REVUE MEDICALE N° 1/2014
SURVEY OF CURRENT DENTAL CARIES AND GINGIVITIS STATUS AND PRACTICAL FACTORS IN ORAL CARE OF SCHOOL CHILDREN
FROM AGE A TO 8 IN SOMES CITIES IN VIETNAM IN 2 0 1 0 Truong Manh Dung*, Ha Ngoc Chieu*, Vo Truong Nhu Ngoc*
ABSTRACT
This study was conducted at 3.986 male children and 3.789 female children in some cities in Vietnam in 2010. Purpose of study; identifying the proportion of dental caries and gingivitis among school children from 4 to 8. identifying oral care activites of school children in practice. Material and method : cross-sectional descriptive study. Results : The average number of teeth with cavities or missing or filling is 4.7, mean dmft index increases with age, from 0.14 in 4 year-group to 4.14 in 5 year-group. The percentage of students having calculus is 80.8%, among those there areslightly more school boys than girls (81.1% compared to 80.5%)...Conclusions: the proportion of caries and periondontics is very high: 90.6% has debris/plaque, 8 1 . 1 % has calculus and 11.9% is reported with bleeding gum. Really high percentage of children from 4 to 8 has decayed primary tooth (81.6%).The average number of teeth with cavities or missing or filled is 4.7, mean dmtt index increases with age. The proportion of permanent tooth decay is 16.3%, mean DMFT index is 0.30.
Keywords: School children, decay, teeth...
I. BACKGROUNDS
Dental carries and gingivitis are two oral diseases which have great influence on people's health and appearance. Together these diseases have relatively high prevelence worldwide, they appear at early years of age and their treatments cost quite a lot in all nations [4],[5][6],[7].
In Vietnam, a comparison between the first National survey of Oral Health in 1992 and the second one in 2001 has shown that oral diseases still have high prevelence and witness an increasing tendency, the rate of children from 6 to 8 years with oral problems nationwide in 2001 was 84.9% with milk teeth's caries, 24.4% with permatnent teeth's caries and 42.7%
with gingivitis. In order to solve the problems, many dental caries and periodontics prevention programs have been publicly established in Vietnam, especially oral care activities at schools for children in kindergarten and primary schools [ 1 ],[2],[3].
There have been several studies about the oral health status of children at schools as well as the effectiveness of dental prevention programs. Howevers, most of them had small sample size that couldn't provide the overview of overall situation of oral heahh and oral care in practice of school children all over the country.
The study namely « survey of current dental caries and gingivitis status and pratical factors in oral care of school children from age 4 to 8 in somes cities in Vietnam in 2010 » using cross sectional descriptive method together with the combination of quantitative and
* The school ofOdonlo- Stomatology - Hanoi Medical University
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REVUE MEDICALE N°1/2014
qualitative approaches was conducted with 2 main objectives: identifying the proportion of dental caries and gingivitis among school children from 4 to 8; identifying oral care activites of school children in practice; based on findings, the study helps propose some recommendations for families, schools and national authorities in order to cut down the rate of dentaln caries and gingivitis in school children.
II. SUBJECTS A N D METHODOLOGY
2.1. Subjects: 7.775 students from the age of 4 to 8 in kindergartens and primary schools at 5 provinces/cities of Vietnam. Parents of students who are eligible for the study.
2.2. Time and place - Time; from 2/2010 to 3/2010
- Place: 5 provinces/cities in Vietnam: Ha noi. Lang Son. Thai Binh. Ninh Thuan, Ti8n Giang 2.3. Design: Cross sectional descriptive study with analysis and the combination of quantitative and quanlitative approaches.
2.4. Sampling method
- Sample size: calculated by a formula for determining a proportion n=z^"-"='p(l-p)/d^
n: minimum sample size
a: level of statistical significance (a = 0.05) z: witha = 0.05 ^ z , ] . , ^ ) = 1,96
p = 0.8 (the proportion of students with periodontal problems in 2001 survey) d = 0.01 (allowed error 1 %).
n = 6146
- Sample sized needed in reality = (6146xl)xll0%= 6760 students
- Sampling was done based on geographical chracrteristics covering all the country and places where "P/S - protecting Smile" program was being established. Except Hanoi being purposely chosen, other 4 provinces were chosen randomly. Within each province/city, 10 schools were taken randomly and 150 students from each school were asked to participate in the study In total, there were 7775 participants in the study.
2.5. Data collection method
- About the proportion of dental caries (based on criteria and evaluation system ICDAS for cavities) and periodontics (WHO 1987): doctors specializing in dentisty from the Institue of Odonto Stomatology personally examed each case and filled in the forms.
- About factors related to the practice of oral care of students: interviewing participants with structured questionaires.
2.6. Statistical analysis
- Data was checked and cleaned before and after being input by Epi DATA software.
- Data was analysed by SPSS 15.1 and R software.
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. RESULTS
3.1. Characteristics of study participants Table 1: Age distribution of sample
Age (years old) 4 5 6 7 8
N 925 1.013 1.052 1.718 2.977
%
11.9 13.0 13.5 22.1 39.5
There is no significant difference among the age of 4. 5 and 6, students at the age of 8 have the highest amount of cases.
Gender: Male: 3.986 students (51.3%). female: 3.789 students (48.7%). There is no significant difference between two genders (p> 0.5).
3.2. Dental caries status among school children
Table 2: Dental caries status among school childrenbased on gender Type of
tooth Milk tooth Permanent
tooth
Pathology With cavities Without ccavities
With cavities Without ccavities
Male N 3267
719 572 3414
%
81 19 14,4 85,6
Female N 3074
715 698 3091
%
81,1 18,9 18,4 81,6
Total n 6341 1434 1270 6505
%
81,6 18,4 16,3 83,7 Comments:
Table 1 shows really high percentage of children from 4 to 8 having decayed milk teeth (81.6%). The rate in female (81.1%) is quite similar to that in male (81%) with p=l.
The proportion of permanent tooth decay is 16.3%, it is quite high regarding the fact that permanent teeth at this age are mostiy first molars and central incisors.The rate is higher in female (18.4%) than in male (14.4%), it is not statistically significant (p=0.6).
Table 3: dmft index in milk tooth based on age Age
4 5 6 7 8 Total
n 925 1013 1052 1718 2977 7775
Decayed tooth index (dt)
0.136 3.914 5.275 3.001 5.842 4.140
Missing tooth index (mt)
0.007 0.184 0.395 0.327 0.969 0.522
Filled tooth index (ft)
0.002 0.050 0.070 0.044 0.149 0.083
dmft 0.145 4.149 5.741 3.373 .6.961 4.745
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Comments: The average number of teeth with cavities or missing or filling is 4.7; mean dmft mdex increases with age, from 0.14 in 4 year-group to 4.14 in 5 year-group and reaches the highest of 5.74 in 6 year-group.dmft index alsoincreases from 3.373 in 7 year-group to 6.961 in 8 year-group.
Chart 1: Distribution of dt, mt, ft based on age
Comments:
- Most of decayed teeth were not restored (95.3%).
The mean number of decayed milk teeth (dt) gradually increases from 4 to 6 years, then decreases in 7 group and reaches the peak at 8.
The number of missing teeth due to caries also has increasing tendency from 5 to 8 years old.
- The number of filled teeth grows from 4 to 8 years of age.
Table 3: DMFTindex in permanent tooth based on age Age
4 5 6 7 8 Total
N 925 1013 1052 1718 2977 7775
Decayed tooth index (DT) 0.002 0.009 0.021 0.079 0.731 0.302
Missing tooth index (MT)
0 0 0 0 0.0003 0.0001
Filled tooth index(FT)
0 0 0 0.0005
0.005 0.002
DMFT 0.002 0.009 0.021 0.080 0.737 0.304 Comments: Mean DMFT index increases from 4 to 8 years of age, from 0.002 at 4 to 0.02 at 6 and has the highest of 0.737 at 8. The difference between 4 year-group and 5 year-group is not statistically significant (p=l), the increase of DMFT from 6 to 8 is statistically significant (p<0,5)
REVUE MEDICALE N°1 /2014
Chart 2: Distribution of DT, MT, FT based on age
Comments: The number of permanent teeth with caries (DT) outweighs the number of missing teeth due to carries (MT) and filled teeth (FT), DT also increases with age, reaches the highest in 8 year-group.
3.3. Periodontal condition
Table 4: Calculus, debris/plaque and bleeding gum index based on gender
^\Condition Gender ^ \
Male Female
Total
Bleeding Yes n / %
463 11.6%
461 12.2%
924 11.9%
No n / %
3523 88.4%
3328 87.8%
6851 88.1%
Calculus Yes n / % 3234 81.1%
3049 80.5%
6283 80.8%
No n / %
752 18.9%
740 19.5%
1492 19.2%
Debris/plaque Yes
n / % 3610 90.6%
3416 90.2%
7026 90.4%
No n / %
376 9.4%
373 9.8%
749 9.6%
Comments:
- Regarding bleeding index, the result is quite similar between two genders (11.6% in male and 12.2% in female), total rate is 11.9%.
- The percentage of students having calculus is 80.8%, among those there areslightly more school boys than girls (81.1% compared to 80.5%).
- Among 7.775 participants, the rate of plaque is noticably high, 90.4%, with 90.6% in male and 90.2% in female.
3.4. Interview results about the practice of oral care among students
- Number of tooth brushing times per day: 1 per day: 1.852 students (21.4%), two per day:
6.218 students (71.7%), Sometimes: 452 students (5.2%), Never: 150 students (1.2%).
REVUE MEDICALE N° 1/2014
- Average amount of time in each tooth brushing process: < 1 minutes: 1104 students (14.2%), 1-2 minutes: 2783 students (35.8%), 3-5 minutes: 3390 students (43.6%), Don't care: 498 students (6.4%).
times of having sweets or soft drinks per day (beyond 3 main meals): 1 per day: 1.661 students (19.2%), Several times perday: 1.154 students (13.3%), Sometimes: 5.857 students (67.5%).
IV. DISCUSSION
4.1. The status of dental caries among school children
Table 1 has shown that very high percentage (81.6%) of children from the age of 4 to 8 has milk teeth with cavities, it's quite simitar to the results from National survey in 2001, in which, the rate of milk teeth caries among 6-8 years old children was 84,9% (p>0,5).
After more than 10 years of scaling up "School dental progam" and other oral care activities for school children like "P/S protecting smile" all over Vietnam, the rate of cavities hasn't really decreased yet. Howevers, it might be due to the different criteria used to exam and diagnose in 2 studies.2001's survey used WHO 1997'sguidelines whichonly considered caries lesions whenhaving obstacled probing examination, while in our study, ICDAS' criteria allowed detection and recognition of cavities in the early stage of carieslesions in enamel so that it may increase the rate of decayed teeth recorded.
The rate of cavities in permanent teeth among children from 4 to 8 is 16,3%.It is quite high regarding the fact that permanent teeth at this age are mostly first molars and central incisors.
Following table 2, the average number of teeth with cavities or missing or filled is 4.7 and most of decayed teeth were not treated (95.3%). Mean dmft index increases with age, from 0.14 in 4 year-group to 4.14 in 5 year-group and reaches the highest of 5.74 in 6 year-group.
This result is consistent with other studies because the nature oftooth decay accumulates over time as we track the dmftindex. This index also increases from 3,373 in 7 year-group to 6,961in 8 year-group. At this age, milk teeth begin to be replaced by permanent teeth, it is hard to record the reasons for missing teeth (caries or natural replacement) and that can lead to changes in dmft index.
Chart 3: Comparison of dt, mt. ft after 10 years
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As can be seen fi-om the chart, the number of milk teeth with caries (dt) decreases slightly after 10 years, while the nximber of missing milk teeth due to caries (mt) is higher in 2010 than in 2001. Eventhough the number of filled teeth (ft) has gone up, it is not statistically significant different from 2001, it reflects how ineffective of tooth decay prevention and treatment activities in our country is.
DMFT index increased from 5 to 8 years of age, from 0.002 at 4 to 0.02 at 6 and the highest of 0.737 at 8. The difference between 4 year-group and 5 year-group is not statistically significant (p=l), the increase of DMFT from 6 to 8 is statistically significant (p< 0.5).This is consistent with the cumulative and progressive nature of DMFT index over time.
4.2. Periodontal condition - Bleeding gum status:
11,9% of children from 4 to 8 years old have bleeding gums, in comparison with National survey in 2001 among 706 chidren from 6 to 7, of which the rate of bleeding gum is 42.7%, our study is lower, statistically significant with p<0.05. It might be due to the participation of younger children of 4 and 5 in this study that can reduce the rate of bleeding gum in total.
Howevers, our results still have common increasing tendency of bleeding gum rate over time with 2001 survey, in which the rate gradually increased from 42.7% in 6-8 group, to 69.2% in 9-11 group and reached the highest of 71.4% in 12-14 group. The difference between male (11.6%) and female (12,2%) is not statistically significant with p> 0,05.
- Plaque index
The results show that health education to change behavior of brushing habit for children is not really effective, over 90% of students coming to school with remaining food debris/dental plaque.
- Calculus index
80.8% of children from 4 to 8 has calculus, it is higher than the rate of 25.5% among 6-8 years old children in National survey in 2001, with p<0.01. The difference between boys and girls is not statistically significant with p> 0.05.
4.3. Interview results about the practice of oral care among students
Regarding tooth brushing times per day, 1 time per day accounts for 21.4%, two times per day is 71.7%, sometimes is 5.2% and 1.2% of all students never brushes their teeth. In comparison with 2001 results (one time per day: 41.7%, two times per day: 14.03%, sometimes: 4.7%), the rate of two times brushing per day is much higher than it was 10 years ago (p<0.05), this reflects the effectiveness of dental health education and communication in order to change children's brushing habit from one time per day to two times per day.
About number of times having sweets or soft drinks per day, one time per day accounts fori 9.2%, several times perday is 13.3% and sometimes is 67.5%.
Talking about the amount of time of each brushing procedure, 43.6% of the children practises sufficient time for 1 procedure (3-5 minute brushing is the minimum amount of time needed to totally clean all teeth with proper brushing technique), over 50% doesn't spend enough time brush their teeth (14.2% spends less than 1 munite, 35.8% uses 1-2 munites and 6.4% doesn't care about the amount of time spending). Eventhough the proper amount of time
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for each brushing procedure has always been mentioned in dental health education, after 10 years, more than 5 0 % of the students haven't changed their habit of controlling the amount of time for teeth brushing.
4.4. Conclusions
Based on the findings, we have the following conclusions:
- Current status of dental caries and periodontics among school children; the proportion of cavities and periondontics is very high, as it's shown by the following datas: 90.6% has debris/plaque; 81.1%o has calculus and 11.9% is reported with bleeding gum. Really high percentage of children from 4 to 8 has decayed primary tooth (81.6%).The average number of teeth with cavities or missing or filled is 4.7; mean dmft index increases with age. The proportion of permanent tooth decay is 16.3%. mean DMFT index is 0.30.
- Practical oral care among school children; Total amount of time spent in each brushing procedure: < 1 minutes; 14.2%, 1-2 minutes; 35.8%, 3-5 minutes; 43.6%; the majority of the students doesn't spend enough time for cleaning the entire two dentintions. Only 5.5% has the habit of brushing 3 times a day. The rate of having snacks habit is still high (67.5%)).
V. RECOMMENDATIONS
- Need to provide information on methods of dental care for the entire population, especially kindergarten and primary school teachers.
- Provide practical brushing guidance in the formal curriculum for kindergarten and primary school students.
- Periodic dental examinations for children (twice a year) become mandatory regulation in kindergartens and primary schools.
- ft is necessary to immediately apply fluoride mouthwash solution or brushing with fluoride gel for students of the school examined.
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4. Centers for Disease Control and Prevention (2001). "Recommendations for using fluoride to prevent and control dental caries in the United States". MMWR, 50pp. 1 - 42.
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