Nazia Sultan Ali1, Nadia Sultan Ali2, Mahjabeen Khan3, Irfan Qamruddin4, Hussain Askary5, Amyna Sajwani6
1. Assistant Professor, Community Dentistry Department Fatima Jinnah Dental College Karachi, Pakistan.
2. Associate Professor, Head of Department of Periodontology Dr. Ishrat-ul- abad Institute of Oral health Sciences, Dow University of Health Sciences Karachi.
3. Assistant Professor Clinical Trials Unit Dow University of Health Sciences Karachi, Pakistan.
4. Asst Prof & HOD Orthodontics Baqai Dental College, Baqai Medical University
5. Assistant professor & HOD Community Dentistry Department Fatima Jinnah Dental College
6. Lecturer, Dow Dental College
Correspondence: Nazia Sultan Ali
How to CITE:
Ali NS, Ali NS, Khan M, Qamaruddin I, Askary H, Sajwani A. Prevalence of Dental Caries in the first permanent molars in children between 8-12 years. J Pak Dent Assoc 2013;22(2):119-123.
OBJECTIVE:
To determine prevalence of dental caries in first permanent molars among 8 – 12-years children.
METHODOLOGY:
The survey involved a cross-sectional study with dental examination. The study was conducted in the area of Garden West located in the city of Karachi, Pakistan. Four schools were selected for the survey. Four hundred and forty seven children were included in the study, ranging from 8 to 12 years of age. Total number of children in government school was 101, whereas 346 children were enrolled in private schools. The diagnostic criteria for dental caries as recommended by WHO (1986) was followed. Data analysis was performed by using SPSS program version 16.
RESULT:
In this study, there were four hundred and forty seven children, ranging from 8 to 12 years of age. Of the 447 children, 137(30.6%) had dental caries in their 1st permanent molars. In females there were 179 students whose first molars were free from caries while 94 had caries in their first permanent molars. Based on entire sample, no caries was found in first permanent molars among 310 (69.4%), while 8 (1.8%) subjects had all (four) first molars affected by dental decay
CONCLUSION:
The prevalence of dental caries in first permanent molars among 8 – 12-years children was 30.60%. Given this finding, it is strongly suggested that oral health services gear up for addressing this comprehensively and as a priority in Pakistan.
KEY WORDS:
Dental caries, Children, Schools, Prevalence, Oral health, Dental decay.
INTRODUCTION
Globally dental caries remains the most widespread disease. Dental caries is a global health problem and has a direct impact on the quality of life, particularly on children’s health and development. Untreated dental caries in children is associated with failure to gain weight. In low-income countries dental restorative treatment has not been the focus of health care services. By WHO estimates, one third of the world’s population has no access for health care.1 It is the children who mostly experience tooth decay, however majority of these teeth are extracted since they are expensive to treat within limited resources.2 World Health Organization (WHO) in 2000 had a global goal for dental caries of no more than an average of 3 DMFT (decayed, missing, filled teeth) at 12 years of age.3 WHO developed oral disease observation systems to monitor dental caries in children at 12-year in 1969. 3 Dental caries prevalence in developed countries has declined in the early 1970s.4,5 In 2007 the WHO reported that 60-90% of school children worldwide have dental caries6. Dental care remains a significant economic problem in developing countries and has been a major public health challenge. In 1997, 22.7% of Indian population was estimated to be 5-14 yrs.7 Dental caries has increased in prevalence and severity in urban and rural areas and there has been minimum data of exact prevalence in India, Iran and Bangladesh. In Pakistan, a few studies have been carried out on oral health. A DMFT value of 0.8 was observed between 12-15 years old children in Multan.8 Similarly a DMFT score of 0.9 was observed by Khan and he reported that 83 percent of all children with decay had caries in first molars.9
Most of the 12-year-old children had all their permanent teeth, except wisdom teeth. The mixed dentition ends and the permanent dentition starts at the age of 12.10 The purpose of this study was to determine prevalence of dental caries in first permanent molars among 8 – 12-years children.
METHODOLOGY
The survey involved a cross-sectional study with dental examination. The study was conducted in the area of Garden West located in the city of Karachi, Pakistan. Four schools were selected for survey, out of which three were community based religious education centers and one was government girl’s secondary school of class 6th to 8th. Four hundred and forty seven children were included in the study, ranging from 8 to 12 years of age. Sample was divided into two groups, Group A and Group B. Group A comprised of 8 to 10 years children (n=225) while Group B comprised of 11 and 12 years children (n=222). Total number of children from government schools were 101 whereas children of all the religious education centers i.e. 346 were enrolled in private schools. The inclusion criteria for the study were children between 8-12 years in the mixed dentition stage. The exclusion criteria were mentally and physically handicapped and medically compromised patients, e.g. suffering from leukemia, hemophilia etc. A voluntary consent of school authorities was taken prior the start of the study. The data collection was done in mid- Jan 2010. Prior to dental assessment, an awareness session was delivered to the children and their parents separately, according to their level of understanding. There was a questionnaire for each patient. Data in this questionnaire was collected from these patients by interviewing the accompanying adults by the graduated dentist. After entering the basic information of the patients (eg. name, age, sex and address) an intra-oral examination was performed by the author only, who was trained for the study and also to reduce inter examiner error. Depending upon the physical conditions of the schools, the exact arrangement for conducting the examination was determined. The subjects were examined on an upright chair in artificial light with a source of hand held torches having white light. A plain mouth mirror and blunt probe were used to assess the dental status based on DMF index. The tooth surface was dried with a cotton pellet and the teeth examined for dental caries using DMFT and deft indices respectively. The diagnostic criteria for dental caries as recommended by WHO (1986) was followed. Data analysis was performed using SPSS program version 16.
RESULT:
In this study, there were four hundred and forty seven children, ranging from 8 to 12 years of age. Of 447 children, 137 were having dental caries in their 1st permanent molars while 310 were having sound first molars. A significant relationship was found between different age groups and caries incidence in first molars (p=0.014) as depicted in Figure 1.
DISCUSSION
The purpose of this study was to determine prevalence of dental caries in first permanent molars among 8 – 12 year-old children. The present study provides information on prevalence of dental caries in a representative sample (n = 447) of 8 to 12- year – old from a selected community of Garden area, Karachi.
In this study we examined only the first permanent molars in children age ranging from 8 to 12 years. Since the average age for the eruption of all first permanent molars is 6 to 7 years therefore the ages of the sample included in this study was 8 to 12 years, so that first permanent molars are exposed to the causative factors of dental caries for a minimum of 2 years as research has proven that carious attack can be seen after two to four years of tooth eruption10 . The reason of taking only molars in this study was caries susceptibility as this tooth is mostsusceptible in pits and fissures as compared with smooth surfaces.11,12,13 Dental caries can ultimately lead to the extraction of the first permanent molars if not treated early. This particular tooth is very important with regards to bearing all the masticatory loads and also helping in functionally desirable occlusion. Molars are meant for mastication which is in turn required for proper digestion of food. Since missing third molars are a very common anomaly either because of impaction followed by extraction of the tooth or agenesis i.e. missing congenitally.14 This enhances the importance of keeping 1st permanent molars safe. If this tooth is lost in early age then it can result in mal-positioning of the other teeth,13,15 midline shifts and even skeletal asymmetry10,16 correction of which needs expensive and prolonged orthodontic treatment.
In this study mandibular first molars were found to be more prone to caries (FDI tooth number 36 and 46) followed by maxillary molars (FDI tooth number 16 and 26). Similar result was observed in another study conducted in Istanbul, Turkey.11
In this research there was significant difference in the caries incidence between both the groups, group A which consist of 8, 9 and 10 years old children had less carious molars as compared with group B which consists of ages 11 and 12. This may be due to more prolonged exposure of the molars to cariogenic factors in that age group therefore Health organizations (WHO and FDI) have declared twelve to be the most important age for making prevention strategies against caries.17 Wyne18 also found more caries incidence in both maxillary and mandibular first molars in the age group of 12 and 13 years.
The study population had differences between two age groups. This finding was in favor of many studies that showed a marked difference between the ages 19,20. Age and dental caries showed a significant relationship. This could be because molars of 11 and 12 years old children have been in the oral cavity since 5 to 6 years or in other words group B children molars were present for 5-6 years as compared with the group A children. This result showed significant relationship which was again favored by the National Health and Nutrition Examination Survey, 1999–2004 in the United States.21
The relation between gender and caries shows that females were more prone to develop caries in their first molars. Numerous other studies also show agreement that the females were more caries prone as compared to males of the same age.15,22,23 The reason could be the age of eruption of first permanent molars which appears earlier in females than in males thus exposing tooth long time in the oral cavity.11 Studies have explained that the risk factors of developing caries are strongly associated with the female gender.24 Salivary composition and flow rate varies in males and females. Salivary flow rate is less in femalesthan in males.25 Saliva helps in washing, buffering and remineralization of teeth thus helps in preventing caries. Else IgA is a salivary protein which protects against caries. This IgA is less in females compare to males.26 Also expected females have shown decreased salivary flow,thus more at risk of developing caries.26 Dietary habits also play an important role in developing caries. In various ocieties females have been given responsibility of cooking and this therefore allows easy availability of food with the responsibility of food preparation other than the meal times. This increases the frequency of intake of substrate, hence allowing mico-organisms to attack and leading to dental caries.27
Pakpour28 found a high incidence of caries in males as compared to females while Sadeghi M. found no difference in caries incidence among both sexes.17 Similarly the studyconducted on 4000 subjects at Dr Ishrat- ul-Ibad Institute of Oral Health Diseases, Karachi showed the similar results, sexual dimorphism was not found.29
In the current study dental caries was found in 30.6% first molars which is a high rate. The average time of eruption of first molar is 6 years of age30 and by 12 years of age, a gradual increase in caries incidence was found. The results confirmed that these children have to survive with decayed, missed or filled molars for the rest of their life.
CONCLUSION
The prevalence of dental caries in first permanent molars among 8 – 12-years children was 30.60%. Given this finding, it is strongly suggested that oral health services gear up for addressing this comprehensively and as a priority in Pakistan.
Conflict of interest: The authors declare no conflict of interest in this study.
Recommendation: We recommend initiation of preventive dental health programs in schools. These programs may comprise of following; awareness programs for children and parents, application of fissure sealants, topical fluoride and home care instructions.
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