|Year : 2021 | Volume
| Issue : 1 | Page : 32-36
Caries prevalence and associated risk factors in school children at Kannur in Kerala, India: A cross-sectional study
K Nithya, Faizal C Peedikayil, TP Chandru, Soni Kottayi, Shabnam Ismail, TP Aparna
Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India
|Date of Submission||06-Jul-2020|
|Date of Acceptance||16-Feb-2021|
|Date of Web Publication||31-Mar-2021|
Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala
Source of Support: None, Conflict of Interest: None
Background: Caries is the most prevalent affliction of children and is dependent on various factors such as social, economic, demographic and nutritional factors. Aim: This study was conducted to determine the prevalence of dental caries in school going children and its association with risk factors. Materials and Methods: A cross-sectional study was conducted during the period from August 2019 to December 2019. Study subjects were 1947 school children. The examination was done by a single examiner and the data was entered by trained assistants. A semi-structured questionnaire was used to record the risk factors for dental caries in children. The components of Decayed, missing, filled (DMF) and Decayed, extracted, filled (def) were recorded as per the criteria of WHO (1997) for diagnosing caries. Using SPSS version 22 (IBM Corporation Chicago, USA) data were analyzed. Chi-square test were done to find the relationship of prevalence with the risk factors. P < 0.05 is considered as statistically significant. Results: Total Caries prevalence was found to be 49.1%.The highest rate of caries occurrence, 55.4% was observed in children who belonged to the age group of 6–8 years. The def was shown to be more in the 9–11 age group and DMF in 12–15 age groups with 3.34 ± 3.74 and 2.18 ± 2.65 respectively. Statistically significant increase in caries is found in children whose both the parents were working (P < 0.001) and also in children who take sweets twice a day or more (P < 0.001). Conclusion: The prevalence of caries in 6–15 year old school children at Kannur is 49.1%. Working parents and high sugar consumption were found to be risk factors for caries in school going children.
Keywords: Dental caries, diet, occupations, oral hygiene, parental instance
|How to cite this article:|
Nithya K, Peedikayil FC, Chandru T P, Kottayi S, Ismail S, Aparna T P. Caries prevalence and associated risk factors in school children at Kannur in Kerala, India: A cross-sectional study. J Indian Assoc Public Health Dent 2021;19:32-6
|How to cite this URL:|
Nithya K, Peedikayil FC, Chandru T P, Kottayi S, Ismail S, Aparna T P. Caries prevalence and associated risk factors in school children at Kannur in Kerala, India: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Oct 22];19:32-6. Available from: https://www.jiaphd.org/text.asp?2021/19/1/32/312636
| Introduction|| |
Oral health is considered as one of the most important elements of general health as the dental caries affects the overall ability of a person to speak, eat and socialize. Caries is the most prevalent affliction of children. Despite of credible scientific advances and the fact that caries is preventable, the disease continues to be a major public health problem. Dental caries is a multi factorial disease with bacteria, carbohydrate diet, time and susceptible host as main etiological factors. Some variable factors such as socio economical, gender, age, socio demographic and nutritional factors have role in development of caries.
WHO report shows that 60%–90% of school children worldwide have experienced dental caries and it is most prevalent in Asian and Latin American countries. India, a developing country, faces many challenges in the field of oral health. The majority of Indian population resides in rural areas and in which more than 40% constitute children below 15 years of age.,
Lot of epidemiological studies is being conducted all over the India to check the prevalence of dental caries. Last National Oral Health Survey in India shows that prevalence of dental caries in children aged 5 years to be 50% with a mean DMFT of 1.9. Among the 12-year-old children caries prevalence was 52.5% with DMFT of 1.8 and in 15-year-old children the prevalence was 61.4% with DMFT of 2.3. Janakiram et al. in a meta analysis shows that the mean prevalence of dental caries is almost similar at 5 years and 12 years at 49% while it shows steady increase from 15 years.
Studies from Kerala, a state in Southern India which is high literate and rapid urbanizing region, have shown caries prevalence of approximately 27%–77%.,, Kannur District is one among the 14 districts along the west coast in the state of Kerala in India. Literature search shows only one study on prevalence was conducted in Kannur. The prevalence was 49.11% for school going children. The study also revealed that caries component of DMF/deft index was high at 90.01% indicating that many carious teeth were left untreated.
This study is conducted in Kannur district of Kerala state to determine the prevalence of dental caries in school going children and the association with risk factors such as diet, oral hygiene practices, parental involvement and dental caries.
| Materials and Methods|| |
A cross-sectional study was conducted in Kannur district of Kerala to access the prevalence of dental caries in school children from 6 to 15 years of age. The sample size was determined based on the previous study in this area where in the prevalence was 49.44. Based on this sample size was calculated using the formula n = Z2pq/d2 z = 2.58 (standard value) P = 0.4944, P = 3% precision rate (0.03) q = 1 − p, based on this, the sample size is 1910, which was rounded off to 2000. During the study 57 students did not complete the study, so the final number of participants in this study was 1947.
After ethical approval (KDC18/1412/T) from the Institutional Ethical Committee, 5 private CBSE schools from different parts of Kannur were selected. Students were selected by random sampling with inclusion criteria of age between 6 and 15 years. Before examining the children, the purpose of the study and procedures were explained to the parents. Children on school rolls who were absent on the day of examination and children without parental consent for examination were excluded. Approval from school administration was taken to conduct the study during the parent teachers meeting. The study was done during the period from August 2019 to December 2019.
The Oral examination was conducted in their respective schools using Plane mirror and community periodontal Index probe as indicated by WHO. The children were examined under broad day light with the participant seated in upright position. Oral examination was done by a single examiner to avoid inter examiner variability. The data was entered by trained assistants. A semi structured questionnaire was used to record the risk factors for dental caries in children.
The components of DMF (D = decayed tooth requiring treatment, M = missing due to caries, F = filled or crowned teeth and def (Deciduous) d = decayed tooth requiring treatment, e = extracted primary teeth and f = filled or crowned teeth) were recorded. The criteria for diagnosing caries were according to the WHO (1997). Total numbers of caries free children were also recorded.
All data were in entered in Excel 2007 worksheet and analyzed using SPSS version 22 (IBM Corporation Chicago, USA). The percentage of prevalence was calculated. Chi square test were done to find the relationship of prevalence with the risk factors. P < 0.05 was considered as statistically significant.
| Results|| |
Total of 1947 students participated in this study. [Table 1] shows the gender distribution of the participants. Out of the total number of participants 1024 (52.6%) are females and 922 (47.4%) were females.
Caries occurrences with age group are more in 6–8 years of children with 55.4%. Followed by 9–11 years of age groups with 48.47% and least is seen in 12–15 years of age group with 42.5%. Total Caries incidence was found to be 49.1%.In the age group of 6–8 years, def is 3.05 ± 3.26, in 9–11 years def is 3.34 ± 3.74 and in 12–15 years 1.22 ± 2.28. In 6–8 years age group DMF is 0.99 ± 1.86, in 9–11 years age group it is 1.84 ± 2.82, and in 12–15 years age group DMF is 2.18 ± 2.65. Increased def is seen in children of age group of 9–11 years with 3.34 ± 3.74 and DMF is more in an age group of 12–15 years at 2.18 ± 2.65 [Table 2]. The deft indifferent age groups among males and females are mentioned in [Figure 1] and DMFT in various age groups are shown in the [Figure 2].
The risk factors taken into consideration in relation to caries incidence were Working status of parents, Daily brushing of teeth, Habit of eating sweets daily, Habit of rinsing the mouth after each meal, and Parental insistence on oral hygiene [Table 3]. The results showed that in case of working parents, when the both parents are working the chance of occurring caries are higher and statistically significant compared to either one of the parent is working. It can be seen that the chance of occurring caries is more in case of child brushing once in a day than twice a day, but results were not statistically significant. The study also shows that children with twice a day or more sweets consumption have more chances of caries as compared to children who consume once in a day. Results were found to be statistically significant (P < 0.001).
Children with a habit of rinsing mouth after meals have shown more caries compared to not regularly washing child but the results are not statistically significant. The study also shows that if there is a parental insistence on oral hygiene, then the chance of occurring caries is less. But these results were statistically insignificant (P < 0.07).
| Discussion|| |
Caries is a multifactorial disease depending on age, sex, socioeconomic status, geographical location, food habits especially sugar/sucrose consumption and oral hygiene habits., This study focuses on finding the prevalence of dental caries and analyze the role of some factors such as diet, oral hygiene practices and parental involvement in development of dental caries. Children between the age group of 6–15 are divided into three age groups 6–8, 9–11 and 12–15 years. Age groups between 6–8 and 9–11 years are important because presence of both primary and permanent tooth are present and also in these age groups exfoliation of primary tooth can interfere with oral hygiene practices. 12–15 years old age group has mostly permanent dentition. Individuals in this age group spend longer time outdoors which leads to greater consumption of in between meals snacks, cariogenic diet, and hence, it is considered as another set of age group.
The present study shows that the prevalence of dental caries in school children at Kannur is 49.1%. In a previous study done in Kannur by Peedikayil et al. in 2013 shows that the prevalence of dental caries is 49.44%. Another study by Retnakumari in 1999 in Trivandrum Kerala found the prevalence to be 68.5%. Jose and King et al. in 2003 studied the prevalence of dental caries among school going children in the age group of 12–15 years in rural Kerala and found that prevalence was 54.3%. In the study of David et al. the prevalence was 27%.These differences may be due to variation in the methods used between the studies and the difference in sampling procedures. Recent studies by Baiju et al. in 2018 found that the overall dental caries experience for the group was 59.8%. In an epidemiological study conducted by Christian et al. in 2018 among children residing in orphanages in Kerala, it was found that in 6-year-old children the prevalence of caries was 77% and in 12-year-old children the prevalence of caries was 44%. Recent studies in other parts of India shows that, in a study done in Karnataka had shown a less prevalence of dental caries of 27.4%. A study conducted by Reddy et al. conclude that Dental caries in both primary dentition and permanent dentition was 64.2% and 26.6% respectively. Very high prevalence of dental caries of 82.62% found in a age group 3–14 years in a study of Jain et al.
In the present study, caries prevalence was more in age group of 6–8 years, 55.4% as compared to other two age groups where the prevalence is 48.47% in 8–11 years and 42.5% in 12–15 years. The findings of this study are in accordance with study of Goenka et al. where 5–7 years of children had a higher caries prevalence compared to higher age groups. Vaish also showed similar trends of decreasing rates in prevalence rates as the age progresses. Caries seen to be declining in 12–15 age group, this may be because that there is exfoliation of these teeth and eruption of permanent teeth occur which have lower susceptibility to dental caries as these teeth are not exposed to the factors responsible for caries for a longer time. This decline in the caries rate may also be due to the fact that awareness and practice of oral hygiene measures also increases with age.,
It has been observed that in all the three age groups males have higher caries occurrence than female children. Similar prevalence rate was obtained in study done by Goenka et al. It may be due to the marked preference for boys than girls which manifest as a longer feeding time for male child compared to female child. In a study of Jose and Joseph concluded that both males and females were are almost equally affected by caries with slightly higher prevalence among males. A study done by Ramachandran et al. found that males are having higher caries prevalence than girls. Gaikwad et al. found in his study that more number of decayed tooth and missing tooth due to caries were present in boys compared to the girls study group. Study of Hiremath et al. found that boys are having more prevalence in caries than girls.
Higher deft was observed in the age group of 9–11 years, this increase may be on the basis of prolonged exposure of the primary teeth to caries risk factors. The study also shows DMFT was lesser in the age group of 12–15 years, which may be due to the presence of newly erupted permanent teeth for only a short period in this age group.
Prevalence of dental caries may attribute to different factors such as socioeconomic status, higher sugar consumption, parental insistence on dental health, parent's education, and job. These factors can vary from place to place. This study shows that there is a statistically significant relation between working parents and dental caries in children. When the both parents are working the chance of occurring caries are higher compared to either one of the parent is working. It is mainly due to the fact that parents play a vital role in good oral care practice of children by instructing the children. There will be a limited attention to the child as working parents get less quantity of time.
Our study shows that there is no statistical difference between the caries prevalence of children who brushes once or twice daily even though the values are better for children who brushes twice daily. Other studies by Viswanath and Sabu and Dhar et al. also showed that children who brushes twice daily have a lesser caries incidence than children who brushes once daily. Shailee et al. in a study concluded that as the frequency of brushing is increased, the prevalence of dental caries decreases.
The study of Woodward and Walker about examining sugar consumption and dental caries in 12 year old children from 90 countries gives an increase in DMFT scores with sugar consumption. This study also reconfirms that sugar as one of the important risk factors of Dental Caries. In this study a statistical significant difference is there in caries occurrence in children who take sugar more than twice a day. Kalsbeek and Verrips found a positive correlation between sugar intake and caries occurrence. In a study done by Wilson et al. concluded that children who had sugar at least three times a day were observed to have higher caries experience which is in accordance this study results. In a study conducted by Vishwanath and Sabu concluded that sugar candies are more risky in causing dental caries than soft drinks or ice cream.
Parental instance of keeping good oral hygiene, practice of rinsing the mouth after food are beneficial for low prevalence of caries., Even though the present study doesn't show correlation between the prevalence and risk factors.
The limitation of this study includes selection of only few variables such as diet, oral hygiene practices and parental involvement. There are other variables such as socio economical, behavioral and sociodemographic factors, which are to be considered. This may give a better relationship between the dental caries with other risk factors and also this study didn't check the treatment needs of the child having caries.
Caries prevalence varies from place to place. Hence use of larger, community-based sample of study participants, will allow for a better analysis of dental caries and contributing factors.
Hence many studies have to be conducted on a larger population involving all the risk factors for arriving a final conclusion. The risk factors recorded are given by the children and may not be purely factual from the real risk factors.
| Conclusion|| |
The prevalence of dental caries among 6–15 year old school children is found to be 49.1%. It has been observed that prevalence of caries is 55.4% in age group of 6–8 years, 48.47% in age group of 9–11 years and 42.5% in 12–15 years school children. The study shows that the children of working parents and high sugar consumption patterns, i.e., more than once daily, are significant risk factors for dental caries.
Parent Teacher Association of Anjarakandy HSS, Malabar English School, Paleri East LP School, Muringeri UP School, Kameth LP School.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mwakayoka H, Masalu JR, Namakuka Kikwilu E. Dental caries and associated factors in children aged 2-4 years old in Mbeya City, Tanzania. J Dent (Shiraz) 2017;18:104-11.
Prasai Dixit L, Shakya A, Shrestha M, Shrestha A. Dental caries prevalence, oral health knowledge and practice among indigenous Chepang school children of Nepal. BMC Oral Health 2013;13:20.
Bali RK, Mathur VB, Talwar PP, Chanana HB. National Oral Health Survey and Fluoride Mapping, 2002-2003, India. Delhi: Dental Council of India; 2004.
Janakiram C, Antony B, Joseph J, Ramanarayanan V. Prevalence of Dental Caries in India among the WHO Index Age Groups: A Meta-Analysis. Journal of Clinical & Diagnostic Research 2018;12:ZE08-13.
David J, Wang NJ, Astrøm AN, Kuriakose S. Dental caries and associated factors in 12-year-old schoolchildren in Thiruvananthapuram, Kerala, India. Int J Paediatr Dent 2005;15:420-8.
Peedikayil FC, Kottayi S, Kenchamba V, Jumana MK. Dental caries prevalence and treatment needs of school going children in Kannur district, Kerala. SRM J Res Dent Sci 2013;4:51-3. [Full text]
WHO. Oral Health Surveys: Basic Methods. 4th
ed. Geneva, Switzerland: WHO; 1997.
Yadav K, Prakash S. Dental caries: A review. Asian J Biomed Pharm 2016;6:1-7.
Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors for dental caries in young children: A systematic review of the literature. Community Dent Health 2004;21:71-85.
Lynch RJ. The primary and mixed dentition, post-eruptive enamel maturation and dental caries: A review. Int Dent J 2013;63:3-13.
Mahfouz M, Abu Esaid A. Dental caries prevalence among 12-15 year old Palestinian children. Int Sch Res Notices 2014;2014:785404.
Retnakumari N. Prevalence of dental caries and risk assessment among primary school children of 6-12 years in the Varkala municipal area of Kerala. J Indian Soc Pedod Prev Dent 1999;17:135-42.
] [Full text]
Jose B, King NM. Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent 2003;25:594-600.
Baiju RM, Peter E, Narayan V, Varughese JM, Varghese NO. Do children of working mothers experience more dental caries? Contemp Clin Dent 2018;9:541-7.
] [Full text]
Christian B, Ummer-Christian R, Blinkhorn AS, Vijaya H, Nandakumar K, Rodrigo M, et al
. An epidemiological study of dental caries and associated factors among children residing in orphanages in Kerala, India: Health in Orphanages Project (HOPe). Int Dent J 2019;69:113-18.
Shwethashree M, George PS, Prakash B, Smitha M, Shabadi N, Narayana Murthy M, et al
. Prevalence of oral diseases among school children of Mysuru and Chamarajanagar districts, Karnataka, India. Clin Epidemiol Glob Health 2020;8:725-7.
Reddy KS, Reddy S, Ravindhar P, Balaji K, Reddy H, Reddy A. Prevalence of dental caries among 6–12 years school children of Mahbubnagar district, Telangana state, India: A cross-sectional study. Indian J Dent Sci 2017;9:1-7. [Full text]
Jain A, Jain V, Suri SM, Jain RK. Prevalence of dental caries in male children from 3 to 14 years of age of Bundelkhand region, India. Int J Community Med Public Health 2016;3:787-90.
Goenka P, Dutta S, Marwah N, Sarawgi A, Nirwan M, Mishra P. Prevalence of dental caries in children of age 5 to 13 years in district of Vaishali, Bihar, India. Int J Clin Pediatr Dent 2018;11:359-64.
Vaish RP. Prevalence of caries among tribal school children in Phulbani district, Orissa. J Indian Dent Assoc 1983;55:455-7.
Joshi N, Sujan S, Joshi K, Parekh H, Dave B. Prevalence, severity and related factors of dental caries in school going children of Vadodara city-An epidemiological study. J Int Oral Health 2013;5:35-9.
Jose A, Joseph MR. Prevalence of dental health problems among school going children in rural Kerala. J Indian Soc Pedod Prev Dent 2003;21:147-51.
] [Full text]
Karunakaran R, Somasundaram S, Gawthaman M, Vinodh S, Manikandan S, Gokulnathan S. Prevalence of dental caries among school-going children in Namakkal district: A cross-sectional study. J Pharm Bioallied Sci 2014;6:S160-1.
Gaikwad SS, Gheware A, Kamatagi L, Pasumarthy S, Pawar V, Fatangare M. Dental caries and its relationship to malocclusion in permanent dentition among 12-15 year old school going children. J Int Oral Health 2014;6:27-30.
Hiremath A, Murugaboopathy V, Ankola AV, Hebbal M, Mohandoss S, Pastay P. Prevalence of dental caries among primary school children of India-A cross-sectional study. J Clin Diagn Res 2016;10:ZC47-50.
Gokhale N, Nuvvula S. Influence of socioeconomic and working status of the parents on the incidence of their children's dental caries. J Nat Sci Biol Med 2016;7:127-9.
Viswanath D, Sabu N. Prevalence of dental caries, the effect of sugar intake and tooth brushing practices in children aged 5-11 years in Bangalore North. SRM J Res Dent Sci 2014;5:155-62. [Full text]
Dhar V, Jain A, Van Dyke TE, Kohli A. Prevalence of dental caries and treatment needs in the school-going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent 2007;25:119-21.
] [Full text]
Shailee F, Sogi GM, Sharma KR, Nidhi P. Dental caries prevalence and treatment needs among 12- and 15- year old schoolchildren in Shimla city, Himachal Pradesh, India. Indian J Dent Res 2012;23:579-84.
] [Full text]
Woodward M, Walker AR. Sugar consumption and dental caries: Evidence from 90 countries. Br Dent J 1994;176:297-302.
Kalsbeek H, Verrips GH. Consumption of sweet snacks and caries experience of primary school children. Caries Res 1994;28:477-83.
Wilson B, Mallikarjuna SB, Narsimha VV, Muddaiah S, Suresh LR. Dental caries and co-relation with sugar intake in 12-year-old school children Coorg, India. Open Access J Public Health 2018;2:1-6.
de Jong-Lenters M, Duijster D, Bruist MA, Thijssen J, de Ruiter C. The relationship between parenting, family interaction and childhood dental caries: A case-control study. Soc Sci Med 2014;116:49-55.
Pai NG, Acharya S, Vaghela J, Mankar S. Prevalence and risk factors of dental caries among school children from a low socio economic locality in Mumbai, India. Age (in years). Int J Appl Dent Sci 2018;4:203-7.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]