|Year : 2014 | Volume
| Issue : 2 | Page : 125-128
Dental caries prevalence in individual tooth in primary and permanent dentition among 6-12-year-old school children in Shimla, Himachal Pradesh
Vinay Kumar Bhardwaj
Department of Public Health Dentistry, H. P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
|Date of Web Publication||19-May-2014|
Vinay Kumar Bhardwaj
Department of Public Health Dentistry, H P Government Dental College and Hospital, Shimla, Himachal Pradesh 171 001
Source of Support: None, Conflict of Interest: None
Background: Prevalence of dental caries not only varies according to age, gender, and arch but also according to the involvement of individual tooth. The study on individual tooth will help in providing incremental dental care and reducing burden of dental caries in this group of population. Objective: To find out the prevalence of dental caries in individual tooth among 6-12-year-old school children in Shimla city, Himachal Pradesh. Materials and Methods: This study was conducted among 1,200 school-going children over a span of 5 months from 11 government schools in Shimla city, in the state of Himachal Pradesh in India. Examination was performed using a mouth mirror and blunt sickle-shaped explorer under natural light, according to World Health Organization (WHO) oral health survey 1997. Results: Females were having higher prevalence of dental caries than males of the same age-group in both primary and permanent dentition (79.3% vs. 74.9%). First molars were most affected with dental caries than other teeth in both the dentitions (78.69% and 48.93%, respectively). Dental caries prevalence was high in mandibular arch than in the maxillary arch i.e. (80.0% vs. 77.38%) in permanent dentition and (51.3% vs. 46.56%) in deciduous, dentition respectively. Statistically, this difference was significant (Fischer's exact test P < 0.05). Conclusion: High prevalence of dental caries among government school children in Shimla city is a cause of concern. There is utmost necessity of regular periodic check-up, application of preventive measures, and treatment modalities as soon as teeth erupt in the oral cavity.
Keywords: Dental caries, individual teeth, prevalence, school children, Shimla
|How to cite this article:|
Bhardwaj VK. Dental caries prevalence in individual tooth in primary and permanent dentition among 6-12-year-old school children in Shimla, Himachal Pradesh. Int J Health Allied Sci 2014;3:125-8
|How to cite this URL:|
Bhardwaj VK. Dental caries prevalence in individual tooth in primary and permanent dentition among 6-12-year-old school children in Shimla, Himachal Pradesh. Int J Health Allied Sci [serial online] 2014 [cited 2020 Feb 21];3:125-8. Available from: http://www.ijhas.in/text.asp?2014/3/2/125/132700
| Introduction|| |
Health is a common theme in most cultures and is a fundamental human right without distinction of race, religion, political belief, economic, and social condition.  Oral health is an integral part of general health.  Healthy mouth enables an individual to eat, speak, and socialize without active disease or discomfort and contribute to the general well-being. It is concerned with maintaining the health of craniofacial complex, teeth and gums as well as the tissues of the face and head that surrounds the mouth.  Dental caries, because of its ubiquitous nature, remains one of the most prevalent afflictions of mankind.  This disease can aptly be termed as a scourge of modern civilization. No nation or continent has escaped the ill effects of this deadly malady. In modern civilization, it is due to the increase in the standard of living and the change in nutritional habits.  The period of mixed dentition is the critical stage from the point of view of the development of normal dentition. During this period, oral hygiene is poor not only because of the carefree age and the emotional stresses of the child but also due to frequent intake of refined sugars, soft and sticky foods, shedding of deciduous teeth, and the eruption of the permanent teeth. 
It is crucial to control the carious process by assessing and rendering the treatment required, along with spreading awareness about prevention of dental caries. Many studies have been conducted worldwide which reveal the prevalence of dental caries among different populations. ,,,, No data is available which gives us a view of the prevalence of dental caries in individual tooth among school children in Himachal Pradesh. Hence, this study has been taken up to find out the prevalence of dental caries in individual tooth among 6-12-year-old school-going children in Shimla city. A data about prevalence of dental caries in individual tooth can help in formulating, implementing the preventive and curative strategies as early as possible after tooth eruption to maintain good oral health of this group of population.
| Materials and methods|| |
Shimla city is the capital of the state of Himachal Pradesh in India with a total area of 32.30 sq. km and with a population of 1,42,535.  This cross-sectional study was conducted among 1,200 school-going children over a span of 5 months (from May 2007 to September 2007). Whole Shimla city was divided into four zones i.e. north, east, west, and south based on the geographical and the administrative configuration. Three schools each were randomly selected from north, east, and west zones where each zone had 9 schools; and 2 schools were randomly selected from south zone that had 7 schools. A selection of 594 male and 606 female students from 11 government schools was made. Official permission was sought from the director elementary education, district education officer, and administrative head of the concerned school. This study was cleared by the educational ethical committee of Government Dental College and Hospital, Shimla. Written consent was obtained from the teachers and parents of the subjects. Type III examination as recommended by American Dental Association was conducted.  Without drying the teeth, examination was performed with dental mirror and community periodontal index (CPI) probe used for dentition status and treatment needs index under natural light, according to WHO oral health survey 1997.  Firstly, carious teeth were identified, and a diagnosis of the caries was made only when there was clear evidence of the loss of the tooth structure. White or brown spots in the enamel, the substance of which remained intact and glossy, were not considered to be caries. Caries were recorded as present when a lesion in a pit or on smooth surface had a detectible softened floor, undermined enamel, or softened wall. A number of 25-30 children were examined daily by the examiner himself in the school premises. Each survey session was followed by dental health education to the students. The children who needed treatment were referred to the Government Dental College and Hospital Shimla for further management. The data was analyzed using the software statistical package for social sciences version 15 (SPSS Inc., Chicago). Difference in caries prevalence among individual tooth was assessed for statistical significance using the Friedman test and Dunn's multiple comparison test. Pearson's Chi-square test and Fischer's exact test were used to compare the difference in caries prevalence among individual tooth genderwise. Univariate analysis were performed by the use of Chi-square statistics and t-test. P≤ 0.05 was considered as statistically significant, and P ≤ 0.01 was considered as statistically highly significant.
| Results|| |
Out of the 1,200 children examined in the present study, 594 were boys and 606 were girls. Among male students, 172, 184, and 238 belonged to the 6-7, 8-9, and 10-12 years age-group, respectively, whereas 190, 206, and 210 female students belonged to 6-7, 8-9, and 10-12 years, respectively [Table 1]. Both the arches had deciduous first molar most affected with dental caries, 46.56% and 51.3%, respectively, irrespective of age and gender. Mandibular central incisor and maxillary lateral incisor were the teeth least affected with dental caries [Table 2]. Maxillary permanent first molar was the most affected tooth with dental caries (77.38%), followed by central incisor (6.18%). Canine was the least affected tooth (1.8%). Mandibular first molar was the most affected tooth (80%), followed by first premolar (4.93%). Lateral incisor (0.31%) was the least affected tooth [Table 3].
|Table 2: Dental caries in individual tooth age wise, gender wise, and arch wise in primary teeth |
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|Table 3: Dental caries age wise, gender wise, and arch wise in permanent dentition |
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| Discussion|| |
The present study revealed the prevalence of dental caries in individual tooth among 6-12-year-old school children in Shimla city in Himachal Pradesh. Mandibular central incisors were least likely to be carious, while mandibular and maxillary molars were the most affected. Dental caries are more prevalent in maxillary teeth than in mandibular teeth. The results of the present study confirm the finding of Luan et al.,  who evaluated the 10-year incidence of dental caries among Chinese children and adults. They observed the lowest disease incidence on mandibular anterior teeth. Mandibular molars were apparently more susceptible to dental caries. The reason could be the earlier eruption of mandibular molars than maxillary molars.
In the present study, maxillary molars were significantly affected than mandibular molars. Macek et al. reported that the lower molars were the most severely affected teeth in the entire dentition.  It was observed that molar teeth were more prone to caries than incisors, canines, or premolars in all the age-groups.  Statistically, this difference in the prevalence of dental caries among different teeth was highly significant (P < 0.01).
It is pertinent to note that neither the majority of the world's population specially in the rural area have access to organized oral health care, nor is the tradition of maintaining proper oral hygiene widespread in such population. ,, However, this situation makes it possible to study the natural history of dental caries. Difference in the prevalence of the dental caries may occur among different populations of children with respect to the geographic location, education, and socioeconomic status of the parents and lifestyle. Main observation was that younger age-group is more prone to dental caries than older age-groups.
The finding that more carious teeth were observed in female subjects in both primary and permanent dentition than in male subjects is in agreement with the findings of other studies. ,, This gender-wise difference was highly significant (P < 0.01). Mansbridge  reviewed several studies presenting data about the gender predisposition of caries and revealed that most of the researchers attribute it to the early eruption of teeth in females than in the males. These early erupted teeth, exposed to risk factors for initiation and progression of dental caries, are responsible for the occurrence of dental caries. Hence, it is logical to assume that female subject's teeth would decay more than the teeth of the male subjects of the same age. Bhardwaj et al.  revealed contrasting results, showing male students with high prevalence of dental caries than among females.
| Conclusion|| |
Females were having higher prevalence of dental caries than male subjects of the same age-group in both primary and permanent dentition. First molars were most affected with dental caries than other teeth in permanent dentition. In deciduous dentition, prevalence of dental caries was highest in the first molar teeth than the remaining teeth in the arch. Dental caries prevalence in both the dentition was high in mandibular arch than in the maxillary arch. The dentists should advice the children for a regular dental check-up so that the teeth can be examined and if required should be treated as soon as they erupt in the oral cavity.
It is a prudent suggestion that a greater degree of awareness should be created among parents and teachers by dentist and health educators. School authorities should organize dental check-up and dental health education camps in their schools. They should follow-up students affected by dental diseases and persuade them to avail dental treatment at the dental care institution.
Limitations and Suggestion
This study was conducted on a smaller sample and without taking into effect of different variables and demographic factors like fluoride content of the drinking water, consumption of in-between meal sugars, method of cleansing and the material used for this purpose, education of mother and socioeconomic status of the parents, and visit to the dentist. A study in the future should be conducted to know the prevalence of dental caries and its association with the above-mentioned factors which can cause and enhance the initiation and the progression of dental caries.
| Acknowledgement|| |
I thank all the children who participated in this study, their parents, and teachers who gave their kind consent, heads of the concerned school, Principal, Himachal Pradesh. Government Dental College and Hospital, Shimla for permitting me to conduct this study. My special thanks to the librarian of Dental College Shimla and the statistician without whom this work could not have been compiled.
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[Table 1], [Table 2], [Table 3]