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ORIGINAL ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 2  |  Page : 133-136

Dental caries experience among preschool children from anganwadi centers of Mangalore taluk: A cross-sectional study


Department of Public Health Dentistry, A. J. Institute of Dental Sciences, Mangalore, Karnataka, India

Date of Submission07-Dec-2017
Date of Acceptance27-Mar-2018
Date of Web Publication24-May-2018

Correspondence Address:
Dr. Ambili Nanukuttan
Department of Public Health Dentistry, A. J. Institute of Dental Sciences, NH 17, Kuntikhana, Mangalore - 575 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_171_17

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  Abstract 

Introduction: Anganwadi worker is the most periphery functionary of the Integrated Child Development Services scheme. They deliver services to children below the age of 6 years who form a very potential group that can be targeted for inculcating positive oral health values. Most of the anganwadi children are from rural communities who experience poverty, poor knowledge of parents, and underutilization of health services that result in poor oral as well as general health. Aim: To collect the baseline data on the dentition status of preschool children in anganwadi centers of Mangalore taluk. Methodology: The study population comprised of 530 preschool children in the age group of 3–6 years. After obtaining informed consent, dentition status was examined according to the WHO 1997 criteria. Statistical analysis was done using Statistical Package for the Social Sciences version 17. Mann–Whitney U-test was used to statistically analyze the data. The level of significance was set at P ≤ 0.05. Results: The dentition status among preschool children was poor with mean decayed, missing, filled teeth score of 2.74 ± 3.44. Gender-wise comparison did not show any statistically significant difference although girls showed a higher caries experience than boys. Conclusion: High caries experience in this study revealed that there is a great need to plan and conduct oral health promotion initiatives and treatment activities for preschool children from rural communities. Dental health services should be made available in the peripheral areas along with oral health education among parents and teachers to inculcate a positive attitude toward oral health among children.

Keywords: Dental caries, preschool children, primary teeth, rural areas


How to cite this article:
Hegde V, Nanukuttan A. Dental caries experience among preschool children from anganwadi centers of Mangalore taluk: A cross-sectional study. J Indian Assoc Public Health Dent 2018;16:133-6

How to cite this URL:
Hegde V, Nanukuttan A. Dental caries experience among preschool children from anganwadi centers of Mangalore taluk: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2018 [cited 2020 Sep 21];16:133-6. Available from: http://www.jiaphd.org/text.asp?2018/16/2/133/233065


  Introduction Top


Health is a positive and dynamic concept; it is a common theme in most cultures.[1] A healthy life is the dream of every individual, irrespective of any physical or social difference.[2] Oral health is integral and essential to general health; it is very important for the achievement and maintenance of health and well-being.[2],[3] Oral health is also an essential and leading component of children's overall health, functional capacity, and social welfare.[4] The health of the mouth and the dentition play a major role in the life of a child, through facilitating nutritional intake, providing a nonverbal means of expressing happiness, and allowing for vocal communication.[5]

Oral diseases qualify as major public health problems owing to their high prevalence and incidence around the world. According to the World Oral Health Report 2003, dental caries and periodontal diseases are the two globally leading oral afflictions. Of which, dental caries remains the most important childhood disease affecting a considerable proportion of young children worldwide. It is one of the most common unmet healthcare needs of children, especially affecting preschool children.[6] Many studies across countries among preschool children have shown that high caries experience and patterns of caries are frequently researched upon to tackle this problem in rural and urban areas.[1],[6],[7] It is recognized as a serious public health problem as it has a potential for increasing the risk of caries in the permanent dentition. This can lead to poor dental health that has detrimental effects on the growth and cognitive development of the child. Many studies have also shown the influence of dental caries on nutrition and concentration, which in turn affects the performance of a child in later life.[1],[7] Untreated caries may lead to early loss of primary dentition and may affect the growth and maturation of permanent dentition.[7]

India is predominantly rural as over 72% of people live in rural areas. According to the 2011 census, 8.33 and 3.77 million people live in rural and urban parts of India, respectively. Among the rural population, 1/3rd are illiterate and 60% of them are deprived or poor. Further, there is a critically low dentist-to-population ratio of only 1:150,000 in rural areas and 1:10000 in urban areas. All of these contribute to negligence about the importance of good dental health among people who live in rural communities. As a result, they compromise their ability to care for themselves and their children to afford the cost of health services.[7],[8],[9],[10],[11]

Hence, to reduce the inequalities in health care, the Government of India initiated a national scheme known as the Integrated Child Development Services (ICDS) which aims at the delivery of a package of basic health services through various functionaries. Anganwadi worker (AWW) is the most periphery functionary of the ICDS scheme. Most of the preschool children belonging to low socioeconomic status attend anganwadi schools, and the AWW delivers services to children below the age of 6 years, which mainly include nonformal preschool education, health, and nutrition maintenance. Empowering Anganwadi workers and mothers regarding oral health and providing basic health awareness are the most feasible methods for improvement of oral health of children in a country like India, where oral health is not a priority in the primary health care as yet.[7],[8],[12]

Although numerous dental literature exists about oral health status in urban Indian population, there is scarcity of any such literature of oral health status in rural areas of India which demands more attention.[1] Moreover, there is no information regarding dental caries status of preschool children living in rural part of Karnataka, which constitutes 7,182,100 of children below 6 years.[13] Therefore, an attempt was made to collect the baseline data on the dental caries experience of preschool children in the anganwadi centers of Mangalore taluk.

Hence, the aim of the study was to assess dental caries experience of 3–6-year-old preschool children in the anganwadi centers of Mangalore taluk and to make gender-wise comparison among the study population.


  Methodology Top


A cross-sectional study was designed and undertaken at various anganwadi centers of Mangalore taluk to assess the dentition status of 530 preschool children. The study was carried out from September 2016 to February 2017. Information regarding anganwadi centers and permission to conduct the study were obtained from Chief Executive Officer from the Department of Women and Child Development, Zilla Panchayat, Mangalore. Following which the study was carried at anganwadi centers of Mangalore taluk. The study population included all the anganwadi children aged between 3 and 6 years from 27 anganwadis of Mangalore taluk.

Study population and sampling design

The study population consisted of preschool children from the anganwadi centers of Mangalore taluk. Children were selected based on convenience sampling. Children aged 3–5 years of age attending the selected anganwadi centers from whom consent was obtained from the parents and the concerned authorities and those who were present on the day of study were included. Children with systemic disorders, oral diseases, or conditions that limit them from oral examination and those who were not cooperative with the examination procedure were excluded from the study.

Sample size determination

A pilot study was conducted, and the caries prevalence was found to be 42% among the study participants following which the sample size was determined and was found to be 530. The confidence level is set at 95% and power of study was set at 90%. The sample size was determined based on the formula given,



Substituting the values in the formula,

n = ([1.96]2 × 42 × 58) ÷ (4.2) 2 = 530

Thus, the sample size was estimated to be 530.

Examination was done by a single examiner. Intraexaminer calibration of the examiner was carried out. The data obtained were analyzed using kappa statistics. The coefficient was found to be 0.83, reflecting a high degree of agreement in the observation.

Examination procedure

After obtaining ethical clearance from the Institutional Ethical Committee (AJEC/REV/D/03/2015-16), the study was carried out. The study participants were examined at the anganwadi centers. A type III (using mouth mirror and explorer with proper illumination) examination was carried out for each child using plain mouth mirror and explorer under natural light.[1] Torch was used when there was no proper illumination.[11] The data related to dentition status were recorded using the WHO Oral Health Assessment Pro forma (1997).[14] After obtaining dentition status, caries experience was calculated by adding the mean number of decayed teeth, missing teeth due to caries, and filled teeth. Descriptive statistics under Data were analyzed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 22 was used to analyze mean and standard deviation, and Mann–Whitney U-test was used to compare between males and females.


  Results Top


The present study was conducted to assess the dentition status of preschool children in the anganwadi centers of Mangalore taluk.

Out of 530 children, 195 (36.8%) were 3 years old, 181 (34.2%) were 4 years old, 137 (25.8) were 5 years old, and 17 (3.2%) were 6 years old [Table 1]. Among them, a total of 282 (53.2%) were males and 248 (46.8%) were females [Table 1].
Table 1: Distribution of study participants according to age and gender

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The mean number of decayed teeth, filled with decay, filled without any decay, and missing due to caries was 2.71 ± 3.42, 0.01 ± 0.15, 0.01 ± 0.15, and 0.005 ± 0.07, respectively. Furthermore, the total mean decayed, missing, filled teeth (dmft) score in this study was found to be 2.74 ± 3.44 [Table 2].
Table 2: Comparison of dentition status among study participants according to gender

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Among boys and girls, the mean number of decayed teeth was 2.62 ± 3.43 and 2.81 ± 3.40, mean number of filled teeth with decay was 0.21 ± 0.20 and 0.00, the mean number of filled teeth without decay was 0.00 and 0.02 ± 0.22, the mean number of missing teeth due to caries was 0.007 ± 0.08 and 0.004 ± 0.06, respectively. The present study also showed a higher mean dmft value among girls (2.85 ± 3.42) than boys (2.65 ± 3.45). The difference was not statistically significant (P > 0.05) [Table 2].


  Discussion Top


In the present study, children were divided into different age groups of 3, 4, 5, and 6 years, similar to other studies.[6],[7],[8],[11],[15],[16],[17]

According to this study, out of 530 preschool children, 282 (53.2%) were males and 248 (46.8%) were females. The ratio of males to females was 1.13:1; it was similar to the study conducted by Gupta et al., where the ratio of males to females was 1.14:1.[1]

The present study states that 316 (59.62%) of 530 study participants had decayed teeth, which was similar to that of the study conducted by Singhal et al.[6] Similar results were also seen in the study conducted by Mahejabeen et al., where the overall prevalence of dental caries was 811 (54.1%) among preschool children of Hubli.[15] The higher prevalence of dental caries in the present study was probably related to improper feeding practices, infrequent mouth rinsing after every meal, and lack of dexterity in this age group.[6],[7] Four (0.8%) of the study participants had filled teeth with decay and another four (0.8%) had filled teeth without any decay, respectively. In the study done by Kashetty et al., the number of filled teeth constituted very less similar to the present study.[7] The lower number of filled teeth compared to the number of decayed teeth is mainly attributed to underutilization of dental-care facilities by the parents of preschool children residing in rural areas.[7],[11]

Only 3 (0.6%) had missing teeth due to caries in the present study. The results were similar to the studies done by Kashetty et al. and Mahejabeen et al., where the number of missing teeth constituted very less compared to the number of decayed teeth.[7],[15]

The mean dmft score in the present study was found to be 2.74, which is in agreement with that of other studies conducted by Jaidka et al., Kashetty et al., Azizi, and Dixit et al., where the mean dmft values were 2.63, 2.34, 2.46, and 2.71, respectively.[2],[7],[18],[19] Contrary to this, the mean dmft values were found to be lower in the National Oral Health Survey, where in 5-year-old children showed lower (1.9) dmft values.[20]

The present study showed that the mean caries experience among girls and boys was 2.85 and 2.65, respectively. However, the difference was not significant (P > 0.05). These results are in agreement with that of the studies conducted by Singhal et al., Zhang et al., Saravanan et al., and Snehal et al., where girls showed a higher mean dmft value than boys.[6],[21],[22],[23] Studies conducted by Gupta et al., Azizi Z et al., Dixit et al., Peedikayil et al., Prabakar et al., Dhar et al., and Priyadarshini et al. showed contrary results.[1],[19],[24],[25],[26],[27] This nonsignificant difference in mean dmft score between the genders may be because, diet and oral hygiene practices for preschool children are mostly controlled by parents and are the common factors for both genders.[7] The study results could be used for similar target population, those children from families living in rural communities with culture, lifestyle, and oral health practices, similar to that of the study participants in the present study. However, there are few limitations of the study where comparison could have been made according to the age groups and risk factors for dental caries and barriers for accessing oral health care were not assessed.


  Conclusion Top


The present study concludes that there is a high dental caries experience in preschool children from anganwadi centers of Mangalore taluk. This could be attributed to factors such as inaccessibility to dental care, poor socioeconomic status, lack of knowledge, and unawareness about oral health among their parsents. Reduction of high caries levels can only be achieved by a preventive and oral hygiene promotion program; therefore, there is a great need to change from restorative-oriented dental services to preventive-oriented dental services for preschool children to improve the oral health status of this population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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