Prevalence of dental caries risk and effect of a multi component oral health program on caries risk among anganwadi children from Thiruvananthapuram

Dental caries is the most commoninfectious disease affecting human. This dental disease is preventable and yetcontinues to be a major public health problem predominantly affecting children.According to the National Oral Health Survey recently conducted throughoutIndia, dental caries was seen in 51.9% of 5yrs old children. The surveyrecommended a preventive dental health program such as use of fluoride toothpaste; water fluoridation should be initiated to address the problem of dentalcaries.9

Children have 20 primary teeth, whichoften erupt about 6months of age and usually when child is 2.5-3yrs old, allprimary teeth are found in the mouth. By 6yrs of age, many children are gettingtheir first adult molars. Primary teeth have function other than biting andchewing. They help to provide nutrition, aid in the normal development of thejaw bones and facial muscles, give face its normal appearances, make speechpossible, reserve space for the permanent teeth and help to guide them intoposition.10

One of the most important functions ofprimary teeth is reserving space for the permanent teeth and help to guide theminto position. So it is very important to maintain the health of the primaryteeth. Neglected cavities can lead to problems which affect developingpermanent teeth. Primary teeth also affect the development of speech and add toan attractive appearance. While the front four teeth last until 6-7 yrs of age,the back teeth (cuspids and molars) are not replaced until age 10-13. 11 As a permanent tooth is ready to erupt, the root ofthe primary tooth begins to dissolve. The permanent tooth pushes the primarytooth that has been resorbing for it. If a primary tooth is lost too soon, thepermanent tooth has no guide to follow. Also the teeth next to a missing toothmay drift into the space left by the missing tooth. In this situation dentistmay provide the child with a space maintainer. But it is preferable to takeearly preventive measures to prevent early tooth loss. So child can keep allprimary teeth until they are ready to be shed.

One of the latest research done inMalappuram, Kerala revealed that the prevalence of dental caries was seen morein children studying in government schools than in private schools which wasstatistically significant (P=0.018). There was no significant difference seenin the prevalence of calculus between government and private school children. Highprevalence of dental caries was found in these school children who suggested apoor performance of oral hygiene practices in them.12

A study done on early childhood carieslesions in preschool children in Kerala, India emphasized that the groups athigh risk from dental caries lesions are, those who consume snacks and aregiven sweets as rewards and those belonging to a lower socio economic class.This study also showed that the majority of caregivers (79%) knew about thecauses of dental caries lesions and 85% of them knew ways to prevent carieslesions but 59% were not sure whether primary teeth needed to be restored.There was no necessity for a dental check up for children before the age of 1yr according to 19% of the care givers, and 76% indicated that they would visitthe dentist only if a dental problem arose.13

Dental caries, also known as toothdecay, cavities or caries is a breakdown of teeth due to activities of bacteria14.The cavities may be in different colors from yellow to black. Symptoms mayinclude pain and difficulty with eating. Complications may include inflammationof the tissue around the tooth, tooth loss and infection or abscess formation15,16.

Dental caries in the primary dentitionhas received renewed attention in recent years because caries in the primarydentition is predictive of later caries experience. A study done by Warren etall on dental caries in the primary dentition and assessing prevalence ofcavitated and noncavitated lesions revealed that the decay experience was mostcommon on the primary second molars. About 56% of untreated decay was locatedin the pits and fissures, while 58 percent of decay was located on smoothsurfaces.17

Many countries have developed differentstrategies to reduce or even eradicate dental caries from preschool childrenfollowing dental caries surveys. Most of them have already obtained excellentresults using water and salt fluoridation, dental health education, school oralhealth program and so forth. The results of a recent research done in Palestineshown that 76% of the studied children have already experienced dental cariesat the age of 4-5 yrs (1046 children). There is a real need to makeimprovements at the level of parent’s dental health education, application ofpreventive measures and dietary habits among preschool children.18

A cross- sectional study to determineprevalence of early childhood caries among preschool children in Trivandrumdepicted that relatively high dental caries prevalence rate of 54%. The studydone on 1329 preschool children of less than 60 months of age randomly selectedfrom rural and urban areas of Trivandrum. This study   also showed a positive association betweenearly childhood caries and age of child, location of residence, dietary habitsand oral hygiene habits.19

Early childhood caries (ECC) isconsidered as a serious public health problem as it is a complex disease ofprimary dentition which relay serious socio-behavioral issues that afflictmainly the infants and toddlers. Early Childhood Caries, if untreated thedeleterious effect are pain, compromised chewing ability, malocclusion,phonetic problem, suboptimal health, lower self esteem. ECC is social,political, behavioral, medical, psychological, economical and dental problemsthat affect the quality of life. 20

Caries is also associated with poverty,poor cleaning of the mouth. Word wide approximately 2.43 billion people (36% ofthe population) have dental caries in their permanent teeth. The WHO estimatesthat nearly all adults have dental caries at some point in time. In baby teethit affects about 620million people or 9% of the population. They have becomemore common in both children and adults in recent years.21

A person experiencing caries may not beaware of the disease. The earliest sign of a carious lesion is the appearanceof a chalky white spot on the surface of the tooth, indicating an area ofdemineralization of enamel. This is referred to a white spot lesion or amicrocavity.22 As the lesion continues to de mineralize, it can turnbrown but will eventually turn into cavitation (cavity). Before the cavityforms, the lost tooth structure can be regenerated. Dental caries can alsocause bad breath and foul tastes. In highly progressed cases, infection canspread from the tooth to the surrounding soft tissues. Complications such ascavernous sinus thrombosis and Ludwig angina can be life threatening.23

Poor oral health can have a detrimentaleffect on children’s performance in school and their success in later life.Children who suffer from poor oral health are 12 times more likely to have morerestricted activity days including missing school than those who do not. Morethan 50 million hours annually are lost from school due to oral diseases. Ithas been hypothesized that oral health can be improved through healtheducation, schools provide an ideal setting for promoting oral health, itoffers an efficient and effective way to reach over 1 billion childrenworldwide, and through them, families and community members.24 A recent study done in Chennai revealed that oralhealth education is effective in improving oral health status of schoolchildren; data shows that oral hygiene is improved by decrease in plaque andgingival bleeding and also there was a significant decrease in dental caries.25

A study to evaluate the effect of aschool-based oral health education in preventing untreated dental caries andincreasing knowledge, attitude practice among adolescent, done in Bangladeshprojected out, there was a significant improvement in school aged adolescents’self reported  knowledge, attitude andpractices scores. The prevalence of untreated dental caries of the studypopulation after the Oral Health Education program was significantly reduced to42.5% from 76.6%.  26

Oral health education is most widelyused in prevention of dental diseases. A systematic review done to evaluate theeffectiveness of oral health education among school children in Chennairevealed that it is highly effective in improving oral health in schoolchildren. Six studies were included in the review. Four studies provided datafor comparison of plaque and gingival index scores and two studies provideddata comparison of DMFT index scores. Results showed interventions wereeffective in reducing the dental plaque, improving gingival status anddecreasing DMFT scores of the children.27

A subsequent randomized trialwhich provided an intensive preventive regimen involving interactivecounseling, intensive oral hygienic intervention, fluoride lozenges, xylitollozenges, fluoride varnish, chlorhexidine varnish and distribution of toothpaste containing 1,500 ppm fluoride and 10% xylotol to high risk Finnishchildren aged 11-12 yrs, found a 44% reduction in caries in the interventiongroup compared to the control group.29

Early childhood caries is one of themost prevalent chronic diseases of children that affect their life and theirfamily in different aspects. Using different types of fluoride is one of themost effective ways for preventing the disease. Fluoride varnish is a topicalfluoride product which could use in the community even by non-professional. Astudy aimed to assess the effect of fluoride varnish on dental caries in agroup of children aged 3-6 years old in Kerman kindergarten during 6 month’speriod. This community interventional study recruited a sample of volunteerchildren from 12 kindergartens through a cluster sampling. Kindergartenrandomly allocated to test and control group after matching. Dental examinationwas performed in three phases of the study by a trained dentist using criteriaof Intentional Caries Detection and Assessment System. Fluoride varnish wasapplied for test group in the first phase after dental examination and also 3and 6 months after this phase. Control group has received varnish product justafter 3 and 6 months after the first dental exam. The results revealed that themean dmft of the participants in the first stage of the study was 5.08 anddecreased to 4.77 in the third stage. Results of this study also prove thosethe preventive effect of fluoride varnish on dental caries. Even though thisstudy was a short-term one, a reduction in caries is evident; therefore we arehopeful that the continued use of varnish in kindergarten will help to promoteoral health of children.30

Theinvestigator during her school and community visits has come across that thepreschool children lack proper oral care and are more prone to develop dentalcaries. The investigator also noticed that there is no specific preventiveprogram for dental caries in our country. Many studies proved that the dentalcaries can be prevented by the proper utilization of oral health programs.These factors motivated the investigator to determine the effect of amulti-component oral health program on caries risk among children fromAnganwadies, Thiruvananthapuram district.

Aims and objectives

The aim of the study is to determine theprevalence and effect of multi component oral health program on   Caries risk among children from AnganwadiesThiruvananthapuram   district.

Phase-I

Primary Objectives

-    Findout the prevalence of caries risk among Anganwadi children fromThiruvananthapuram   district by AmericanAcademy of Pediatric Dentistry (AAPD) Caries risk tool and Salivary mutantsstrip test.

Secondary Objectives

-    Findthe association between caries risks and selected demographic variables of theAnganwadi children from Thiruvananthapuram.

Phase-II

Primary Objectives

-    Determinethe effect of a multi component oral health program on caries risk amongchildren from Anganwadies, Thiruvananthapuram interms of dmft index and ICDAS(International Caries Detection and Assessment System).

Secondary objectives

-    Identifythe effect of a planned teaching program on knowledge of mothers regarding Oralhealth and Prevention of Dental caries.