|Year : 2020 | Volume
| Issue : 3 | Page : 199-203
Prevalence of early childhood caries among children attending anganwadis in Davangere City: A cross sectional survey
Puja Chandrashekar Yavagal1, Chandrabhaga S Velangi1, Ishita Singh2, Prathmesh Desai2, Christy Helen Sunny2
1 Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
2 Interns, Bapuji Dental College and Hospital, Davangere, Karnataka, India
|Date of Submission||14-Dec-2019|
|Date of Decision||09-Jul-2020|
|Date of Acceptance||17-Jul-2020|
|Date of Web Publication||24-Oct-2020|
Puja Chandrashekar Yavagal
Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Early childhood caries (ECC) is a public health problem and children from low-income and minority families are particularly vulnerable to it. Aim: This study aims to assess prevalence of ECC among children attending Anganwadis in Davangere City. Materials and Methods: A cross-sectional survey was carried out among 349 children aged 2–5 years selected via cluster random sampling, attending Anganwadis in Davangere city. Caries experience was assessed using decayed missing filled teeth (dmft) index (the WHO-criteria) and ECC was recorded. IBM SPSS Statistics software version 19 was used for statistical analysis and significance level was set at P < 0.05. Descriptive data were generated in percentages. Chi-square test, Kuskall–Wallis test and Man–Whitney U-test were used for statistical analyses. Results: A total of 349 children, with mean age 3.8 ± 1.3 years, were examined. Among them, 47.7% were boys and 52.3% girls. The prevalence of ECC was 52.9%. The prevalence of ECC increased with the increasing age. It was significantly higher among 5-year-old female children compared to males (P = 0.02). The mean dmft of study population was 1.16 ± 1.54. There was only one detectable filled tooth among study population. Conclusion: The high prevalence of ECC (52.9%), along with very low prevalence of filled teeth among the Anganwadi children of Davangere city is a cause of concern. It suggests unmet dental treatment needs. Therefore, there is a need for caries preventive and treatment programs for this section of children.
Keywords: Anganwadi, children, dental caries, prevalence
|How to cite this article:|
Yavagal PC, Velangi CS, Singh I, Desai P, Sunny CH. Prevalence of early childhood caries among children attending anganwadis in Davangere City: A cross sectional survey. J Indian Assoc Public Health Dent 2020;18:199-203
|How to cite this URL:|
Yavagal PC, Velangi CS, Singh I, Desai P, Sunny CH. Prevalence of early childhood caries among children attending anganwadis in Davangere City: A cross sectional survey. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Nov 29];18:199-203. Available from: https://www.jiaphd.org/text.asp?2020/18/3/199/299000
| Introduction|| |
Early childhood caries (ECC) is defined as the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of 6 years. It is a public health problem that continues to affect infants and preschool children worldwide. It is a multifactorial disease as a result of the complex interaction of three factors susceptible tooth surfaces, plaque bacteria, and carbohydrate diet – over time. The pattern of the disease is primarily linked with the feeding practices., Additional risk factors that are unique to the age group may exist. These include early colonization with mutans streptococci, and frequent nursing and snacking, factors that create an environment which encourages the growth and dominance of mutans streptococci in dental plaque. Furthermore, the common presence of enamel hypoplasia in the primary dentition may also predispose the newly erupted and immature enamel to dental caries. Low socioeconomic status (SES) along with social determinants such as mother's educational level, cultural attitudes, are some of the other risk factors for the development of ECC., ECC can cause lasting harm to a child's oral and general health, and social and intellectual development. Not only does ECC affect teeth, but the consequences of this disease may also lead to more widespread health issues. Some young children with ECC may be severely underweight because of associated pain and their disinclination to eat. ECC may also be associated with iron deficiency anemia. A comprehensive review of the epidemiology of ECC showed that its prevalence varies from population to population. The prevalence of ECC is 27.9% in the USA, 12% in the UK, 36%–85% in Asia, 38%–45% in Africa, and 22%–61% in the Middle East. In India, the prevalence of dental caries among 5 years of age group was 50% and the dental caries prevalence in Karnataka was 53.4%.
Anganwadi centers (AWCs) are childcare centers developed under the Integrated Child Development Scheme (ICDS), by the Ministry of Woman and Child Development, India. The beneficiaries of the ICDS are all children below 6 years of age, pregnant women and lactating mothers and primary objective of this scheme is to improve the nutritional status and health of the beneficiaries, along with which nonformal preschool education is given. The services in the center are delivered by the Anganwadi worker (AWW) who is the most peripheral functionary of the ICDS scheme. Even though the scheme is open to all the citizens, the children attending AWCs are usually from the low SES group. Literature search revealed that no study had been done to assess the prevalence of ECC among Anganwadi children in Davangere city. ECC can be prevented and promptly treated during its early stages. By knowing the prevalence of ECC among Anganwadi children, preventive measures can be customized and AWWs may be trained towards prevention of ECC. Hence, the study was planned to assess experience and prevalence of ECC among children attending Anganwadis in Davangere City.
| Materials and Methods|| |
This study was across-sectional survey. Ethical clearance was obtained prior to the study (Ref No. BDC/267/2016-17. The sample size was calculated scientifically using a standard formula for descriptive studies, wherein Type I (α) error was fixed at 0.05, Z1−α, that is standard normal variate at 5% Type I error (P < 0.05) was 1.96 and P, the prevalence of ECC from previous study  was 0.37. The sample size was estimated to be 360.
A two stage cluster sampling technique was followed. Davanagere was arbitrarily divided into six circles, with each circle having 22–25 (AWCs). One AWC was randomly selected from every circle and 60 children were randomly selected from one AWC to achieve a total sample size of 360.
Children aged 2–5 years attending the AWCs in Davangere city and present on the day of examination and whose parents consented for participation of their children in the study were included. Children with systemic diseases, acute infections which interfere in oral examinations and who were mentally retarded and physically challenged were excluded from the study.
Four examiners were trained to check for decayed missing filled teeth (dmft) index by Professor of the department of public health dentistry. Inter-examiner reliability was good with kappa coefficient score of 0.88 with respect to dmft index. Voluntary written informed consent was obtained from the parents and assent was obtained from the children. ECC was defined as the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of 6 years. Caries was recorded on pro forma using dmft index as per the WHO criteria.
Collected data were compiled, tabulated, and analyzed using IBM SPSS Statistics for Windows, Version 19.0. (Armonk, NY: IBM Corp.). Descriptive statistics were generated in terms of percentages. Statistical significance was set at P ≤ 0.05. The data was not normally distributed hence Kruskal–Wallis test followed by Mann–Whitney U-test were applied for comparison of dmft scores between the age groups.
| Results|| |
A total of 349 children with mean age of 3.8 ± 1.3 years, were present on the day of examination. Among them, 47.7% were boys and 52.3% girls [Figure 1]. The prevalence of ECC was 52.9% [Table 1]. The prevalence of ECC increased with the increasing age with the highest prevalence among 5 year old (67.2%) followed by 58.3%, 49.3%, and 31.7% among 4, 3, and 2 years old, respectively. The prevalence of ECC was significantly higher among 5-year-old female children compared to males (P = 0.02) [Table 1]. Mothers of majority of children were unemployed. The prevalence of ECC was more among children of working mothers (56.38%) compared to children of unemployed mothers (51.37%). However, this difference was statistically nonsignificant (P = 0.44). The mean dmft of study population was 1.16 ± 1.54 and the median was one [Table 2]. The mean dmft among 4- and 5-year -old subjects was significantly higher than the 2-year-old children. There was only one detectable filled tooth among study population [Table 2]. The mean dmft among females was 1.22 ± 1.63, which was higher than mean dmft in males, 1.10 ± 1.45. The difference was statistically nonsignificant at P = 0.451 [Table 3].
|Figure 1: Age and gender distribution of the study population in percentages|
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|Table 2: Distribution of decayed missing filled teeth and comparison of decayed missing filled teeth scores among participants|
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| Discussion|| |
In the present study, the prevalence of ECC was 52.9%. Similar findings were seen in some studies in India where the prevalence of ECC among Anganwadi children was observed to be 71.1% (Narmada district, Gujrat), 62.14% (Mudhol town, Karnataka), 64.2% (UdupiTaluk, Karnataka), 37.3% (Bengaluru, Karnataka), and 39.9% (Srinagar, Jammu and Kashmir). Some of the studies in India wherein children from varied population were considered, the prevalence of ECC was found to be 27.5% (Bengaluru urban, Karnataka), 32% (Rohtak, Haryana), 42.03% (Bahadurgarh, Haryana), 54.1% (Hubli-Dharwad city, Karnataka), and 47.2% in Bhubaneswar.
The prevalence of ECC among children aged 3–5 years varies between continents and countries. The higher prevalence of dental caries among preschool age group might be attributed to poor oral hygiene, lack of awareness about oral hygiene maintenance, and negligence on the part of parents and caretakers and lack of dexterity in this age group. In addition, the population considered in this study were the Anganwadi children, who are mostly from low socioeconomic background. The parents of this population usually spend maximum time and energy to earn a living and oral health gains less priority, which may be another reason for high prevalence of ECC in this population. In this context, the authors would like to draw attention on the issues of SES and dental caries prevalence as studied by Boyce et al. among African-American children. This study had concluded that the childhood dental caries associated with low SES may involve social and psychobiological pathways through which lower SES is associated with higher numbers of cariogenic bacteria and higher levels of stress-associated salivary cortisol. This convergence of psychosocial, infectious, and stress-related biological processes appears to be implicated in the production of greater cariogenic bacterial growth. Unavailability and nonaffordability of dental services seem to be a probable reason for the high prevalence in this group. The population in the present study had a mean dmft of 2.18. This is in conformity with the studies done on similar population in Chandigarh city (2.25), and in Srinagar, Jammu, and Kashmir (1.80). Still higher dmft of 3.50 was seen in Narmada, Gujrat, and 3.74 in UdupiTaluk, Karnataka. The prevalence of dental caries was higher among girls (54.4%) as compared to boys (51.2%). The mean dmft score was higher among girls than boys. This is in accordance with studies conducted by Virdi et al. wherein higher prevalence was observed in females in Bahadurgarh, Haryana. Contrary to this prevalence of ECC was found to be more in boys as compared to girls in studies conducted in Narmada, Gujarat  and Trivandrum, Kerala, whereas no significant differences between gender were found in studies conducted in Mudhol town, Karnataka. The results from different studies from different regions regarding gender differences of caries prevalence are contradictory and further exploration is required to get strong evidence and reason for the same.
The present study showed significant increase in the prevalence of ECC with increasing age. A similar trend was observed in some previous studies by Prakash et al. and Stephen et al. The possible reasons for this could be increase in unhealthy dietary patterns with increasing age and prolonged exposure of teeth to the oral cavity thus suggesting a relationship of dental caries with age.
An important finding of this study was that there was only one recordable filled tooth present in the study population. This is similar to a study conducted by Shah et al., where investigators did not find a single filled tooth in the children of AWCs of Srinagar city, Jammu and Kashmir. This is indicative of a total lack of awareness about oral health among parents. Lack of accessibility and affordability for oral health care seems to be a less probable reason as Davangere city has two dental institutions which offer treatment at low costs for the lower SES population. In addition to this, dental treatment is provided free of cost at the District hospital. In addition, these institutions educate and motivate the people about oral health care by conducting community-based programs from time to time. In the present study, the caries prevalence was more in children whose mothers were working as compared to caries prevalence among children whose mothers were not working. However, the difference was not statistically significant. A study conducted by Kuriakose et al. had found a strong positive association between the working status of mother and dental caries whereas low prevalence of ECC was seen in children of working mothers in study conducted by Stephen et al. A study conducted by Plutzer and Keirse  though did not find a difference in the frequency of ECC in children whose mothers were working, but children of an employed single mother more frequently had caries than those of a working mother in a two-parent family. Such a data for the Indian population is not available to the best of authors' knowledge and further research in this context is recommended.
Data regarding risk factors for ECC such as history of breastfeeding, dietary habits, oral hygiene practices, and social determinants such as family income, number of siblings, occupation of the parents and so on which could have had an influence on ECC was not recorded. Further studies taking all these factors into account are recommended.
Public health significance
ECC is most widespread, persistent dental predicament in India. Concern and consideration are crucial to avert dental caries among the preschool children. The risk factors that were found to be concurrent with dental caries among preschool children according to various studies were the longer duration of breastfeeding and bottle feeding, followed by the increasing age of the child, many children in a family, children who did not brush teeth under parent's supervision, uneducated mother, and low socioeconomic condition.,,, Dental health services should be made available at grass root level to meet the needs of children. AWWs need to be trained to educate the mothers regarding prevention of dental caries and timely treatment. They can also be trained to identify early carious lesions and get the treatment done for children at the nearest dental health-care set up for which they can be given incentives. Anticipatory Guidance programs can be held for pregnant women at primary health-care centers by dental professionals where they can educate the women regarding feeding practices and prevention of dental caries.
| Conclusion|| |
The high prevalence of ECC along with very low prevalence of filled teeth among the Anganwadi children of Davangere city is a cause of concern. It suggests unmet dental treatment needs. Therefore, there is a need for caries preventive and treatment programs for this section of children.
The authors would like to acknowledge all the undergraduate students who have contributed for the collection of data and all the participants. We would also like to acknowledge the Deputy Director, Department of Women and Child Development, Davangere for giving us this opportunity to conduct the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]