Oral Health Status and Treatment Needs of 12-year-old School Children among Urban and Rural Areas of Raichur Taluk, Karnataka, India.

INTRODUCTION: Oral health is an integral part of general health. Oral health status has a direct impact on general health, and conversely, general health influences oral health.
OBJECTIVES: The objectives of the study were to assess oral health status and treatment needs of 12-year-old school children among urban and rural areas of Raichur Taluk, Karnataka, India.
MATERIALS AND METHODS: A cross-sectional study was conducted on 1240 school children in the age group of 12 years from urban (620) and rural (620) areas of Raichur Taluk, Karnataka, India. Oral health status was assessed using the World Oral Health assessment form 1997.
RESULTS: The prevalence of caries in urban and rural areas of school children was 63.5% and 64.5%, respectively. The mean decayed teeth, missing teeth, filled teeth, and decay, missing, filled teeth of school children in Raichur Taluk were 1.15 ± 1.20, 0.0, 0.03 ± 0.23, and 1.19 ± 1.21, respectively.
CONCLUSION: This study highlights the need for preventive and curative oral health services and should be made integral to other health programs. Oral health promotion strategies need to be implemented to improve the oral health of primary school children. Health education should be given regarding the prevention of dental caries by maintaining good oral hygiene. Copyright:

INTRODUCTION

While the eyes may be the window to the soul, our mouth is a window to our body's health.[1] Children who suffer from poor oral health are 12 times more likely to have restricted – activity days than those who do not.[2] More than 50 million school hours are lost annually because of oral health problems which affect children's performance at school and success in later life.[3] Dental caries is a lot of burden to children and also placing financial burden on the care takers. In developing countries, migration of people from rural areas and urbanization brings about changes in lifestyle and dietary habits, which, in turn, can affect the oral health status adversely. The National Commission for Protection of Child Rights team visited the Raichur District on November 2011, to know the malnutrition deaths and other child rights' violations. Raichur District is one of the 30 most backward districts of the country. Raichur District is one of the 30 most backward districts of the country with unhygienic environmental conditions, high disease burden, negligible oral health seeking behavior of the population and non-availability of the medical facilities etc.[4] The objective of the study is to assess oral health status and treatment needs of 12-year-old school children residing in urban and rural areas of Raichur Taluk, Karnataka, India, and also to compare oral health status and treatment needs among these urban and rural school children.

MATERIALS AND METHODS

The study was carried out in both urban and rural areas of Raichur Taluk, Karnataka, over a period of 3-month duration. A total of 8002 (4304 boys and 3698 girls) school children in the age group of 12 years were included from 84 schools in urban and 128 schools in rural areas of government, aided, and private (unaided) schools. The study protocol was approved by the Institutional Ethical Committee, Navodaya Dental College and Hospital, Raichur. Prior permission and consent was obtained from the Block Education Officer (BEO) of Raichur Taluk, Karnataka. A pilot study on 30 urban and 30 rural 12-year-old school children was carried out to determine the final sample size within 95% confidence interval. On the basis of prevalence of dental caries, a final sample size was calculated using the following formula.

where,

N = Sample,

Z crit = Z critical value at 95% confidence level = 1.96.

Z1-β= Z value at 95% power = 1.64

P1= Proportion of children with dental caries in urban region (66.7%).

P2= Proportion of children with dental caries in rural region (56.7%).

The estimated final sample size was 611 in each urban and rural area and was rounded off to 620. Twelve-year age group of school children were selected from both urban and rural areas of Raichur Taluk, by multistage sampling method. Urban schools were divided into 5 clusters and rural schools were divided into 19 clusters by the Department of BEO. In each cluster, sampling frames of the government, aided, and unaided schools were prepared and approximately half the numbers of schools were selected using simple random sampling (lottery) method. From the selected schools, a proportionate sample was chosen from the 7th standard by simple random sampling (lottery) method using attendance register as sampling frame (each day 20 children were examined). The prevalence of dental caries, fluorosis, and caries experience was measured. Descriptive statistics and Chi-square test were used.

RESULTS

Among the 12-year-old children of Raichur Taluk, 54.7% were boys and 45.3% were girls. The percentage of children from rural area had higher oral mucosal conditions than that of urban area, and it was statistically not significant (P = 0.25). The prevalence of fluorosis was higher in 12-year-old children of rural area than that of urban area of Raichur Taluk, and it was statistically significant (P < 0.001) [Table 1]. The percentage of children from rural area had more healthy periodontium than that of urban area, and it was statistically not significant (P = 0.39). The percentage of children from urban area had more bleeding than that of rural area and it was highly significant (P < 0.0001), and the percentage of children from rural area had more calculus than that of urban area and it was highly significant (P < 0.0001) [Table 2]. The prevalence of dental caries was higher among the children of rural area than that of urban area and was statistically not significant [Figure 1]. The mean decayed teeth, missing teeth, filled teeth, and decay, missing, filled teeth (DMFT) of school children in Raichur Taluk were 1.15 ± 1.20, 00, 0.03 ± 0.23, and 1.19 ± 1.21, respectively. Overall, for the 12-year-old school children of Raichur Taluk, 944 (76.1%) of children required treatment and 296 (23.9%) of children were not [Table 3].

Table 1

Distribution of children according to the presence or absence of dental fluorosis

Dental fluorosis	Urban, n (%)	Rural, n (%)	Total, n (%)
Absent	554 (89.4)	509 (82.1)	1063 (85.7)
Present	66 (10.6)	111 (17.9)	177 (14.3)
Total	620 (100.0)	620 (100.0)	1240 (100.0)

χ2=13.35; P<0.001 significance

Table 2

Number and percentage of children with healthy periodontal tissues, bleeding, and calculus

Type	Urban, n (%)	Rural, n (%)	Z	P
Healthy	9 (1.5)	13 (2.1)	0.86	0.39
Bleeding	108 (17.4)	33 (5.3)	6.83	<0.0001
Calculus	503 (81.1)	574 (92.6)	6.05	<0.0001
Excluded	0 (0.0)	0 (0.0)	-	-
Total	620 (100.0)	620 (100.0)

Figure 1

Prevalence of dental caries

Table 3

Number and percentage of children requiring treatment in Raichur taluk

Treatment	Urban, n (%)	Rural, n (%)	Total, n (%)
Treatment required	461 (74.3)	483 (77.9)	944 (76.1)
No treatment	159 (25.7)	137 (22.1)	296 (23.9)
Total	620 (100.0)	620 (100.0)	1240 (100.0)

DISCUSSION

In this study, among 12-year-old children in Raichur Taluk, 2.8% had oral mucosal conditions such as abscess and pigmentation and 97.2% were free from oral mucosal conditions because of lack of literature data, comparison with other studies cannot be done. In this study, the percentage of dental fluorosis (10.6%) was higher than the study conducted in Chennai, India[5] (2.5%) and Haryana, India[6] (6.8%). This could be because Raichur District belongs to the endemic zones of fluorosis. Among Raichur children, 86.9% had calculus, higher than those in China[7] (58.0%) and Thailand[8] (44.5%). The higher levels of calculus in this study could be due to lack of awareness and poor oral hygiene. The overall prevalence of dental caries was 64.0%. It was 63.5% in the urban area and 64.5% in the rural area, higher than the studies conducted in Bengaluru[9] (49.2%), Africa[10] (33.8% urban area and 21.2% rural area), Delhi[11] (36.3%), Himachal Pradesh, India[12] (32.6%), Hyderabad, India[13] (41.4%), and Deoghar (Jharkhand)[14] (32.6%). The caries experience (DMFT) of 12-year-old school children of Raichur (1.19 ± 1.21) was higher than the Hyderabad, India[13] (0.6 ± 0.08) and Deoghar (Jharkhand)[14] (0.62 ± 1.42). The higher dental caries could be due to majority of children belonged to upper lower class of socioeconomic status who could afford high sugar consumption in the form of tea/milk and sweets/chocolate.

CONCLUSION

The study highlights the need for preventive and curative oral health services and need to be implemented to improve the oral health of primary school children. Oral health education should be given and advice regarding continuous dental follow-ups should be made. The World Oral Health Day is celebrated every year on March 20th focussing on the benefits of healthy mouth to promote oral health and reduce overall disease burden. Education department should promote to conduct such programs to create awareness in students, parents, and teachers regarding the importance of oral health. Health-care providers should incorporate oral- and dental health-related topic in school curriculum in future.

Limitations and recommendations

The current study had some limitations and recommendations. Encourage regular periodic dental checkups for children who are at high risk of developing dental caries. Oral health promotion through a well-structured oral health education program can create positive change in awareness for special groups like school children. Implementation of school dental health programs mainly focusing on preventive aspects with inclusion of application of fluoride mouth rinse and tooth brushing is the need of the hour.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.