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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 3  |  Page : 214-219

Dental caries status and treatment needs of children attending government primary schools in Goa: A descriptive survey of a coastal state in India


Department of Public Health Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India

Date of Web Publication18-Sep-2017

Correspondence Address:
Amit Kumar
Department of Public Health Dentistry, Goa Dental College and Hospital, Bambolim, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_48_17

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  Abstract 

Introduction: Oral health is an integral part of overall health. Very little information is available on the status of dental caries status of children in Goa state. Aim: The aim of this study is to assess the dental caries status and treatment needs of government primary school children in Goa. Materials and Methods: This cross-sectional, descriptive study was conducted among 6–12 years old government primary school children using the WHO survey methodology 1997. Multistage probability cluster sampling technique was adopted to obtain proportional sample from 11 talukas of Goa. Descriptive statistics was calculated, and t-test was used for group comparisons. Results: The overall caries prevalence in primary dentition was 65.52%, with mean decayed, missing, and filled teeth (dmft) of 5.21 ± 1.81 for North Goa, and 5.28 ± 1.93 for South Goa district. Caries prevalence in the permanent dentition was 56.6% with mean DMFT of 3.89 ± 1.14 for North Goa and 4.12 ± 1.74 for South Goa district. Males aged 9 and 11 years exhibited statistically significant higher caries prevalence in primary dentition than females, while females aged 6 years exhibited higher caries prevalence than male children in permanent dentition but both groups exhibited high proportion of treatment needs. Conclusions: Dental caries was high in Goan children. Dental caries was found to be a significant health issue in child population requiring immediate attention. The provision of oral health education and school-based preventive programs seem to be a viable alternative to tackle overwhelming the burden of dental caries and other oral diseases.

Keywords: Children, dental caries, Decayed, Missing and Filled Teeth/decayed, missing and filled teeth, Goa, oral health


How to cite this article:
Gaunkar RB, Kamat AK, Puttaswamy B, Kumar A. Dental caries status and treatment needs of children attending government primary schools in Goa: A descriptive survey of a coastal state in India. J Indian Assoc Public Health Dent 2017;15:214-9

How to cite this URL:
Gaunkar RB, Kamat AK, Puttaswamy B, Kumar A. Dental caries status and treatment needs of children attending government primary schools in Goa: A descriptive survey of a coastal state in India. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2019 Oct 21];15:214-9. Available from: http://www.jiaphd.org/text.asp?2017/15/3/214/215062


  Introduction Top


Oral health is an essential component of general health throughout life. However, millions of individuals suffer from dental caries and periodontitis, which if left untreated results in pain, difficulty in speaking, chewing, swallowing, loss of school or work hours and increased medical costs.[1],[2] Important factors to be considered in planning dental care are the prevalence of dental diseases and treatment needs of the population.

WHO recorded a global Decayed, Missing and Filled teeth (DMFT) of 1.61 for 12-year-old in 2004, a reduction of 0.13 as compared to the DMFT of 1.74 in the year 2001. DMFT of India was 3.94 in 2003. Thus, making India a part of those countries; needing an urgent attention to tackle a very high percentage of oral diseases while 139 countries had three DMFT or less (74 percent).[3],[4],[5]

In India, according to 2011 census,[6] children (5–14 years) comprise 40% of rapidly growing population. The prevalence of dental caries varies from 33.7% to 90% in child population and is increasing at an alarming rate. This age group being such a high proportion of the population needs to be assessed from time to time for adequate and effective assessment, planning and evaluation of the present systems in place to control oral diseases.[1],[2],[7]

Early attention in this age group to inculcate positive oral health behaviors and attempts for improving their oral health will carry a lasting effect on their life time oral disease experience and the quality of life.

Voluminous literature exists on the status of dental caries among the school children throughout India and Globe.[1],[2],[3],[4],[7],[8],[9],[10],[11] In Coastal state of Goa, no systematic and comprehensive assessment on the prevalence of dental caries are available. Hence, the present study was planned to assess the dental caries and treatment needs status of primary school going children enrolled in government Schools of the State in the age group of 6–12 years which would help us in planning and implementing necessary remedial measures.


  Materials and Methods Top


This cross-sectional survey was conducted in coastal regions of Goa state from July 2013 to August 2014 among Government Primary school children aged 6–12 years. The study was approved by the Institutional Ethical Committee. All parents/legal guardians were informed about the survey, and informed consent was taken. This survey was a part of a 5-year oral health program which was launched in Goa, India on August 19, 2013. The total number of students attending such schools was 29,293 in the survey year. At he time of the study, the state was geographically divided into two Districts, North Goa (5 talukas) and South Goa (6 talukas). Presently North Goa district also is split into 6 talukas, thus making a total of 12 talukas.

Pilot study was conducted among 100 students to calculate the sample size and to check feasibility of the study. The prevalence of dental caries obtained from pilot study was 60%, applying the precision level of ±3% with 95% confidence interval and a design effect of 1.3, a sample size of 1331 was considered necessary. Nonresponse error of 30% was added thus making the final sample size of the study as 1604. A multistage probability cluster sampling was used. The primary sampling unit consisted of 11 talukas. Within each taluka, the schools were randomly selected to get the required number of school children as estimated by sample size prediction method proportional to the population of the respective taluka using cluster sampling method.

Before the beginning of the study, the examiners performed training and calibration for the used index. During the survey, data collection was repeated on 5% of the sample to assess inter examiner reproducibility. The minimal time interval between examinations was 2 days. Kohen's unweighted kappa was 0.86 for interexaminer reliability.

All the children who were present at school on the day of survey and cooperated for the examination were included. Before the dental examination demographic information was recorded for each subject. Examination took place at the school premises with participants seated on an ordinary chair under natural light using sterilized instruments in accordance with WHO criteria (1997).[8]

Statistical analysis was carried out using SPSS software version 20 (Armonk, NY, IBM Corp).[12] Descriptive statistics was used for analysis. Student's t-test was used to determine the differences in oral health status between the genders as well as difference in the distribution in North and South Goa district. P < 0.05 was considered to be statistically significant.


  Results Top


A total of 869 (54.2%) males and 735 (45.8%) females were derived from 11 different talukas of both the districts in Goa. It was noted that slightly higher numbers of children from North Goa district were affected by caries in both primary and permanent dentition (53.47% and 53.58%); while South Goa children fared better (46.53% and 46.42%), respectively.

Significantly higher percentage of children (1051 [65.52%]) were affected, with only 34.48% of children free from dental caries. The mean total dmft was 3.09 ± 0.85 in males and 3.01 ± 0.81 among females. A significant difference of mean dmft was noted among males and females of 9 and 11 years with male children affected more than females. The dmft score gradually declined from 6-year-old (4.76 ± 4.4) to 12-year-old (0.14 ± 0.71) [Table 1].
Table 1: Caries distribution in primary dentition

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In the 6-year age group, 84.46% (163) children were free from caries, which gradually decreased as the age advanced with a small number of (28.57% (36)) children remaining caries free at 12 years. A significant difference of mean dmft was noted among males and females of 6 years with female children affected more than males [Table 2].
Table 2: Caries distribution in permanent dentition

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The total number of children requiring treatment was 1051 (65.52%) for primary dentition while it was 909 (56.67%) for permanent dentition. [Table 3] depicts treatment need assessment amongst both the dentition. Combined need show that the greatest need was for restorations. One surface filling need (34.97%) than two or more surfaces (34.29%). The number of teeth needed to be extracted was 1563 (17.64%) of the total teeth affected (8861); mostly the badly decayed primary and permanent decayed teeth and over retained primary teeth.
Table 3: Treatment needs of Primary school going children

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Pulp care and restoration were the least in the 12-year-old while it was maximum in 8-year-old children. Sixty five (0.73%) of the affected teeth required crown, 4 (0.05%) required veneer/laminate, and 20 (0.23%) teeth required prosthesis. The above-mentioned needs were mainly recorded for permanent teeth.

To avoid further decay process, approximately 10% (2065) of the total permanent teeth were indicated for preventive care ranging from pit and fissure sealant and preventive fillings.


  Discussion Top


Geographically, most parts of Goa state lie on the Konkan coast of Arabian Sea, making it an exclusive coastal state with varied and unique environmental, climatic, and cultural factors.

The present study was targeted at school going children in the age group of 6–12 years, due to ease of accessibility. It gave us a comprehensive picture of dental caries in primary, mixed, and permanent dentition. Another reason for the inclusion of such a wide age range was that caries in the primary dentition is a strong predictor of caries in the permanent dentition and a strong indicator of the future disease. Twelve year being an important WHO index age group and also the global monitoring age for caries assessment in children was included to facilitate comparison with other published research.[8]

The WHO oral health goal advocated for the year 2010 was below 2 DMFT in 12-year-old and the same was below 3 DMFT for the year 2000. Furthermore, another goal aimed to attain 50% of caries free children of 5–6 year-old by 2000.[1] The present study among the primary school children of Goa showed that our population has reached none of these targets.

The prevalence of dental caries in the present study among children was found to be 65.52% (1051 children), which is way higher than the reported caries prevalence across Indian republic. River water is the principal source of drinking water supplied to various households.[13],[14],[15],[16] It contains negligible amounts of fluoride in it; mostly in the range of 0.01–0.3 ppm.[17] Another study done on Goan population also noted that the fluoride content of the drinking water supply ranges from 0.05 to 0.1 mg/L F; and fluoride supplements, gels, and rinses are not available in Goa.[16]

Thus, the children in Goa state are deprived of the positive benefits of fluoride during developmental stages of teeth, which would have helped in strengthening the teeth in turn reducing their carious involvement.[13],[14],[15],[16]

Most areas in Goa are well developed, and semi urbanized including the villages. Staple food of Goa is paav (Bread), which is a highly refined form of fermentable carbohydrate and is stickier than other forms of Indian breads. Adding to the above fact, it is the preferred food being served in mid-day meal programme in Government primary schools of Goa. Easy accesses to refined carbohydrate food substances and their invasion into the diet could have resulted in an increased cariogenic challenge in comparison to other Indian states.[6]

Lower caries prevalence was noted in permanent dentition when compared to primary dentition (65.52% vs. 56.67%, respectively). This could be attributed to the fact that the thickness of enamel in the deciduous teeth (1 mm) is less than that of permanent teeth (2.5 mm). Thinner enamel layer combined with other factors as; high-dietary sugar intake or the inability of the younger child to brush the teeth on their own cumulates the effect. Lower calcium content of deciduous teeth and structural difference may increase the caries susceptibility in deciduous teeth along with lack of preventive measures.

Higher caries prevalence of deciduous dentition in boys could be attributed to increased caring and over feeding of boys compared to girls.[18] This could be done by parents exhibiting preferential behavior for male child; which is very common in rural India. Continued gender bias in accessing the oral hygiene material and professional care might play a small role if present.

Conversely, female children were affected more in terms of number and severity in permanent teeth. The early eruption of teeth leads to increased duration of their exposure to caries promoting oral environment predisposing them for increased cariogenic challenge.[4],[5]

Low level of restorative dental care in the present study makes them particularly suitable for the study of caries patterns since the distribution of the lesions was not modified by treatment decisions of the dentist.[16] In all the age groups where primary and permanent dentition was assessed, the decayed teeth accounted for the greatest percentage of dmft and DMFT.[15],[19],[20],[21],[22]

The reason behind many untreated caries among this group of children may be attributed to lack of awareness, motivation, and accessibility or due to dental neglect and inability to afford dental care which may not be the case with the children coming from higher socioeconomic status (SES), seen elsewhere in Goa.[1]

Most parents in such schools were employed as daily wage workers or migrant laborers and could not find time to visit the dentist as that would lead to loss of day's earnings. Parents' education levels are often used as indicators of SES. The previous studies of dental caries in children have shown a decrease in caries prevalence and severity with increase in SES or parents' education levels.[23] Ismail et al. noted parents' education levels are a risk marker for incipient carious lesions.[24]

Evaluation of treatment needs revealed that the greatest need was for restorations (Both one and two or more surfaces). Two surface restoration requirement was more than one surface in 5-year age group though reverse was the case with 12 years age group. The reason could be that there are more chances of occlusal caries in permanent teeth as they have deeper pit and fissures when compared to deciduous teeth which usually show proximo-occlusal lesion.[1]

The need for preventive care was higher after 9 years of age and increased as the age advanced. This could be due to presence of noncarious developmental defects in permanent molars at risk. Underlining the above-mentioned fact, it would be impossible to achieve oral health goals by 2020 without addressing these issues.

Generalization of the findings should be done cautiously, as the present study includes only a part of government primary school children leaving behind a major part of other such children. Our study might also underestimate the true caries risk in this population as the assessment method used does not take into account the incipient carious lesions. All the efforts made by authors to record missing and filled components can deviate due to the remembrance and the reasoning capacity of the children. Bitewing radiographs were not used to diagnose caries in this study. This is likely to have led to an underestimation of enamel and dentin caries presence and severity.

It is important that the prevalence of oral diseases in a given population is assessed at regular intervals of time to ascertain the disease burden, spread of disease, and need for preventive and restorative care. Such studies would help in planning the preventive steps needed to keep the population disease free. A suggested oral health promotion program for the State of Goa is to recruit teachers as basic disseminators of information, education, and motivation to School going children as teachers have a great impact on their developing minds and act as role models. Teachers should be trained by oral health professionals to detect oral diseases at an early stage and initiate rapid intervention by early referral. For the specific protection of high-risk patients, on site fluoride and pit fissure sealant application program can be initiated by utilizing the services of mobile dental van.


  Summary and Conclusions Top


Disease data with treatment needs provide a basis for planning type of treatment required for the child population and with the existing infrastructure and manpower facilities; it is difficult to provide curative treatment to such a vast and diverse population as access and affordability to the dental facilities become a constraint.

The curative approach is limited only to the people who can pay but a financial burden on others. Therefore, for the effective management of dental caries, emphasis should be laid on designing more of preventive and promotional oral health strategies as this is easy to reach out to majority population at a lower cost and time frame with a scope for follow-up.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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