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Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 34-38

Dietary consumption and its association with dental caries in schoolchildren in Benghazi, Libya

Department of Pediatric Dentistry, Faculty of Dentistry, University of Benghazi, Benghazi, Libya

Date of Submission07-Aug-2020
Date of Decision24-Oct-2020
Date of Acceptance28-Oct-2020
Date of Web Publication14-May-2021

Correspondence Address:
Ahmed Musrati
Department of Pediatric Dentistry, Faculty of Dentistry, University of Benghazi, Benghazi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/dmr.dmr_43_20

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Introduction: Dental caries is a common public health problem among schoolchildren. Diet can affect oral health via many ways. Several researches have established that dietary factors are directly related to dental caries. Aims: To investigate the prevalence of dental caries in a group of schoolchildren in Benghazi, Libya, and its possible association with gender and diet. Methods: A cross-sectional observational study design was used among public schoolchildren in Benghazi, Libya. A random sample of 12-year-old school children within randomly selected schools underwent dental examination and completed a questionnaire to provide dietary data. This questionnaire was based on the one previously used in the UK National Diet and Nutrition Survey (2000). Dental caries was assessed using the World Health Organization criteria. Associations between caries and dietary variables under study were investigated through processes of bivariate and multivariate analyses. Results: About 62% had experience of dental caries. A higher experience of caries was observed among girls than boys (Fisher's exact test; P < 0.05). Consumption frequency of sugared drinks and foods was higher in girls (P < 0.001). Conclusions: Over two-thirds of the subjects had dental caries. The high level of dental caries is a cause for concern. Interestingly, more caries was noticed in girls than in boys. Apparently, sugared drinks, which were consumed more by girls, were the main source of total dietary sugared consumption. The consumption of sugared drinks was high, and efforts are required to reduce it.

Keywords: Dental caries, gender, Libyan schoolchildren, sugared drinks and foods

How to cite this article:
Huew R, Musrati A. Dietary consumption and its association with dental caries in schoolchildren in Benghazi, Libya. Dent Med Res 2021;9:34-8

How to cite this URL:
Huew R, Musrati A. Dietary consumption and its association with dental caries in schoolchildren in Benghazi, Libya. Dent Med Res [serial online] 2021 [cited 2022 Dec 3];9:34-8. Available from: https://www.dmrjournal.org/text.asp?2021/9/1/34/315966

  Introduction Top

The prevalence of the disease is the number of population having a disease at a particular time. The prevalence of dental caries is a main subject of several epidemiological investigates being carried out all over the world. Dental caries is an international health problem and has a direct influence on the quality of life, particularly on children's health and development. Dental caries is probably the most common chronic diseases of the world in both developed and developing countries and is the main cause of loss of teeth in younger people. It is an infectious microbiologic disease of the teeth that results in localized dissolution and destruction of the calcified tissues. It causes tooth pain, discomfort, eating problems, loss of tooth, and delay language development. Even though the fact that dental caries is preventable, it continues to be a major public health concern. Although the prevalence of dental caries has declined in developed countries during the past 30 years, it remains a significant dental disease and a major public health challenge in children and adults. In a number of developing countries, dental caries affects 60%–90% of schoolchildren.[1] Significant proportions of children and adults are still affected by caries in developing countries where fluoride is not available, with more opportunities to consume sugars.[2] Changing life-styles and dietary patterns have led to a marked increase in caries incidence in developing countries.[3],[4],[5]

Despite the fact that caries is the commonest dental disease in children, little attention has been given to studies measuring the prevalence of caries amongst Libyan schoolchildren. The importance of monitoring the prevalence of dental caries is in planning services and determining whether progress has been made toward controlling the distribution of this dental disease. In Libya, data from cross-sectional observational studies showed that caries prevalence in schoolchildren ranged from 50% to 74.7%.[6],[7],[8] Unfortunately, these results showed an upward trend of the caries prevalence in Libya.

Dental caries is a multi-factorial disease. It involves various factors such as diet, microorganisms, tooth morphology, saliva, gender, location, dietary habits, as well as genetic predisposition. The importance of diet-related diseases has increased over the last 30 years.[9] Diet has an important effect on the development of the oral disease, its most significant local effect on teeth is the development of dental caries.[2] The frequency of consumption of a sugary diet is the most important etiological factor in the development of dental caries. Conclusive evidence supports the association between sugared drinks, food consumption, and dental caries.[2],[10],[11],[12] Dental caries is widely recognized as an infectious disease induced by diet. Moreover, the risk of dental caries increases with more frequent sugar consumption. Sugars consumption between meals is associated with a greater potential risk of dental caries than consumption at meals[13],[14],[15] as salivary flow and its buffering capacity are high at meals and low between meals.

In Libya, there are few data on the consumption frequency of sugared drinks and foods collected by questionnaire and their relationship with dental caries.

The aims of this study were to determine the prevalence of dental caries among 12-year-old schoolchildren in Benghazi, Libya, and to investigate any association of dental caries with gender and dietary potential risk factors.

  Methods Top

Ethical approval and permissions

Approval and permissions were secured from the local authorities and schools to carry out the dietary survey and the dental examinations on schoolchildren.

Obtaining the sample

The inclusion criteria of our sample included 12-year-old healthy schoolchildren resident in Benghazi who want to participate in the study. There was no existing classification of social class in Benghazi, which could be used to provide a sampling frame; therefore, cluster sampling within schools was used. Cluster sampling, using the schools as the clusters, was used for the sampling procedure. Using a list of randomly generated numbers between 1 and 99, a random sample was selected to participate in the dietary survey and undertake the dental examination. The target sample size for completion was 170, which would provide 95% confidence to detect a correlation coefficient of 0.3, assuming a Type 1 error rate of 5%. Boys and girls were sampled separately to ensure representative samples.


This questionnaire was based on the questionnaire used in the oral health component in the UK National Diet and Nutrition Survey.[16] The questionnaire was designed to be applicable to 12-year-old schoolchildren, who were old enough to understand the questions and able to make written answers. The questionnaire included questions on amount, frequency, and timing of consumption of sugared and drinks and foods. The questionnaires were distributed to the children in schools before the dental examination to prevent bias following the dental examination. The researcher (RH) explained the importance of their honest answers and that there were no wrong or right answers.

Dental examination

The data collection form for recording dental caries was based on the indices recommended by the World Health Organization (WHO).[17] The prevalence of dental caries was assessed in accordance with the WHO criteria on crown surfaces for the permanent dentition. One examiner (RH) conducted the dental examinations, while a trained assistant recorded the data. Dental examinations were performed in the schools with the child seated in front of the examiner and using artificial lighting and a headlamp. Prepacked sterilized oral examination kits were used. Instruments used during data collection were sterilized before the dental examination and at the end of the data collection. Disposable gloves and masks were used during the data collection. The dental examination forms contained the diagnostic criteria codes for the examiner's quick reference, demographic information (ID number, date of birth, gender, and school number), and a dental charting with designated cells for coding the entry of dental caries data. All maxillary and mandibular teeth were examined for dental caries. Teeth were examined in the following order: Upper Left-Upper right-lower right-lower left. Each surface was examined, coded, and called in the following order: Distal-occlusal-mesial-buccal-lingual.

Reproducibility of the study

To ensure the reproducibility of the application of diagnostic criteria in each school, 10% of the total sample was re-examined, i.e., 18 subjects were re-examined. The examiner was being blind to identity of the subjects re-examined. The results of the dental examination were analyzed for intra-examiner reproducibility using Cohen's kappa.

Data analysis

Following descriptive analysis, all questionnaire data were analyzed using SPSS (version 16, Chicago, SPSS Inc, USA) with Chi-square analysis to determine if there was a statistically significant difference in the responses for different groups. The data were also analyzed by gender (Chi-square analysis). For the 177 individuals with data from both the dental examination and the questionnaire survey, a process of bivariate analysis for nonparametric data using the exact versions of Chi-Square, Fisher's, and Linear Association was used. Nonparametric test was used because data were not normally distributed. The bivariate process was used to investigate the associations between the experience of dental caries and exploratory variables, which included reported consumption frequency of sugared foods and drinks. In addition, the odds ratio and 95% confidence intervals (CIs) were calculated for contingency tables. The statistical significance level was set at 5% (P < 0.05). Associations between dental caries variables (yes/no) and caries-related variables were tested through a process of bivariate analysis.

  Results Top

The sample

One hundred and ninety schoolchildren were randomly selected in the randomly selected public schools. From these, 177 schoolchildren completed the questionnaire and attended the clinical dental examination. There were 90 boys (51%) and 87 girls (49%). The mean age of the 177 children was 12.5 years (standard deviation ± 0.29).

Prevalence of dental caries of the sample

Of the 177 schoolchildren, 110 (62%) had the experience of dental caries. A higher experience of caries was observed among girls (70%) than boys (56%). This difference was statistically significant (Fisher's exact test; P = 0.047) [Table 1].
Table 1: Significance of association (P) between the number (n) and proportion (%) of subjects with or without experience of dental caries in the schoolchildren by gender

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Reproducibility of the study

The levels of intra-examiner agreement in the assessment of dental caries, as measured by the Cohen's kappa statistic, were 0.95.

Dental caries and sugared-acidic drinks and foods

The majority of subjects (62%) had experience of dental caries. Consumption frequency of sugared drinks and foods was higher in girls than boys. This difference was statistically significant (P < 0.001). Sugared drinks were the main source of dietary sugared consumption. Total sugar frequency consumption was mainly in the form of free sugars in snacks rather than meals. Daily frequency of consumption of fresh fruits (excluding fruit juices) was low. Association between dental caries and dietary items consumption is shown in [Table 2].
Table 2: Dietary consumption frequency and comparison of Libyan children with and without caries experience and mean, standard deviation, mean difference, 95% confidence intervals of the mean difference, median, interquartile range, and significance of difference (P)

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  Discussion Top

Dental caries and gender differences

The analysis of the dental examination data from the present sample showed two-thirds (62%) had experience of dental caries. However, results from previous cross-sectional observational Libyan studies showed that the prevalence of dental caries in schoolchildren was 56.9%, 50%, 50%, and 57.8%.[6],[7],[8],[18] Obviously, their findings were lower than those reported in the present study, which showed an upward trend of caries prevalence in Libya.

In comparison with other countries with a similar age group, the same prevalence of dental caries was found in Iraq,[15] higher than in India (10%), Iran (36.2%), Tunisia (48.3%), Uganda (40.2%), Italy (43.1%), the UK (32.7%), and in Nigeria (35.5%).[19],[20],[21],[22],[23],[24]

On the other hand, the prevalence of dental caries found in the present study was lower than that found in 12-year-old schoolchildren in the Philippines (74.9%), in 12–13 year-old schoolchildren in Riyadh and Qaseem, Saudi Arabia (92.3%, 87.9%), in 13–14 year-old schoolchildren in Brazil (78%).[4],[12],[25]

In the present study, the prevalence of dental caries experience was higher in girls compared with boys; as similarly reported in some other studies.[19],[25] This seems unusual since girls generally pay greater attention to oral hygiene and aesthetics more than boys do. However, the reason might be attributed to girls consuming more sugared drinks and foods than boys (P < 0.0015), or due to the tendency of earlier permanent tooth eruption in girls than boys, so the teeth get exposed to risk factors for dental caries for longer periods than in boys. Actually, the differences in eruption times reside in only a few months, which may result in a little difference from a clinical perspective.

Caries and its association with dietary risk factors

In our work, prevalence of dental caries and its association with sugared drinks and foods consumptions in schoolchildren in Libya is presented to reduce the shortage in the available data on developing countries. Obtaining general dietary information from the schoolchildren is essential to provide a basis for dietary counseling and analysis of their nutritional consumption. It is a cause of concern that the amount and frequency of sugar consumption of Libyan schoolchildren were high; the access to certain foods such as dietary sugars might be easier and less expensive than other dietary components. Besides, more sugar consumption at snack times than at meal times has more damaging effects on the tooth structures since salivary flow is low and its buffering capacity is reduced between meals.

A questionnaire conducted by the author in 2011 showed that only 6% of the Libyan subjects consumed two to four portions of fruits per day.[26] Although the present study reports a low consumption frequency of fruits, it still seems to be in line with the dietary pattern observed for young subjects in other studies. Approximately 14% of 14-year-old children in Birmingham never consumed fruit.[27]

When dietary data from the questionnaire were analyzed, all types of sugared drinks were considered as one group. Sugared acidic drinks were more frequent in total dietary consumption. There was an association between the prevalence of dental caries and sugared drinks, which were higher in girls than in boys. Several studies have reported the association between sugared drinks and food consumption and dental caries.[2],[10],[11],[12] Others have reported no or weaker association between dietary consumption and dental caries.[12] This difference might be due to the chronological discrepancy between dietary data collection, which usually covers only 1 day to few months obtained often from questionnaires, and detection of carious lesions, which accumulate over years.[28] In other words, occurrence of dental caries is a chronic process; thus, its development apparently is influenced by a long (years) regimen of dietary habits, which could have changed more than once during the conduction of the study. Therefore, cross-sectional studies need to be interpreted cautiously.

Dental caries is a multifactorial condition influenced by the interaction of chemical, biological, and behavioral factors, and this explains why some individuals exhibit more caries than others and, in the same way, why some children with apparently noncariogenic diets develop dental caries while some children with cariogenic diets do not. As a limitation in our study, it is not possible to assess whether the collected dietary data was representative of a long-term dietary pattern, which would potentially contribute to the experience of dental caries.

  Conclusions Top

This cross-sectional epidemiological study has shown approximately two-thirds of the subjects had dental caries. Caries experience was higher amongst girls than boys. This difference was statistically significant (Fisher's exact test; P = 0.047). Consumption of sugared drinks and foods was higher in girls (P < 0.001). The consumption of sugared drinks and foods was high, and efforts are required to diminish it in order to prevent or at least reduce dental caries. This paper explored the association between dental caries and diet in Libyan children and emphasizes the importance of dietary advice and preventive programs. More studies are required to investigate the association between the prevalence of dental caries and its dietary potential risk factors.


The authors are grateful to all schoolchildren, parents, schools staff, and local authorities in Benghazi for their cooperation in the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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