|Year : 2015 | Volume
| Issue : 1 | Page : 15-19
Oral health status of 5, 12, and 15-year-old school children in Tiruvalla, Kerala, India
Benley George, Vinod Mathew Mulamoottil
Department of Public Health Dentistry, Pushpagiri College of Dental Sciences, Medicity, Perumthuruthy, Tiruvalla, Kerala, India
|Date of Web Publication||21-Jan-2015|
Department of Public Health Dentistry, Pushpagiri College of Dental Sciences, Medicity, Perumthuruthy, Tiruvalla, Kerala
Source of Support: Project funded by Kerala State Council for
Science, Technology and Environment, Thiruvananthapuram,
Kerala, Government of Kerala (No: 009/SRSHS/2011/CSTE),, Conflict of Interest: None
Background: Dental caries can be traced to be as old as civilization with its evidence seen even in skeletal remnants of prehistoric humans. Dental caries is the most prevalent dental affliction of childhood. Materials and Methods: A stratified cluster sampling technique was employed in the selection of 39 schools in the geographical region. A total of 5688 students was screened. Of the total students screened, 1623 students were 5-year-old, 1936 were 12-year-old and 2129 were 15-year-old students. Pearson Chi-square test and Fishers exact test were the statistical tests employed in the survey. The level of significance was set to be P < 0.05. Results: The present study revealed that the majority (73.9%) of the 12 years students had healthy gingiva. It was revealed that among girls, 21.8% had calculus, and 2.5% had bleeding gums. Among boys, 24.3% had calculus, and 3.1% had bleeding gums. The prevalence of dental caries was the highest among 5 years students who belonged to the lower socioeconomic status (41.5%). The difference was found to be statistically significant (P = 0.004). The mean decayed, missing, and filled teeth was found to be the highest in students of 5 years age group when compared to their counterparts (P = 0.041). Conclusion: The study reveals that dental caries still remains as a major oral health problem among school children of all age group. Gingival problems also formed one of the major oral health problems of 12 and 15-year-old school children.
Keywords: caries, children, gingivitis, Tiruvalla
|How to cite this article:|
George B, Mulamoottil VM. Oral health status of 5, 12, and 15-year-old school children in Tiruvalla, Kerala, India. Dent Med Res 2015;3:15-9
| Introduction|| |
Dental caries can be traced to be as old as civilization with its evidence seen even in skeletal remnants of prehistoric humans.  Dental caries is the most prevalent dental affliction of childhood. In spite of credible advances in dentistry, the disease continues to be a major public health problem. Untreated oral diseases in children frequently lead to serious general health problems, significant pain, interference with eating, and lost school time.  Poor oral health in childhood often continues into adulthood, affecting economic productivity and quality-of-life.
Polarization of dental caries is occurring on a worldwide basis, where the prevalence of dental caries is declining in developed countries, increasing in less-developed countries and is epidemic in countries with emerging economies.  This decline in dental caries prevalence in developed countries has been associated with a more sensible approach to sugar consumption, improved oral hygiene practices and several preventive programs. The changing lifestyle and dietary patterns is markedly responsible for the increasing dental caries incidence in developing countries. 
Traditionally, the occurrence of dental caries was highly prevalent in western industrialized countries but the status of oral health has improved in recent years. In children, the prevalence proportion rate of dental caries as well as the mean dental caries experience have declined. ,,, In developing countries, especially in Sub-Saharan Africa, the trend over time in dental caries prevalence is not particularly clear. In some Asian countries, the prevalence of dental caries in the child population is reported at low to moderate levels. ,, India, a developing nation has shown an inclined trend of this disease over a relatively short period.  In 1940, the prevalence of dental caries in India was 55.5%, and it rose to 68% in the 1960s.  According to the national oral health survey, dental caries prevalence in India was 51.9, 53.8, and 63.1% at ages 5, 12, and 15 years, respectively. 
Malocclusion has been a significant oral health problem among children. The prevalence of malocclusion in India varies from 20% to 71%. ,,, At present, there is dearth of information in the literature on oral health status of school children in Kerala in general. Therefore, the aim of this study was to determine the oral health status of 5, 12 and 15-year-old school children in Tiruvalla which would provide a baseline data for the planning of preventive oral health services in this region.
| Materials and methods|| |
The present study was conducted among 39 schools in Tiruvalla during the period of May 2013 to May 2014. Tiruvalla is a town and a taluk headquarters located in Pathanamthitta district in the state of Kerala in South India. This is the largest town in the district. Tiruvalla is situated on the western border of Pathanamthitta district. The municipal town limits are Thirumoolapuram, Kattod, Kuttapuzha, and Manipuzha.  The town spans a geographic area of 27.94 km with a population of 234,503 as of 2001 India census.  Males constitute 48% of the population and females 52%. Tiruvalla has an average literacy rate of 90%, which is higher than the national average of 59.5%, male literacy is 90%, and female literacy is 98.7%. 
The study population consisted of 5, 12, and 15-year-old school children in Tiruvalla. The list of schools in Tiruvalla was obtained from the Assistant Educational Officer (AEO) of Tiruvalla. A stratified cluster sampling technique was employed in the selection of 39 schools in the geographical region. The computed minimum sample size was estimated to be 1420. A total of 5688 students was screened. Of the total students screened, 1623 students were 5-year-old, 1936 were 12-year-old, and 2129 were 15-year-old students.
Prior permission and approval for the conduct of the study was obtained from the AEO, Tiruvalla and Heads of the institutions which had consented to participate in the study. The ethical approval was obtained from the Institutional Ethical Committee (No. PIMS and RC/E1/388A/02/'13). All students participating in the study were given oral information emphasizing the purpose of the study. A written informed consent was obtained from the parents/guardian of the participating students.
The investigators and recorders were trained and calibrated through a series of clinical training sessions organized prior to the start of the survey. The kappa statistics for inter-examiner variation was 0.84.
The study design was two-fold
A pretested questionnaire was distributed 2 days prior to the start of the survey in each school. The questionnaires were distributed to the parents of the students which were duly filled and returned back to the school teachers. The questionnaire consisted of questions pertaining to the general details of the student, socioeconomic details of the parent, and oral hygiene practices of their child.
Two trained investigators assessed the oral health status of each student. Each student was seated on a bench and clinical examination was carried out under natural light by means of mouth mirror and a periodontal probe which conform to World Health Organization (WHO) specifications (American Dental Association, Type III Dental Examination Method). Sterilized instruments were used for the examination of the students. Data were recorded by two recorders in the printed modified WHO Oral Health Assessment Form 1997. It included an assessment of Community Periodontal Index, and dentition status and treatment needs. After the oral examination, the students were informed about his/her oral health status and treatment required if any.
Data were manually entered into the computer, tabulated, and analyzed. Data analysis was performed using the software IBN Statistical Package for Social Sciences, version 17.0. Pearson Chi-square test and Fishers exact test were the statistical tests employed in the survey. The level of significance was set to be P < 0.05.
| Results|| |
Clinical examinations were carried out on 5688 school children. Among the study population, 1623 children were of the age group of 5 years, 1936 children in the age group of 12 years and 2129 children in the age group of 15 years. The study population comprised of 2491 girls and 3197 boys [Table 1].
Majority (73.9%) of the 12 years students had a healthy gingiva. Among girls, 21.8% had calculus, and 2.5% had bleeding gums. Among boys, 24.3% had calculus and 3.1% had bleeding gums and the difference was insignificant (P = 0.269) [Table 2]. Among the 15-year-old students, majority of the boys and girls had a healthy gingiva. Among boys, 23.9% had calculus while 20.6% of girls had calculus [Table 3]. The difference was found to be insignificant (P = 0.088).
Decayed, missing, and filled teeth
The prevalence of dental caries was the highest among 5 years students who belonged to the lower socioeconomic status (41.5%). The difference was found to be statistically significant (P = 0.004). The prevalence of missing and filled teeth was found to be the highest among the students in the upper middle category. The mean decayed, missing and filled teeth (DMFT) was the highest in students of the lower middle socioeconomic status [Table 4].
Among 12-year-old students, the prevalence of decayed teeth was found to be highest among students who belonged to the lower socioeconomic status (36.9%). The mean DMFT was the highest in students of the upper middle socioeconomic status (0.68 ± 1.042). The difference was found to be not statistically significant [Table 5] (P = 0.607).
|Table 4: Distribution of 5-year-old students by socioeconomic status and DMFT |
Click here to view
|Table 5: Distribution of 12-year-old students by socioeconomic status and DMFT |
Click here to view
Among 15-year-old students, the prevalence of decayed teeth was found to be highest among students who belonged to the lower socioeconomic status (43.4%). The mean DMFT was the highest in students of the lower socioeconomic status (0.72 ± 1.065). The difference was found to be statistically insignificant [Table 6] (P = 0.471). The mean DMFT was found to be highest in students of 5 years age group when compared to their counterparts. The difference observed was statistically significant [Figure 1] (P = 0.041).
|Figure 1: Comparison of mean decayed, missing, and filled teeth among 5, 12, and 15-year-old students. ANOVA test, P = 0.041|
Click here to view
|Table 6: Distribution of 15-year-old students by socioeconomic status and DMFT |
Click here to view
| Discussion|| |
The present study was conducted among 5, 12, and 15-year-old school children in Tiruvalla, Kerala. The oral health data of school children were collected in order to enable the Kerala Government to develop strategies of oral health care. Around 24% of girls in the age group of 12 years suffered from gingival problems which was less (50.8%) compared to a study conducted in Chennai.  Twenty-seven percent of boys in the same age group suffered from gingival problems which was lower (51.7%) compared to school children in Chennai. 
In the present study, it was observed that around 20% of the girls in the age group of 15 years suffered from gingival problems which was less (56.6%) compared to a study conducted in Shimla.  Twenty-four percent of boys in the same age group suffered from gingival problems which was less (57.5%) when compared to a study conducted in Shimla. 
The mean DMFT was 0.67 ± 1.444 among 5-year-old students which was low when compared to studies conducted in Brazil,  Chennai,  Udaipur,  and Gurgaon  and greater compared to studies conducted in Laos.  The prevalence of dental caries was the highest among 5 years students who belonged to the lower socioeconomic status (41.5%). The mean DMFT was the highest in students of the lower middle socioeconomic status. In 12-year-old students, the mean DMFT was 0.58 ± 1.021 which was lower compared to studies conducted in Chennai,  Gurgaon,  Laos,  Yemen,  Shimla,  and Tanzania  and was greater compared to studies conducted in Amritsar,  Sudan.  The mean DMFT among 15-year-old students was 0.65 ± 1.005 which was lower compared to a study in Shimla,  and Tanzania  and higher compared to a study conducted in Amritsar.  The high caries experience of the three age group of school children could be attributed to their dietary habits and oral hygiene measures. This study revealed that no caries preventive treatments were performed in any of the study subjects.
Some limitations of the study should be addressed. First, since this was a cross-sectional study, it provided limited information. Prospective studies should be conducted to determine the impact of dental problems on the quality-of-life of the children.
| Conclusion|| |
The study reveals that dental caries still remains as a major oral health problem among school children of all age group. This study also showed that gingival problems also formed one of the major oral health problems of 12- and 15-year-old schoolchildren. The present data shall serve the oral health authorities in planning preventive health programs for this high-risk group.
In view of the present study, the following recommendations are suggested:
- A preventive program including pit and fissure sealant application which would be an ideal measure in prevention of dental caries in the permanent dentition of school children and topical fluoride application would also aid in protecting the permanent dentition which has to remain lifelong
- Oral health education programs should be made mandatorily organized at all government, private aided and private unaided schools semiannually to reinforce the importance and maintenance of a healthy oral cavity. Similarly, teachers training programs should be organized so that they are trained in identification of dental problems such as dental caries and gingivitis in children. The early identification by teachers and referral to a dentist can reduce the severity of the problem and prevent loss of school hours of children and work productivity of parents
- Health education programs utilizing cartoons characters in various Medias such as Television, Internet, and Radio will be highly effective in communicating the oral health messages to children and thereby creating a long-lasting impact in them.
| Acknowledgments|| |
The authors would like to acknowledge the contribution of Mrs. Nisha Kurien, Assistant Professor, Biostatistics, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla for conducting the statistical analysis of this study. We also acknowledge the AEO of Tiruvalla and heads of the institutions who gave permission for the conduct of the study. We gratefully acknowledge the funding received from Kerala State Council for Science, Technology and Environment, Government of Kerala (No: 009/SRSHS/2011/CSTE).
| References|| |
National oral health organization. National oral health policy: JIDA 1986;58:397-401.
Biesbrock AR, Walters PA, Bartizek RD. Initial impact of a national dental education program on the oral health and dental knowledge of children. J Contemp Dent Pract 2003;4:1-10.
Studervant CM, Roberson TM, Heymann HO, Studervant JR. The Art and Science of Operative Dentistry. 3 rd
ed. Missouri:Mosby Co; 1995. p. 62-3.
Rao A, Sequeira SP, Peter S. Prevalence of dental caries among school children of Moodbidri. J Indian Soc Pedod Prev Dent 1999;17:45-8.
World Health Organization. Global Oral Health Data Bank. Geneva: WHO; 2000.
Marthaler TM, O'Mullane DM, Vrbic V. The prevalence of dental caries in Europe 1990-1995. ORCA Saturday afternoon symposium 1995. Caries Res 1996;30:237-55.
Burt BA. Trends in caries prevalence in North American children. Int Dent J 1994;44:403-13.
Beltrán-Aguilar ED, Estupiñán-Day S, Báez R. Analysis of prevalence and trends of dental caries in the Americas between the 1970s and 1990s. Int Dent J 1999;49:322-9.
Wei SH, Holm AK, Yuen SW. Dental caries prevalence and related factors in 5-year-old children in Hong Kong. Pediatr Dent 1993;15:116-9.
Petersen PE, Hoerup N, Poomviset N, Prommajan J, Watanapa A. Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand. Int Dent J 2001;51:95-102.
Chawla HS. Dental health promotion - Reaching the needy. J Indian Dent Assoc 1985;57:387-95.
Ramachandran CR. Oral health. ICMR Bulettin 1994;24:51-5.
Prakash H, Shah N. National Oral Health Care Program Implementation Strategie, Project of DGHS, MOH and FW. Ansari Nagar, New Delhi: Govt. of India, Department of Dental Surgery, AIIMS; 2004.
Sureshbabu AM, Chandu GN, Shafiulla MD. Prevalence of malocclusion and orthodontic treatment needs among 13-15 year old school going children of Davangere city, Karnataka, India. Indian Assoc Public Health Dent 2005;6:32-5.
National Oral Health Survey and Fluoride Mapping (India) 2002-03. New Delhi: Dental Council of India; 2004.
Dhar V, Jain A, Van Dyke TE, Kohli A. Prevalence of gingival diseases, malocclusion and fluorosis in school-going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent 2007;25:103-5.
Das UM, Venkatsubramanian RD. Prevalence of malocclusion among school children in Bangalore, India. Int J Clin Pediatr Dent 2008;1:10-2.
Available from: http://www.en.wikipedia.org/wiki/Tiruvalla. [Last accessed on 2014 Jan 04].
Available from: http://www.pathanamthitta.gov.in/statistics.htm. [Last accessed on 2014 Jan 04].
Mahesh Kumar P, Joseph T, Varma RB, Jayanthi M. Oral health status of 5 years and 12 years school going children in Chennai city - An epidemiological study. J Indian Soc Pedod Prev Dent 2005;23:17-22.
Shailee F, Girish MS, Kapil RS, Nidhi P. Oral health status and treatment needs among 12- and 15-year-old government and private school children in Shimla city, Himachal Pradesh, India. J Int Soc Prev Community Dent 2013;3:44-50.
Marquezan M, Marquezan M, Faraco-Junior IM, Feldens CA, Kramer PF, Ferreira SH. Association between occlusal anomalies and dental caries in 3- to 5 year-old Brazilian children. J Orthod 2011;38:8-14.
Tadakamadla SK, Tadakamadla J, Tibdewal H, Duraiswamy P, Kulkarni S. Dental caries in relation to socio-behavioral factors of 6-year-old school children of Udaipur district, India. Dent Res J (Isfahan) 2012;9:681-7.
Mittal M, Chaudhary P, Chopra R, Khattar V. Oral health status of 5 years and 12 years old school going children in rural Gurgaon, India: An epidemiological study. J Indian Soc Pedod Prev Dent 2014;32:3-8.
Besseling S, Ngonephady S, van Wijk AJ. Pilot survey on dental health in 5-12-year-old school children in Laos. J Investig Clin Dent 2013;4:44-8.
Al-Haddad KA, Al-Hebshi NN, Al-Ak'hali MS. Oral health status and treatment needs among school children in Sana'a City, Yemen. Int J Dent Hyg 2010;8:80-5.
Kerosuo E, Kerosuo H, Kallio P, Nyandini U. Oral health status among teenage schoolchildren in Dar es Salaam, Tanzania. Community Dent Oral Epidemiol 1986;14:338-40.
Walia SS, Sadana GK, Kaur A. KAP and oral health status among 12-15 years old school children in Amritsar district. Indian J Compr Dent Care 2011;1:53-6.
Nurelhuda NM, Trovik TA, Ali RW, Ahmed MF. Oral health status of 12-year-old school children in Khartoum state, the Sudan; a school-based survey. BMC Oral Health 2009;9:15.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]