|Year : 2017 | Volume
| Issue : 2 | Page : 122-126
Oral health status and treatment needs of asthmatic children aged 6 – 12 Years in Lucknow
Pramod Kumar Yadav1, Sabyasachi Saha2, Sanjay Singh2, ND Gupta1, Neha Agrawal1, Kusum Bharti3
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 Publication||13-Jun-2017|
Pramod Kumar Yadav
Department of Periodontics and Community Dentistry, Dr. Z A Dental College, AMU, Aligarh - 226 025, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
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 2021 May 7];15:122-6. Available from: https://www.jiaphd.org/text.asp?2017/15/2/122/207911
| Introduction|| |
Asthma has become one of the most common chronic diseases in industrialized countries, and its prevalence is increasing throughout the world. Asthma affects all age groups and is often persistent, accounting for a large proportion of health care spending and loss of work.,,, 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. It presents an increased prevalence in preschool children and one out of every ten preschool-age children has asthma disorder.
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. In India, about 15–20 million people are suffering from bronchial asthma. 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.
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. 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., However, little is known of their possible significance in vivo, and in particular with respect to systemic medication or systemic disease.,, 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.
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.,,,,,, 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, or association over time between asthma and caries increment. 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. 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.,,, 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.,
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|| |
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.
- 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.
- 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), oral hygiene index-simplified (OHI-S), and Dentition status and treatment need of the WHO Oral Health Survey proforma (1997). 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).,,
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.
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|| |
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].
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|
Click here to view
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|
Click here to view
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].
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|
Click here to view
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].
| Discussion|| |
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.
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. 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)., A study conducted by Kankaala et al. observed male predominance and related it to a greater degree of bronchial lability in males.
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., and Sowmya et al. in Mysore city  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., Ersin et al., Khalilzadeh et al., and Wierchola et al. However, lower values were found in other studies.,,
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.,,, While contrasting result was reported by Sowmya et al.
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., However, this is in contrast to Ryberg et al.
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., Kankaala et al. and Wogelius et al.
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|| |
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
Conflicts of interest
There are no conflicts of interest.
| References|| |
Thomas MS, Parolia A, Kundabala M, Vikram M. Asthma and oral health: A review. Aust Dent J 2010;55:128-33.
von Mutius E. The burden of childhood asthma. Arch Dis Child 2000;82 Suppl 2:II2-5.
Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. J Dent Res 1992;326:862-6.
Serra-Batlles J, Plaza V, Morejón E, Comella A, Brugués J. Costs of asthma according to the degree of severity. Eur Respir J 1998;12:1322-6.
Sullivan SD. Economics of asthma and asthma treatments. Eur Respir J 1998;8:351-5.
Keles S, Yilmaz NA. Asthma and its impacts on oral health. Meandros Med J 2016;17:35-8.
Innes JA, Reid PT. Respiratory diseases. In: Boon NA, Colledge NR, Walker BR, Hunter JA. Davidson's Principles and Practice of Medicine. 20th
ed. London, Churchill Livingstone: Elsevier; 2006. p. 670-8.
Sowmya KR, Reddy CV, Veeresh DJ. Oral health status and treatment needs of asthmatic children. J Indian Assoc Public Health Dent 2007;9:13-7.
Shahapur RP, Shahapur PR. Knowledge, attitude, and practices of pediatricians toward oral health of asthma patients. World J Dent 2016;7:92-4.
Herrera JL, Lyons MF 2nd
, Johnson LF. Saliva: Its role in health and disease. J Clin Gastroenterol 1988;10:569-78.
Tenovuo J, editor. Nonimmunoglobulin defense factors in human saliva. In: Human Saliva: Clinical Chemistry and Microbiology. Boca Raton, FL: CRC Press; 1989. p. 55-91.
Rudney JD. Does variability in salivary protein concentrations influence oral microbial ecology and oral health? Crit Rev Oral Biol Med 1995;6:343-67.
Gråhn E, Tenovuo J, Lehtonen OP, Eerola E, Vilja P. Antimicrobial systems of human whole saliva in relation to dental caries, cariogenic bacteria, and gingival inflammation in young adults. Acta Odontol Scand 1988;46:67-74.
Nederfors T, Dahlöf C. Effects of the beta-adrenoceptor antagonists atenolol and propranolol on human whole saliva flow rate and composition. Arch Oral Biol 1992;37:579-84.
Kirstilä V, Tenovuo J, Ruuskanen O, Nikoskelainen J, Irjala K, Vilja P. Salivary defense factors and oral health in patients with common variable immunodeficiency. J Clin Immunol 1994;14:229-36.
Hyyppä T, Paunio K. Oral health and salivary factors in children with asthma. Proc Finn Dent Soc 1979;75:7-10.
Hyyppä TM, Koivikko A, Paunio KU. Studies on periodontal conditions in asthmatic children. Acta Odontol Scand 1979;37:15-20.
Storhaug K. Caries experience in disabled pre-school children. Acta Odontol Scand 1985;43:241-8.
Ryberg M, Möller C, Ericson T. Saliva composition and caries development in asthmatic patients treated with beta 2-adrenoceptor agonists: A 4-year follow-up study. Scand J Dent Res 1991;99:212-8.
Arnrup K, Lundin SA, Dahllöf G. Analysis of paediatric dental services provided at a regional hospital in Sweden. Dental treatment need in medically compromised children referred for dental consultation. Swed Dent J 1993;17:255-9.
McDerra EJ, Pollard MA, Curzon ME. The dental status of asthmatic British school children. Pediatr Dent 1998;20:281-7.
Kankaala TM, Virtanen JI, Larmas MA. Timing of first fillings in the primary dentition and permanent first molars of asthmatic children. Acta Odontol Scand 1998;56:20-4.
Shulman JD, Taylor SE, Nunn ME. The association between asthma and dental caries in children and adolescents: A population-based case-control study. Caries Res 2001;35:240-6.
Meldrum AM, Thomson WM, Drummond BK, Sears MR. Is asthma a risk factor for dental caries? Finding from a cohort study. Caries Res 2001;35:235-9.
Ryberg M, Möller C, Ericson T. Effect of beta 2-adrenoceptor agonists on saliva proteins and dental caries in asthmatic children. J Dent Res 1987;66:1404-6.
Haahtela T, Järvinen M, Kava T, Kiviranta K, Koskinen S, Lehtonen K, et al.
Comparison of a beta 2-agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma. N Engl J Med 1991;325:388-92.
Haahtela T, Järvinen M, Kava T, Kiviranta K, Koskinen S, Lehtonen K, et al.
Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med 1994;331:700-5.
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. NHLBI/WHO Workshop Report. Publication No. 95-3659. Bethesda, MD; 1995.
National Asthma Education and Prevention Program Expert Panel Report 2. Guidelines for the Diagnosis and Management of Asthma. NIH Publication No. 97-4051. Bethesda, MD; 1997.
Loe H, Silness J. Periodontal Disease In Pregnancy. I. Prevalence and Severity. Acta Odontol Scand 1963;21:533-51.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
WHO. Oral Health Survey Basic Methods. 4th
ed.. Geneva: WHO; 1997.
Jayakumar HL, Pallavi HN, Mahesh Chandra K, Jyothi D. Association of anti-asthmatic medication and dental caries 4-16 year old children attending selected hospitals in Bangalore city. J Indian Assoc Public Health Dent 2011;17:412-8.
Reddy DK, Hegde AM, Munshi AK. Dental caries status of children with bronchial asthma. J Clin Pediatr Dent 2003;27:293-5.
Ersin NK, Gülen F, Eronat N, Cogulu D, Demir E, Tanaç R, et al.
Oral and dental manifestations of young asthmatics related to medication, severity and duration of condition. Pediatr Int 2006;48:549-54.
Khalilzadeh S, Salamzadeh J, Salem F, Salem K, Hakemi Vala M. Dental caries-associated microorganisms in asthmatic children. Tanaffos 2007;6:42-6.
Wierchola B, Emerich K, Adamowicz-Klepalska B. The association between bronchial asthma and dental caries in children of the developmental age. Eur J Paediatr Dent 2006;7:142-5.
Stensson M, Wendt LK, Koch G, Oldaeus G, Birkhed D. Oral health in preschool children with asthma. Int J Paediatr Dent 2008;18:243-50.
Shashikiran ND, Reddy VV, Raju PK. Effect of antiasthmatic medication on dental disease: Dental caries and periodontal disease. J Indian Soc Pedod Prev Dent 2007;25:65-8.
] [Full text]
Wotman S, Mercadante J, Mandel ID, Goldman RS, Denning C. The occurrence of calculus in normal children, children with cystic fibrosis, and children with asthma. J Periodontol 1973;44:278-80.
Wogelius P, Poulsen S, Sørensen HT. Use of asthma-drugs and risk of dental caries among 5 to 7 year old Danish children: A cohort study. Community Dent Health 2004;21:207-11.
Eloot AK, Vanobbergen JN, De Baets F, Martens LC. Oral health and habits in children with asthma related to severity and duration of condition. Eur J Paediatr Dent 2004;5:210-5.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]