Assessment of Oral Health Status and Dental Treatment Needs Among 12- and 15-Year-Old School-Going Children of Fisherman Community Residing at East Coast Road, Chennai: A Cross-Sectional Study.

AIMS AND
OBJECTIVES: This study was conducted to assess the dental treatment needs of 12- and 15-year-old school-going children of fishermen community residing at East Coast Road, Chennai.
MATERIALS AND METHODS: Of 35 schools, 2 schools of private and government each were chosen to a final sample size of 650 students. Ethical clearance to conduct the research was obtained. A pilot study was undertaken during February 2012 at St. Joseph school, Kovalam to determine the feasibility of the study and also to determine the sample size. Examination was carried out by a single examiner to assess the treatment needs using World Health Organization Oral Health Surveys: Basic Methods pro forma (1997) excluding prosthetic treatment needs. The Chi-square test (χ2) was used to find out whether there existed a significant difference in the oral health status between 12- and 15-year-old school children and private and government school children.
RESULTS: 12-year-old children and 15-year-old children had a mean decayed-missing-filled teeth value of 2.14 and 2.72, respectively. Majority of the study population 454 (241[68.8%] 12-year-old children and 213[71%] 15-year-old children) need one surface restoration. Majority of the study population 623 (95.8%) had community periodontal index (CPI) score of 2 (i.e., calculus), whereas only 27 (4.1%) of the study population had CPI score of 0 (i.e., healthy gums).
CONCLUSION: This study revealed that the oral health status of these children was poor with high caries prevalence and high Malocclusion.

INTRODUCTION

Oral health is an integral part of general health. Poor oral health can have a detrimental effect on general health. The mouth is also a portal of entry for pathogens and toxins, which can affect the oral health and if not cleared by the many defense mechanisms that have evolved to protect the oral cavity, may spread to the rest of the body.[1] The consequences of poor oral hygiene and a diseased mouth can be disastrous to general health. In India, the major oral diseases are dental caries and periodontal diseases.

According to National Oral Health Survey and Fluoride Mapping of 2002,[2] the prevalence of dental caries was increasingly high in children and it is said that 60% of children in India were affected by dental caries and were classified as high-risk population. Southern India being a peninsula, fishing is a major industry in its coastal states, employing over 14 million people.[3] The occupation of fishing is stressful because of difficult physical conditions, dislocation, isolation, and less than ideal personal habits.[4] Fishermen have lower socioeconomic status and their illiteracy adds to their poor oral hygiene, which may influence general and oral health.[5] Oral diseases seem to be the most common health problem of seafarers’ worldwide.

Fishermen due to their stressful work in the night would rest in day hours and they may not spare time to take care of their health and also their children’s health and have poor oral health when compared with that of general population.[6] As a result, Fishermen having little attention toward the oral health of children, they may be more prone for dental diseases. Also with the associated factors such as diet, oral hygiene practice, they are at high-risk population for dental caries and other dental diseases. In India only few studies were conducted to assess the treatment needs of fishermen’s children, so this study was conducted to assess the dental treatment needs of 12- and 15-year-old school-going children of fishermen community residing at East Coast Road (ECR), Chennai.

MATERIALS AND METHODOLOGY

This study was a descriptive cross-sectional survey conducted to assess the treatment needs of 12- and 15-year-old school-going children of fishermen community residing at ECR, Kanchipuram, Tamil Nadu, which was carried out during December 2011 to April 2012. ECR is a two-lane highway, built along the coast of the Bay of Bengal connecting Chennai to Cuddalore via Pondicherry. The ECR starts at Kottivakkam in Chennai and is a part of the Greater Chennai City till Kovalam. There are totally 12 coastal villages in ECR belonging to Greater Chennai. The occupation of coastal population is mainly fishing.

Ethical clearance to conduct the research was obtained from the Institution Review Board of Ragas Dental College and Hospital. List of all the schools located along ECR of Chennai was obtained from the office of the chief educational officer (CEO), Kanchipuram district. Furthermore, the permission to conduct the study was obtained from the CEO Kanchipuram and also from the respective school authorities.

Those Children, whose parents involved in fishing as primary occupation obtained with the help of school records and who were present on the day of examination and those children who were willing to participate in the study were included in the study. Eventually, those children who were absent during the time of examination were excluded.

A pilot study was undertaken during February 2012 at St. Joseph school, Kovalam to determine the feasibility of the study and also to determine the sample size. The study population included were 74 fishermen’s children of 12 and 15 years old. World Health Organization (WHO) Oral Health Assessment pro forma (1997) was used to assess the treatment needs excluding prosthetic treatment needs. It took an average duration of 10–15 minutes to complete the pro forma and questionnaire per study participant. It was found that the minimum sample size required was 590 assuming the population proportion as 0.74. A nonresponse rate of 10% was anticipated prior for the main study and hence the sample size was increased by 10%. Thus the final sample size was calculated to be 650 students.

On the day of examination, type-3 intraoral examination was carried out by a single examiner to assess the treatment needs using WHO Oral Health Surveys: Basic Methods pro forma (1997) excluding prosthetic treatment needs. Calibration of the examiner was assessed by kappa statistic and interpreted to be 0.83. The Chi-square test (χ2) was used to find out whether there existed a significant difference in the oral health status between 12- and 15-year-old school children and private and government school children.

RESULTS

Table 1 and Figure 1 show distribution of study population based on crown status. Of 511 children, 266 (76%) 12 years old and 245 (82%) 15 years old had decayed teeth. Four (1.1%) 12-year-old children and 2 (0.6%) 15-year-old children had filled teeth with decay. Nine (2.5%) 12-year-old children and 47 (15.6%) 15-year-old children had filled teeth. Thirty (8.5%) 12-year-old children and 97 (32.3%) 15-year-old children had missing teeth because of caries. One (0.1%) child had missing due to reason other than caries. Six (1.7%) 12-year-old children and 4 (1.3%) 15-year-old children had fractured teeth.

Table 1

Distribution of study population based on crown status

	Private school		Government school		Total
	12 years	15 years	12 years	15 years
Decayed
Yes	142 (78.5%)	113 (75.8%)	124 (73.4%)	132 (87.4%)	511 (78.6%)
No	39 (21.5%)	36 (24.2%)	45 (26.6%)	19 (12.6%)	139 (21.4%)
Filled with decay
Yes	3 (1.6%)	2 (1.3%)	1 (0.6%)	0 (0%)	6 (0.9%)
No	178 (98.4%)	147 (98.7%)	168 (99.4%)	151 (100%)	644 (99.1%)
Filled without decay
Yes	6 (3.3%)	11 (7.4%)	3 (1.8%)	36 (23.8%)	56 (8.6%)
No	175 (96.1%)	138 (92.6%)	166 (98.2%)	115 (76.2%)	594 (91.4%)
Missing due to caries
Yes	16 (8.8%)	28 (18.8%)	7 (4.1%)	42 (27.8%)	93 (14.3%)
No	165 (90.6%)	121 (81.2%)	162 (95.9%)	109 (72.2%)	557 (85.7%)
Missing other reason
Yes	1 (0.6%)	0 (0%)	0 (0%)	0 (0%)	1 (0.1%)
No	180 (99.4%)	149 (100%)	169 (100%)	151 (100%)	649 (99.9%)
Trauma
Yes	3 (1.7%)	4 (2.7%)	3 (1.8%)	0 (0%)	10 (1.5%)
No	178 (98.3%)	145 (97.3%)	166 (98.2%)	149 (100%)	640 (98.5%)

Figure 1

Distribution of study population based on crown status

Table 2 shows distribution of study population based on root status of children. Among the study population, 4 (0.6%) children (3 [0.8%] 12-year-old children and 1 [0.3%] 15-year-old child) had decayed root.

Table 2

Distribution of study population based on root status

	Private school		Government school		Total
	12 years	15 years	12 years	15 years
Root decay	2 (1.1%)	1 (0.7%)	1 (0.6%)	0 (0%)	4 (0.6%)
Root unexposed	179 (98.9%)	148 (99.3%)	168 (99.4%)	151 (100%)	646 (99.4%)

Table 3 and Figure 2 show distribution of study population based on treatment needs. Majority of the study population 454 (68.8%) 12-year-old children and 213 (71%) 15-year-old children need one surface restoration. Two surface restorations were needed by 77 (22%) 12-year-old children and 144 (48%) 15-year-old children needed two surface restorations. Twenty-seven (7.7%) 12-year-old children and 22 (7.3%) 15-year-old children needed pulp care and 17 (4.9%) 12-year-old children and 12 (4%) 15-year-old children needed extraction.

Table 3

Distribution of study population based on treatment needs

	Private school		Government school		Total
	12 years	15 years	12 years	15 years
One-surface restoration
Yes	129 (71.3%)	88 (59.1%)	112 (66.3%)	125 (82.8%)	454 (69.9%)
No	52 (28.7%)	61 (40.9%)	57 (33.7%)	26 (17.2%)	196 (30.1%)
Two-surface restoration
Yes	42 (23.2%)	81 (54.4%)	35 (20.7%)	63 (41.7%)	221 (34%)
No	139 (76.8%)	68 (45.6%)	134 (79.3%)	88 (58.3%)	429 (66%)
Pulp care
Yes	11 (6.1%)	16 (10.7%)	16 (9.5%)	6 (4%)	49 (7.5%)
No	170 (93.9%)	133 (89.3%)	153 (90.5%)	145 (96%)	601 (92.6%)
Extraction
Yes	5 (2.8%)	6 (4%)	12 (7.1%)	6 (4%)	29 (4.4%)
No	176 (97.2%)	143 (96%)	157 (92.9%)	145 (96%)	621 (95.6%)

Figure 2

Distribution of study population based on treatment needs

Table 4 and Figure 3 show the mean decayed-missing-filled teeth (DMFT) of the study population. Twelve-year-old children and 15-year-old children had a mean DMFT value of 2.14 and 2.72, respectively. Statistical test showed significant difference between mean DMFT and age.

Table 4

Distribution of study population based on mean DMFT

DMFT	Private school		Government school
	12 years	15 years	12 years	15 years
Mean (SD)	2.01 (1.63)	2.28 (1.9)	2.27 (1.93)	3.15 (2.24)
Median	2	2	2	2
Mean rank	294.28	313.98	315.20	285.97
P value	<0.001 (highly significant); Kruskal–Wallis ANOVA

ANOVA = analysis of variance Mann–Whitney U Value = 44903; P = 0.001

Figure 3

Distribution of study population based on mean DMFT

Table 5 and Figure 4 show distribution of study population based on temporomandibular joint (TMJ) symptoms, clicking, tenderness, and reduced jaw mobility. Among the total study population, almost 647 (99.6%) had no TMJ symptoms and only 3 students had clicking. Statistical test showed that there is no significant difference with respect to TMJ symptoms between 12- and 15-year-old students studying in private and government schools.

Table 5

Distribution of study population based on TMJ symptoms (clicking, tenderness, and reduced jaw mobility)

TMJ symptoms	Private school*		Government school*		Total
	12 years#	15 years#	12 years#	15 years#
Clicking
Yes	3 (1.6%)	0 (0%)	0 (0%)	0 (0%)	3 (0.4%)
No	178 (98.3%)	149 (100%)	169 (100%)	151 (100%)	647 (99.6%)

*χ2 = 0.912; P = 0.340

#χ2 = 3.368; P = 0.338

Figure 4

Distribution of study population based on TMJ symptoms, clicking, tenderness, and reduced jaw mobility

Table 6 and Figure 5 show distribution of study population based on oral mucosa condition. Only 3 (0.4%) children of 12 years old had ulcerations in their mouth. Statistical test showed that there is no significant difference with respect to oral mucosa condition between 12- and 15-year-old students studying in private and government schools.

Table 6

Distribution of study population based on oral mucosa condition

Oral mucosa condition	Private school*		Government school*		Total
	12 years#	15 years#	12 years#	15 years#
No abnormal condition	180 (27.6%)	149 (22.9%)	167 (25.6%)	151 (23.2%)	47 (99.6%)
Present	1 (0.1%)	0 (0%)	0 (0%)	2 (0.3%)	(0.4%)

*χ2 = 6.630; P = 0.010

#χ2 = 3.341; P = 0.342

Figure 5

Distribution of study population based on oral mucosa condition

Table 7 and Figure 6 show distribution of study population based on enamel opacities. Among the total study population, majority (607 [93.4%]) had no enamel opacity, whereas 24 (6.9%) of 12 years old and 18 (6%) of 15 years old had demarcated opacity. Statistical test showed that there is no significant difference with respect to enamel opacities between 12- and 15-year-old students studying in private and government schools.

Table 7

Distribution of study population based on enamel opacities

Enamel opacity	Private school*		Government school*		Total
	12 years#	15 years#	12 years#	15 years#
No enamel opacity	172 (26.5%)	143 (22%)	153 (23.5%)	139 (21.4%)	07 (93.4%)
Demarcated opacity	9 (1.4%)	6 (0.9%)	15 (2.3%)	12 (1.8%)	42 (6.5%)
Diffuse opacity	0 (0%)	0 (0%)	1 (0.2%)	0 (0%)	1 (0.2%)

*χ2 = 1.012; P = 0.603

#χ2 = 7.209; P = 0.302

Figure 6

Distribution of study population based on enamel opacities

Table 8 and Figure 7 show distribution of study population based on dental fluorosis. Among the total study population, 16 (2.5%) had questionable fluorosis, whereas 2 (0.3%) had mild fluorosis. Statistical test showed that there is no significant difference with respect to dental fluorosis between 12- and 15-year-old students studying in private and government schools.

Table 8

Distribution of study population based on dental fluorosis

Dental fluorosis	Private school*		Government school*		Total
	12 years#	15 years#	12 years#	15 years#
No dental fluorosis	176 (27.1%)	145 (22.3%)	164 (25.2%)	147 (22.6%)	632 (97.2%)
Questionable fluorosis	5 (0.8%)	3 (0.5%)	5 (0.8%)	3 (0.5%)	16 (2.5%)
Mild fluorosis	0 (0%)	1 (0.2%)	0 (0%)	1 (0.2%)	2 (0.3%)

*χ2 = 0.984; P = 0.611

#χ2 = 2.831; P = 0.830

Figure 7

Distribution of study population based on dental fluorosis

Table 9 and Figure 8 show distribution of study population based on community periodontal index (CPI). Majority of the study population 623 (95.8%) had CPI score of 2 (i.e., calculus), whereas only 27 (4.1%) of the study population had CPI score of 0 (i.e., healthy gums). Statistical test showed significant difference between age and highest CPI code.

Table 9

Distribution of study population based on CPI index

Age	Number of examined persons	Number of dentate persons	Persons coded (%)
			H	B	C	P1	P2
12 and 15 years	650	650	4.1	0	95.8	0	0

χ2 = 4.7; P = 0.02 (significant)

Figure 8

Distribution of study population based on CPI index

DISCUSSION

Oral health is an essential component of general health. Among children, those belonging to fishing community deserve special attention due to myriad reasons. Long sea voyages force the fishermen to work for prolonged hours. Owing to their stressful work in the night, they would rest in day hours and hence may not spare time to take care of their health as well as their children’s health.[6] Another important factor that influences oral health is the diet of fishermen community. Lack of fruits and vegetables and increased frequency of fish intake make this population vulnerable to dental diseases. Moreover, their access to dental services is also very limited. Hence, this study was contemplated to assess the treatment needs of 12- and 15-year-old school-going children of fishermen community residing at ECR, Chennai.

This study included 330 private school students and 320 government school students. It is difficult to collect data on socioeconomic factors from children, as they may not be aware of their parent’s income. So to get an insight into their socioeconomic status, the study population was classified into those belonging to private and government schools. It may be perceived that children belonging to lower socioeconomic status might study in government schools rather than in a private school. The study population consists of 350 children of age 12 years and 300 children of age 15 years. Children belonging to these two age groups were included as 12 years is the global monitoring age for caries, whereas 15 years is the index age for assessment of periodontal disease indicators.

Among this study population based on CPI index, majority of the study population 623 (95.8%) had CPI score of 2 (i.e., calculus), whereas only 27 (4.1%) of the study population had CPI score of 0 (i.e., healthy gums). This finding is similar to 93.1% periodontal disease prevalence in the fisherman study conducted by Saravanan et al.[5] in Tirunelveli district, Tamil Nadu. This may be due to socioeconomic factors and the availability, affordability, and awareness toward oral hygiene, lack of proper technique of brushing, and lack of access to dental care. This finding is higher in relation to CPI score of 2 (i.e., calculus) and low in compared to CPI score of 0 (i.e., healthy gums) when compared to Kumari et al.[7] in Lucknow.

In this population study, 12-year-old children and 15-year-old children had a mean DMFT of 2.14 and 2.72, respectively. This finding is similar to the study conducted by Dhaval and Sujal[8] among school-going 12- and 15-year-old children in Ahmedabad city. The study finding is lower when compared with the study conducted by Saravanan et al.[5] among fishermen in Tirunelveli district, Tamil Nadu, where the mean DMFT was 3.61. The study finding is higher than the study conducted by Meghashyam et al.[9] where the mean DMFT was 1.89 conducted in fisher folk communities in coastal areas of Karnataka among 10–14 years children, Bhat[10] study conducted in Harikantra fishing community in Karnataka, and Mehta et al.[11] study conducted among12–13 years school children in Chennai.

The study finding is comparatively very high than the study conducted by Ganesh et al.[12] among 12- and 15- year-old children in Chennai and Mehta et al.[11] among 4–17 years children in various government and private schools in Chandigarh, Grover et al.[13] among school-going children. This may be due to higher sweet consumption (54%), increased intake of fish (71.5%). Diet, availability of sticky carbohydrate rich food, presence of certain trace elements such as selenium, relative humidity might have influenced the occurrence of dental caries in this study population. Implementation of oral health program at early age helps in improving preventive dental behavior and attitudes, which is beneficial throughout the lifetime. This can be achieved by educating the parents about dental health through school dental program.

In this study population, 78.6% had caries prevalence; of which, 76% were 12 years and 82% were 15 years. This is comparatively similar to Meghashyam et al.[9] study conducted in fisher folks communities in coastal areas of Karnataka where 80.64% had decayed teeth. This reading is relatively higher compared to 63.8% dental caries in Bhat[10] study in Harikantra rural fishing community in Karnataka, 49.9% decayed teeth in the study conducted by Mehta et al.[11] among various government and private school children in Chandigarh, 54.9% caries prevalence in Saravanan et al.[5] among fishermen in Tirunelveli district, Tamil Nadu, 64.98% caries prevalence in Amith and D’Cruz[14] in 12- and 15-year-old school children in Warananagar, Maharashtra, 50.34% decayed teeth in Sujatha et al.[15] study among 7–12 years and 13–16 years group in both urban and rural areas in Guntur district, 40.2% for 12 years and 51% for 15 years in the study conducted by Ganesh et al.[12] in Chennai, 57.7% for 12 years and 48.5% for 15 years in the study conducted by Grover and Anuradha[13] in the school-going children.

The higher prevalence may be the results of poor dietary habits including high consumption of sugar containing products combined with frequency of tooth brushing and frequency of dental visits. So, need for promotion of oral health and provision of availability of treatment to every child as well as planned school-based oral health education program were needed to increase the oral health knowledge among these school children.

Majority of the study population 454 (68.8%) 12-year-old children and 213 (71%) 15-year-old children need one surface restoration. Two surface restorations were needed by 77 (22%) 12-year-old children and 144 (48%) 15-year-old children needed two surface restorations. Twenty-seven (7.7%) 12-year-old children and 22 (7.3%) 15-year-old children needed pulp care and 17 (4.9%) 12-year-old children and 12 (4%) 15-year-old children needed extraction.

The study finding is similar to Ganesh et al.[12] study conducted among 12 and 15 years in Chennai in relation to 4.1% extraction and higher for one surface restoration (44.4%), two surface restoration (15.5%), and pulp care (2.9%). The study finding is relatively lower compared to adult fishermen study conducted by Saravanan et al.[5] in Tirunelveli district, Tamil Nadu, in which the treatment needed for extraction (39.6%), filling (20.8%), and root canal treatment (11.8%).

Hazardous occupations, unscheduled working hours, job-related stress, pernicious habits, irregular diet due to lack of availability of home cooked food, lower awareness levels, and socioeconomic status seemed to influence the oral health status of fishermen population.

As oral health is an integral part of general health, the oral health of these children may also get influenced by such environmental and socioeconomic factors. Majority of the study population required oral prophylaxis and restoration of their teeth. Among the oral diseases, Dental caries and periodontal diseases have historically been considered the most important global oral health burdens. Despite various steps taken to improve the oral health of people, oral health problems still remain as a burden in many communities, particularly among underprivileged people.

This study was conducted to assess the oral health status and treatment needs of 12- and 15-year-old school-going children of fishermen community residing at ECR, Chennai, revealed that the oral health status of these children was poor with high caries prevalence and high malocclusion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.