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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 4  |  Page : 179-186

Dental caries experience in primary school pupils in Port Harcourt, Nigeria


1 Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria
2 Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria

Date of Web Publication17-Apr-2018

Correspondence Address:
Dr. Joycelyn Odegua Eigbobo
Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt
Nigeria
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DOI: 10.4103/smj.smj_70_15

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  Abstract 


Aim: This study aimed to investigate the prevalence and pattern of dental caries in children in public and private primary schools in Port Harcourt, Nigeria. Materials and Methods: This was a comparative cross-sectional study carried out among children in two private and two public primary schools in Obio/Akpor local government area. Information was obtained from the school records and parents by means of structured questionnaires. The dentition status was obtained with the aid of sterile instruments in an upright chair under natural light. Data collected were analyzed using SPSS version 20. Results: There were 200 (46.5%) males and 230 (53.5%) females, with a mean age of 7.6 (±2.7) years. The prevalence of dental caries was 12.6%; the private school pupils had a prevalence of 10.2% while that of the public school pupils was 15%. Forty-five (13.1%) pupils had a decayed, missing, filled teeth of primary dentition (dmft) >0; 17 (37.8%) were private school pupils. They had a mean dmft index of 0.25 (±0.76); the private school pupils had a lower mean dmft. The mean decayed, missing, filled teeth of permanent dentition (DMFT) index was 0.05 (±0.33); the difference between private and public schools was not statistically significant (P = 0.50). Untreated dental caries was 84.2% and 94.3% of permanent and primary dentitions, respectively. Conclusion: Dental caries is not a common problem in this study population; the mean dmft/DMFT values were very low. However, the prevalence of dental caries was higher among children attending public schools. There was a high prevalence of untreated caries.

Keywords: Dental caries, Port Harcourt, prevalence, primary school


How to cite this article:
Eigbobo JO, Alade G. Dental caries experience in primary school pupils in Port Harcourt, Nigeria. Sahel Med J 2017;20:179-86

How to cite this URL:
Eigbobo JO, Alade G. Dental caries experience in primary school pupils in Port Harcourt, Nigeria. Sahel Med J [serial online] 2017 [cited 2018 Sep 24];20:179-86. Available from: http://www.smjonline.org/text.asp?2017/20/4/179/230266




  Introduction Top


Oral health is very essential to the overall health and well-being of children and adolescents.[1] It comprises prevention of oral diseases, oral health promotion, and the proper development of the bones of the face, jaws, and proper occlusion. It also includes the prevention and management of oral diseases/conditions and traumatic injuries to the oral cavity/teeth.[2] Globally, there is a rapid change in the pattern of disease presentation and this has been associated with changes in lifestyles such as increase in the consumption of diets rich in sugars, use of tobacco, and ingestion of alcohol.[3] Although there is an immense improvement in the oral health of children across the world, oral health challenges still persist particularly among poor and disadvantaged groups in both developed and developing countries.[4]

The most common chronic childhood disease is dental caries and it is the localized destruction of hard dental tissues by acidic by-products from bacterial fermentation of dietary carbohydrates.[5] It is the most frequent noncommunicable disease worldwide; five times more common than asthma in the US.[1] It affects both the primary and permanent dentitions of children. Its distribution and severity vary in different parts of the world, within the same country and region.[3],[6] It is most prevalent among Asians and Latin Americans while least prevalent among Africans. Although there is a decline in the incidence of dental caries in the developed countries, there seems to be an upsurge in developing countries because of nutrition transition and globalization.[7],[8]

Dental caries remains a significant public health challenge, especially in children.[9] The presence of dental caries in children is considered an essential outcome for assessing the oral health status of children, and the presence/prevalence of untreated dental caries is used as a measure of poor utilization of dental care.[10] Untreated dental caries in children can impart on the quality of life. For children, the persistent pain from untreated caries decreases their quality of life; ability to learn, play, eat, and sleep.[4],[11] Children with severe dental caries do not thrive and they weigh significantly less than their peers.[12]

It has been observed that children with dental caries in their primary dentition are more likely to have dental caries in their permanent dentitions when compared to those who have never had caries in primary dentition.[13] Therefore, if more attention can be given to oral health of children, especially in primary dentition phase, then almost perfect oral health is guaranteed in the permanent dentition. Therefore, the aim of this study was to investigate and compare the prevalence of 3 to 12-year-old schoolchildren in public and private primary schools in Port Harcourt, Rivers State, Nigeria.


  Materials and Methods Top


This was a comparative cross-sectional study carried out among primary school pupils in Obio/Akpor local government area (LGA) of Rivers State, Nigeria. Obio/Akpor LGA is one of the 23 LGAs in Rivers state. The study population consisted of pupils of public and private primary schools in Obio/Akpor LGA of Rivers state.

The sample size was predetermined using a formula for comparison of two proportions as follows.[14]



The total minimum sample size was 362.

The representative sample was chosen by a multistage sample design. Two private and two public primary schools in Obio/Akpor LGA were selected randomly by ballot using the list of schools obtained from the local education district, as a sampling frame. Children were selected from each of the selected schools. Twenty children were selected from each arm of the classes (nursery–primary 5). All 3 to 12-year-old children with signed consent forms in selected schools were considered eligible. Though 362 was the minimum sample size, 480 questionnaires were given out to the eligible children.

The intra-examiner reproducibility was tested by having the same examiners re-examining the twenty children after 72 h. Intra-examiner consistency was strong using kappa statistics with a κ value of 1 since there was complete agreement in the repeated examination in the diagnosis of caries in twenty cases. Inter-examiner agreement was tested also using Cohen's kappa statistics, giving a high agreement of κ =0.95.[15] Of the repeated examinations, there was complete agreement in the diagnosis of caries in twenty cases.

Data collection

Information was obtained from the school records and parents by means of self-administered questionnaires.[15] The parents filled the questionnaires sent to them through their children. Information were recorded in a structured questionnaire with particular reference to the following:

  1. Sociodemographic information - Age/the date of birth, sex, ethnic group, religion, and parent or guardian's level of education were obtained and recorded
  2. Intraoral examination was carried out in an upright chair under natural light with the aid of sterile dental explorer and dental mirror by the investigator. The diagnosis of dental caries was made using the World Health Organization (WHO) Oral Health Assessment criteria for children.[15]


The dentition status was obtained by taking note of the teeth present, the carious lesions, missing teeth as a result of extraction due to caries, and restored teeth. The decayed, missing, and filled teeth of primary dentition (dmft) were scored with decayed, missing, and filled teeth of permanent dentition (DMFT)/dmft index, in permanent/primary teeth, respectively. The measures were recorded as present or absent. The D component was used to describe decayed tooth; filled tooth with recurrent caries/decay; retained root; and temporary filling or filled tooth surface with other decayed tooth surface. The M component was used to describe missing teeth due to caries and F component was used to describe filled teeth due to caries. Teeth were considered filled without decay when one or more permanent restorations were present and there were no recurrent caries or other area of the tooth with primary caries.

The DMFT index values according to the WHO were assessed as follows:

  1. Very low: 0.0–1.1
  2. Low: 1.1–2.6
  3. Moderate: 2.7–4.4
  4. High: 4.5–6.5
  5. Very high: >6.5.


Treatment needs: Treatment needs were categorized [15] as follows:

  1. No treatment
  2. Preventive or routine treatment needed
  3. Prompt treatment, immediate treatment necessary due to pain, and
  4. Referred for comprehensive evaluation.


The children who had treatment needs were counseled and their health needs were recorded and given to their class teachers. They were referred to the dental clinic for treatment of the oral health condition. Oral health education that comprised frequency and techniques of tooth brushing, dietary counseling, and importance of regular dental attendance was given to all the children in the selected arms of the schools whether they participated in the study or not.

Data analysis

Data collected were analyzed using Statistical Package for the Social Sciences (SPSS) version 20 (IBM corp., Chicago, United States of America). The means of the indices, i.e., DMFT in permanent teeth and dmft in primary teeth, were calculated. Descriptive summary statistics were obtained for demographic variables and difference in proportion was tested using Chi-square tests at 95% confidence interval, P < 0.05 was considered statistically significant. Difference in mean was also tested using Student's t-test for two groups.

Ethical clearance

Approval was sought and obtained from Research and Ethics committee of the University of Port Harcourt, Rivers State, to carry out the study. Written permission was also obtained from the State Universal Basic Education Board. At the schools, informed consent was obtained from the head teachers while written consent was sought and obtained from the parents.


  Results Top


Out of the 480 questionnaires given out, 430 (89.6%) pupils from two public and two private primary schools in Obio/Akpor LGA in Rivers State participated in the study; 215 children in private schools and 215 in public schools. There were 200 (46.5%) males and 230 (53.5%) females. Their mean age was 7.6 (±2.7) years; the mean age among private schoolchildren was 7.1 (±2.6) years while that of the public schoolchildren was 8.2 (±2.7) years [Table 1] and [Table 2]. There were statistically significant differences in the level of education of the parents of the pupils who attended private and the public schools (P = 0.001).
Table 1: Sociodemographic characteristics of the pupils

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Table 2: The distribution of dental caries among the children according to their ages

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The prevalence of dental caries among the schoolchildren

Dental caries was present in 54 (12.6%) schoolchildren; the prevalence of dental caries among the private school pupils was 10.2% while that of the public school pupils was 15%. Prevalence of dental caries among the females was 14.5%, while the prevalence in males was 10.5%. There was no statistical difference between males and females (P = 0.22). The prevalence was highest among the 6 and 8 year olds; 25.6% and 25%, respectively [Table 2]. Nineteen (11.9%) of the 3 to 6-year-old children had dental caries while 6.8% of them had early childhood caries. Majority (51.3%) had one decayed tooth [Figure 1].
Figure 1: The distribution of the number of carious lesions per child

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The decayed, missing, and filled teeth index (primary dentition) in the pupils

Three hundred and forty-four children had primary dentition; 45 (13.1%) of them had a dmft >0. Seventeen (37.8%) of them were private school pupils while 28 (62.2%) were from public schools [Table 3]. The mean dmft index was 0.25 (±0.76); private school pupils had a mean dmft of 0.17 (±0.63), while the public school pupils had a mean dmft of 0.33 (±0.87). There were no statistically significant differences between the private and public schools (P = 0.06) When the dmft of the 3 to 6-year-old children was assessed, the mean value was 0.25 (±0.82). The components of the dmft consisted of 94.3% decayed, 4.6% missing (extracted), and 1.1% filled teeth. There were no missing maxillary teeth, and the 3 and 4 year olds had dmft = 0, they had no caries experience.
Table 3: The decayed, missing, and filled teeth/Decayed, Missing, and Filled teeth of the pupils according to type of school

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The decayed, missing, and filled teeth index (permanent dentition) in the pupils

Three hundred and twenty-seven children had permanent dentition. The mean DMFT index was 0.05 (±0.33); private school pupils had a mean DMFT of 0.07 (±0.33) while the public school pupils had a mean of 0.04 (±0.34), this difference was not statistically significant (P = 0.50) [Table 3]. Sixteen (4.9%) had untreated caries (D) in their permanent dentition and this was 84.2% of the component of the mean DMFT, while 15.8% were missing as a result of dental caries [Table 4].
Table 4: The distribution of the decayed, missing, and filled teeth/Decayed, Missing, and Filled teeth components of the primary/permanent dentition

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The pattern of dental caries showed that all the primary teeth with the exception of the mandibular incisors were affected by dental caries; 86.7% of the teeth affected were posterior teeth [Table 4]. Females had a higher dmft than that of males [Table 5].
Table 5: The decayed, missing, and filled teeth index of the pupils according to their sex (gender)

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Treatment needs (intervention) among the schoolchildren

Three hundred and twenty-two (74.9%) children required only preventive and routine procedures. Almost a quarter (22.6%) of the children had prompt treatment need. Fifty-four (12.6%) children needed immediate and prompt treatments and referrals for comprehensive assessment; 22 (40.7%) of these pupils were from private schools and 32 (59.3%) were from public schools (χ2 = 2.228, df 1, P = 0.14) [Table 6].
Table 6: Treatment needs of the public and private school pupils

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  Discussion Top


Oral health of children and adolescents is best accessed during their formative years and oral health promotions during these phases of development are necessary for establishing lasting oral health behavior. Schools provide the needed setting for both preventive and curative oral health services which include but not limited to nutrition and oral hygiene programs.[16],[17] However, to be able to formulate and evaluate oral health promotion programs that will be beneficial to the school community, the disease burden should be known.

The finding in this study is similar to previous reports that dental caries is not a widespread disease among Nigerian children.[18],[19],[20],[21] The prevalence of dental caries in this study was 12.6% among primary school pupils. This value was slightly lower than that reported among urban primary school pupils in Lagos.[21] The difference may be because of the age captured in the primary schools; the present study surveyed 3–12 year olds while the study done in Lagos had children aged 4–16 years. It has also been reported that there could be an increase in caries experience with increasing age and since the study in Lagos had older age groups included; this may be the reason for the difference.[22] The prevalence reported in this study was very low when compared to studies in Asia and Europe. The study carried out in Maharashtra, India, had a prevalence of 80.9%,[16] and a prevalence of 60.8% was reported in schoolchildren under 12 years old in Macedonia.[23]

In this study, a lower prevalence of caries was reported among private school pupils when compared to public school pupils, this finding was similar to the study carried out among children in Ile-Ife,[20] but the converse was reported in Lagos where the fee-paying pupils had a higher prevalence than the nonfee-paying pupils.[18] The difference may also be due to the age or composition of the sample and location of study.

Females had a higher caries prevalence than males, this observation has been reported in several studies.[23],[24],[25] This maybe because females have early tooth eruption [26] due to their dietary habits.[27] It was however different from the report in children in Ile-Ife where males were reported to have a higher prevalence of dental caries.[20] However, the difference was not statistically significant as was reported in schoolchildren in Enugu.[25] When the children in this study were categorized according to their ages, those who had caries in the 3–6 years' age group were 11.9%; this was slightly higher than the 10.9% reported in children of the same age group in Ile–Ife, Nigeria.[20] The prevalence was highest among the 6 – 8 years age group, which was similar to the result reported in public primary schools in Lagos, Nigeria, where the prevalence was highest in the 8 year olds of the study population.[28] However, the proportion was higher in this study.

In the present study, the mean dmft of 0.25 in the primary dentition was in the very low category according to the WHO classification of mean dmft.[15] Less than a tenth had a dmft >0 in the primary dentition and the dmft for private school pupils was lower than the public school pupils. This finding was similar to that reported by Gathecha et al.[4] and Sofola et al.[18] The dmft among the 3 to 6-year-old children was comparable to that reported among nursery school pupils in the same age group category.[20]

However, the converse was observed in the permanent dentition where the public schools had a lower DMFT index than the private school pupils and the mean DMFT was also in the very low category. The mean DMFT was slightly higher than that reported in a study in Lagos [18] where the DMFT was reported as 0.02 compared to this study's 0.05; however, the finding is similar to that reported among 12-year-old students in Ile-Ife.[20] The DMFT of private school pupils was higher than that of public school pupils. This finding is comparable to the study reported in Khartoum, Sudan, among 12 year olds.[29] However, the values were lower in Nigerians probably because of the composition of the study; the Nigerian sample had a different age composition. The DMFT/dmft indices showed the caries experience among the schoolchildren and these results showed that the caries experience was low in both dentitions in the study population. The value obtained in the primary dentition is comparable with that reported in Ile-Ife.[20]

It has been reported that early childhood caries experience increased with age in primary dentition [30] and this was observed in this study as the 3 or 4-year-old children did not have dental caries and the finding was similar to the study reported by Sofola et al.[18] However, increase of dental caries with age was not a consistent finding in the primary and permanent dentition of children aged 6 years and older. However, about a quarter of the 6 year olds had caries experience which collaborates the global report that one in four children in the 5- and 6-year-old age category had dental caries.[22] This could be as a result of nutrition transition and globalization.

The mandibular second primary molars had more decayed, missing, and filled index values than other teeth followed by the primary first molars; this was also reported among Brazilian children.[31] Over four-fifths of the carious lesions were in the posterior teeth; this was higher than the 63% reported in Ile-Ife,[20] possibly because of the composition of the sample.

Although the prevalence of dental caries was low, over 90% of the carious lesions in the primary dentition and over 80% of the permanent dentition were not treated. This may be as a result of poor awareness, financial constraints, or poor attitude to oral health care. The value in the permanent dentition is lower than 98.4% reported in permanent dentition of 12 to 15-year-old children in Benin city, Nigeria.[32] The difference may also be due to the age or composition of the sample and location of study. Sequel of dental caries has public health significance and can impart on the quality of life of a child affecting the ability to learn, play, eat, and sleep.[4],[11]


  Conclusion Top


  • The prevalence of dental caries in schoolchildren in Port Harcourt, Nigeria, is low. Dental caries is not a common problem in this study population; however, there is a high prevalence of untreated caries
  • The prevalence of dental caries was higher among children attending public schools
  • The mean index values in primary (dmft) and permanent dentitions (DMFT) were very low. The private school pupils had a mean dmft value lower than public school pupils while the converse was observed in the mean DMFT.


Recommendation

Oral health education plays an important role in achieving good oral health.

  1. Oral health education of parents:


    1. This can be done in the primary health centers and hospitals during ante- and postnatal visits. Antenatal visits to the dental clinic should be encouraged and expectant mothers can be educated on oral health care of their unborn children since they are most sensitive to new information during the ante/prenatal period


      1. They should be informed on oral care of their infants and toddlers such as the infant/toddler should not be put to bed with a bottle containing natural or added sugar
      2. The teeth of the infants should be cleaned as soon as the first tooth erupts and
      3. The importance of the first dental visit on or before the first birthday.


    2. This can also be carried out during parent–teacher fora/forums.


  2. Schools should provide effective settings for oral health programs:


    1. There should be a vital collaboration between the pediatric dentists, pediatricians, and dental and medical public health practitioners in the schools
    2. Teachers should be updated regularly on oral health care. The school curriculum on health education should have oral health care incorporated with emphasis on the diet, plaque control, and regular dental checkups


  3. Other protective/preventive habits for the child should be encouraged such as:


    1. Receiving optimally fluoridated drinking water or fluoride supplements
    2. The oral cavity cleaned/teeth brushed two times daily with fluoridated toothpaste
    3. Child receives topical fluoride from health professionals during dental checkups.


Limitation of the study

There could be an underestimation of caries experience since radiographs were not used to detect interproximal caries. In addition, the dmft/DMFT index does not show the number of teeth at risk of developing caries. The plaque index was not obtained during the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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