Prevalence of dental caries among poor locality school children of Lahore
ORIGINAL ARTICLE
PREVALENCE OF DENTAL CARIES AMONG 5-14 YEARS OLD POOR
LOCALITY SCHOOL CHILDREN OF LAHORE
SHAMSHER ALI, BDS, MCPS
1
2
MUHAMMAD UMAIR DASTGIR BHATTI, BDS, MSc
3
AYMA SYED, BDS, MPhil
4
AROOJ UL HASSAN CHAUDHRY, BDS, MPH Student
5
ZUNAIRA IQBAL, BDS, MCPS (Trainee)
ABSTRACT
The aim of study was to investigate the Prevalence of dental caries among 5-14 years old poor
locality school children of Lahore Pakistan. Sixteen hundred and seventy three poor locality school
children aged 5-14 years; 1113, 5-11 years old and 560, 12-14 years old were examined for dental caries
and oral hygiene status using the World Health Organization criteria for diagnosis of caries and oral
hygiene status. The overall caries prevalence among the study group was 71%. The mean df (decayed
and filled primary teeth) score in the 5-11 years age group was 2.98. The mean DMFT (decayed, missing
and filled teeth) score among 12-14 years old age group it was 3.70. Only 14% of the poor locality school
children had good oral hygiene with corresponding mean df of 1.33 and mean DMFT score of 1.97,
followed by 31% having fairly good oral hygiene, 26% having poor oral hygiene. 29% of children had
a very poor oral hygiene with corresponding mean df score of 2.96 and mean DMFT score of 3.31. The
results of the study emphasize the need for re-orientation of oral health services and programs to a more
preventive approach. Serious efforts need to be made by focusing on this neglected group of population.
Key words: Dental caries, poor locality school children, Prevalence of dental caries, DMFT, df
INTRODUCTION In most developing countries prevalence of dental
caries is on the rise, probably because oral diseases are
Dental caries is a chronic disease of hard tissues of the fourth most expensive diseases to treat and the
the tooth, characterized by alternating phases of dem- access to services is very limited.5 According to World
ineralization and remineralization, which can lead to Health Organizations pathfinder survey which exam-
cavitations and eventually tooth loss.1 Dental caries ined over nine thousand individuals in twenty one
affects 60% - 90 % of school children and a vast majority districts of Pakistan, dental caries was found the single
of adults across the globe and is known to restrict most common chronic childhood disease in the country
activities in schools, at work and at home, causing being 5 times more common than Asthma and 7 times
millions of school and work hours to be lost each year more common than hay fever.6 Khan reported that
all over the world. Moreover the physical, functional, more than 50% of children between ages of 12-15
social, psychological and emotional impacts of dental years are caries free however on the negative side
caries have been well documented to diminish the 97% of all carious lesions are untreated.7 Unfortu-
quality of life.2,3,4 nately no study regarding prevalence of dental caries
1
Department of Periodontology, de,Montmorency College of Dentistry, Lahore, Pakistan
2
Department of Public Health Dentistry, Faculty of Dentistry, The University of Lahore, Pakistan
3
Department of Public Health Dentistry, Faculty of Dentistry, The University of Lahore, Pakistan
4
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, The University of Lahore, Pakistan
5
Department of Operative Dentistry, Lahore Medical & Dental College Lahore, Pakistan
Corresponding author: Dr Arooj ul Hassan Chaudhry, Address: 227A Military Accounts Housing Society
College Road, Lahore, Pakistan, Phone: +923444420953. Email:
[email protected]Pakistan Oral & Dental Journal Vol 32, No. 2 (August 2012) 279
Prevalence of dental caries among poor locality school children of Lahore
has been conducted in Lahore specifically targeting the The study team consisting for four calibrated den-
large amount of children studying at poor locality tists was divided into two groups i.e. Group A and B.
schools. Each group consisted for two members. Group A was
assigned to take history and socio demographics of the
METHODOLOGY children using standardized validated form and Group
This study was carried out in two phases in Septem- B was assigned to examine the oral condition. Groups
ber-October 2011. In the first phase data of all poor A members recorded the information on missing,
locality schools affiliated with government of Punjab, decayed and filled teeth form while Group B members
board of Intermediate and Secondary education (BISE) were examining the children. The oral examination
Lahore was obtained from the education department was carried using a wooden tongue depression and
government of Punjab. A multistage random sampling explorer under sunlight while seating every child on
technique was then adopted which consisted of follow- chair to identify presence of caries. Although the
ing stages: examiners checked soft tissue including gums
tongue palate for any gum disease, calculus or abnor-
• At the first stage a random selection between mality but the main emphasis was given on caries,
Lahore City and Lahore Cantt from the data of missing and filled teeth. The information recorded
Lahore district was made. included:
• Once Lahore city was selected the second 1 Demographic data i.e. name of school, name of
hierarchy of structure was considered i.e. the student and age of student.
poor locality schools. Out of the 34 poor locality
2 Data for dental caries i.e. Number of decayed
schools registered with Government of Punjab
and filled deciduous teeth (df), Number of
(Board of Intermediate and Secondary Educa-
decayed filled or missing permanent teeth
tion) Lahore, 10 were selected using a random
(DMFT).
number technique.
3 Data for oral hygiene as per parameters recom-
• A formal permission was then taken by the
mended by the WHO: existence of food depos-
Incharge of each poor locality school by ex-
its, calculus, gingivitis and periodontal disease.
plaining the complete study protocol and the
Thus the oral hygiene was divided into 4 cat-
benefits. Before starting the actual study a
egories i.e. good, fairly good, poor and very
pilot study was conducted to overcome any
poor; as per WHO recommendations.
issues in actual study. In this pilot study a total
of 40 students were recruited and examined by Data were entered and analyzed using SPSS
the calibrated dentists for the presence of version 16.0
dental caries using the WHO criteria for re-
RESULTS
cording caries.8 The parameters measured
were df and DMF. This pilot study was con- A total of sixteen hundred and seventy three poor
ducted over a period of three days in one of the locality school children aged 5-14 years; 1113 (66%) 5-
selected schools. 11 years old and 560 (34%) 12-14 years old were
examined for dental caries and oral hygiene status.
• In the second phase all sixteen hundred and The overall caries prevalence among the study group
seventy three poor locality school children was 71%.
aged 5 to 14 years were included in the study
Table 1 reports the decayed filled (df) primary teeth
from the 10 selected schools. The age distribu-
and decayed filled and missing permanent teeth (DMFT)
tion of children was based on the index age
of the study sample according to the age groups i.e.
groups as per World Health Organization guide-
5-11 years and 12-14 years respectively.
lines.8
Table 2 reports the oral hygiene status and the
5-11 years old: 1113 (66%)
corresponding dental caries index scores i.e. df and
12-14 years old: 560 (34%) DMFT scores of the study sample.
Pakistan Oral & Dental Journal Vol 32, No. 2 (August 2012) 280
Prevalence of dental caries among poor locality school children of Lahore
TABLE 1: DF AND DMF INDICES BY AGE (SCHOOL CHILDREN OF LAHORE)
Age in years Total n (%) d f df D M F DMF
5-11 1113 (66%) 3296 24 2.98 – – – –
12-14 560 (34%) – – – 1965 74 38 3.70
d: decayed primary teeth f: filled primary teeth D: decayed permanent teeth
M: missing permanent teeth F: filled permanent teeth
TABLE 2: ORAL HYGIENE AND DENTAL CARIES According to the result of the path finder survey of
Oral hygiene Population df DMFT World Health Organization (WHO) more than 50% of
n (%) children of Pakistan were found to be caries free 7
however, the results of this study have revealed that
Good 234 (14%) 1.33 1.97
71% of poor locality school children have dental caries.
Fairly good 519 (31%) 1.69 2.03 The finding is also far away from the WHO goal of at
Poor 435 (26%) 2.82 2.23 least 80% of caries free children.16
Very poor 485 (29%) 2.96 3.31 The results of this study also show that the mean
df score in the 5-11 years age group was 2.98. This
finding is in coherence with other studies conducted on
DISCUSSION
similar age groups (6-10 years) in Mexico where mean
The aim of this study was to investigate the Preva- dmf score was 2.36,10 In Saudi Arabia where the mean
lence of dental caries among poor locality school chil- dmf score among 5-12 years old school children was
dren of Lahore Pakistan. The results of the study show reported to be 3.20.17 However this finding differs from
that the overall prevalence of dental caries in the study the study of Bardal et al in Brazil among 7-12 years old
sample was 71%. This finding is in line with studies school children where the mean dmf score was found to
conducted in China where the prevalence of dental be 1.82.18
caries among 5-7 years old school children was found to The mean DMFT score among 12-14 years old age
be 76.6% and Mexico where the prevalence of dental group of this study was 3.70. This finding is much
caries among 6-10 years old school children was found higher than the DMFT of 12-15 years old school chil-
to be 65.5%.9,10 The finding is however different from dren of UAE where mean DMFT was 2.1,19 China where
study conducted in United Kingdom where lower levels mean DMFT of same age group was 1.2,20 India where
of dental caries of 39.6% among 5 years old were mean DMFT of 12-15 years old school children was 1.1
recorded .11 Although a decline in caries has been 21
and in Nigeria where mean DMFT for 12-15 years old
observed in most developed countries, its prevalence age group was 1.0.22 The WHO global data of 2003 has
still poses a considerable challenge. Alone in the USA shown an increase in DMFT of 12 years old Pakistani
where there is expected to be less caries than any- children from 0.9 to 1.38.23 The results of the current
where else national surveys have reported that the study show a much higher value (3.70) of DMFT among
prevalence of any dental caries among children aged 12-14 years old children.
12—17 years declined from 90.4% in 1971—1974 to 67% The possible limitation of the study is exclusion of
in 1988—1991; severity (measured as the mean num- females from the study sample but that is well justified
ber of decayed, missing, or filled teeth) declined from since no female student was enrolled as permanent
6.2 to 2.8 during this period.12,13,14,15 However it is still student in any of the poor locality schools selected for
surprising to note that these decreases in caries preva- the study. One of the strengths of the study is the size
lence and severity have been uneven across the gen- of sample, which involved numerous localities and
eral population; the burden of disease now is concen- examined a sufficient number of poor locality school
trated among certain groups and persons. For ex- children in different parts of Lahore City. Also all the
ample, 80% of the dental caries in permanent teeth of examiners were well trained and calibrated before the
U.S. children aged 5—17 years occurs among 25% of study in order to enhance the precision of results and
those children.15 to reduce bias.
Pakistan Oral & Dental Journal Vol 32, No. 2 (August 2012) 281
Prevalence of dental caries among poor locality school children of Lahore
Based on the findings of the study the recommen- 10 Maria EI, Adriana MG, Marco AZZ et al. Trends in dental caries
in Mexican school children. Med Oral Patol Oral Cir Bucal-
dations for future research are that studies should now Ahead Of Print - Article In Press. http://www.medicinaoral.com/
be conducted in different districts of the country in medoralfree01/aop/18008.pdf, accessed on 23rd May 2012.
order to further explore the prevalence of dental caries 11 Pitts.N.B, Boyles. J, Nugent.Z.J, Thomas.N et al. The Dental
among poor locality school children which will be Caries Experience of 5-yr old Children in Great Britain (2005/
06). Community Dental Health 2007; 24, 1:59-63.
helpful in gaining immediate attention of policy mak-
12 National Institute of Dental Research. The prevalence of
ers and political administrations. The recommenda-
dental caries in United States children, 1979—1980. Bethesda,
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immediately be reoriented towards a preventive ap- Human Services, National Institutes of Health, 1981; NIH
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13 Kelly JE, Harvey CR. Basic dental examination findings of
which are being neglected currently and have a vast
persons 1—74 years. In: Basic data on dental examination
majority of children enrolled for basic education. The findings of persons 1—74 years, United States, 1971—1974.
health services should have specific preventive pro- Hyattsville, MD: US Department of Health, Education, and
Welfare, Public Health Service, Office of Health Research,
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14 National Institute of Dental Research. Oral health of United
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