care, but it was not statistically significant. A total of 77 individuals needed extraction, out of which more number of males than females and individuals in 8–10 years age group required extraction [Table 6].
Table 6: Age- and gender-wise treatment needs in asthmatic children

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  Discussion Top


The human body is affected by many systemic diseases; of which asthma is one of the serious health problems affecting more than 100 million people worldwide. Pediatric asthma is a serious global health problem. It accounts for a large number of lost school days. Most cases of asthma begin in childhood with peak prevalence the ages of 6 and 11 years.[2]

The study was conducted to determine the oral health status of asthmatic children. In the current study, among 450 asthmatic children aged group of 6–12 years comprises more males 199 (44%) than females 251 (56%). This finding is similar to the one observed by Jayakumar et al. The study was conducted on a sample of 450 asthmatic children, comprising more males 199 (44%) than females 251 (56%). A similar study was done by Jayakumar et al.[33] reported lower proportion of female individuals (39%) and considerable higher proportion of male individuals (60.9%). Some studies observed higher male:female ratio of 1.8:1, than our study which was having male:female ratio (0.9:1).[15],[19] A study conducted by Kankaala et al. observed male predominance and related it to a greater degree of bronchial lability in males.[22]

In the present study, the participants were broadly divided into three age groups, i.e., 6–8, 8–10 and 10–12 years. The majority of which (49.7%) belonged to 6–8 years. A similar study was conducted by Jayakumar et al.,[33] and Sowmya et al. in Mysore city [8] on different age groups.

The mean DMFT of the present study for male and female was 2.98 ± 1.52 and 3.05 ± 1.60, respectively. This was found to be higher than the mean DMFT (1.8) reported in the national oral health survey and Fluoride Mapping 2002–2003. Similar studies reported more mean DMFT than the present study by Reddy et al.,[34] Ersin et al.,[35] Khalilzadeh et al.,[36] and Wierchola et al.[37] However, lower values were found in other studies.[21],[38],[39]

The mean GI score in the present study in asthmatic male was 1.55 ± 0.52 and female was 1.53 ± 0.42 which was in line with other studies.[22],[40],[41],[42] While contrasting result was reported by Sowmya et al.[8]

In the present study, it was observed that the mean OHI-S for male was 2.51 ± 0.72 and female was 2.37 ± 0.77. Studies conducted by Wotman et al. and McDerra et al. were in accordance to the present study.[40],[21] However, this is in contrast to Ryberg et al.[19]

Asthma is treated using many types of drugs. In the present study, beta-2 agonist, steroids, and combination of beta-2 agonist and steroids drugs were used in the asthmatic children. The mean DMFT (3.12 ± 1.91) was more in beta-2 agonist than the steroids and combination of beta-2 agonist and steroids. This finding was in agreement with the studies conducted by McDerra et al.,[21] Kankaala et al.[22] and Wogelius et al.[41]

The present study depicts that 119 (26.4%) participants needed fissure sealant out of which higher proportion (37%:74) were males than the female individuals (17.9%:45). Participants needed one/two surface filling were found to be 118 (26.2%). Participants needed crown were found to be 70 (15.5%) out of which males (21.6%:43) were more than females (10.7%:27). Participants needed pulp care were found to be 120 (28.8%) out of which in gender-wise distribution females (31.8%:80) were more than males (20.1%:40). Participants needed extraction were found to be 77 (17.1%) out of which in gender-wise distribution males (22.6%:45) were more than females (12.7%:32). Participants needed need for other care (prosthesis) were found to be 86 (19.1) out of which in gender-wise distribution males (29.1%:58) are more than females (11.1%:28).

The current study had some limitations. Small sample was studied because of the time limits, availability of asthmatic children of particular age group. Hence, the study cannot be generalized. However, further longitudinal researches should be done with larger sample size to confirm the obtained results. Oral health education should be given about the potential harmful effects of inhaled medication. Encourage regular periodic dental checkups for children who are at high risk of developing dental caries.


  Conclusion Top


The present study concludes that oral health status of asthmatic children were comparatively poor with high dental caries experience, poor gingival health, and compromised oral hygiene status. The prevalence of increased dental caries, gingivitis and compromised oral hygiene status had a positive association with the medication taken. A multidisciplinary approach for the treatment of the affected children is the key to improved health-care delivery and better quality of life among these patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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