RESEARCH ARTICLE Prevalence of dental caries

Sonika et al

International Journal of Public Health Dentistry

RESEARCH ARTICLE Prevalence of dental caries and its association with Snyder test among preschool children in anganwadis of a North Indian city Raj Sonika, Sonu Goel , Sharma Vijaylakshmi, Naveen Kishan Goel

Abstract Background: Dental caries not only causes damage to the tooth, but is also responsible for several morbid conditions like tooth loss before time which results in malocclusion, inferiority complex and malnutrition. Objectives: 1. To assess the prevalence of dental caries among preschool children attending anganwadi centres 2. To study the association of dental caries and Snyder’s test. Methods: A cross sectional study was conducted among the anganwadis of Chandigarh, India in October 2010. 495 children aged 3 to 6from 21 anganwadis were selected using simple random sampling. Dental caries was recorded using the decayed, missing, filled teeth (dmft) index. The mothers were also interviewed regarding oral habits of their children. Samples of saliva (0.2 ml) of children of Anganwadi Centres (AWC) were taken in sterile tubes with Snyder test agar media to detect caries activity. Results: The prevalence of caries in the study population was found to be 48.3 % (n=258).The prevalence of dental caries was maximum (63.2%) in 5-6 year age group. 47.2% children reported brushing once daily. Mean dmft score in the population was 2.1± 3.20. Caries activity was found in 48% (n=240) of total children examined. Conclusion: The study has revealed that preschool children not only have high incidence of caries but also high susceptibility of caries in future life. Snyder test is a simple and cost-effective test to determine the caries susceptibility among children. It should be introduced as a part of routine assessment of dental health examination of pre-school children. Keywords: Prevalence; Dental Caries; Snyder test; Association. loss for the parents. This has further caused an

Introduction

increase in tooth loss before time, resulting in Dental caries is an important public health problem and is the most prevalent oral disease among children in the world (1). In India, the prevalence of caries among preschool children was found to be in range of 40-70% (2-5). The disease not only causes damage to the tooth, but is also responsible for several morbid conditions of the oral cavity and other systems of the body (6).This high prevalence of dental caries results in the absenteeism of school

malocclusion,

inferiority

complex

and

subsequently leads to malnutrition (7). If a high risk group of children with primary tooth caries can be identified and characterized, it would be useful to apply preventive measures to children with elevated risk. So the present study was conducted to assess the prevalence of dental caries among preschool children attending anganwadi

centres

and

to

ascertain

the

relationship between oral health habits and

hours and loss of working hours and economic 1

International Journal of Public Health Dentistry 2012:3(1):1-10. © Publishing Division, Celesta software Private Limited

Sonika et al


dental caries of preschool children and to study

estimation

of

the association of dental caries (by oral

Halitosis

examination) and Snyder test.

examination. If the child had foul breath at time

Methods

of examination it was considered as positive for

was

dental

morbidity

recorded

was

during

the

used. oral

halitosis. Only habit of thumb sucking was The crosses sectional study was conducted

considered. Presence of plaque was seen on

among

in

upper anterior teeth only. The explorer was

2010.There are 423 anganwadis in Chandigarh

passed over the labial surface of anterior teeth

divided into 3 projects catering to around 35000

and if plaque present only on gingival one third

preschool children (8). The sample size for the

then considered as stage 1, if extended to

study has been determined by EPI-INFO WHO

middle one third then stage 2 and if covering

package.

0.05

incisal one third area also then it was taken as

(likelihood of association by chance alone as

stage 3. Proforma for recording of Snyder test

less that 5%) and beta error 0.20 (i.e. statistical

was also used.

anganwadis

Taking

alpha

of

Chandigarh

error

to

be

power of the study as 80%), and prevalence of dental caries as 40% and taking 10% as no

For collection of data, the AWC were visited and

response rate, a total of 495 children were taken

anganwadi workers (AWW) were explained

for the study. Assuming that an anganwadi will

about the nature and purpose of the study.

contain around 20-25 children in the age group

Caries was recorded based on dmft (decayed,

of 3-6 years, a total of 21 anganwadis were

missing, filled teeth) index using codes and

included in the study. Simple random sampling

criteria as described by WHO (9) .The mothers

technique was used for selection of AWC

were also interviewed regarding oral habits,

(anganwadi centres) from 3 projects, 7 from

frequency of brushing, rinsing, medium for

each project (n=21). All the children aged 3-6

cleaning teeth of their children. Socioeconomic

years attending the AWC on the date of visit,

status was classified according to revised

whose parents consented for the study were

Kuppuswamy’s socio-economic status criteria

included. The children absent on the day of visit

(10).

or those < 3 years or > 6 years or whose parents denied consent were excluded from the study. The consent of the Project Officer, Integrated Child Development Services (ICDS)and Medical Officer, ICDS, Chandigarh was obtained prior to the study. Informed verbal consent was also taken from the anganwadi workers (AWW).

Collection of saliva for Snyder’s test -Samples of saliva (0.2 ml) of children of AWC were taken in tubes with Snyder test agar media to detect caries activity. The media contains peptones as sources of carbon, nitrogen, vitamins and minerals.

Dextrose

Bromcresol

green

is is

the the

carbohydrate. pH

indicator.

Data was analyzed using the software SPSS-

Microorganisms that use the dextrose in the

version 16. A pretested structured proforma for

medium

acidify the medium

and the pH

indicator, bromcresol green, changes color from 2


Sonika et al


blue-green to yellow. The tubes were then

children examined. The dmft per affected child

transported back to laboratory and incubated at

was highest (4.74) in age group of 4-5 years and

37degree C. The readings were taken at 24, 48,

difference was found to be statistically significant

72 and 96 hrs to detect the colour change in

(p = 0.000). The dmft score was highest (2.25) in

media (11).

urban settings and in lower strata (3.50) but the difference was insignificant (p = 0.438) (Table-

Results

2).

Out of total children examined, 271(50.7%) were

Table2: The dmft and mean dmft scores of

males and 263(49.3%) females (Table-1).The

the study population (n=534).

prevalence of caries in the study population was found to be 48.3 % (n=258).The prevalence of caries was maximum (63.2%) in the 5-6 year

Age Group

age group.

3-4

Table1:Demographic study subjects.

information

of

DMFT Mean±SD

Children with decayed teeth N

%

1.53±2.77

97

37.4

4-5

2.72±3.67

106

56.3

5-6

2.53±3.00

55

63.2

Female

2.08±3.23

118

44.8

Male

2.14±3.17

139

51.2

the

Age Group

N

%

3-4

259

48.5

4-5

188

35.2

5-6

87

16.3

Female

263

49.3

Male

271

50.7

Urban

2.25±3.51

124

48.1

Upper

1

0

Peri urban

2.15±2.99

67

54.1

Upper Middle

17

3

Rural

1.84±2.77

73

48

Lower Middle

87

16

Socio-economic status

Upper Lower

415

78

Lower

14

3

P value

0.000

Gender

Gender

0.806

Setup

Socio-economic Status

Upper

-

0

0

Upper Middle

1.94

7

41.1

Lower Middle

1.85

39

44.8

The mean dmft score of study population was

Upper Lower

2.13

202

48.6

slightly higher in males (2.14) as compared to

Lower

3.50

10

71.4

Residential Setup Urban

252

48

Peri Urban

124

23

Rural

152

29

0.438

0.642

females (2.08) but the difference was not found

The primary mandibular left second molar

to be statistically significant (p = 0.806).There

(25.3%)

were no cases of filled teeth in any of the

mandibular right second molar (24.5%). Around

3

was

most

affected

followed

by


*

Sonika et al


47.2% children reported brushing once daily

highly caries active while 20.2% (n=101) were

while 15% children had never brushed their

moderate active (Table-4).The difference was

teeth. Majority of them (n=455, 85.2%) used

found to be statistically significant (p