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Year : 2016  |  Volume : 14  |  Issue : 4  |  Page : 403-408

Prevalence of dental caries among 3–6-year-old Anganwadi children in Mudhol town, Karnataka, India

1 Department of Public Health Dentistry, Pandit Deendayal Upadhyay Dental College, Solapur, Maharashtra, India
2 Department of Pedodontics and Preventive Dentistry, H.K.E's S. Nijalingappa Institute of Dental Sciences and Research, Gulbarga, Karnataka, India
3 Department of Oral Medicine and Radiology, Navodaya Dental College and Hospital, Raichur, Karnataka, India

Date of Web Publication15-Dec-2016

Correspondence Address:
Sagar Kumbhar
Pandit Deendayal Upadhyay Dental College, 19/1 Kegaon, Pune Road, Solapur - 413 255, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2319-5932.195840

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Introduction: Dental caries is the most prevalent oral disease among childhood. Dental caries in primary dentition is often neglected since they exfoliate, and its treatment is considered as economic burden among lower socioeconomic families. Aim: To assess the prevalence of dental caries in the primary teeth of 3–6–year-old preschool Anganwadi children in Mudhol town of Karnataka. Materials and Methods: A cross-sectional study was conducted over 758 children, aged 3–6 years studying in 15 Anganwadis of Mudhol. Type III WHO method of examination was followed, and decayed, missing, filled teeth (dmft) index was recorded according to the WHO criteria. The data were analyzed by Z-test and Chi-square test using SPSS version 17 software. Results: Among the study population, 62.14% were found to be affected by dental caries. The prevalence of dental caries increased with increase in age. No significant difference was found with respect to gender. The mean dmft was 2.34. The filled component was nonexistent among these children. Second primary molars were the teeth most affected by caries followed by first molars and central incisors. Conclusion: Dental caries prevalence of 62.14% and mean dmft of 2.34 among Anganwadi children of Mudhol town is a cause for concern. The nonexisting filled component among these children indicates high unmet restorative treatment needs. Dental health services should be made available in the peripheral areas to meet the needs of young children.

Keywords: Dental caries, preschool children, prevalence, primary teeth

How to cite this article:
Kashetty MV, Patil S, Kumbhar S, Patil P. Prevalence of dental caries among 3–6-year-old Anganwadi children in Mudhol town, Karnataka, India. J Indian Assoc Public Health Dent 2016;14:403-8

How to cite this URL:
Kashetty MV, Patil S, Kumbhar S, Patil P. Prevalence of dental caries among 3–6-year-old Anganwadi children in Mudhol town, Karnataka, India. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2024 Mar 4];14:403-8. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2016/14/4/403/195840

  Introduction Top

Dental diseases have afflicted humanity since the dawn of recorded history. Dental caries is one of the most common of all chronic diseases. It may be considered a disease of modern civilization since prehistoric man was rarely affected from dental caries. The changing lifestyle and dietary patterns are markedly increasing the caries incidence. Although sucrose has been indicated as the “arch criminal” in the etiology of caries, the concept of multifactorial disease became more acceptable.[1],[2]

Dental caries is a disease that begins at a very young age. However, children of disadvantage subpopulation regardless of race, ethnicity, or culture have been found to be the most vulnerable.[3] It is recognized as a serious public health problem due to its potential for increasing risk of caries in the permanent dentition.[4] Untreated caries may lead to early loss of primary dentition and affect the growth and maturation of the secondary adult dentition. Poor dental health has a significant impact on the growth and cognitive development of child by interfering with nutrition, concentration, and subsequently school participation.[3],[4],[5]

In developing countries like India, the incidence of dental caries is increasing due to the changing lifestyle and dietary patterns.[1] 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. She delivers services to mainly children below the age of 6 years which mainly include nonformal, preschool education, health, and nutrition maintenance. Most of the preschool children belonging to low socioeconomic status attend Anganwadi schools.[6]

The prevalence of early childhood caries worldwide is highly variable ranging from 2.1% in Sweden to 85.5% in rural Chinese children, whereas the prevalence in the USA is reported to be 11%–53.1%. The prevalence in the UK is 6.8%–12%.[7] The prevalence of dental caries in India among preschool children varies from 19.2% to 71.1%.[8],[9] However, National Oral Health Survey 2002–2003 documented an average prevalence of 40.5% in Karnataka state and 40%–60% in the country.[10],[11]

An early identification of dental caries provides an opportunity to identify the children who are at a greater risk for the disease so that appropriate preventive interventions can be initiated to protect the unaffected teeth and protect the permanent dentition.[12] To the best of our knowledge, no other studies have been conducted to assess the prevalence of dental caries among Anganwadi children in Mudhol town. Hence, the present study was undertaken to assess the dental caries prevalence among 3–6–year-old Anganwadi school children of Mudhol town, Karnataka, India.

  Materials and Methods Top

A cross-sectional study was conducted among 758 children (360 boys, 398 girls) of age 3–6 years enrolled in the 15 Anganwadi centers of Mudhol town, Bagalkot, Karnataka, India. The study was conducted in the month of July and August 1999 over a period of 15 days. All the Anganwadis (15) were selected for the study. Each Anganwadi consisted of 40–60 children. Ethical approval was obtained from the Institutional Review Board. Official written informed consent to carry out the oral health survey was obtained from all the concerned authorities – Child Development Project Officer, Mukhyasevikas, AWWs and the parents of the children.

A pilot study was carried out in one school chosen using simple random sampling to check the feasibility, and the main survey was then planned accordingly. The WHO criteria were used to record the decayed, missing, filled teeth (dmft) index.[13] Sample size for the present study was calculated using the formula for descriptive design. The prevalence of dental caries required for calculating the sample size was taken from the previous study.[7] The significance level (Type I error) was fixed at 5% with the probability of committing Type II error was 20%. The power of the study was fixed at 80%. The final sample size was calculated, and it was found to be 680 children. Among the total children present on the day of visit, 758 children in the age group 3–6 years met the inclusion criteria.

Intraexaminer reliability (calibration) was done by assessing 15 children who were selected randomly by a simple random technique from an above-mentioned randomly selected school on whom investigator applied the self-designed format and recorded the findings. The kappa coefficient score was 0.88 with respect to dmft index. Children aged between 3 and 6 years were included in the study. Children with any major systemic diseases, acute infections which interfered in oral examinations, who were mentally retarded and physically handicapped, and permanent teeth were excluded from the study.

Data were collected using a standard pro forma, and clinical examination was performed. All the examinations were performed by the single examiner. Examination using mouth mirror, explorer, and adequate natural light illumination was followed.[13] Children were examined on a school table in the lying down position with the help of torch as an additional light source.

The data obtained were statistically analyzed using SPSS version 17. Inc, Chicago, IL, USA. Descriptive statistics included computation of percentages, means, and standard deviations. Z-test and Chi-square test were performed to find the significant differences. P < 0.05 was considered statistically significant.

  Results Top

The study sample consisted of 758 preschool Anganwadi children of age 3–6 years. Out of 758 children, 360 (47.49%) were males and 398 (52.51%) were females. The children were divided into three age groups ([3–4 years, 4–5 years, and 5–6 years] [Table 1]).
Table 1: Distribution of study population according to age and gender

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The prevalence of dental caries among the study sample was 62.14%. 207 (50.73%) children in the first age group, 150 (72.81%) children in the second age group, and 114 (79.16%) children in the third age group had caries. Female children in second and third age groups had more caries as compared to male children [Table 2].
Table 2: Age- and gender-wise prevalence of dental caries among the study population

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The mean dmft of the study population was 2.34 ± 2.64. Decayed component was maximum as 99.89% followed by missing as 0.11% and filled as 0%. The mean dmft in the first, second, and third age groups was 1.65 ± 2.81, 2.91 ± 3.43, and 3.46 ± 3.15, respectively. The mean dmft score showed an increasing trend with age; this difference was statistically significant with P < 0.0001. The mean dmft in males and females in all the three age groups was statistically nonsignificant [Table 3].
Table 3: Mean dmft of study population according to age and gender

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The caries distribution was found fairly symmetrical in both the arches across the age groups and the genders. Highly significant difference was found only in the first age group males who had 58.78% caries in maxillary arch and 41.29% caries in mandibular arch with P < 0.01 [Table 4].
Table 4: The arch-wise distribution of dental caries

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The most commonly affected teeth were posteriors. The mandibular second molars (52.57%) were maximum affected followed by mandibular first molars (43.53%) and maxillary central incisors (39.98%). The least affected teeth were both central and lateral incisors of mandibular arch with 1.08% and 0.84%, respectively [Table 5].
Table 5: Tooth-wise distribution of dental caries in the both the arches

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  Discussion Top

Anganwadis are government-run day care centers, which cater to the needs of children from 0 to 6 years age of low socioeconomic groups. These centers provide free food and informal education to preschool children. Parents of most of the children were illiterates and their monthly income was low.

The prevalence of dental caries in the present study is 62.14% which is high and in accordance with the study done by Singhal et al.[12] who reported 64.2% of caries prevalence among Anganwadi children in Udupi. Virjee and Aradhya [14] reported 60% to 65% of caries prevalence among preschool children of Bengaluru.

A similar trend of caries prevalence ranging from 44% to 67% was reported in previous studies.[1], 12, [15],[16],[17],[18],[19],[20] Still higher prevalence of 71.1% was observed by Dixit et al.[9] among Anganwadi Children in Narmada, Gujarat. Seow et al.[20] and Zhang et al.[21] also reported a very high prevalence of 78% and 85%, respectively. Although there have been major advances in the understanding of the pathogenesis and the prevention of dental caries in the past two decades, still there are reports of a high prevalence of caries in preschool children across the globe, owing to its multifactorial nature.[15],[18] Lower caries prevalence ranging from 17% to 42% was reported by many studies done in India as well as other countries.[3],[4],[8],[12],[18],[22],[23],[24],[25],[26]

In the present study, “decayed” component constituted 99.89%, “missing” constituted 0.11% whereas “filled” constituted 0%. The decayed component constituted a major part in our study which is in agreement with other studies,[1],[9],[12],[19],[22],[27] and the filled component constituted 0% which is in accordance with the study done by Priyadarshini et al.,[7] Halappa et al.,[26] and Dixit et al.[9] This states a high unmet restoration need in this study population. This could be due to lack of preventive dental care facilities and awareness among population in this region.

The population in the present study had a mean dmft of 2.34. This mean dmft value is in conformity with the studies by Prakasha Shrutha S et al. (2.03),[1] Virjee and Aradhya (2.3–2.9),[14] Halappa et al. (2),[26] Raj et al. (2.1),[22] and Mahejabeen et al. (2.7).[17] Contrary to this, mean dmft value <2 was found in several other studies.[7],[10],[11],[12],[16],[26],[28],[29] Still higher dmft of 3.50 by Dixit et al.[9] and 3.74 by Singhal et al.[12] were observed in their study. A very high mean dmft of 5.8 was observed by Zhang et al.[21] in Bulang, China.

The higher prevalence of dental caries and the higher mean dmft score of the present study were probably related to the parent's poor socioeconomic status and lack of knowledge about the importance of good dental health. They usually consider oral care as less important, thus leading to less self-awareness and a lower utilization of the health service facilities. They also experience financial, social, and material disadvantages that compromise their ability to care for themselves and afford professional health-care cost.

The present study showed an increase in dmft value with increase in age which was highly significant (P< 0.0001). A similar trend was observed with a significant difference in most of the previous studies.[7],[9],[16],[18],[20],[25],[26],[29],[30],[31],[32],[33] The possible reasons could be due to prolonged exposure of teeth to oral cavity, prolonged breastfeeding, bottle feeding, and unhealthy dietary habits.[1],[20] Whereas very few studies such as Singh et al.[27] and Ghandour et al.[33] reported the nonsignificant difference in caries prevalence with an increase in age. In contrary, mean dmft decreased significantly with increase in age in the study of Dixit et al.[9]

The present study showed slightly higher mean dmft scores among boys in all the age groups than girls, but the difference was nonsignificant. Similar results have been observed in many other studies.[1],[3],[4],[5],[7],[8],[9],[16],[18],[23],[25],[27],[28],[32],[34],[35] This nonsignificant difference in mean dmft between the genders may be due to diet and oral hygiene practices that are mostly controlled by their parents and is a common factor for both genders.[1] In contrary, the study by Singhal et al. and Rosenblatt et al. have reported a higher mean dmft scores among girls than boys which are nonsignificant.[12],[32]

The total proportion of caries reported in maxillary arch was 52.96% and 47.04% in mandibular arch in the present study. It is slightly higher in the maxillary arch, but the difference is nonsignificant (P < 0.05). In contrary, Sarkar and Roy Chowdhury [30] observed more caries in mandibular arch as compared to maxillary arch. In the present study, a significant difference (P < 0.01) was found only among the male children of 3–4 years age group who had more caries in maxillary arch (58.71%) as compared to mandibular arch (41.29%).

In the present study, posterior teeth (33.18% in second molars) were more affected with dental caries than the anterior teeth (21.63% in incisors). These results are consistent with the study of Mahejabeen et al.,[17] Raadal et al.,[34] Douglass et al.,[16] O'Sullivan and Tinanoff,[35] and Bjarnason et al.[29] who also reported highest molar caries accounting 66% of the total dmft score in both 3- and 4-year children. Sarkar and Roy Chowdhury [30] also showed similar results with occlusal caries accounting highest. The reason could be anatomical pattern of occlusal surface of posterior teeth with a deeper and more numerous pits and fissures, accessibility of toothbrush in posterior region. In contrary, Zhang et al.[21] observed more caries in maxillary anterior teeth (71%) than maxillary posterior teeth (54%).

In the present study, mandibular molars (52.57% in second molars) were more affected with dental caries than maxillary molars (23.67% in first molar). These results are consistent with the study by Halappa et al.[26] and Zhang et al.[21] This difference could be due to the numerous and deep fissure pattern and associated food lodgment. The most commonly affected teeth in the present study were mandibular molars followed by maxillary incisors. Similar findings were observed by Douglass et al.[16] in Beijing children and Hennon et al. and [36] Douglass et al.[16] observed 62%–82%caries prevalence in posterior teeth and 42% in maxillary anterior teeth. In contrary, Wyne et al.,[3] Singh et al.,[27] and Zhang et al.[21] reported more caries in maxillary incisors followed by mandibular molars. Hennon et al.[36] reported most frequent dental caries in the mandibular second molars (26%), maxillary second molars (18%), and maxillary central incisors (13%). Mandibular incisors were least affected in the present study which is in accordance with the previous studies.[3],[22],[28]

As the study was a field survey, there were some limitations such as minimal instruments and light, lack of radiograph, and limited mouth opening in especially 2–3 year-aged children. Few of initial lesions may have been missed, especially on the proximal surfaces of posteriors. This might have led to slight underestimation of caries experience. Hence, further longitudinal studies are required to substantiate the results.

  Conclusion Top

Childhood caries is still a major oral health problem worldwide. The prevalence of 62.14% dental caries among preschool children in the present study is a cause for concern. The nonexistent filled component among these children indicates high unmet restoration needs mainly due to lack of awareness, low socioeconomic status, and lack of available dental services. There is a need to focus on parent's, school teacher's, and care provider's education about early detection, prevention, and treatment aspects of dental caries. Dental health services should be made available in the peripheral areas to meet the needs of young children.

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

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