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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 4  |  Page : 293-300

Age and reasons for first dental visit: A cross-sectional study of children in Bengaluru, India


Department of Pedodontics and Preventive Dentistry, The Oxford Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission21-Mar-2019
Date of Decision22-May-2019
Date of Acceptance22-Oct-2019
Date of Web Publication12-Dec-2019

Correspondence Address:
Dr. Priya Subramaniam
Department of Pedodontics and Preventive Dentistry, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bengaluru - 560 068, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_36_19

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  Abstract 


Background: An early first dental visit lays down the foundation of preventive dental care in order to ensure optimal oral health during childhood. The timing of a child's first dental visit varies in different countries. Aim: The aim of this study was to find the age at which parents first seek dental care for their children in Bengaluru, India, and reasons for the first dental visit. Materials and Methods: A cross-sectional study was conducted across randomly selected dental colleges, private dental clinics, and dental department of hospitals in Bengaluru city, India. Sociodemographic details and reasons for the first dental visit were recorded using a pro forma. Data obtained were subjected to statistical analysis using SPSS software V.22, IBM, Corp., USA. The Chi-square test was used, and the level of significance was set at P < 0.05. Results: The mean age of the first dental visit was 8.18 ± 3.2 years. The maximum number of children reported for their first dental visit at age 6 years. Ninety-six percent of children visited only when there was a problem. Dental pain, dental caries, irregularly placed teeth, deposits, and trauma were found to be significant reasons (P ≤ 0.001). Conclusion: Age 6 years was the most common age for the first dental visit. Pain and dental caries were the most common reasons for the first dental visit.

Keywords: Age, children, dental caries, first dental visit, pain


How to cite this article:
Subramaniam P, Reghuvaran J. Age and reasons for first dental visit: A cross-sectional study of children in Bengaluru, India. J Indian Assoc Public Health Dent 2019;17:293-300

How to cite this URL:
Subramaniam P, Reghuvaran J. Age and reasons for first dental visit: A cross-sectional study of children in Bengaluru, India. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2020 Feb 28];17:293-300. Available from: http://www.jiaphd.org/text.asp?2019/17/4/293/272790




  Introduction Top


Oral health is an integral part of a child's overall well-being. Good oral health during early life sets the foundation for a lifetime of good dental health. The American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics have adopted the concept of “age 1 dental visit” since 2001.[1] Early intervention allows the identification of high-risk children and the implementation of preventive regimens. A timely first visit to the dental office creates oral health awareness among parents and caregivers. It can have long-term benefits for the child and should be an integral part of pediatric health care.

Over the past several years, much discussion has been focused on the age at which a child without identified dental problems should first visit a dentist. Various studies have suggested it to be ideally before completion of 12 months of age.[2],[3],[4] However, a lesser number of children are found to have a preventive dental visit at or around the age of 1 year.[5],[6] Early dental visits are also found to have resulted in fewer restorative needs and decreased expenditures.[6] Lack of dental care or dental neglect during early childhood can affect speech, nutrition, performance at school, and quality of life.

Familiarization with the dental environment at an early age is helpful in reducing a child's dental anxiety. It provides an opportunity for parents to address their concerns and questions regarding their child's oral care.[7] The parents are educated about infant oral hygiene, feeding practices, home- and office-based preventive therapies, dietary patterns, oral habits, and prevention of dental injury.

Early childhood caries can cause pain and psychological trauma to young children. An early first visit to the dentist could arrest the progress of dental caries.[7] Most parents continue to take their children to the dentist preferentially for curative instead of preventive treatment. A great barrier remains to be overcome in order to reduce the incidence of dental caries. Awareness of the importance of early first dental visit among dentists shows different data on the number of those familiar with the recommendations that children visit dental offices before the age of 1 year.[8],[9],[10]

The timing of the first dental visit was found to differ in different countries.[5],[11],[12] As oral health promotion for the very young needs to be directed at their mothers, it has been suggested for a dental visit around the 4th month of intrauterine life. This will help in educating expectant mothers on the importance of an early dental visit for the child as per the recommendations.[13]

Timing and reasons may differ for each child and are related to other factors. Studies have reported inequalities in access to health care and utilization of dental care services, related to age and reasons for the child's first dental visit.[6],[14] Children who had their first preventive visit by the age of 1 year were more likely to have subsequent preventive visits, whereas children who had their first preventive visit by age 2 or 3 years were more likely to have subsequent restorative and emergency visits.[6]

India is a vast country with diverse sociocultural practices. In a metropolitan city like Bengaluru, there are several dental schools (colleges) with a pediatric dental department offering oral care to children at affordable costs. In addition, there are exclusive private pediatric dental practices and a large number of general practitioners. Dental care is more accessible to children living in urban and semi-urban areas. However, very few Indian studies have reported on Indian children regarding their age for the first dental visit.[11],[15]

Therefore, this study was undertaken to know the age at which parents first seek dental care for their children in Bengaluru and the common reasons for the first visit in different types of dental practices.


  Materials and Methods Top


A cross-sectional study was conducted across randomly selected dental colleges, private dental clinics, and dental department of hospitals in Bengaluru city, India. The STROBE checklist for the flow of writing the manuscript. Prior approval to conduct the study was obtained from the Ethics Review Committee of the institution (222/2014).

The purpose of the study was explained to general practitioners and clinicians, and written permission was obtained from the concerned authorities of the various dental colleges, hospitals, and dental clinics.

A specially prepared pro forma, designed for recording all relevant data related to the objective of the study, was used. The pro forma had two sections: to record demographic details and a questionnaire regarding “reasons for the first dental visit.” The sociodemographic details included were name, age and gender of the child, occupation and educational qualification of parents, family income, and place of residence. The questionnaire consisted of 18 questions that were based on the common reasons for a dental visit.[12] It was a combination of both open- and closed-ended questions; the pro forma was in both English and the local language (Kannada). The translated questionnaire was tested on a sample of 50 intended respondents. These respondents were then asked to elaborate what they thought of each question and the meaning of their corresponding response. This ensured that the translated questionnaire retained the same meaning with no alteration.[16]

Normal healthy children accompanied by the parent for the first dental visit only were included in the study. The exclusion criteria of this study were as follows: (1) children accompanied by anyone else other than the parent and (2) children with special health-care needs.

The nature of the study with regard to its objectives was explained to the parents. Only those parents who were willing to participate in the study and who gave their written consent for the same were included. Systematic random sampling was used in this study. A probabilistic sample was calculated with a 95% confidence level and a 32.2% prevalence of the first visit at 1–3 years.[17] The minimum sample size needed was 1321, and an additional 10% was added to compensate for potential refusals, which was then rounded off to 1500. A total of 1500 parents formed the study group.

n = [DEFF × Np (1 − p)]/[(d 2/Z 21−α/2× (N − 1) +p × (1 − p)]

Population size (for finite population correction factor) (N): 1000000

Hypothesized percentage frequency of outcome factor in the population (p): 32.2% ± 5

Confidence limits as percentage of 100 (absolute ±%) (d): 5%

Design effect (for cluster surveys, DEFF): 1

In dental schools, the questionnaire was distributed among parents who visited the department of pedodontics and preventive dentistry. It was also distributed to parents visiting general practitioners and pediatric dentists across the city of Bengaluru.

Parents were assured of maintaining their confidentiality. The study was conducted through a one-to-one interaction between a single investigator and the parents of the child who was on his/her first dental visit. In certain cases, the investigator answered the questionnaire based on information given by the parents.

Data obtained were expressed as number and percentage and tabulated for statistical analysis. The Chi-square test was used to compare various responses of the study participants for different age groups. The level of significance was set at P < 0.05 and P < 0.001 was considered as highly significant. The data were analyzed using the Statistical Package of the Social Sciences (SPSS) software V.22, IBM, Corp., USA.


  Results Top


Of the total 1500 children, 794 (53%) were male and 706 (47%) were female. The mean age of the first dental visit was 8.18 ± 3.2 years. Only one child reported for the first dental visit at the age of 1 year. The highest percentage (13%) of children reported for their first dental visit at the age of 6 years. From above 10 years of age, there was a decrease in the number of children who reported for the first dental visit. There was no significant difference observed between males and females for the first dental visit [Table 1].
Table 1: Comparison of age and gender of first dental visit

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The age-wise distribution of children according to the reason for the first dental visit is given in [Table 2]. Ninety-six percent of children made their first dental visit with a complaint, and it was seen to be higher in children aged 6–10 years. Only 4.4% of the children visited for a routine dental checkup.
Table 2: Age-wise distribution of children according to reason for first dental visit

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Across all ages, pain and dental caries were observed to be the most common reasons for the child's first dental visit. From the age of 1 year, there was an increase in the number of children who presented with a complaint of pain and dental caries. The highest percentage of children aged 6–10 years presented with pain and dental caries (35.6% and 45.73%, respectively) which then gradually decreased to 12% and 16.53%, respectively, in the 11–16-year age group. From age 7 years, irregularly placed teeth were also one of the reasons, with the highest number seen in the older age group. Children aged 11–16 years were the highest among those with trauma as the reason for the first dental visit. This age group also reported with dental plaque, whereas retained and mobile teeth were the chief complaints in the 6–10-year-old children. Tooth discoloration, oral habits, and missing teeth were rarely the reasons for making the first dental visit [Table 3].
Table 3: Age-wise distribution of children according to types of complaint on first dental visit

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The reasons for the first dental visit were compared between the three age groups. Reasons such as pain, dental caries, irregularly placed teeth, deposits, and trauma were found to be highly significant (P < 0.001). Pain was observed to be highest in the age group of 6–10 years (65.9%). The maximum number of children reported with dental caries in the age group of 1–5 years (88.6%). Children who reported with mobile teeth were highest in the age group of 6–10 years (3.1%) and were found to be significant (P ≤ 0.001) [Table 4].
Table 4: Association of reasons for first dental visit among age groups

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Among the various reasons given for pain, tooth decay (97.4%) was found to be highly significant in children aged 6–10 years (P < 0.001), whereas abscess (4.9%) was found to be significant in the age group of 1–5 years (P < 0.05). Complaints of crowding (4.6%), forwardly placed teeth (4.1%), and tooth fracture (6.1%) were found to be highly significant in 11–16-year-old individuals (P < 0.001). Spacing (1.4%) and rotated teeth (1.4%) were also found to be significant reasons in this age group (P < 0.05) [Table 5].
Table 5: Association of type of dental complaint among age groups

Click here to view



  Discussion Top


Age of the first dental visit of a child helps in determining the quality of preventive dental care the child will receive and thus the future oral health of the child. The AAPD and the American Dental Association have recommended that “a child should visit the dentist within 6 months of eruption of the first primary tooth and no later than 12 months of age.”[18] Various countries have put forward similar recommendations regarding the age of the first dental visit.[2],[3],[13],[19] There is a wide difference in the timing of the first dental visit in different countries.[5],[11],[12]

The timing and reasons for the first dental visit may differ for each child and also for different age groups of children. Other studies regarding the first dental visit have assessed children up to 12 months of age,[20] at 2–3 years,[21] at 4–6 years,[22] up to 6 years,[12] or even 12 years of age.[11] A large majority of parents still take their children to the dentist preferentially for treatment instead of preventive treatment.[23],[24] Some may visit a dental practice for the first time during the preadolescent or adolescent years. Hence, a wide age range of children up to 16 years of age were included in the present study.

This study was carried out at various dental colleges, private dental clinics, and at dental department of hospitals, thus including all possible areas of dental practice. Whereas, earlier studies on a child's first dental visit were conducted as part of oral health maintenance programs,[20],[25] or at a health center,[26] or at pediatric dental department of hospitals.[11],[12]

The majority of the children who reported for their first dental visit in the present study were in the age group of 4–10 years. The mean age at the first dental visit was 8.18 years, which was higher than that reported in earlier studies on Indian children.[11],[15] Only 3.5% of the children under the age of 3 years reported for their first dental visit which suggests the lack of parental awareness of the importance of an early first dental visit. Several parents tend to neglect their child's primary teeth and become concerned only during eruption of the permanent teeth and take them to a dental clinic at a later age.

This is in contrast to Western countries such as Canada and the United States of America, where better access to dental care and oral health maintenance programs are responsible for the first dental visit occurring at a lower age.[23],[26],[27] However, it is still not adequate, as it does not meet the recommendations of AAPD of an age 1 dental visit. A cohort study in Iowa reported that 31% of the children had seen a dentist by the time they reached their third birthday.[5] In a Bulgarian study, 40% of the children who reported for the first dental visit were below 3 years, 52% of them were aged between 3 and 6 years, and only 1.73% of the children were found to have their first dental visit before the age of 1 year.[12] Interestingly, in our study, only one child reported for a dental visit by 12 months of age and 9 children by the age of 24 months. In developing countries, factors such as the lack of awareness of infant oral health care among general dentists and pediatricians,[8],[10] absence of dental homes and well-baby clinics, cultural beliefs, socioeconomic reasons,[28] and reluctance of dental professionals to treat young children [29] have also been related to the first dental visit occurring at a later age.

Awareness of dentists regarding the importance of an early first dental visit showed different data related to those familiar with the recommendations of an age 1 dental visit.[8],[9],[10],[30] A significant gap remains between practice recommendations supported by national academies and ability and willingness of the members to implement the recommendations. It was reported that 50% of general dentists in the city of Bengaluru recommended age 1 dental visit for high caries risk children.[31] However, for lower caries risk children, the first dental visit was recommended only by 3 years of age by many general dentists. Lack of hands-on experience, children too young to cooperate, and referral to another dental provider were the common reasons reported by general dentists for not seeing children <2 years of age.[29]

Reports on gender preference for the age of the first dental visit have been conflicting.[14],[26],[27],[32] Although no significant gender bias was observed in the present study, a higher number of younger males reported for their first dental visit. Between 11 and 16 years, the number of males and females who reported for the first dental visit was comparable. It is because adolescent girls as well as their parents become more conscious of their appearance as they reach puberty. In Brazil, female children were more likely to have made an earlier dental visit than males.[14] Only 4% of the children in the present study made their first visit for a routine dental checkup. This was in accordance with reports on Chennai, India, where only 1%–5% of the children first reported for a routine visit.[11] In developing countries such as India, health disparities affecting disadvantaged children remain a nationwide problem, and dental care still remains a luxury and unaffordable to many. In certain countries such as Brazil, Canada, and the United States of America, the establishment of dental homes, well-baby clinics, and implementation of preventive programs has resulted in an improved awareness of oral health. This has led to a substantial increase in early first dental visits in these countries. According to a survey conducted in Bulgarian children aged between 12 months to 6 years, 27% of them reported for prophylactic examination.[12] In India, in spite of several health-care professionals in the urban areas, such initiatives are very few.

In our study, 96% of the children were brought by parents only in the presence of a complaint for curative treatment. It is probably due to lack of awareness of the importance of an early first dental visit. Dental caries (82.7%) and pain (62.6%) were found to be the most common complaints, which are in accordance with earlier Indian studies.[11],[15] There were children who reported for the first dental visit in their preadolescent and adolescent years, with a complaint of irregularly placed teeth. This suggests that parents do not seek the prevention of dental diseases and respond only when there is a symptom or sign of a dental/oral condition.

Earlier studies on the first dental visit have not reported on oral habits.[15],[20],[25] Although the prevalence of oral habits in Bengaluru was reported to be 4% in children of 10–16 years of age,[33] a very low percentage (0.5%) of children reported for oral habits on the first dental visit. It could be related to lack of recognition and unawareness on the detrimental effects of oral habits. Parents could also be indifferent to the presence of an oral habit in their children. Similarly, a very small percentage of children reported for retained, missing, and mobile teeth on their first dental visit. Most parents are aware that primary teeth will eventually exfoliate and get replaced by eruption of permanent teeth at a later age. Hence, they may tend to ignore the presence of a retained and/or loose primary tooth.

From the results of the present study, it is evident that a large majority of parents still seek dental care for children only for treatment and not as a routine visit. This is in spite of availability of dental care in Bengaluru, an urban area where there is a widespread presence of dental schools, private practices, and corporate dental clinics. Factors such as socioeconomic status, maternal education, and lack of awareness of the importance of an early dental care may be related to dental visits of children. Further studies on the association of these factors with the first dental visit of children need to be carried out.

Gynecologists, pediatricians, and other allied specialists are more likely to see expecting mothers and infants at a much earlier age than dentists. It was earlier reported that only 52% of pediatricians in Bengaluru felt an early first dental visit which is very important.[31] Lack of adequate knowledge about recommendations prevents these professionals from promoting initiation of oral health care at an early age. Thus, attempts should be made to educate and motivate these health-care professionals on the importance of the first dental visits at age 1 year.


  Conclusion Top


  1. The mean age of the first dental visit was 8.18 ± 3.2 years. The most common age for the first dental visit was 6 years (12.9%)
  2. Only 4% of the children had a routine dental checkup on their first dental visit, whereas 96% of the children reported for the first dental visit with a dental complaint
  3. The most common reasons for the first dental visit were pain and dental caries (P < 0.001)
  4. Other less common but significant reasons for the first dental visit were irregularly placed teeth, deposits, trauma, and mobile teeth (P ≤ 0.001).


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Pro forma Top


  • Name of the child:
  • Age:
  • Gender: Male/Female
  • Educational qualification of parents


Father Mother

  • Postgraduate
  • Graduate/University
  • Schooling
  • Illiterate
  • Occupation of parents:


Father Mother

  • Health Professional
  • Salaried Employee-IT professional, chartered accountant, bank employee, teacher
  • Business-shop owner, retailer agent
  • Grocer, butcher, driver
  • Security, sales person,
  • Others
  • Unemployed
  • Family income per month (in rupees): (put tick mark where appropriate)
  • ≥40,562
  • 20281–40561
  • 15211–20280
  • 10140–15210
  • 6084–10139
  • 2049–6083
  • ≤2048
  • Various reasons for the first visit to the dental clinic:


  1. Have you come for just a checkup? Yes/No
  2. Do you have any complaint? Yes/No
  3. Presence of pain? Yes/No


  4. What is the pain due to?

    1. Tooth decay– Yes/No
    2. Teething– Yes/No
    3. Abscess– Yes/No
    4. Others


  5. Dental caries: Yes/No
  6. If yes, decay is present in:


    1. Right or left side of teeth or both
    2. Upper or lower region or both
    3. Front or back teeth or both
    4. All the teeth


  7. Irregularly placed teeth: Yes/No


  8. If yes, which of the following is the complaint?

    1. Spacing– Yes/No
    2. Crowding– Yes/No
    3. Forwardly placed teeth– Yes/No
    4. Rotated teeth– Yes/No
    5. Cross-bite– Yes/No
    6. Others


  9. Deposits: Yes/No
  10. Tooth discoloration: Yes/No
  11. If yes,


    1. Is it due to tooth decay? Yes/No
    2. Is it due to trauma? Yes/No


  12. Presence of oral habits: Yes/No
  13. If yes,


    1. Which of the following type of habit is the child having?


    Is it thumb sucking? Yes/No

    Is it tongue thrusting? Yes/No

    Is it mouth breathing? Yes/No

  14. Trauma: Yes/No
  15. If yes,


    1. Is there any tooth fracture? Yes/No
    2. Is there any soft tissue injury? Yes/No


  16. Are there any missing tooth?


  17. Yes/No

  18. Any retained teeth present?


  19. Yes/No

  20. Mobile teeth: Yes/No
  21. Any soft tissue lesion: Yes/No
  22. If yes,


  1. Present in relation to which region of mouth?
  2. What is the type of lesion?
  3. Is it ulceration? Yes/No
  4. Is it enlargement of gums? Yes/No
  5. Is it any red and white lesions? Yes/No




 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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