|Year : 2023 | Volume
| Issue : 1 | Page : 1-7
Oral health status and treatment needs in primary school children of Kochi: A Mixed Indian urban population setting survey
MM Dempsy Chengappa1, Akshai Kannan2, Rahul Koul3
1 Department of Dentistry, INHS Sanjivani, Kochi, Kerala, India
2 INDC Danteshwari, Mumbai, Maharashtra, India
3 Department of Dentistry, Field Hospital, Imphal, Manipur, India
|Date of Submission||17-Aug-2021|
|Date of Decision||05-Jun-2022|
|Date of Acceptance||06-Jun-2022|
|Date of Web Publication||29-Dec-2022|
M M Dempsy Chengappa
INHS Sanjivani, Naval Base, Willingdon Island, Kochi - 682 004, Kerala
Source of Support: None, Conflict of Interest: None
Background: Oral health has a multifaceted nature as it encompasses a person's ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex. Oral health paves way for good general health and essential well-being.
Aim: The present study was undertaken to determine the oral health status and treatment needs of school-going children aged 6–10 years of attending government schools in Kochi, Kerala, India.
Materials and Methods: The present study was a cross-sectional study that included screening for dental caries, enamel fluorosis, dental trauma, malocclusion, and treatment needs of 533 primary government school-going children of Willingdon Island, Kochi. Children were assessed as per the World Health Organization Oral Health Assessment Form for Children given in the year 2013. A stratified random sampling method was followed. The means and percentages were calculated, and comparison was done using ANOVA, Chi-square test, and Student's t-test to find the difference in proportion. All values were considered statistically significant at P < 0.05.
Results: The dentition status of the surveyed children revealed a prevalence of dental caries in the study was found to be 50.09% (267). A significant difference was observed between different class students concerning mean DMFT scores (F = 8.5660, P < 0.05). The survey also revealed that the prevalence of enamel fluorosis, traumatic dental injuries, and malocclusion was found to be 3.38%, 1.69%, and 2.63%, respectively. Treatment needs status among students revealed that 85 students needed a preventive or routine treatment and a minimum of two students needed immediate (urgent) treatment who were referred to a dental hospital and 9.76% of students needed Orthodontic intervention.
Conclusion: The high prevalence rate shows that further follow-up and awareness among the teachers, parents, and students regarding dental caries, oral health, and dental hygiene is needed. Further, studies of similar nature on a larger sample are required to correlate the prevalence of dental caries in the target population with other socio-behavioral factors.
Keywords: Children, dental caries, fluorosis, malocclusion, oral health, prevalence, school, trauma
|How to cite this article:|
Dempsy Chengappa M M, Kannan A, Koul R. Oral health status and treatment needs in primary school children of Kochi: A Mixed Indian urban population setting survey. J Oral Res Rev 2023;15:1-7
|How to cite this URL:|
Dempsy Chengappa M M, Kannan A, Koul R. Oral health status and treatment needs in primary school children of Kochi: A Mixed Indian urban population setting survey. J Oral Res Rev [serial online] 2023 [cited 2023 May 30];15:1-7. Available from: https://www.jorr.org/text.asp?2023/15/1/1/365922
| Introduction|| |
The World Health Organization (WHO) defines oral health as “Oral health has a multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.” Oral health is a key factor influencing good general health and is quintessential for well-being.
Dental caries is the most common among the spectrum of oral diseases and is still a major public health burden in developing countries, affecting 60%–90% of school children and several adults. This reason could be largely due to the increased consumption of sugars and reduced exposure to fluoride. A substantial improvement in the reduction of the disease has not yet been achieved.
Children of all age groups are affected by dental caries, enamel fluorosis, dental trauma, and developing malocclusion. Malocclusion and enamel defects like enamel hypoplasia also contribute to the burden of dental caries by creating an environment favorable to the development of dental caries in children suffering from such conditions and also make teeth vulnerable to traumatic dental injuries (TDI) in children The treatment of these conditions is not only expensive but also demanding for the child as well as parents.
TDIs have been projected as the fifth most prevalent disease worldwide. As per literature, the global prevalence of TDI has been estimated to be 13%–17.5%, while the pooled prevalence of TDI in India was found to be 13%.
Oral diseases continue to have a high prevalence despite the decline in dental caries in some developed countries. The best approach, which is most acceptable and economical for the children is prevention. To assess the magnitude of the preventive task it is necessary to know the extent and severity of the disease. Schools are the best centers for effectively implementing comprehensive health-care programs, as they are accessible to most children.
Hence, it becomes imperative to collect the data on the prevalence of dental caries and associated factors such as enamel fluorosis, dental trauma, and malocclusion to formulate the policies and guidelines to determine the course of action for preventive care.
The present study was conducted to assess the oral health status by determining the prevalence of dental caries, enamel fluorosis, dental trauma, malocclusion, and the necessity of treatment needs among school-going children aged 6–10 years of Kochi, Kerala, India. The data were collected to get an insight into the basic knowledge about the oral health status and the treatment needs among this population. These data were also used for planning preventive and restorative oral health programs in the population studied.
| Materials and Methods|| |
The present study was an observational cross-sectional study.
Primary Government Schools of Willingdon Island, Kochi.
Children belonging to both the sexes attending government schools of Kochi who had entered 6th or 9th year on their last birthday and in whom permanent first molars had erupted, were included in this study after taking consent from the parents and permission from the head of the school.
Noncooperative children, children with special healthcare needs, those who were undergoing orthodontic therapy, and children providing incoherent history were excluded from the study.
Stratified random sampling was followed, and age group and gender were stratified.
Sample size calculation
Sample size calculation was done based on previous studies of similar nature. The final sample size was 533 children.
Ethical clearance was obtained from the institution. Informed consent and permission for examination were obtained from the parents and from the institutions to collect the demographic data and oral health status. School authorities and parents were notified in advance about the examination dates so that a maximum number of students could be present at the time of the survey. O/o DGAFMS letter no 19569/DG-3B dated 01 Sep 2019.
Data collection and dental examination
The examiners were trained and calibrated by the principal investigator. The consistency of the examination criteria was measured by a pretest done over 50 school children at a 2-week interval to establish intra-examiner reproducibility. These children were not part of the final sample. Inter examiner agreement was checked using Cohens' kappa statistics. Inter-examiner reliability yielded a Kappa value of 0.73 and 0.80, for the worst and best agreement, respectively.
A pretested and prevalidated screening form based on the WHO oral health assessment form was used to collect the data. WHO Oral Health Assessment Form for Children, 2013 was divided into three parts: demographic data (age, sex, class) Hard tissue status (caries, dental trauma, enamel fluorosis, and malocclusion) treatment intervention of both primary and permanent teeth. The children from the primary schools who were present on the days of visits were examined.
All aseptic precautions were carried out at the time of oral examination American Dental Association Type III clinical examination was followed for the oral examination. Clinical examinations were carried out in the classroom under natural light with the patient seated on a stool and the examiner seated on a chair behind the subject. Children were interviewed by examiners who knew the local language and recorded the socio-demographic data.
The school children requiring complex treatment were referred to a dental hospital. Recorded data were transferred from the precoded survey pro forma to a Microsoft excel sheet on a computer.
These data were entered into the excel sheets and analyzed using SPSS for Windows, Version 25, SPSS Inc. Chicago, IL, USA. The means and percentages were calculated, and comparison was done using ANOVA, Chi-square test, and Student's t-test to find the difference in proportion. The significance level was set at a P value (P < 0.05).
| Results|| |
The socio-demographic characteristics of the studied children are shown in [Table 1]. Out of a total of 533 students, the majority (58.16%) were males and were studying in Class 3 and Class 4.
The dentition status decayed, missing and filled teeth (DMFT) and prevalence of dental caries of the surveyed children are shown in [Figure 1] and [Figure 2], respectively. The overall prevalence of dental caries in the present study was found to be 50.09% (267). Children having teeth with active carious lesions and not restored were found to be 36.96% (197) while 7.50% (40) have filled teeth without secondary caries and 5.63% (30) had caries secondary to restorations, 6.75% (36) had lost their teeth due to caries. The prevalence of enamel fluorosis as per results obtained from the present study was found to be 3.38% (18) [Figure 3]. The prevalence of TDI among students was found to be 1.69% (9), out of which only 1.50% (8) students had treated injury while only one student had a traumatic dental injury with pulp involvement [Figure 4].
A comparison of the classes surveyed concerning mean DMFT scores was carried out using the ANOVA [Table 2]. A significant difference was observed between different class students (F = 8.5660, P < 0.05). It can be inferred that the students who belonged to class three had a significantly higher mean DMFT as compared to others. A significant difference was observed between different class students concerning mean DT scores (F = 4.6372, P < 0.05). It was observed that students belonging to class two had significantly higher mean it as compared to others. A significant difference was observed between different class students concerning mean MT scores (F = 5.6837, P < 0.05). It was observed that student who belongs to Class 3 has significantly higher mean mt as compared to others.
|Table 2: Comparison of classes with mean caries experience by one-way ANOVA|
Click here to view
A comparison of ages with mean caries experience by one-way ANOVA of the classes surveyed is displayed in [Table 3]. A significant difference was observed in students belonging to different age groups concerning mean DMFT scores (F = 7.0836, P < 0.05). It was observed that students in 8 years of age group had significantly higher mean DMFT as compared to other age groups. A significant difference was also observed among students belonging to different age groups concerning mean it scores (F = 2.9565, P < 0.05). It was observed that students belonging to the age group of 8 years had significantly higher mean it as compared to others. A significant difference was observed among students belonging to different age groups concerning mean mt scores (F = 4.5951, P < 0.05). Again, students belonging to the age group of 8 years had significantly higher mean mt as compared to others.
A significant association was observed between the prevalence of dental caries and the class in which the child was studying (Chi-square = 13.6770, P = 0.0030) and between the prevalence of dental caries with age of the child (Chi-square = 12.8030, P = 0.0120). No significant association was observed between gender and prevalence of dental caries ((Chi-square = 2.3390, P = 0.1260) [Table 4].
The prevalence of malocclusion as per results of present study was found to be 2.63% (14). Majority of students were found to have Class I malocclusion. The status of malocclusion is shown in [Figure 5].
The status of treatment needs is shown in [Figure 6]. Treatment needs status among students as per results of present study revealed that out of a total of 533 students, 85 (15.95%) students needed a preventive or routine treatment while 9.76% students needed orthodontic intervention and only 2 students (0.38%) needed immediate (urgent) treatment and were referred to nearest dental center. A significant association was observed between treatment needs and class in which a child was studying (Chi-square = 94.2900, P = 0.0001) and between treatment needs with age of child (Chi-square = 86.5790, P = 0.0001), but no significant association was found between gender and treatment needs (Chi-square = 5.3600, P = 0.3740) [Table 5].
| Discussion|| |
Most of the studies carried out have investigated the dental caries among children at the two age groups: less than or equal to 6 and 12 years or higher. The present study has provided data on the prevalence and associated factors of dental caries including enamel fluorosis, malocclusion, and treatment needs at primary/mixed dentition stage among 6–10-year-old school children. The caries prevalence of primary and mixed dentition obtained in this study was on similar grounds as compared to results obtained from studies of similar nature conducted over different parts of India.,, Age group of 8–9-year-old showed higher caries prevalence that too in primary teeth, because caries is a cumulative process. These results were in concurrence to results found from other studies conducted earlier. This may be due to lack of awareness about oral health and over retention of primary teeth as well as the parental attitude that the primary teeth are exchangeable by permanent teeth and are not important. This could also be attributed to the fact that the population surveyed was a mixed Indian population coming from different socioeconomic and cultural backgrounds.
In the present study, there was no significant difference in the prevalence of dental caries with regard to gender (P > 0.05). Similar results were found in study conducted by Poornima et al., and Ndanu et al., Contrary to the results obtained from present study, results obtained from the study conductedby Shekar et al., found a prevalence of dental caries which was significantly more among boys than in girls.
The present study revealed that the prevalence of enamel fluorosis in the primary school students was just 3.38%. This is lower as compared to the result obtained by study conducted by Reddy et al. in south Indian population as well as compared to regional population studies carried out across India in urban and rural centers.,,, The lower prevalence of fluorosis in study population could be due to the reason that current study population was a mixed population group having variations in the water fluoride level where the children resided. Another reason could be different frequency of fluoride intake at different ages that would have corresponded with the development of different teeth.
The prevalence of TDIs among present study population was found to be 1.69% which is far lesser than national prevalence. The reason for same could be mixed population of study sample with teeth in different stages of eruption. These results also indicate a good level of awareness regarding TDI among parents and teachers of study population.
This survey revealed that, the prevalence of malocclusion among students is 2.63% which is lesser than national prevalence (28.4%–66.7%). Similar results were obtained from studies conducted on urban populations in cities of South India.,
Treatment needs status among students revealed that, out of a total of 533 students only 85 students needed a preventive or routine treatment and 2 other students needed immediate or urgent treatment. A total of 9.76% students needed orthodontic intervention. These results were in concurrence with other studies conducted pan India in urban centers.,,, These results necessitate the development of immediate and effective oral health promotional and interventional strategies to combat various oral diseases on a regional scale.
Since there was less disparity between socioeconomic statuses of the children included in the study population; it was not included in the present study. Studies of similar nature that have a larger sample size and consider more contributing factors to various oral conditions are required.
| Conclusion|| |
The high prevalence rate of caries shows that further follow-up and awareness among the teachers, parents, and students regarding dental caries and dental hygiene is needed. Further, studies on a larger sample are required to correlate the prevalence of dental caries in the target population with other socio-behavioral factors.
Limitation of the study
- Sample size was small
- Various contributing factors to dental caries such as oral hygiene practices, socioeconomic status, sugar consumption, meal snacking, and attitude toward dental services need to be considered.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]