Prevalence of Dental Caries among School Children in Sundarban, India

Dental health is often neglected by a vast majority of population. In the developing countries like India the prevalence of dental carries is very high particularly among the children and adolescents. The prevalence is even higher in rural people and among school children. The absence of practice of healthy habits often leads to this type of problem. Dental caries is not only a medical problem but many sociodemographic factors are said to be associated with this. Usually the habit of taking care of dental health is obtained from the parents and other senior members of family. In India where the birth rate is still high and there is less spacing between two births, mothers often are not capable of giving proper care to all the children. The unhealthy practice of children often leads to many medical problems some of which can cause permanent damage. If dental caries develops after the eruption of permanent dentition and proper care is not taken, it may lead to permanent damage and spread of infection throughout the body can also occur. Utmost care must thus be taken so that dental caries should not develop. Early diagnosis with prompt treatment is also necessary. The present study was conducted in a rural hard to reach block of Sundarban to assess the prevalence of dental caries among students after the eruption of permanent dentition to find out the association of socio-demographic characteristics with the prevalence of dental caries.

Study area and study population

The study was conducted in a high school located at Gosaba block of Sundarban of South-24 parganas of West Bengal. The area is considered as a hard to reach area in the delta island of Sundarban. All the students studying in class VII were included in the present study. Usually the age of the students studying in class VII is 13-14 years and so, they have complete eruption of permanent dentition except 3^rd molar.

Study tools and techniques

The study was done by interviewing the students using a pre-designed, pre-tested, semi-structured questionnaire and an examination of the condition of the teeth was done by dentist.

Statistical analysis

The data generated were entered in Microsoft excel sheet and copied into a SPSS sheet (version 16.0). The analysis was done using SPSS (version 16.0). Chi square test was used to test the statistical significance between different groups.

Majority of the students were 13 years and 14 years old (42.98% and 40.35% respectively). A small percentage (16.67%) of the students were 15 years old. 56.14% students were male and 43.86% were female. 66.67% students belonged to Hindu religion and the rest students were Muslims. As far as socio-economic status is considered, using modified Prasad scale, majority belonged to lower middle and upper lower socioeconomic class (22.81% and 33.33% respectively). Only 7.89% students belonged to upper class. 49.12% students had one sibling, 22.81% had two siblings and 28.07% students were the only child of their parents.

The students were asked about the habits and practices regarding the dental health. 68.42% students used to brush once daily, 16.67% students had the brushing habit more than once daily and 14.91% students did not have the habit of brushing every day. They used to brush the teeth occasionally, not daily. The students were asked about the habit of washing mouth after taking food. It was found that majority (67.80%) had the habit of washing their mouth rarely, mainly after taking major meals, not after taking any other food. 22.80% student often washed their mouth after taking food and 11.40% students replied that they washed their mouth always after taking any meal. 57.89% students complained of toothache and the rest did not have any episode of toothache in last 15 days. 25.44% students were taking medicines for the toothache.

According to physical examination, 82 (72%) students had dental caries. Prevalence of dental caries was assessed according to different socio-demographic parameters. It is seen that 61.2% of the students aged 13 years, and 80% of the students aged more than 13 years had dental caries. So, prevalence of dental caries increased with increase in age and this difference is statistically significant (p=0.027). It was seen that 68.8% of boys had dental caries as compared to 76% girls having the same problem. However, this difference is not significant statistically. 71.1% Hindu students as compared to 73.7% of Muslim students had dental caries though the difference is not significant statistically. Median per capita income of the family of the students was found to be Rs. 1800/- and the students were grouped into two categories based on this median per capita income. It is seen that 84.2% of the students belonging to the less income group had dental caries in comparison to 59.65% students in higher income group and this difference is statistically significant. Prevalence of dental caries was assessed according to presence of siblings. It is observed that students having no sibling or one sibling were significantly less commonly suffering from dental caries as compared to students having more than one siblings.

Students were asked about their habit of brushing the teeth. It is seen that 47.4% of the students who used to brush twice a day had dental caries as compared to 76.84% of the students having habit of brushing the teeth either once daily or not every-day suffered from dental caries. This difference is statistically significant. 56.41% of the students having habit of washing mouth after taking food always or most of the time had presence of dental caries. The prevalence is 80% among students who rarely used to wash mouth after taking food. This difference is again statistically significant. 95.5% of the students having toothache were suffering from dental caries; on the other hand those did not have toothache, 39.6% of them were suffering from dental caries and this difference is again statistically significant (Tables 1-4).

Table 1: Socio-demographic characteristics of the study population.

Table 2: Habits of the study population.

Table 3: Association of prevalence of dental caries with socio-demographic characteristics of the study population.

Table 4: Association of prevalence of dental caries according to hygienic habit.

Dental caries is one of the leading problems in school going children as well as in adults. The World Health Organization (WHO) has recognized dental caries as a pandemic and reported its prevalence among school children to range from 60-90% [1]. Present study has found out the prevalence of dental caries to be as high as 72% in the rural adolescents in India. Another study by Shingare et al. [2] in Maharashtra, India reported the prevalence of dental caries among 3-14 years old children to be 80.92% which is higher than reported in the present study. Dixit et al. [3] conducted a study among school children in Nepal and they found that the prevalence of dental caries among the school children aged 12-13 years was 41% which is far below the prevalence in the present study. In Kenya, Ng’ang’a and Valderhaug [4] reported a prevalence of 40-50% among children aged 13-15 years. Another study was conducted by Kassim et al. [5] in Nairobi in 2006 which revealed that the prevalence to be 43% among rural adults (Figures 1-3); however as it investigated prevalence among adults, its prevalence should not be compared with the prevalence of the present study. In our study, the prevalence of dental caries was higher in girls (76%) than in boys (68.8%). Dixit et al. [3] also reported a higher prevalence among girls (48.4%) than in boys (32%) although the overall prevalence in their study was lower than in present study. Similar to our findings, there was no significant difference in prevalence between girls and boys. Gathecha et al. [6] revealed that the difference of prevalence of dental caries between boys and girls are not significant. Contrary to our report and the report of Dixit et al. [3], Natapov et al. [7] reported a higher prevalence among 5 years old boys than girls.

Figure 1: Prevalence of dental caries.

Figure 2: Prevalence of dental caries according to age.

Figure 3: Prevalence of dental caries according to sex.

The present study found that prevalence of dental caries was significantly higher in lower income group as compared to upper income group. Usually people belonging to lower income group are devoid of hygienic practice and they live in unhygienic environment. These factors often lead to dental caries. Prevalence of dental caries was significantly higher among children having more than one sibling. Usually when the number of children increases, less care is given to each child by the mother and the elder ones suffer most. As a result the prevalence of diseases related to hygiene increases Students were asked about their habit of brushing the teeth and it is revealed that those who used to brush twice a day had significant less prevalence of dental caries as compared to those whose brushing habit is either once daily or not every day. Gathecha et al. [6] in a study in Kenya have found that brushing habit has no significant effect on the prevalence of dental caries which is contradictory to the results of present study. In the present study 16.67% children had brushing habit more than once per day. However Dixit et al. [3] in their study found that 24% children had the brushing habit more than once a day and overall prevalence of dental caries is less in their study as compared to the present study. Rao and Bharambe [8] in their study found that 60.8% children were habituated to clean their teeth with toothpaste. They found that tribal children showed a better oral health status than urban children.

Dental caries is not only a medical problem but also a social problem. Awareness among students can be generated by the school teachers because they are the role model for the students. Parents should be aware of the dental health of their children. Parent/teacher meetings should be regularly organized during which parents are educated on the importance of good hygiene practices in disease prevention. Health education should be incorporated within the regular activities of the school. Overall education, particularly female education can help to solve the problems in future.