Dental caries is the most common
infectious disease affecting human. This dental disease is preventable and yet
continues to be a major public health problem predominantly affecting children.
According to the National Oral Health Survey recently conducted throughout
India, dental caries was seen in 51.9% of 5yrs old children. The survey
recommended a preventive dental health program such as use of fluoride tooth
paste; water fluoridation should be initiated to address the problem of dental
caries.9 Children have 20 primary teeth, which
often erupt about 6months of age and usually when child is 2.5-3yrs old, all
primary teeth are found in the mouth. By 6yrs of age, many children are getting
their first adult molars. Primary teeth have function other than biting and
chewing. They help to provide nutrition, aid in the normal development of the
jaw bones and facial muscles, give face its normal appearances, make speech
possible, reserve space for the permanent teeth and help to guide them into
position.10 One of the most important functions of
primary teeth is reserving space for the permanent teeth and help to guide them
into position. So it is very important to maintain the health of the primary
teeth. Neglected cavities can lead to problems which affect developing
permanent teeth. Primary teeth also affect the development of speech and add to
an attractive appearance. While the front four teeth last until 6-7 yrs of age,
the back teeth (cuspids and molars) are not replaced until age 10-13. 11 As a permanent tooth is ready to erupt, the root of
the primary tooth begins to dissolve. The permanent tooth pushes the primary
tooth that has been resorbing for it. If a primary tooth is lost too soon, the
permanent tooth has no guide to follow. Also the teeth next to a missing tooth
may drift into the space left by the missing tooth. In this situation dentist
may provide the child with a space maintainer. But it is preferable to take
early preventive measures to prevent early tooth loss. So child can keep all
primary teeth until they are ready to be shed. One of the latest research done in
Malappuram, Kerala revealed that the prevalence of dental caries was seen more
in children studying in government schools than in private schools which was
statistically significant (P=0.018). There was no significant difference seen
in the prevalence of calculus between government and private school children. High
prevalence of dental caries was found in these school children who suggested a
poor performance of oral hygiene practices in them.12 A study done on early childhood caries
lesions in preschool children in Kerala, India emphasized that the groups at
high risk from dental caries lesions are, those who consume snacks and are
given sweets as rewards and those belonging to a lower socio economic class.
This study also showed that the majority of caregivers (79%) knew about the
causes of dental caries lesions and 85% of them knew ways to prevent caries
lesions but 59% were not sure whether primary teeth needed to be restored.
There was no necessity for a dental check up for children before the age of 1
yr according to 19% of the care givers, and 76% indicated that they would visit
the dentist only if a dental problem arose.13 Dental caries, also known as tooth
decay, cavities or caries is a breakdown of teeth due to activities of bacteria14.
The cavities may be in different colors from yellow to black. Symptoms may
include pain and difficulty with eating. Complications may include inflammation
of the tissue around the tooth, tooth loss and infection or abscess formation15,16. Dental caries in the primary dentition
has received renewed attention in recent years because caries in the primary
dentition is predictive of later caries experience. A study done by Warren et
all on dental caries in the primary dentition and assessing prevalence of
cavitated and noncavitated lesions revealed that the decay experience was most
common on the primary second molars. About 56% of untreated decay was located
in the pits and fissures, while 58 percent of decay was located on smooth
surfaces.17 Many countries have developed different
strategies to reduce or even eradicate dental caries from preschool children
following dental caries surveys. Most of them have already obtained excellent
results using water and salt fluoridation, dental health education, school oral
health program and so forth. The results of a recent research done in Palestine
shown that 76% of the studied children have already experienced dental caries
at the age of 4-5 yrs (1046 children). There is a real need to make
improvements at the level of parent’s dental health education, application of
preventive measures and dietary habits among preschool children.18 A cross- sectional study to determine
prevalence of early childhood caries among preschool children in Trivandrum
depicted that relatively high dental caries prevalence rate of 54%. The study
done on 1329 preschool children of less than 60 months of age randomly selected
from rural and urban areas of Trivandrum. This study also showed a positive association between
early childhood caries and age of child, location of residence, dietary habits
and oral hygiene habits.19 Early childhood caries (ECC) is
considered as a serious public health problem as it is a complex disease of
primary dentition which relay serious socio-behavioral issues that afflict
mainly the infants and toddlers. Early Childhood Caries, if untreated the
deleterious effect are pain, compromised chewing ability, malocclusion,
phonetic problem, suboptimal health, lower self esteem. ECC is social,
political, behavioral, medical, psychological, economical and dental problems
that affect the quality of life. 20 Caries is also associated with poverty,
poor cleaning of the mouth. Word wide approximately 2.43 billion people (36% of
the population) have dental caries in their permanent teeth. The WHO estimates
that nearly all adults have dental caries at some point in time. In baby teeth
it affects about 620million people or 9% of the population. They have become
more common in both children and adults in recent years.21 A person experiencing caries may not be
aware of the disease. The earliest sign of a carious lesion is the appearance
of a chalky white spot on the surface of the tooth, indicating an area of
demineralization of enamel. This is referred to a white spot lesion or a
microcavity.22 As the lesion continues to de mineralize, it can turn
brown but will eventually turn into cavitation (cavity). Before the cavity
forms, the lost tooth structure can be regenerated. Dental caries can also
cause bad breath and foul tastes. In highly progressed cases, infection can
spread from the tooth to the surrounding soft tissues. Complications such as
cavernous sinus thrombosis and Ludwig angina can be life threatening.23 Poor oral health can have a detrimental
effect on children’s performance in school and their success in later life.
Children who suffer from poor oral health are 12 times more likely to have more
restricted activity days including missing school than those who do not. More
than 50 million hours annually are lost from school due to oral diseases. It
has been hypothesized that oral health can be improved through health
education, schools provide an ideal setting for promoting oral health, it
offers an efficient and effective way to reach over 1 billion children
worldwide, and through them, families and community members.24 A recent study done in Chennai revealed that oral
health education is effective in improving oral health status of school
children; data shows that oral hygiene is improved by decrease in plaque and
gingival bleeding and also there was a significant decrease in dental caries.25 A study to evaluate the effect of a
school-based oral health education in preventing untreated dental caries and
increasing knowledge, attitude practice among adolescent, done in Bangladesh
projected out, there was a significant improvement in school aged adolescents’
self reported knowledge, attitude and
practices scores. The prevalence of untreated dental caries of the study
population after the Oral Health Education program was significantly reduced to
42.5% from 76.6%. 26 Oral health education is most widely
used in prevention of dental diseases. A systematic review done to evaluate the
effectiveness of oral health education among school children in Chennai
revealed that it is highly effective in improving oral health in school
children. Six studies were included in the review. Four studies provided data
for comparison of plaque and gingival index scores and two studies provided
data comparison of DMFT index scores. Results showed interventions were
effective in reducing the dental plaque, improving gingival status and
decreasing DMFT scores of the children.27 A subsequent randomized trial
which provided an intensive preventive regimen involving interactive
counseling, intensive oral hygienic intervention, fluoride lozenges, xylitol
lozenges, fluoride varnish, chlorhexidine varnish and distribution of tooth
paste containing 1,500 ppm fluoride and 10% xylotol to high risk Finnish
children aged 11-12 yrs, found a 44% reduction in caries in the intervention
group compared to the control group.29 Early childhood caries is one of the
most prevalent chronic diseases of children that affect their life and their
family in different aspects. Using different types of fluoride is one of the
most effective ways for preventing the disease. Fluoride varnish is a topical
fluoride product which could use in the community even by non-professional. A
study aimed to assess the effect of fluoride varnish on dental caries in a
group of children aged 3-6 years old in Kerman kindergarten during 6 month’s
period. This community interventional study recruited a sample of volunteer
children from 12 kindergartens through a cluster sampling. Kindergarten
randomly allocated to test and control group after matching. Dental examination
was performed in three phases of the study by a trained dentist using criteria
of Intentional Caries Detection and Assessment System. Fluoride varnish was
applied for test group in the first phase after dental examination and also 3
and 6 months after this phase. Control group has received varnish product just
after 3 and 6 months after the first dental exam. The results revealed that the
mean dmft of the participants in the first stage of the study was 5.08 and
decreased to 4.77 in the third stage. Results of this study also prove those
the preventive effect of fluoride varnish on dental caries. Even though this
study was a short-term one, a reduction in caries is evident; therefore we are
hopeful that the continued use of varnish in kindergarten will help to promote
oral health of children.30
The
investigator during her school and community visits has come across that the
preschool children lack proper oral care and are more prone to develop dental
caries. The investigator also noticed that there is no specific preventive
program for dental caries in our country. Many studies proved that the dental
caries can be prevented by the proper utilization of oral health programs.
These factors motivated the investigator to determine the effect of a
multi-component oral health program on caries risk among children from
Anganwadies, Thiruvananthapuram district. Aims and objectives The aim of the study is to determine the
prevalence and effect of multi component oral health program on Caries risk among children from Anganwadies
Thiruvananthapuram district. Phase-I Primary Objectives - Find
out the prevalence of caries risk among Anganwadi children from
Thiruvananthapuram district by American
Academy of Pediatric Dentistry (AAPD) Caries risk tool and Salivary mutants
strip test. Secondary Objectives - Find
the association between caries risks and selected demographic variables of the
Anganwadi children from Thiruvananthapuram. Phase-II Primary Objectives - Determine
the effect of a multi component oral health program on caries risk among
children from Anganwadies, Thiruvananthapuram interms of dmft index and ICDAS
(International Caries Detection and Assessment System). Secondary objectives
- Identify
the effect of a planned teaching program on knowledge of mothers regarding Oral
health and Prevention of Dental caries. |