Prevalence of dental caries among school-going children in Namakkal district: A cross-sectional study.

AIM: The aim of this study is to determine the prevalence of dental caries in primary teeth among 4-6 years old school going children in the Namakkal District.
MATERIALS AND METHODS: The study covered a total of 850 school going children in a total of 26 schools in the Namakkal district of Tamil Nadu. The age group selected for this study ranged from 4 to 6 years of age. Each child was examined in their respective schools by one of the four calibrated examiners and decay, missing and filled teeth (dmft) index was recorded along with demographic details. This study was done in September-October 2013 in a span of 1 month duration.
RESULTS: Of 850 children examined, 560 (65.88%) children had dental caries. Mean dmft score was 2.86. Prevalence of dental caries was higher in boys (69.6%) than in girls (61.5%). The untreated decay teeth accounted for 92.4%.
CONCLUSION: The prevalence of dental caries among 4-6 years old children is high in the Namakkal district. The need for the creation of dental awareness among children and their primary caregivers is crucial and the need for developing immediate oral health promotion strategies including an increase in school dental health programs is recommended.

The history of diagnosing dental caries began in 1883 by W.D. Miller who found bacterial involvement in caries development. Though centuries have passed and advancements in medical techniques and technology have evolved mankind is yet to achieve a significant reduction in prevention of dental caries. Shafer (1993) defined dental caries as an irreversible microbial disease of the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth, which often leads to cavitation.[1]

Oral health care in rural areas are often limited[2] due to shortage of dental manpower, financial constraints, and the lack of perceived need for dental care among rural masses. Among oral diseases, the dental caries[34] is an important dental public problem in India and is predominantly a disease of childhood. Pain due to dental caries can affect normal food intake and daily curriculum and sports activities in the children. Dental caries has high prevalence[5] all around the world involving the people of all region and society. In India, only sporadic data regarding dental caries is available. Most of studies have been localized to a smaller area involving a particular community. India is a country known for the difference in culture with the vast diversity in region, religion, language, caste, and race. Studies have shown that in developing countries[6] changing lifestyles and dietary patterns are increasing the incidence of caries. Epidemiological data[78] plays a vital role in updating recent trends of the disease and treatment needs. The localized prevalence data is essential not only to understand the disease, but also plays a vital role in prevention and treatment planning. In developing countries,[9] children have a high prevalence of dental caries affecting primary dentition than permanent dentition.

Materials and Methods

The study was carried out on 850 school going children in 26 schools located in the urban areas of Namakkal district, Tamil Nadu, India. Namakkal district as per Indian government survey-2011 covers a land area of 3420 square kilometers with a population of 1,726,601 people of which there were total 150,699 children under the age of 0-6. The literacy rate of the general population is 74.63%. Namakkal district has three private dental colleges. For our study 13 government schools and 13 private schools located in Namakkal district were randomly selected to include children of all socioeconomic status. Children were of age group 4-6 years of age. Age was recorded from school records. The study was approved by Ethics Committee of Vivekananda Dental College, Namakkal. Prior permissions and consents were obtained from school authorities, parents, and teachers.

This study was completed in a span of 1 month, by four examiners. The examiners underwent 1 day training program and clinical calibration exercises before screening the children. The children were examined individually in the school premises by one of the four examiners on a simple straight wooden chair using plane mouth mirrors and community periodontal index probe. The examination was done under natural day light using WHO criteria.[10] The children were examined for the presence of decay, missing and filled teeth (dmft) index was used to record primary dentition status. dmft index values are recorded and mean and standard deviation calculated.

Results

The sample distribution and mean dmft scores with a standard deviation is shown in Table 1.

Table 1

Sample distribution

In this study, a total of 850 school children were examined of which 460 were boys and 390 were girls. The prevalence of dental caries was 69.57% among boys and 61.5% among girls. The girls had lower dmft scores than boys and the overall prevalence was 65.9%. The untreated caries accounted for 92.4% of the score, while filled teeth were only 6.1% and extracted teeth accounted for 1.5%. The mean dmft score for boys was 2.89 and girls was 2.82.

Discussion

The age group of 4-6 years school going children was selected for the study to assess the caries status in the primary dentition alone and this age group is often regarded as global monitoring age group and international comparison age group for general and oral health status.[3] In 1981, WHO and the foreign direct invested (FDI) World Dental Federation jointly formulated goals for oral health to be achieved by the year 2000 A.D as 50% of 5-6 years old to be free of dental caries. In Namakkal district, the prevalence of caries is 65.9%, which is very far from goal set by FDI and WHO. Our findings of girls having lower dmft was similar to Mittal et al.[3] and Mahesh Kumar et al.[6] studies and contradiction to Mishra and Shee[11] Mwakatobe and Mumghamba[12] and Shingare et al.[13] According to National Oral Health Survey India caries prevalence among 5 years age children was 51.9%.

The study concludes that dental caries prevalence in Namakkal district school going children of age 4-6 years is significantly high. Although literacy rate of the population is 74.63% and the district has three private dental institutions, the treatment required is over 92%. This could be because of negligence or lack of awareness about the importance of primary teeth. From this study, we may also infer that there may be only a little correlation between overall literacy rate and oral health care knowledge in this population. The increase in caries would be due to lack of dental awareness, improper brushing techniques, improper dietary habits, ignorance, and lack of motivation. This study is significant in establishing the data for rural areas in a county where over 72% of Indian population lives in a rural area. We recommend to create dental awareness by increasing school dental health programs in this regions. Awareness to the public may be increased by using audio-visual communications such as radio, televisions, magazines, and public notices. Parents and teachers must be encourages to devote sufficient time for dental health education programs and diet counseling.