|Year : 2022 | Volume
| Issue : 4 | Page : 379-383
Oral hygiene practices and caries experience among school leaving children in rural area
Srinivas Ravoori, Suresh Chand Yaddanapalli, Parveen Sultana Shaik, Devaki Talluri, Srinivas Pachava, Nijampatnam P M Pavani
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
|Date of Submission||31-Mar-2021|
|Date of Decision||20-Aug-2022|
|Date of Acceptance||21-Sep-2022|
|Date of Web Publication||19-Dec-2022|
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Takkellapadu, Guntur - 522 509, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Dental caries is the most common chronic childhood disease and its treatment is the most prevalent unmet health need among school-leaving children. Caries experience among school leaving age group is important as India is a rapidly growing nation in terms of population as today's children are tomorrow's future citizens of the nation. Methodology: To know the oral hygiene practices and caries experience among school-leaving children in a rural area, a cross-sectional study was conducted in the Chebrolu Mandal using a multistage random sampling technique to obtain the required sample size. The data were collected using pretested structured questionnaire followed by oral examination using the decayed, missing, and filled teeth (DMFT) index. The descriptive analysis included mean and standard deviations, Chi-square test, unpaired t-test, and one-way analysis of variance. Results: Only a few children have a habit of brushing their teeth twice daily 137 (27.6%); rinse their mouth after every meal 116 (23.4%); dispose of toothbrush every 3 months (11.7%); spends <1-min brushing (4.8%); and cleans their tongue using tongue cleaner (25.2%). When DMFT scores were compared to the brushing techniques of the children, significantly higher mean DMFT scores were observed in children who brush once a day (1.49 ± 1.133). Conclusion: Caries' experience was more in children who brushed their teeth once a day with horizontal brushing technique and this shows that the study subjects do not follow correct brushing techniques and other oral hygiene practices.
Keywords: Dental caries, DMF index, oral hygiene, tooth brushing
|How to cite this article:|
Ravoori S, Yaddanapalli SC, Shaik PS, Talluri D, Pachava S, Pavani NP. Oral hygiene practices and caries experience among school leaving children in rural area. J Indian Assoc Public Health Dent 2022;20:379-83
| Introduction|| |
Dental caries is viewed as a most extreme public health problem universally because of its high pervasiveness and critical social effect. The World Health Organization proclaims that 60%–90% of school children worldwide have experienced caries, with the disease being most prevalent in Asian and Latin American countries. Dental caries is the most common chronic childhood disease and its treatment is the most prevalent unmet health need in children.
Dental caries affects people of all ages with the highest priority risk group being school-going children. More than 50 million h are lost from schools annually due to oral hygiene-related diseases. Studies have shown that school hours are skipped because of high tooth decay in both primary and permanent dentition. According to the National Oral Health Survey 2002–2003, caries prevalence in India was 63.1% (mean decayed, missing, and filled teeth [DMFT] 2.3) for 15 years of age group children.
Dental caries causes pain, discomfort in chewing, food lodgment, headache, restlessness, and sleeplessness and thus influence the esthetic, functional, well-being, and quality of life. It additionally causes foul breath and taste. Further progressed the infection can spread from the tooth to the surrounding soft tissues with resultant complications such as cavernous sinus thrombosis and Ludwig's angina (Cellulitis) which can be life-threatening.
Children who suffer from poor oral health are 12 times more likely to have more confined activity days including missing schools than those who do not. While there has been improvement in the oral health of children in the last few decades, tooth decay remains one of the most common childhood diseases, in both industrialized and developing countries. A substantial portion of children in many developing countries are affected by tooth decay and most decay is left untreated due to limited access to oral health services.
Unfortunately, oral care was more concentrated on the treatment aspect than on preventive care. Oral health is a fundamental part of well-being throughout life, because of the relationship of the oral cavity with the improvement of a personality, discernments, and quality of life. Untreated oral problems among children habitually lead to major general health problems, critical pain, interrupt with eating, and school absence. The earliest sign of a new carious lesion is the appearance of a chalky white spot on the tooth surface, which indicates an area of demineralization of the enamel surface.
Taking into account that school age is a compelling period during which each child perceives health-related behaviors, convictions, and attitudes and that dental caries is irreversible, endeavors ought to be focused on revealing factors that help in the prevention of dental caries.
With this background, we have done a study in the Chebrolu Mandal to know the oral hygiene practices and caries experience among school-leaving children in a rural area.
| Methodology|| |
A cross-sectional, multilocality, school children-based study was conducted from December 2019 to January 2020 in Chebrolu Mandal where the list of all the schools, with children of school leaving age, situated in Chebrolu Mandal in Guntur district was obtained from the District Education Officer. A multistage random sampling technique was carried out to obtain the required sample size. For computing sample size, a pilot study was conducted among 20 school children to know the prevalence of dental caries and the feasibility, and validity of the questionnaire. Out of 20 children examined, a prevalence of 80.5% dental caries was observed, while content validity was assessed using the content validity ratio in the target population, and the value was found to be 0.75. The sample size was derived using the formula Z2PQ/d2 where Z = standard normal deviate – set at 1.96 at 95% confidence level, P = proportion of the study population (P = 90.7%), q = 1 − p, and d = degree of accuracy desired at 0.05; it was determined that 496 school children were included into the study. Ethical clearance was obtained from the institutional ethical committee (37/IRB/SIBAR/2019).
In the first stage, the Mandal was divided into four zones: north, south, east, and west. School children who were present on the day of examination were included in the study. Children with physically or mentally challenged, who were not willing to participate, and were absent on the day of examination were excluded from the study. The structured format consisted of three sections. The first section collected demographic information of the participants such as age in years, and gender. The second part of the format consisted of questions regarding oral hygiene practices which included the frequency of cleaning and materials used to clean the teeth. The third part consisted of data regarding dental caries experience which was recorded using the DMFT index for permanent dentition. Oral examination was conducted in the school classrooms, under the normal room light with a mouth mirror and CPI probe, and according to the WHO criteria. The collected data were analyzed using the IBM SPSS Statistics for Windows, Version 20.0. IBM Corp, Armonk, New York, USA software package. The descriptive analysis included mean and standard deviations, Chi-square test, unpaired t-test, and one-way analysis of variance. The level of significance was set at P ≤ 0.05.
| Results|| |
A total of 496 children participated in the study, of which 240 (48.4%) are male and 256 (51.6%) are female children with a mean age of 15.23 ± 0.58 years, while 490 (98.8%) of them are using a toothbrush and paste for cleaning their teeth and has adopted horizontal method of brushing (74.2%). Only a few children have a habit of brushing their teeth twice daily 137 (27.6%); rinse their mouth after every meal 116 (23.4%); dispose of toothbrush every 3 months (11.7%); spends <1-min brushing (4.8%); and cleans their tongue using tongue cleaner (25.2%) [Table 1].
|Table 1: The demographic details and brushing habits of the study population|
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The mean DMFT of the study participants was 1.35 ± 1.106, where males had more mean DMFT score (1.66 ± 1.168) compared to females (1.07 ± 0.964) (P = 0.001) while male children reported higher scores of decay component ((1.28 ± 1.007), missing component (0.05 ± 0.218), and filled component (0.35 ± 0.655) of the DMFT index [Figure 1].
|Figure 1: Illustrating the gender-wise comparison of mean DMFT. Chi-square test, *statistically significant. DMFT: Decayed, missing, and filled teeth|
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When DMFT scores were compared to the brushing techniques of the children, significantly higher mean DMFT scores were observed in children who brush once a day (1.49 ± 1.133); who do not rinse their mouth after every meal (1.46 ± 1.018), and in children who spend less than 1 min for brushing (1.79 ± 1.215) [Table 2].
|Table 2: Mean decayed, missing, and filled teeth of the participants according to their brushing habits|
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One decayed, two decayed, three decayed, and four decayed teeth were observed to be more in males (40.4%, 23.3%, 10.8%, 2.1%) compared to females (37.9%, 15.6%, 5.1%, 0%) whereas no decayed tooth is observed more in females (41.4%) than males (23.3%) which was statistically significant (0.001) [Table 3].
One decayed, two decayed, three decayed, and four decayed teeth were observed to be more in participants who brushes once a day (40.4%, 21.2%, 8.4%, 1.4%) compared to participants who brushes twice a day (35.8%, 14.6%, 6.6%, 0%) whereas no decayed tooth is observed more in twice a day brushes (43.1%) than once a day brushers (28.7%) which were statistically significant (0.023) [Table 4].
|Table 4: Comparision of frequency of tooth brushing with the number of decayed teeth|
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| Discussion|| |
Decayed teeth are one of the most common chronic diseases of childhood in the low middle income countries like India where untreated cavities might cause pain and infections that may lead to various problems with eating, speaking, playing, learning, and eventually affects the development of the children. Children who have poor oral health often miss school and might receive lower grades than the children who do not. Therefore, treating the decay at an early age results in the cessation of further progression of oral diseases thereby lowering the financial burden of dental-care treatment and achieving a better quality of life.
In the present study, 240 (48.4%) were male and 256 (51.6%) were female children showing a female preponderance which was, in contrast, to the study done by Singh and Sethi where male children are more than female children. Four hundred and ninety (98.8%) children use a toothbrush and paste which was similar to the study conducted by Bhagat et al. while 2 (0.4%) of them use the finger with tooth powder as oral hygiene practice.
In this study, the overall mean DMFT of school children was 1.35 ± 1.106, and boy's mean DMFT (1.66 ± 1.168) was slightly higher than girls (1.07 ± 0.964), which was, in contrast, to a study done by Pai et al. and Aparna et al. and Al-Rafee et al. where the mean DMFT of study subjects was higher when compared to the present study, whereas the mean DMFT for the present study was higher when compared with the studies done by Goel et al. and Brighton Mafuvadze et al., Okeigbemen and Bhagat et al. In the current study, the mean DMFT for male children was 1.28 ± 1.007, 0.05 ± 0.218, 0.35 ± 0.655, respectively, and for females was 0.84 ± 0.867, 0.02 ± 0.176, 0.20 ± 0.514, respectively, which was higher in males than in females, might be due to the reason that the females are concerned with aesthetics and also could be because they maintain their oral hygiene better than males, which was similar to the study conducted by Aparna et al. and it was in contrast to the studies done by Brighton Mafuvadze et al., Khalid et al. and Arora et al. In the present study, the mean DMFT is less when compared with the retrospective analysis done by Kundu et al.
In this study, dental caries was recorded higher in males than females; this might be because females are more concerned with esthetics so they got them treated with tooth-colored restorations. Because girls are fond of esthetics, as a result, girls might brush and floss their teeth more thoroughly every day during this period to avoid gum diseases and has better oral health than their counterparts.
In the present study, children who brushed twice daily showed 43.1% caries free when compared to children who brushed once daily. Brushing twice results in good oral hygiene, whereas the lower rates in caries-free study subjects might be due to improper brushing techniques and poor oral hygiene practices. Tooth brushing is regarded as an important vehicle for the application of anti-caries agents, such as fluorides into our system. Most patients still cannot accomplish adequate plaque removal by performing oral cleanliness procedures at home. As a result, most dentists recommend brushing teeth twice a day to improve oral hygiene through plaque control. Brushing twice also eliminates food impaction while shortening the impact of sucrose by cleaning teeth after meals seems to be recommendable.
Cross-sectional studies are observational studies that look at data from a group of individuals at one point in time. They are widely used to assess the prevalence of health outcomes, comprehend health determinants, and identify population characteristics. Finally, the detection of dental caries in children was performed without radiographs.
Hierarchical studies have to be done to find out oral hygiene practices and caries experience among school leaving children in rural areas as most of the population in India lives in rural parts than in the urban counterparts where there was fewer establishments of oral health services.
| Conclusion|| |
Although the overall caries experience in the present study was less and a very less number of children had a habit of brushing twice daily, caries experience was more in children who brushed their teeth once a day, majority of the children adopted to horizontal brushing technique and this shows that the study subjects do not follow correct brushing techniques and other oral hygiene practices. There is a need to conduct oral health education programs on correct brushing techniques and other oral hygiene aids.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]