|Year : 2017 | Volume
| Issue : 4 | Page : 344-347
Prevalence of early childhood caries in 3- to 5-year-old preschool children in Rohtak City, Haryana
Mamta Ghanghas, Adarsh Kumar, BC Manjunath, Ridhi Narang, Ankita Goyal, Hansa Kundu
Department of Public Health Dentistry, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
|Date of Web Publication||13-Dec-2017|
Dr. Mamta Ghanghas
Department of Public Health Dentistry, Post Graduate Institute of Dental Sciences, Rohtak, Haryana
Source of Support: None, Conflict of Interest: None
Introduction: Early childhood caries (ECC) is a significant dental public health problem that affects infants and preschool children all over the world, and there is scarcity of epidemiological data regarding ECC in Rohtak city. Aim: This study aims to assess the prevalence of ECC among 3- to 5-year-old preschool children in Rohtak city, Haryana, India. Materials and Methods: A descriptive cross-sectional study was carried out among 489 preschool children aged 3–5 years in Rohtak city, Haryana. Children were randomly selected from preschools of Rohtak. Caries experience was recorded using “deft” index, and questionnaire comprising sociodemographic details and oral hygiene practices was also used. Data were analyzed using Statistical Package for Social Sciences version 20.0. Chi-square tests were used for the comparison of proportions. P < 0.05 was considered as statistically significant. Results: The overall prevalence of ECC was found to be 32% with mean deft 1.08 ± 2.27. No significant association of dental caries was found with sociodemographic factors such as gender, parental education, parental occupation, socioeconomic status, number of children, birth order, type of family, and oral hygiene practices. Conclusion: As burden of dental caries is high, treatment of dental caries would impose a great financial burden; hence, effective preventive strategies should be developed and implemented.
Keywords: Child, dental caries, preschool, prevalence
|How to cite this article:|
Ghanghas M, Kumar A, Manjunath B C, Narang R, Goyal A, Kundu H. Prevalence of early childhood caries in 3- to 5-year-old preschool children in Rohtak City, Haryana. J Indian Assoc Public Health Dent 2017;15:344-7
| Introduction|| |
Early childhood caries (ECC), despite a variety of available preventive and treatment strategies, remains a serious and prevalent childhood disease, especially among the most socially disadvantaged. ECC is defined as “the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age.” It is the most common chronic disease in young children which may develop as soon as teeth erupt and begins as white-spot lesions in the upper primary incisors along the margin of the gingiva. If not treated in time, it may lead to pain, compromised mastication, malocclusion, speech problems, poor health, and lower self-confidence. Although it is not life threatening, ECC is a major dental public health problem that affects infants and preschool children which creates social, behavioral, medical, psychological, economical, and dental complications affecting quality of life of preschool children and imposing financial burden on their families.,
Owing to sound scientific rationale and the fact that caries is preventable, ECC is exhibiting diminishing trends in most of the developed countries, but still increasing trends seen in many developing countries and is reported to be as high as 70%., Studies have shown considerably high burden of ECC among children below 5 years in India.,, Prevalence studies may be helpful to design and plan effective preventive strategies for the individuals at higher risk so as to reduce the burden of disease. There is scarcity of epidemiological data regarding ECC in Rohtak city, and hence, the present study was carried out with the aim to assess the prevalence of ECC among 3- to 5-year-old preschool children in Rohtak city, Haryana, India.
| Materials and Methods|| |
A descriptive cross-sectional study was designed and carried out for 2 months in August and September 2015 among 3- to 5-year-old preschool children in Rohtak city, Haryana. Rohtak city is located in Haryana, a state in North India, and lies 70 km northwest from New Delhi, with a population of about 10 lakhs and a literacy rate of 80%. The study protocol was reviewed by institutional ethical committee and ethical clearance was granted. Official permission was obtained from the district education officer and also from concerned school authorities. After explaining the purpose and details of the study, a written informed consent was obtained from the parents of all children aged 3–5 years.
The sample size of 469 for the study was calculated at 41% prevalence derived from pilot study and 5% margin of error. A two-stage stratified cluster sampling technique was employed to ensure representativeness from all parts of city. In the first stage, Rohtak city was divided into nine clusters, and then, randomly two clusters were chosen (Cluster 5 and Cluster 9). There are 29 schools in nine clusters based on geographical locations. A total of five schools from Cluster 5 and four schools from Cluster 9 were randomly chosen through lottery method. Finally, from each selected school, every odd roll number of age group 3–5 years was enrolled to reach a sample of 469. Children present on the day of examination and who were willing to participate in the survey were included, whereas those who were uncooperative and had a history of systemic diseases and developmental anomalies were excluded.
Data collection included combination of questionnaire administration and clinical examination for the caries assessment. The questionnaire comprised data regarding sociodemographic characteristics and oral hygiene practices of study participants and was sent to their homes to be filled by their parents. Type III clinical examination was carried out at preschool by a single calibrated examiner using mouth mirror and explorer under artificial light. Caries experience was recorded using “deft” index. The training and calibration of investigator was done before the pilot study in the Department of Public health Dentistry. The intraexaminer reliability was 85%. Children requiring immediate care were referred to the department. After questionnaire recording, health education brochures were distributed to all preschool children to be given to their parents for creating awareness.
Data were analyzed using Statistical Package for Social Sciences version 20.0 (IBM Corporation in Armonk, New York, United States). Descriptive and inferential statistics were used. Chi-square tests were used for the comparison of proportions. Kruskal–Wallis test was used to find significant mean deft across different age groups and Mann–Whitney U-test was used to find difference of mean deft against gender. P < 0.05 was considered as statistically significant.
| Results|| |
The present study was conducted among 469 study participants who were of age 3–5 years where 271 (57.8%) were males and 198 (42.2%) were females. The mean age of study population was 4.05 ± 0.749 years. The overall prevalence of ECC was found to be 32% with a mean deft of 1.085 ± 2.27. [Table 1] shows the details about sociodemographic characteristics of the study population.
[Table 2] shows that higher caries prevalence (35.6%) was found in 4-year-old children than 3- to 5-year-olds, and it was found to be statistically significant. Caries prevalence showed no significant association to mother's education. Children of nonworking mothers had higher caries prevalence (37.4%) than those of working mothers (30.1%) but not statistically significant. It was observed that caries prevalence was not significantly associated to socioeconomic status in the present study. Caries prevalence in children who were single to their parents (24.8%) was lower than those who had one or more siblings, and also, it was lower in children with first birth order and the difference was nonsignificant. Furthermore, caries prevalence in children in nuclear family was 32.3%, which was higher than those in joint family (31.8%) and the difference was nonsignificant.
|Table 2: Association between different characteristics of study sample with caries prevalence|
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[Table 3] shows that mean deft was higher in girls (1.131 ± 2.294) than boys (1.052 ± 2.255) and the difference was nonsignificant. The mean def is significantly higher among 4-year-old individuals when compared to other age groups.
|Table 3: Distribution of deft score according to gender among study sample|
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| Discussion|| |
Epidemiological studies from all over the world have showed that dental caries is one of the most widely distributed dental diseases. Despite availability of evidence-based preventive strategies, the burden of dental caries is increasing in India, which makes it necessary to adopt and implement effective oral health policy. Caries prevalence in the present study was found to be lower than Indian studies by Tyagi et al., Singh et al., and Chandramohan et al. This can be accounted to the fact that Rohtak is an endemic fluoride area. The prevalence of ECC fluctuates widely worldwide, ranging from 2.1% in Sweden to 85.5% in rural Chinese children. This could be attributed to dissimilarities in dietary factors, cultural practices, perceived importance of oral health along with variations in case definitions, and diagnostic criteria used for caries evaluation.
The mean deft in 4-year-old children was significantly higher than 3 and 5 years age group similar to that reported by Singh et al. and Schroth et al. A higher prevalence among a younger age group of an irreversible condition might indicate erroneous result despite utilizing the best feasible sampling methodology. Furthermore, majority of the study population belonged to 4-year age group. The d score contributed maximally for deft scores similar to that reported by Singh et al., Mahejabeen et al., and Tyagi. This reflects that services available may remain unutilized due to lack of felt needs among population, and disparity in treatment-seeking behavior in developing versus developed countries.
Higher caries prevalence was observed in females than males similar to that reported by Gaidhane et al. and Agarwal et al. though the difference was not statistically significant. These findings were not in agreement with studies done at Lucknow where males were more affected. The authors attributed this to difference to diet, geographical location, and cultural differences giving more priority to males.
In the current study, children of working mothers had lower caries prevalence than nonworking mothers similar to that reported by Kuriakose et al. and Gaidhane et al. which might be related to better awareness regarding oral health in them. Furthermore, children of exclusive homemakers have increased servings of diet frequently, leading to improper dietary practices.
Higher caries prevalence was reported in lower socioeconomic class in the present study which is in collaboration with the findings of Gaidhane et al. and Sogi et al. This disparity in dental caries experience according to socioeconomic status can be explained by differences in their oral habits, sugar consumption, use of fluoride in its various forms, and oral hygiene practices in addition to utilization of oral health services. Number of vendors per unit length of road increases from medium- to high-density areas, which might be responsible for ease of availability of unhealthy food, thereby increasing caries experience in high-density areas which are usually inhabited by lower socioeconomic strata.
Children with first birth order showed lesser caries experience than children with subsequent birth orders in the present study supporting Dilley et al. who hypothesized that most children at higher caries risk would be the first-born children because parental knowledge and experience in child rearing would be less. Although no significant association was found between the birth order of the child and dental caries, further studies should be done to explore the relationship.
The present study demonstrated high caries prevalence in children who are a part of nuclear families which might be due to more care of children in joint family systems and also because nuclear family tends to fulfill more demands of children.
ECC is a complex disease involving interplay of various factors such as oral hygiene practices and its supervision by parents/guardians and feeding practices which may have a marked effect on the prevalence of ECC. These remain untouched in the present study, and hence further research is advocated to reveal the effects of these hidden aspects. Furthermore, there may be underestimation of caries experience in the present study as indices that recognize initial caries lesions have not been used.
| Conclusion|| |
ECC is a chronic disease which affects infants and children worldwide. In the present cross-sectional study, no significant association of dental caries was found with sociodemographic factors such as gender, parental education, parental occupation, socioeconomic status, number of children, birth order, and type of family showing a change in trend of dental disease which needs to be verified by further studies. As burden of dental caries is high, treatment of dental caries would impose a great financial burden; hence, effective preventive strategies should be developed and implemented. Poor perception among parents regarding various oral health problems leads to discrepancy in felt and normative needs; and hence, health education programs should be conducted regarding importance of oral health. Current health policy focus on mother and child health care; however, oral health being an important component of overall health is being neglected, and thus, it is imperative that policymakers should consider integrating oral health care interventions into other national health programs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]