|Year : 2021 | Volume
| Issue : 4 | Page : 99-105
The prevalence and severity of dental caries in permanent molars amongst 8–10 years of children in Vadodara, Gujarat: An epidemiological study
Bhriti Aditya Thaker1, Bhavna Haresh Dave2, Aditya Thaker1, Susmita Shrenik Shah2, Deepika Narasimha Chari2
1 MDS Pediatric and Preventive Dentist, K. M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
2 Department of Pediatric and Preventive Dentistry, K. M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
|Date of Submission||29-Apr-2021|
|Date of Decision||02-Jul-2021|
|Date of Acceptance||10-Jul-2021|
|Date of Web Publication||16-Oct-2021|
Bhavna Haresh Dave
Department of Pediatric and Preventive Dentistry, K. M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat
Source of Support: None, Conflict of Interest: None
Introduction: Oral diseases and traumatic injuries are serious public health problems, especially when talking about children. Mutilation of the function and reduced quality of life has an influence on individuals and communities. The most widespread oral disease in developing countries has been found to be dental caries. The maintenance of healthy permanent molars is very important. DMFT and PUFA index can be used to determine the caries status and severity in untreated carious teeth of an individual. Materials and Methods: This was a cross-sectional descriptive survey that included 1380 children between the age group 8–10 years from public and private schools of Vadodara, Gujarat. The study population was divided based on their socioeconomic status as upper, middle and low according to the Kuppuswamy scale. The study was conducted 2 days per week for 6 months to examine the participants. Dental caries was assessed using DMFT index, and the severity of caries was evaluated by PUFA index for permanent first molars. Results: The prevalence of first permanent molar caries in Vadodara city was 55.38%; 747 out of 1380 children of 8–10 years of age were affected with caries evaluated using DMFT index. The severity of first permanent molar caries (PUFA index) was found to be 56.22%. That is, 420 out of 747 children had more severe first permanent molar caries. Conclusion: Caries prevalence and severity increase with age. PUFA index is an effective index in evaluating the clinical sequel of untreated carious teeth and helps better treatment plans for a socially deprived group of society.
Keywords: Dental caries, DMFT/deft index, oral diseases, permanent molars, prevalence, PUFA/PUFA index, schoolchildren, socioeconomic status
|How to cite this article:|
Thaker BA, Dave BH, Thaker A, Shah SS, Chari DN. The prevalence and severity of dental caries in permanent molars amongst 8–10 years of children in Vadodara, Gujarat: An epidemiological study. Adv Hum Biol 2021;11:99-105
|How to cite this URL:|
Thaker BA, Dave BH, Thaker A, Shah SS, Chari DN. The prevalence and severity of dental caries in permanent molars amongst 8–10 years of children in Vadodara, Gujarat: An epidemiological study. Adv Hum Biol [serial online] 2021 [cited 2021 Dec 4];11:99-105. Available from: https://www.aihbonline.com/text.asp?2021/11/4/99/328402
| Introduction|| |
Oral diseases and traumatic injuries are serious public health problems, especially when in children. Mutilation of function and reduced standard of life has an influence on individuals and communities. The present example of oral diseases imitates notable risk profiles across countries.
Dental caries is the most widespread chronic disease spreading universally amongst children in both developed and developing countries, which is affecting 60%–90% of school-going children and the majority of adults. Teeth are left untreated/removed because of pain/discomfort; this is because of poor accessibility to oral health services in developing countries.
Dental caries prevalence has been documented globally using the DMFT index for the last seven decades. DMFT index, though, lacks in providing information on clinical sequelae of untreated dental caries. Furthermore, in WHO Oral Health Surveys: Basic Methods, pulpal involvement has not been mentioned. In order to get better healthcare, there is a need for a diagnostic index that presents a picture of the consequences of advanced stages of dental caries to the authorities.
Monse et al. introduced a new index for the detection of sequelae of untreated dental caries. Four oral situations developed from untreated caries were named in PUFA/pufa index. Unlike the classical DMFT/deft index, PUFA/pufa is an index applied to measure the incidence of oral lesions developed from untreated dental caries. It basically scores the presence of visible pulp, ulceration of oral mucosa due to root fragments, a fistula or an abscess.
This index attempts to compliment and increases the understanding of the original DMFT index. PUFA/pufa index has to be presented along with DMFT/deft or ICDAS II because PUFA index complements them.
Due to morphology and functional characteristics, first, permanent molars are usually more susceptible to dental caries than any other teeth., There is a high incidence of occlusal caries throughout all age groups for first permanent molar.
The importance of the first permanent molar cannot be underestimated since it is key to occlusion. The early loss due to caries can have a considerable impact on the future dental health of the child. Hence, maintenance of a healthy permanent first molar is essential because, within a short period after the eruption, the occlusal surface is more prone to caries.
Along with site and age of caries incidence, socioeconomic status is also one of the major determinants of health and disease. Kuppuswamy (1981) invented a socioeconomic scale to classify rural and urban populations. The scale is the amalgamation of scores of education and occupation of the head of the family along with monthly earnings of the family unit. The scale classifies the population in upper, middle and low socioeconomic status.,
Oral health is a part of general health, for raising the awareness correct community information is a must. Therefore, it was decided to estimate the incidence and severity of caries of the permanent first molars as it can support the induction of the future dental health of the rest of the dentition. The objective of the study was to discover the prevalence and severity of dental caries in permanent first molars amongst 8–10 years of children in Vadodara, Gujarat.
| Materials and Methods|| |
This was a cross-sectional descriptive survey conducted amongst 8–10-year-old children attending public and private primary schools of Vadodara city. The study was approved by the institutional ethical committee (SVIEC/ON/Dent/BNPG13/D13200). A list of public and private schools of Vadodara was obtained from the office of Nagar Prathmik Shikshan Samiti, Vadodara, Gujarat. Selection of schools from different zones was made using a chit system.
Children present in the school on the day of examination and children whose parents gave consent were included in this study. Children with partially erupted/unerupted permanent first molars, children with congenitally missing permanent first molars, children with any systemic disease and syndromes and children who have undergone pit-fissure sealants or fluoride application were not included in the study.
A sample size of 1380 was derived after the statistical analysis. The sample size was selected assuming 66.4% prevalence from the previous study. With 10% allowable error and 99% confidence interval, the following distribution was done using multistage sampling. Care was taken that an equal number of children were selected from the public as well as private schools where boys and girls get selected equally from each class by lottery method. That is, children from public and private schools were 690 each. Two hundred and thirty children of each class from both public and private schools of age 8 years, 9 years and 10 years were selected by a table of random numbers [Figure 1].
|Figure 1: Consort chart showing flow of participants through each stage of the study|
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The study population was divided based on their socioeconomic status as upper, middle and low according to the Kuppuswamy scale.
The study was conducted 2 days per week for 6 months to examine the participants. Clinical examination of all the participants was done by a single investigator who was calibrated prior to the evaluation to eliminate error. An assistant was trained to assist in the documentation of the observations done by the investigator.
All children were examined on the ordinary upright chair individually with the help of a sterilised mouth mirror and no. 23 explorers in natural daylight. Prior to the examination, all the participants were asked to rinse the mouth with water. Dental caries was assessed using the DMFT index, and the severity of caries was evaluated by PUFA index for permanent first molars.
| Results|| |
This cross-sectional descriptive survey was conducted amongst 1380 children of 8–10 years in Vadodara, Gujarat. The data obtained were systematically compiled. The statistical software IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA) was used for analyses of data and Microsoft Word and Excel were used to generate graphs and tables. In order to check the association between two variables, Pearson's Chi-square test was applied. The prevalence of first permanent molar caries in Vadodara city was 55.38%; 747 out of 1380 children of 8–10 years of age were affected with caries evaluated using DMFT index. The severity of first permanent molar caries (PUFA index) was found to be 56.22%. That is, 420 out of 747 children had more severe first permanent molar caries.
Analysis using DMFT index
After the age group-wise allotment of children who experienced first permanent molar caries, prevalence amongst 8 years (37.17%), 9 years (66.43%) and 10 years (62.5%) was found, which shows that the occurrence of caries is reasonably less in the 1st year after the eruption of the tooth. This drastically increases at 8–10 years of age. The decayed element was greatest amongst all the groups; the missing component was almost zero, showing hardly one tooth being missing amongst 9–10 years of age group. At the same time, the filled component was nominal compared to the untreated carious lesion [Table 1].
After gender-wise distribution of children under age 8-10 years for total caries exposure, present study showed that males were affected more than females that is 57.8% and 52.94% respectively. In the total DMFT score, the major difference was in the decayed component, which is more in males than in females. From 8–10 years of age, missing teeth are negligible in schoolchildren of Vadodara. While seeing the filled component, females and males were having no significant difference in it.
Amongst total carious first permanent molars, it was found that first permanent mandibular molars were most commonly affected with caries than maxillary first permanent molars. In the maxillary-mandibular first permanent molar teeth, the incidence of caries was identical on both sides of the mouth [Table 2]. For the right and left first molars, there was no huge discrepancy in the bilateral prevalence of dental caries.
Amongst 747 children affected with first permanent molar caries, 379 (56%) were from public schools and 368 (54.791%) were from private schools of Vadodara city. The socioeconomic class-wise distribution of first permanent molar caries frequency was 35.07% (n = 156), 66.36% (n = 299) and 64.71% (n = 292) in upper-middle class, middle/lower-middle class and lower/upper lower class, respectively [Table 3].
|Table 3: Socioeconomic class wise total caries exposure score by DMFT index|
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Analysis using PUFA index
In 8-year-old schoolchildren, the total PUFA score was 30.32%; in 9 years, it was 74.12%; and in 10 years, it was 64.38% [Table 4]. On gender-wise distribution, the PUFA score in males was 227 (60.56%), and in females, it was 193 (51.88%), which was statistically significant (P < 0.001).
|Table 4: Age group wise comparison of severity of first permanent molar caries|
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When the socioeconomic class-wise observation was done, it shows that the middle/lower middle had a maximum PUFA score that was 66.36%. The lowest score was found in the upper-middle class, 35.07%. The lower/upper lower class has a 64.71% PUFA score, which also states greatly affected, but when compared with middle/lower middle class, it is less [Table 5].
|Table 5: Socioeconomic class wise total caries exposure score by PUFA index|
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On public and private school-wise comparison of severity of first permanent molar caries based on PUFA index we found that; P = 36.15%, U = 5.46%, F = 1.73%, A = 11.8% for public schools and P = 35.87%, U = 6.34%, F = 4.83%, A = 11.18% for private schools respectively. There was no statistically significant difference found in total caries severity score comparison 213 (58.22%) public school and 207 (55.4%) private school children.
| Discussion|| |
The current concept of dental caries involves the relations between genetic and environmental factors in where biological, social, behavioural and psychological tools are expressed in a highly complex and interactive manner. There is scanty literature that describes the status and extent of dental caries in the first permanent molar in the Indian population. In this cross-sectional study, oral examination of total of 1380 schoolchildren of 8–10 years of Vadodara, Gujarat, was done.
Due to the timing of permanent first molar eruption, it is first in a queue of permanent dentition. It exhibits superior control over the teeth that erupt later. First permanent molar plays a crucial role in maintaining the dental and overall health of a person. They take maximum occlusal forces and are situated in the oral cavity such that they control the vertical distance, the vertical dimension, aesthetic proportions as well as the best source of anchorage.
In the present study, only the first permanent molars were recorded as this tooth is most vulnerable in pits-fissures as compared with smooth surfaces.,, As well as research has proven that the maturation of the first permanent molar takes place after 2 years of eruption. As there are more chances of caries attack in the first 2 years of the eruption of first permanent molars, the age group of selected children was between 8 and 10 years of age.
Caries prevalence in first permanent molar was found to be 55.38% (n = 747) out of 1380 children of 8–10 years of age (evaluated by DMFT index). In 2014, the prevalence of first and second permanent molar caries was found 35.2% amongst 12–15 years of age according to the DMFT index in Nalgonda district, India.
Chukwu et al. showed that the permanent first molars are responsible for 42% of all extractions because of caries which is the highest percentage of all other teeth. Warren JJ studied that 48% of children of age 6 years had caries-free first permanent molars in Taiwan; however, 52% showed caries.
McDonald and Sheiham have shown a high occurrence of caries on the occlusal surface of permanent first molar in all age groups. The anatomy, timing and location of the tooth confer inverted drawbacks or benefits to the different approaches employed for a variety of purposes.
After the age group-wise allotment of children who experienced first permanent molar caries, prevalence amongst 8 years (37.17%), 9 years (66.43%) and 10 years (62.5%) was found. This drastically increases at 9–10 years of age. The decayed element was greatest amongst all the groups; the missing component was almost zero, showing hardly one tooth being missing amongst 9–10 years of age group. At the same time, the filled component was nominal compared to active carious lesions.
When compared to the current study, Hescot and Roland reported that 4.9% of the children had first permanent molar caries at 6 years of age. Studies reported that the prevalence in caries of first permanent molar teeth in the Kingdom of Saudi Arabia was 68%–70% amongst school-going children.,
Skeie MS found that the permanent first molar caries incidence between 8-, 9- and 10-year-old children was more compared with that of ages 11 and 12. This may be due to extended exposure of molars to cariogenic factors in that age group; therefore, health organisations (WHO and FDI) have declared 12 to be the most important age for making prevention strategies against caries.
According to Petersen et al., as the age of the children progresses and they were uncovered to cariogenic factors, teeth become more carious due to their anatomy, early eruption and position. Increased Streptococcus mutans count was seen.
In contrast to the abovementioned studies, several authors also found that caries prevalence is more in younger age groups than the subjects of 12–16 years of age. Petersen (1991) observed an increase in caries incidence amongst 5–12 years and a decrease in caries level in 13–15 years. Similar results were found in some studies.,,,,
In present study, gender-wise distribution of total caries exposure in the first permanent molar in males (57.8%) and in females (52.94%), respectively. In total DMFT, score major difference was in the decayed (D) component. Amongst 7–10 years of age, missing teeth are negligible. While seeing the filled component, females and males were having no significant difference in it.
Similar results were found by Joshi et al., showing that dental caries prevalence was 69.12% with high frequency in boys (70.01%) than in girls (68.22%). Furthermore, Jose and Joseph stated that dental caries prevalence in males was 54.3% in females 51%. In direct contrast with our study, Sogi, Mishra and Mwakatobe,, reported a higher frequency in females than in males. Some authors stated that there was no significant difference between both genders. The differences may be due to the survey's diverse age ranges and geographic areas.,,
Amongst total carious first permanent molars, it was found that mandibular permanent first molars were most commonly affected with caries than maxillary first permanent molars. Caries incidence of maxillary and mandibular first permanent molar teeth was similar on both sides of the mouth. There was no statistically significant difference seen in the occurrence of dental caries on both sides' first molars. Skeie et al. found that caries occurrence was similar on both sides in the first permanent molars. Statistically, there were no significant differences seen between the caries occurrence of right and left sides found in their study.
Socioeconomic status has been measured as a determinant factor in caries risk as per few studies.,,, There was no statistically significant difference found in the middle/lower-middle and lower/upper lower class. Similar results were found by Sheiham. As the socioeconomic status increases, the incidence of loss of teeth decreases. Higher social class individuals utilise the dentist more often than the lower social class.
The results of the present study are also in harmony with the findings of studies Newman and Gift and Sanders et al., Aids used in oral hygiene maintenance were better amongst the subjects in the upper classes than in the lower classes. People in the lower classes can seek out cheaper alternatives in the form of charcoal or mud due to a lack of affordability in purchasing oral hygiene aids that are unfavourable to oral health.
When the comparison between public and private school children was made, the prevalence of first permanent molar caries was higher in public school than the private school children. In every school dental health programme, children from government schools should be given preference over children from private schools because government school children have limited information about oral health-related diseases and knowledge regarding their prevention.,,,,,,
The need for advanced diagnostic criteria for dental caries assessment was fulfilled by the PUFA index. International caries detection systems have focused more to develop more sensitive diagnostic standards since the last decade, which aids in identifying carious lesions at an early stage., This study had employed the PUFA index to assess the complications of teeth which are untreated.
On age-wise distribution of PUFA score, we found that children of age 9 years had the highest scores (74.12%) compared to 8 years (30.32%) and 10 years (64.38%). It signifies minimal awareness, negligence for oral health and lack of dental health education. Bagińska et al. found similar results when prevalence and experience of the pufa index in primary dentition were evaluated. The prevalence of PUFA amongst 6–12 years was 85%.
Dubey stated that pulpal involvement is seen commonly in all the permanent teeth at 13–16 years. The main component of the PUFA/pufa value of this study was pulpal involvement, which was similar to our study. Code 'p' that is pulp involvement was found to be most prevalent. Similar results were found in the present study when compared to 'A', 'U' and F.
The gender-wise comparison showed that females are less commonly affected than males. Similar results were found., As female children are sincere, and they follow teacher/parent's instructions as well as esthetic is a major concern. Whereas negligence and the carefree nature can be one of the reasons causing more caries amongst males than in females.
Socioeconomic class-wise observation shows that middle/lower middle had a maximum PUFA score (96.24%). The main reason can be the easy availability of sugary foods and readymade food packets which are low in cost and effortlessly available.
The lowest score was found in the upper-middle class (6.93%). The reason for this could be educated parents, regular dental checkups in schools as well as parents' attentiveness regarding it. Financial stability also plays a role. The lower/upper lower class has a 62.72% PUFA score, which also states greatly affected, but when compared with middle/lower middle class, it is less. The reason for this may be due to lack of understanding amongst parents and teachers, no accessibility of free routine dental checkups and more staple food than the junk food packets available.
| Conclusion|| |
The current research focused on the prevalence and severity of dental caries in permanent first molars, and results suggest that there is a lack of awareness amongst children, parents and teachers regarding the importance of maintaining good oral hygiene. During the mixed dentition period, permanent first molars are the most common teeth found to be neglected because of misjudgement between deciduous and permanent dentition. Hence, school-based educational and awareness programmes are needed not only for children but also for parents and teachers. PUFA index is found to be effective in evaluating clinical consequences of untreated caries and help to plan treatment programmes for these socially deprived groups of society.
Ethical approval and consent of the participants
Ethics approval, as outlined in the methodology.
Availability of data and material
Further data are available on request from the corresponding author on reasonable request
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]