|Year : 2019 | Volume
| Issue : 1 | Page : 1-6
Oral Health Status of Martyr Memorial Residential School Children of Sunsari, Nepal
Santosh Kumari Agrawal, Ashish Shrestha, Tarakant Bhagat
Department of Public Health Dentistry, CODS, BPKIHS, Dharan, Nepal
|Date of Submission||29-Nov-2018|
|Date of Acceptance||01-Jan-2019|
|Date of Web Publication||6-Mar-2019|
Santosh Kumari Agrawal
Department of Public Health Dentistry, CODS, BPKIHS, Dharan-18
Source of Support: None, Conflict of Interest: None
Context: Students, who are healthy, active, and well nourished, are likely to attend schools regularly which accelerate their learning process. Poor oral health has a profound effect on general health and quality of life.
Aims: The aim of this study was to assess the oral health status of Martyr Memorial Residential School Children of Sunsari, Nepal, during 5-year period and also to assess the effectiveness of school oral health program.
Settings and Design: A retrospective longitudinal study was carried out among Martyr Memorial Residential School children.
Subjects and Methods: Aretrospective longitudinal study was performed among 411 school children of Martyr Memorial Residential School, Sunsari, Nepal. Five years' data of children were collected from the department record forms from 2009 to 2014. Data on demographic parameters, oral health condition (Decayed, Missing, and Filled Teeth [DMFT], oral hygiene status, type of dentition, malocclusion, and diet history), and treatment done for each child were collected from the surveyed forms.
Statistical Analysis Used: Frequency distribution, prevalence, and incidence of dental caries were calculated.
Results: This study showed that the prevalence of dental caries in 2009, 2010, 2011, 2012, 2013, and 2014 was 21.0%, 23%, 29.1%, 10.0%, 13.5%, and 30.9%, respectively. The incidence of dental caries in permanent dentition was high (22.0%) in 2011 follow-up. None of the dentition developed new cavity in 2010 follow-up period. More than half of the children had good oral hygiene status in 2012, whereas only 32.9% had so in 2009. Majority (95.5%) of the enrolled children had normal occlusion.
Conclusions: This study showed the overall positive impact on the children's prevalence and incidence of dental caries as well as on oral hygiene status. The incidence of developing new caries in both types of dentition decreased. There was an increase in filled component of DMFT/decayed, filled teeth index. Most of them had good oral hygiene status at the end of the study.
Keywords: Dental caries, oral hygiene status, school children
|How to cite this article:|
Agrawal SK, Shrestha A, Bhagat T. Oral Health Status of Martyr Memorial Residential School Children of Sunsari, Nepal. J Oral Res Rev 2019;11:1-6
|How to cite this URL:|
Agrawal SK, Shrestha A, Bhagat T. Oral Health Status of Martyr Memorial Residential School Children of Sunsari, Nepal. J Oral Res Rev [serial online] 2019 [cited 2020 Apr 10];11:1-6. Available from: http://www.jorr.org/text.asp?2019/11/1/1/253431
| Introduction|| |
Good oral health is essential for life because poor oral health has a profound effect on general health and quality of life. The health of students has great impact on academic career. Students, who are healthy, active, and well nourished, are likely to attend schools regularly which accelerate their learning process. There are various oral diseases prevailing worldwide such as dental caries, periodontal disease, and tooth loss, which are found to be major public health problems and affecting people daily lives and well-being.
Dental caries is a multifactorial oral disease developed by the localized dissolution of the hard tooth tissues, caused by bacteria. It is the most prevalent dental disease of childhood. It was found that caries is five times more common than asthma among children. In developing countries, changing lifestyle and dietary pattern are leading to marked rise in the incidence of dental caries. Nepal has a high morbidity of dental caries in all age groups of both genders. According to the National Oral Health Policy 2004, the prevalence of dental caries is 67% and 41% in the age groups of 5–6 years and 12–13 years children, respectively. Malocclusion has been a significant oral health problem among children. The prevalence of Class I, II, and III malocclusion in a population of Eastern Nepal is 67.5%, 28.8%, and 3.7%, respectively, and it is most commonly seen in the age group of 12–24 years. Thus, the assessment of the prevalence of dental caries and malocclusion would help in identifying the subpopulation at risk and the predictors associated with it as well. However, in Nepal, majority of the studies investigating risk factors or magnitude of the dental diseases adopted cross-sectional design. There is a paucity of data of various dental diseases based on long-term follow-up that involve children of residential schools. Early identification of these patients would allow health authorities to develop or optimize preventive strategies targeting high caries risk individuals and to increase the efficiency of preventive programs within the community. Thus, the study was conducted with an objective of assessment of oral health status among schoolchildren of Martyr Memorial Residential School, Sunsari, Nepal, during 5-year period and also to assess the effectiveness of school oral health program.
| Subjects and Methods|| |
A longitudinal study was conducted from March 2015 to September 2015 among school children of Martyr Memorial residential school, Hansposha, Sunsari. Registry analysis was done on the data of school surveyed from 2009 to 2014 by the Department of Public Health Dentistry, B.P. Koirala Institute of Health Sciences (BPKIHS). The sample size was calculated by taking the lowest prevalence among the outcome variables that are of dental caries (60.3%); calculated sample size was 264. However, this study is a part of ongoing school oral health program conducted biannually by BPKIHS, Dharan. Under this program, all the children were provided basic dental treatment such as atraumatic restorative treatment and extraction of hopeless tooth as well as oral health education mainly focused on toothbrushing, diet, and their impact on progression of dental caries. This program was started in 2009 in this school. At that time, the school had classes one to five later on classes had been added up till ten. Initially, we had analyzed a group of 73 students' oral examination forms from 2009 to 2014 from their first standard. In the next part, oral examination forms of new incoming children were analyzed separately each year. All the children aged 6–13 years were followed up from their admission date until 2014. Hence, the longest duration we could follow them up was 5 years. Data on demographic parameters (age and gender), oral health condition (Decayed, Missing, and Filled Teeth and decayed, filled teeth [DMFT and dft], oral hygiene status, type of dentition, malocclusion, and diet history), and treatment done for each child were collected from the oral examination forms, whereas forms with inadequate information were excluded from the study. Before the conduction of the study, training and calibration of the examiners were done in the Department of Public Health Dentistry, BPKIHS. Ethical approval was obtained from the Institutional Review Committee (IRC), BPKIHS, Dharan (Reference No. 110/073/074-IRC). Written consent was obtained, before the examination and treatment of the children from the Head of the Martyr Memorial Residential School, Sunsari, and parents of the children. Verbal consent was obtained from the participants. For statistical analysis, data obtained were entered into Microsoft Excel Sheet version 2007 and analyzed using the Statistical Package for the Social Sciences (SPSS version 11.5, SPSS, Inc., Chicago, IL, USA). Frequency, prevalence, and incidence of dental caries were calculated from the collected data.
| Results|| |
The total number of collected forms were 500, out of which 411 (n = 73 (2009), 161 (2010), 53 (2011), 36 (2012), 22 (2013), and 66 (2014)) completely filled forms were analyzed. Total number of male participants were 220 (53.5%) and female 191 (46.5%).
In 2009, a total of 73 oral examination forms of children with full information were analyzed for 5 years. Oral health status of the children aged range 6–13 years was evaluated and majority (n = 58) were male and few (n = 15) were female. However, during the follow-up period, information from 17 forms could not be retrieved because of incomplete clinical record, or children were absent at the time of examination and procedure and itineration. The prevalence of dental caries (n = 73) at baseline for permanent and primary teeth was 23.0% and 42.5%, respectively, and after 5 years, the prevalence increased to 32.1% for permanent teeth and decreased to 26.7% for primary teeth. The incidence of developing a new cavity in permanent teeth was highest (10.7%) in (n = 56) 2014 whereas lowest (1.7%) in (n = 59) 2012, with increasing number of filled components as shown in [Figure 1]. Children developing new cavity in primary teeth was highest (9.38%) in (n = 64) 2010 and gradually decreased in subsequent years lowering to 3.6% in (n = 56) 2014. Interestingly, none of the children developed dental caries in primary dentition in (n = 55) 2013. Filled component (f) of the dft showed increment as compared to decayed teeth as shown in [Figure 2].
[Table 1] shows the oral hygiene status at baseline (n = 73 in 2009) and at follow-up for 5 years. Nearly, 36% of the children had good oral hygiene, 58.9% had fair, and 5.5% had poor oral hygiene. After 5-year follow-up, it was found that more than 80% had good oral hygiene. All of the students had Class I occlusion bilaterally and few (2.7%) had crowded lower anterior teeth.
|Table 1: Oral hygiene status of the children followed up in year from 2009 to 2014|
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In 2010, a total of 161 new students were examined. At baseline examination, the prevalence of dental caries in permanent and primary dentition was 23.5% and 44.51%, respectively. The prevalence of dental caries in permanent and primary dentition decreased from the year 2010–2014 to 6.6% and 7.4%, respectively. The percentage of children with new dental caries for both types of dentition had decreased in subsequent years; however, the filled component had increased as shown in [Figure 3] and [Figure 4]. [Table 2] shows the oral hygiene status of the children from 2010 to 2014. The percentage of children with good oral hygiene status in each year had increased and reached 73.5% by 2014. Out of the total study sample (n = 161), 96.7% had normal occlusion, 2.2% had Class II, and 1.1% had class III malocclusion. Only one child had enamel hypoplasia and microdontia.
|Table 2: Oral hygiene status of the children followed up in year from 2010 to 2014|
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In 2011, 53 new children were followed up for 3 years and the prevalence of dental caries was 26.9% and 52.8% for permanent and primary dentition, respectively. On subsequent years, the prevalence of dental caries decreased to 20.4% for permanent dentition and 45.4% for primary dentition. The incidence of new cavity was high for permanent teeth in (n = 44) 2013 but primary teeth were caries free, with increasing incidence of filled component of DMFT and dft as shown in [Figure 5] and [Figure 6]. More than three fourth of the students (84.1%) had good oral hygiene at the end of the follow-up from baseline (37.7%) as shown in [Table 3]. Most of them (96.3%) had normal Class I occlusion, 3.7% had crowded anterior teeth (Class I malocclusion), and one student had the presence of mesiodens.
|Table 3: Oral hygiene status of the children followed up in year from 2011 to 2013|
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In 2012, a total of 36 students were enrolled in this year. The prevalence of dental caries in permanent and primary teeth at baseline was 19.35% and 41.1%, respectively. After 2-year follow-up (2014), the prevalence of dental caries in permanent teeth increased to 26.6% while in primary dentition decreased to 36.6%. [Figure 7] shows the increased incidence of decayed and filled component in permanent teeth. None of the children had developed new cavity in primary teeth, and the filled (f) component increased to 40% from baseline (17.6%). Three-fourth (77.8%) of the students had good oral hygiene at baseline and it increased to 89.6% by 2014 as shown in [Table 4]. Among the study population, 95% of them had normal occlusion and 5% had Class II malocclusion.
|Table 4: Oral hygiene status of the children followed up from 2012 to 2014|
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The prevalence of dental caries at (2013) baseline, of 22 newly enrolled students, was 8.7% and 47.8% for permanent and primary teeth, respectively. The incidence of new cavity had increased for both types of dentition by 16%, although the filled component had risen by 5.5% and 33.3% for permanent and primary teeth, respectively. At baseline (n = 22), half of the students (50.0%) had fair oral hygiene status, and after follow-up, more than half of them (56.5%) had good oral hygiene. All the students had normal Class 1 occlusion and 9% had crowded anterior teeth.
In 2014, a total of 66 newly enrolled students in year 2014 had 28.8% and 21.2% prevalence of dental caries in permanent and primary dentition, respectively. Total percentage of decayed (D) permanent teeth was 24.2% of the newly enrolled students, and decayed primary teeth (d) were 20%. Most of the children (49.3%) had fair oral hygiene, 40.3% had good oral hygiene, and only 10.4% had poor oral hygiene. Restoration was done in 10.6% of decayed permanent teeth and 15.1% of decayed primary teeth at the end of the study. Almost all of the children (95.5%) had Class I occlusion, 1.5% had Class II, 3.0% had Class III malocclusion, and 6.0% of them had crowded anterior teeth.
| Discussion|| |
The Study showed that over 5 years followed up, there was increase in prevalence of dental caries in permanent dentition from baseline to the end of the study (23%, 32.1% respectively). The reason for increasing prevalence could be children who were not followed up in subsequent years may have appeared at the end of the study or caries being a continuous and cumulative process had obviously increased within a span of 5-year follow-up. Dental caries shows the secular change pattern over time.
Das et al. in 2013 reported the overall caries prevalence in permanent teeth of schoolchildren of West Bengal as 28.06% which was more than the present study. Similarly, the high prevalence of dental caries was found by Kalra et al. 2011 in children of Panchkula, Haryana.
The current study showed the substantial reduction in the prevalence of dental caries in primary dentition from baseline 42.5% to the end of the study at 26.7%. This was similar to the finding reported by Praveen et al. (2013) and Sarvanan and Bhaskar, this may be attributed to the fact that toothbrushing more effective for removable of plaque from tooth surface and improvement of the oral hygiene status. The reduction in the prevalence of dental caries could be due to an exfoliation of a high percentage of carious teeth during the 5-year follow-up.
Findings from the baseline examination and subsequent follow-ups confirm that the caries experience in the primary dentition is greater than the permanent dentition. Fejerskov et al. described that the deciduous teeth have thin enamel as compared to the permanent teeth. As the enamel is thinner, the progression becomes faster and reaches the dentine sooner in deciduous teeth than in permanent teeth.
The incidence of dental caries was significantly decreasing in subsequent follow-ups in both types of dentition, but it had increased in 2014 in both primary dentition and permanent teeth. Children developed new caries because of frequent consumption of carbohydrate diet. Watanabe et al. had reported the possibility of caries incidence with high amount of carbohydrate consumption. These findings could be supported by our results. Milsom et al. also reported that among the children who were caries free at recruitment, 26.7% developed caries in their primary molar teeth during 3-year follow up. These data showed that developing a new caries lesion increased with age. Watanabe et al. also reported that the incidence of dental caries was significantly higher in children who consumed sugary beverages daily (20.4%).
Oral hygiene status of the children was fair at baseline since 2009, while on subsequent follow-up, all of them had good oral hygiene status. This could be due to good oral health education and self-motivation of the children improve awareness leading to adoption of a healthier lifestyle. Similar findings were reported by Pawar et al.
In the present study, it was observed that the children had low prevalence of malocclusion (2.7%). A study done by Shailee et al. in Himachal Pradesh, showed that it was more in 12-year-old children (58.1%). Pawar et al. reported crowding in the incisal segment in 37.58% children which is much higher than the present study (3.7%).
Some limitations of this study need to be addressed. First, the incidence of dental caries of each tooth was not calculated. Second, surface-wise incidence and prevalence of dental caries were not assessed. For that, recording form needs to be revised. Third, follow-up data of new children enrolled in 2014 could not evaluate as this program is ongoing and data are yet to be recorded. In view of the present study, the following recommendations are suggested, the oral health education programs for school teachers should be conducted, which would aid in decreasing the incidence of dental caries. School oral health programs should be made mandatory to all government and private schools and organized semiannually to reinforce the importance and maintenance of healthy oral cavity.
| Conclusions|| |
This study illustrated that the prevalence of dental caries was higher in primary dentition than in permanent dentition. The incidence of developing new caries in both types of dentition decreased with increase in filled component of DMFT/dft index. The present study also showed the positive impact on the oral hygiene status of the students. Most of them had good oral hygiene status at over the 5-year study period. Majority of the enrolled children had Class I occlusion.
The authors would like to express special thanks to the school Principal and all the students who agreed to participate in the study. We also express gratitude to the entire staff members, friends, dental students, and interns of Department of Public Health Dentistry.
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], [Figure 7]
[Table 1], [Table 2], [Table 3], [Table 4]