|Year : 2020 | Volume
| Issue : 1 | Page : 23-27
Oral health screening of residents of bhagwanpur rural municipality, Siraha, Nepal
Krishna Subedi1, Abanish Singh2, Ashish Shrestha2, Tarakant Bhagat2, Prajjwal Pyakurel3, Santosh Kumari Agrawal1
1 Department of Public Health Dentistry, College of Dental Surgery, BPKIHS, Dharan, Nepal
2 Narayani Hospital, Birgunj, Parsa, Nepal
3 School of Public Health and Community Medicine, BPKIHS, Dharan, Nepal
|Date of Submission||28-May-2019|
|Date of Acceptance||19-Jul-2019|
|Date of Web Publication||24-Jan-2020|
Department of Public Health Dentistry, College of Dental Surgery, BPKIHS, Dharan
School of Public Health and Community Medicine, BPKIHS, Dharan
Source of Support: None, Conflict of Interest: None
Context: Dental caries, gingivitis, and periodontitis are very common oral health problems of Nepalese population, and the severity is more among underprivileged population groups.
Aims: This study aimed at screening for oral hygiene status, oral mucosal condition, gingival condition, dental caries, tobacco use, and socioeconomic status of residents of Bhagwanpur Rural Municipality, Siraha, Nepal.
Settings and Design: A descriptive cross-sectional study was conducted among residents of Bhagwanpur Rural Municipality.
Subjects and Methods: This study was conducted among randomly selected 285 people aged 5–85 years from 142 households of Bhagwanpur Rural Municipality, Siraha, Nepal. The Modified Kuppuswamy Scale was used for assessing socioeconomic status. Oral examination was performed using mouth mirror and the World Health Organization (WHO) probe as mentioned in the WHO Oral Health Survey Methods 1997. Oral hygiene status, oral mucosal conditions, gingival status, dentition status, and treatment needs were recorded. Tobacco prevalence was assessed through structured questionnaire.
Statistical Analysis Used: Frequency distribution, mean, standard deviations, prevalence of dental caries, and tobacco use were calculated.
Results: Majority (166, 58.2%) were male. The mean decayed, missing, and filled teeth (DMFT) and decayed and filled teeth (dft) were found to be 2.00 ± 4 and 0.60 ± 1, respectively. The prevalence of dental caries in permanent and primary dentition was 41.5% and 37.6%, respectively. Oral health status was poor. All the participants had inflamed gingiva. The tobacco prevalence was 95 (33.33%). Majority of people (253, 88.8%) belonged to low-socioeconomic status.
Conclusions: The study showed poor oral hygiene, low dft/DMFT, lower prevalence of dental caries, and high tobacco use prevalence, and a higher number of people belonged to low-socioeconomic status.
Keywords: Bhagwanpur Rural Municipality, Nepal, oral health, screening, tobacco
|How to cite this article:|
Subedi K, Singh A, Shrestha A, Bhagat T, Pyakurel P, Agrawal SK. Oral health screening of residents of bhagwanpur rural municipality, Siraha, Nepal. J Oral Res Rev 2020;12:23-7
|How to cite this URL:|
Subedi K, Singh A, Shrestha A, Bhagat T, Pyakurel P, Agrawal SK. Oral health screening of residents of bhagwanpur rural municipality, Siraha, Nepal. J Oral Res Rev [serial online] 2020 [cited 2020 Jul 13];12:23-7. Available from: http://www.jorr.org/text.asp?2020/12/1/23/276704
| Introduction|| |
Globally, oral health problem exists particularly among underprivileged groups in both developing and developed countries, despite the great improvements in oral health of populations in several countries. Although it is highly preventable, a meaningful proportion of the Nepalese population experiences oral health problems, especially poor and marginalized individuals. In Nepal, there have been a significant amount of dental problems identified, but the prevention and treatment of oral diseases is virtually unavailable to the rural population. Dental caries, gingivitis, and periodontitis are very common oral health problems of Nepalese population, and the tobacco use is more among underprivileged population. This study targets socially and economically deprived population. There is a paucity of research conducted targeting people of such places in Nepal. Mostly illiterate and uneducated population resides in that community. There is a need for oral health promotion targeting such population. Access is one of the main barriers of dental care delivery system in this community.
The objectives of the study were to screen for oral hygiene status, oral mucosal condition, gingival condition, dental caries, tobacco prevalence, and socioeconomic status of residents of Bhagwanpur Rural Municipality, Siraha, Nepal.
| Subjects And Methods|| |
A community-based descriptive cross-sectional study was conducted among the residents of Bhagwanpur Rural Municipality, Siraha, Nepal. Ethical approval for the study was obtained from the Institutional Review Committee (IRC), BPKIHS, Dharan, Nepal (Ref. No. 397/074/075-IRC). Written informed consent was obtained from the individuals of 18 years or older. Proxy consent was taken for the individuals <18 years. As the people of <18 years could not give written informed consent, it was mandatory for them to be accompanied by guardians of 18 years or older from the same households. Randomly selected 285 people of Bhagwanpur Rural Municipality, Siraha, Nepal, were included in the study.
The inclusion criteria were at least one child or adolescent below 18 years of age in the family and at least one adult respondent (above 18 years) of the family. The exclusion criteria were people not willing to participate, people with debilitating disease, and people not in the condition for oral screening (trauma and severe medical illness). The sample size was calculated by taking the prevalence of dental caries (60.3%); considering 10% relative precision, 95% confidence interval, and 10% nonresponse rate, the calculated sample size was 277.
Cluster sampling followed by simple random sampling was used. There were totally five wards comprising 3541 households and 21389 population. Of the five wards, two wards (ward number 2 and 5) of the municipality were randomly selected as clusters followed by random selection of the houses in each ward. There were about 1300 households in these two wards. For random selection of the houses, a social mapping was made where a significantly identifying character was identified as a landmark to guide for random selection of the houses. Every eighth house from the landmark was considered into the study. Then, two participants (one child/adolescent and one adult) were selected among the present individuals in the house at the time of visit by simple random sampling through lottery method.
Questionnaires with demographic profile included age, sex, education level, occupation, income, socioeconomic status, tobacco use, and forms of tobacco. The Modified Kuppuswamy Scale was used for socioeconomic status which includes the education, occupation of head of the family, and income per month from all sources. Education and occupation do not change as per time, but the income varies with time, so during modification of Kuppuswamy Scale, the income was recategorized based on the current Consumer Price Index of the current year 2017. The current Consumer Price Index was obtained online from Nepal Rastra Bank website (Nepal RB 2017), and the conversion factor was calculated (conversion factor = Consumer Price Index 2017 divided by Consumer Price Index of 1976).
All the participants were examined at their houses during home-to-home visit by two trained and calibrated examiners, under natural light using plane mouth mirror and the World Health Organization (WHO) periodontal probe. Duplicate examination was performed among 25 participants during the study to test the interexaminer reliability which was measured by Cohen's kappa.
Clinical assessment was done as mentioned in the WHO Oral Health Survey Methods 1997. Oral hygiene status, oral mucosal conditions, gingival status, dentition status, and treatment needs were recorded as per standard guidelines.
The outcomes measured were oral hygiene status, oral mucosal condition, gingival status, prevalence of dental caries, tobacco use, and socioeconomic status.
For statistical analysis, data obtained were entered in Microsoft Excel Sheet 2007 and analyzed using Statistical Package for the Social Sciences (SPSS version 11.5, SPSS, Inc., Chicago, IL, USA). Descriptive statistics including the mean and standard deviations were computed for decayed, missing, and filled teeth (DMFT)/decayed and filled teeth (dft). Frequency distribution (percentage and table) among the study population was calculated for gender, age, tobacco consumption, oral health status, visual periodontal index, and oral mucosal condition.
| Results|| |
A total of 285 people were enrolled in the study, and majority (58.2%) were male. In <18 years and ≥18 years, majority were male (54.1% and 62%, respectively). According to the Modified Kuppuswamy Scale 2017, more than three-fourth of the population (88.8%) belonged to low-socioeconomic status followed by only 11.2% in middle class.
[Table 1] shows the tobacco prevalence. The overall tobacco prevalence was 33.33%. Smokeless tobacco was the most prevalent tobacco form followed by both smoking and smokeless forms and smoking only. Majority (77.9%) consumed smokeless tobacco. It was more prevalent among males (91.6%) as compared to females (7, 8.4%) in ≥18 years' age group.
|Table 1: Tobacco use (n=12 and 83 in <18 years and ≥18 years, respectively)|
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All people had plaque. Almost 76% had plaque, calculus, and stain, whereas 2.5% had plaque and calculus and 16.8% had plaque and stain [Table 2].
All the participants had inflamed gingiva. Ulceration was present in 9.3% in ≥18 years' age category, whereas a single individual had ulceration in <18 years' age group. Profuse bleeding was present in a single person in both the groups [Table 3].
Acute necrotizing gingivitis, abscess, and mucocele were found in one person each in <18 years' age group, whereas tobacco pouch keratosis was most frequent (23.3%) followed by aphthous ulcer (3.3%) and abscess (1.4%) in ≥18 years' age categories [Table 4].
|Table 4: Oral mucosal condition (1 or more condition can occur in same individual) (n=135 and 150 in <18 years and ≥18 years, respectively)|
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The prevalence of dental caries was found to be more in permanent dentition than primary dentition (41.5% versus 37.6%). The mean DMFT and dft of the dentitions were 2.00 ± 4 and 0.60 ± 1, respectively.
| Discussion|| |
This cross-sectional study was deliberated to screen oral hygiene status, oral mucosal conditions, gingival condition, dental caries, and tobacco prevalence along with socioeconomic status of residents of Bhagwanpur Rural Municipality, Siraha, Nepal.
Most of the people were living in low-socioeconomic status (88.8%). Tobacco prevalence was found to be 55.3% in ≥18-year-old people, which is in accordance with the studies conducted by Singh et al. in which 52% of workers consumed tobacco. This is in contrast to a study conducted by Sreeramareddy et al. where tobacco use prevalence was found to be lower (30.3%). It is similar to a study done in Nepal where the prevalence is significantly higher in males as compared to females. High prevalence of smokeless tobacco was found similar to that of Sreeramareddy et al. where tobacco chewing was more prevalent in eastern and Terai/plain region of Nepal. It is in contrast to a study conducted by Shrestha et al. and the WHO's STEPwise approach to noncommunicable disease risk factor surveillance survey in Nepal where smoking is more prevalent than tobacco chewing (78% vs. 59%; 35.5% of men and 15% of women vs. 31.2% of men and 4.6% of women, respectively). High tobacco prevalence may be correlated to low-socioeconomic status as tobacco use is found to be more in people living with low-socioeconomic status.,, More prevalence of smokeless tobacco consumption may be associated with the production of tobacco at local level. Most of the people harvest tobacco in their own field.
Globally, poor oral hygiene occurs due to increased plaque, and calculus deposits with increased age have been reported. In this study, oral health status was found to be poor. All (100%) had plaque, 77.9% (222) had plaque and calculus, and 75.4% (215) had supragingival plaque, calculus, and stains. This is in line with the studies done by Carneiro and Kabulwa in 14–17-year-old school students which showed a high proportion of students with supragingival plaque and calculus. It showed that most of the people had poor oral health, may be due to poor knowledge, not performing oral hygiene practices adequately, and require oral health awareness and oral prophylaxis.
All the participants had inflamed gingiva. Not a single person had healthy gingiva. Ulceration was present in 9.3% (14) in ≥18-year-old adults, whereas only one person (0.7%) had ulceration in <18 years' age group. Profuse bleeding was present in only single person in both the groups. Recording periodontal status was done on the basis of the presence/absence of gingival inflammation, ulceration, and profuse bleeding which may not show the severity of gingivitis and periodontal destruction.
Of 83 people who used tobacco products in the ≥18 years' age category, tobacco pouch keratosis was the only tobacco-associated lesion which was 42.1% (35). It was found to be higher as compared to studies done by Joshi and Tailor (30.1%) and Chandra and Govindraju (1.4%), but no any other precancerous lesion was seen in the current study population.
The dft value was 0.60 ± 1 which was less compared to Bhagat and Shrestha (1.82 ± 2.57), Karki et al. (2.32 ± 2.53), and Limbu et al. (3.28 ± 3.581). The prevalence of dental caries in primary dentition was found to be low (37.6%) in comparison to studies done by Bhagat and Shrestha (60.3%), Karki et al. (66.90%), and Limbu et al. (55.6%). The DMFT value was 2.00 ± 4 which was higher as compared to Bhagat and Shrestha (0.37 ± 0.87) and Karki et al. (0.66 ± 1.34), and the mean DMFT score of 12–13-year-olds was 1.1. This may be because all these studies were in schoolchildren aged 6–12 years, whereas the current study was conducted in people aged 5–85 years. Meanwhile, DMFT in the current study was lower as compared to the average worldwide DMFT (2.11 ± 1.32). The prevalence of dental caries in permanent dentition was found to be lower (41.5%) in comparison to a study done by Bhagat and Shrestha (55.6%). In contrast to this current study, it was found to be lower in a study done by Karki et al. (29.57%). Despite poor oral hygiene, caries prevalence in this study was found to be lower due to the fact that fluoride concentration in natural water resources in Siraha was high (1.80 ppm).
There were few limitations of the study. First of all oral health status was assessed on the presence/absence of supragingival plaque, calculus, and stains only. Recording periodontal status was done on the basis of the presence/absence of gingival inflammation, ulceration, and profuse bleeding which could not provide the severity of gingivitis and periodontal destruction. This study was done in a limited time period. However, the data provide brief insight of oral health condition of people for which further health program and policy from the government level could be done to improve the condition of population in this area.
Random sampling technique for selection of sample where children, adolescents, and adults were equally selected is the strength of the study which accounts for representativeness and generalizability of the study among residents of Bhagwanpur Rural Municipality, Siraha, Nepal.
| Conclusions|| |
The study showed a low dft/DMFT and lower prevalence of dental caries which is encouraging, but at the same time, the burden of treatment was high as decayed component constituted the major portion of dft and DMFT with negligible proportion of filled component. Poor oral hygiene seems to be due to lack of oral health knowledge and practices. High tobacco prevalence is alarming which indicates providing awareness program and putting some regulations on tobacco production and utilization. Although no cancerous patient was seen during the study, people should be made aware about harmful consequences of tobacco use. Therefore, focus should be given on prevention through oral health promotion and education on harmful effects of tobacco use rather than on treatment which a developing country like Nepal cannot afford.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-9.
Thapa P, Aryal KK, Mehata S, Vaidya A, Jha BK, Dhimal M, et al.
Oral hygiene practices and their socio-demographic correlates among Nepalese adult: Evidence from non communicable diseases risk factors STEPS survey Nepal 2013. BMC Oral Health 2016;16:105.
Cook J. Socioeconomic status and tobacco use. Int J Glob Health Health Disparities 2005;3:83-8.
Bhagat TK, Shrestha A. Prevalence of dental caries among public school children. J Chitwan Med Coll 2014;4:30-2.
Ghosh A, Ghosh T. Modification of Kuppuswamys socioeconomic status scale in context to Nepal. Indian Pediatr 2009;46:1104-5.
Singh M, Ingle NA, Kaur N, Yadav P, Ingle E, Charania Z. Dental caries status and oral hygiene practices of lock factory workers in Aligarh city. J Int Oral Health 2015;7:57-60.
Sreeramareddy CT, Ramakrishnareddy N, Harsha Kumar H, Sathian B, Arokiasamy JT. Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: A secondary data analysis of Nepal demographic and health survey-2006. Subst Abuse Treat Prev Policy 2011;6:33.
Shrestha A, Rimal J, Singh SB, Khanal VK. Oral health and tobacco issues among the people of Garamani village in Eastern Nepal. J Nepal Dent Assoc 2013;13:1-5.
Carneiro LC, Kabulwa MN. Dental caries, and supragingival plaque and calculus among students, Tanga, Tanzania. ISRN Dent 2012;2012:245296.
Joshi M, Tailor M. Prevalence of most commonly reported tobacco-associated lesions in central Gujarat: A hospital-based cross-sectional study. Indian J Dent Res 2016;27:405-9.
] [Full text]
Chandra P, Govindraju P. Prevalence of oral mucosal lesions among tobacco users. Oral Health Prev Dent 2012;10:149-53.
Karki S, Wangdu K, Kunwar N, Namgyal K. Prevalence of dental caries among 6-12 years old Tibetan children residing in Nepal. Int J Dent Med Res 2015;1:51-3.
Limbu S, Dikshit P, Bhagat T. Evaluation of dental caries among preschool children in Kathmandu-using significant caries index. JNMA J Nepal Med Assoc 2017;56:341-5.
Da Silveira Moreira R. Epidemiology of Dental Caries in the World. In: Oral Health Care-Pediatric, Research, Epidemiology and Clinical Practices. Rijeka, Croatia: InTech; 2012.
Singh A, Shrestha A, Bhagat T. Fluoride level in drinking water sources of Eastern Nepal. J Nepal Health Res Counc 2019;16:414-8.
[Table 1], [Table 2], [Table 3], [Table 4]