K. INDIRA BAI A N D P. RATNAMALIKA
Dental Caries in Primary School Children of Tirupati 'by K. INDIRA BAI* Professor of Paediatrics, S.V. Medical College and Paediatrician, S.VJUi. Hospital, Tirupati. 517502 and P. RATNAMALIKA Medical Officer, School Health Clinic attached to Paediatric Department, S. VA..R. Hospital, Tirupati. 517502
caries in well developed countries like United States is as high as 98% and is the most prevalent disease of all the diseases.4 Mathew et als reported the incidence of dental caries to be as high as 49.1% in children among the age group of 6 months to 12 years.
Introduction Dental caries is a widely spread chronic disease. Its prevalence varies from 98% in United States of America to practically nil figure in Papua (New Guinea). Though it has been extensively studied and many of the etiological factors are traced out, the nature of its great variation from region to region still remains to be discovered. WHO has been spending much of its resources on the study of dental caries particularly in New Guinea. We present a comprehensive study of dental caries in school children of Tirupati.
Sex Boys were more involved than girls (Table II). As per the available statistical data on dental caries in United States, the girls were more affected than boys, and the explanation given for it by John B. and Dunbar 3 is the earlier eruption of teeth in girls than in boys. In Indian children at least in the present study the experience was different. Probably the incidence varies as per the exposure to the adverse conditions and the beginning of tooth decay rather than the time of tooth eruption. In that case the Indian boy has more chances to develop caries as he is cared more and bribed with sweets and money than the girl who is usually more docile and less demanding.
Material and methods A total of 4,500 school children from the age group of 4-14 years attending various primary and upper primary schools in Tirupati were examined for evidence of dental caries. Examination by standard methods with probe and mirror under clear daylight was done. Information regarding the dietary habits, socio-economic status and oral hygiene was collected and correlated along with the assessment of general health and association of any other disease.
Table II Sex Total No. of children with dental caries 450
Boys
Girls
247 (54.9%)
203 (45.1%)
Observations and discussion Among the 4,500 children examined, 450 children showed evidence of dental caries (Table I). The incidence was 10 per cent. The incidence of dental
Age _ In Bombay School children according to Sehgal6 the peak incidence was round about the age of 7 years (Table III).
Table I Incidence
Diet Relationship of dietary habits to the incidence of dental caries is stressed by many authors. It is reported to be more in non-vegetarian families than
Total children examined
Dental caries present
Dental caries absent
4,500 (100%)
450 (10%)
4,050 (90%)
Environmental Child Health, December 1976
Acknowledgement •We wish to record our grateful thanks to the Superintendent, S.V.R.R. Hospital, Tirupati for his kjnd permission to use the hospital records and for his kind permission to publish this article. 285
Downloaded from http://tropej.oxfordjournals.org/ at University of Michigan on July 5, 2015
Abstract A survey of 4,500 primary and upper primary school children was conducted for evidence of dental caries. The results were tabulated and compared with the results of others.
K. INDIRA BAI A N D P. RATNAMALIKA
vegetarians, probably because of the accumulation of remnants of the non-vegetarian food stuff in between the teeth after taking non-vegetarian diet. In the present study the difference was not very spectacular though there was small difference (Table IV). Table III Age No. of children showing dental caries
4- 5 5- 6 6- 7 7- 8 8- 9 9-10 10-11 11-12 12-13 13-14
12 59 78 75 77 78 39 15 9 8
Total
450
Type of teeth involved Dental caries usually starts very early. The deciduous teeth usually are short lived, their value is under estimated and neglected and hence they easily show signs of destruction very early. As Milton penned "The childhood shows the man as morning shows the day". These destroyed teeth in the childhood are perhaps the early signs of later dental troubles. John B. Dunbar's experience is many children at the age of 6-7 years develop caries in the first permanent tooth even before it is fully erupted. In the present study both deciduous and permanent teeth were involved and many of the children showed involvement of both (Table VI). Table V Socio-economic status
Table IV Diet Total No. of children
No. of children with dental caries
No. of children free of dental caries
Nonvegetarians
3,500
Vegetarians
1,000
360 (10.28%) 90 (9%)
2,900 (89.72%) 910 (91%)
Type of Diet
A detailed study of dietary habits revealed that these children had to be considered as practically vegetarians as many of the families were taking nonvegetarian diet only once in a week or once in 2 or 3 weeks. Even during those non-vegetarian meals the share that the children got was very very negligible. Socio-economic status In this study dental caries was more prevalent in low income group in contrast to the published data of Mathew et al. Where the incidence was more in higher socio-economic group and the reason given was the chances were more for consumption of refined foods particularly sweets. In the present study all the children who were having dental caries had the habit of consuming more sweets but they were not the refined sugars (Table V). They were the locally made cheap sweets which were very sticky and stay hours together in the mouth sticking to the teeth. These small mobile sweet meat shops with this particular variety of sticky sweets are a constant sight at every school. The children easily become a prey for these because they are cheap and also satisfy them for a long time. The 286
Income per month Rs. 100-200 200-300 Above Rs.300
Dental caries
Percentage
178 152 120
39.6 34.1 26.3
Association of other diseases Many of the children with dental caries also showed signs of" other deficiency disorders. Bibby and Shaw2 reported that susceptibility was significantly increased among the offsprings as a result of protein deficiency in the mothers. In the present study we could not assess the nutritional status of the mothers during conception; but in general the children with dental caries also showed signs of other deficiencies (Table VII). As per Anatoly Rybakov1 of U.S.S.R. dental caries just cannot be treated as a local disturbance. It is the result of the systemic changes, disturbance in carbohydrate metabolism bringing considerable changes in mineral metabolism. Dental caries can occur only when both external and internal factors simultaneously act on the teeth. Thus the Central Research Institute for Stomatology of U.S.S.R. stresses on the diet and general health of the people in the prevention and treatment of dental caries. The role of fluorides Fluoride deficiency is supposed to be the cause for dental caries. John C. Greene2 states that two of three cavities can be prevented by providing children with the right amount of fluorides (IPPM). Many of the treatment measures also include supplying fluorides to Environmental Child Health, December 1976
Downloaded from http://tropej.oxfordjournals.org/ at University of Michigan on July 5, 2015
Age in years
common slogan is "A clean tooth will never decay". Early introduction to dental hygiene, careful brushing and clean habits are essentials for prevention of dental caries; which are very much lacking in the low socioeconomic group of children.
K. INDIRA BAI A N D P. RATNAMALIKA
Table VI Type of teeth involved Age in years
Only deciduous teeth involved
12 59 78 75 77 78 39 15 9 8
12 40 31 21 14 11 4
Table VII Association of other diseases Other deficiency and infective diseases associated 1. 2. 3. 4.
Xerophthalmia Angular stomatitis Glossitis Signs of protein calorie malnutrition 5. Phrenoderma 6. Peridontal diseases like pyorrhoea
Environmental Child Health, December 1976
No. of children with dental canes 391 298 241 112 90 21
Both _ 19 30 35 41 47 30 13 8 7
17 19 22 20 5 2 1 1
—
the teeth. In the present study the role of fluorides could not be studied. Though dental caries is seen in almost all communities to a greater or lesser extent it is peculiar to note the complete "immunity" from the disease in a group of people in Papua New Guinea amongst whom the disease is virtually non existent. WHO has been studying these people and their environment including various trace elements in the soil, water and food, in the hope of discovering why dental caries does not
Only permanent teeth involved
exist even in the complete absence of conscious attempts to prevent it. When WHO efforts will shed light on the reasons it may be possible to completely eradicate the disease. Table VIII Regional Peculiarities Place U.S.A. U.S.S.R. Trivandrum Hyderabad Tirupati
Percentage 98 25-98 49.1 48 10
References 1. Anatoly Rybakov, Health Indivisible — caries studies in USSR, World Health, 16,18,1973. 2. Bibby, B. G. and Shaw, J. H., Intern. Dental J., 15, 1, 1965. 3. John B. and Dunbar, Epidemiology of Oral Health, Harvard University Press, 1,14,1969. 4. John C. and Greene, First teeth foundation for health, World Health, 6,9,1973. 5. Mathew, O., Joseph, J. and Koshi, J., Indian Pediatr., 7, 2,1970., pp.131-135. 6. Sehgal, U., J. All India Dental Ass., 32, 97, 1960.
287
Downloaded from http://tropej.oxfordjournals.org/ at University of Michigan on July 5, 2015
4- 5 yrs 5- 6 yrs 6- 7 yrs 7- 8 yrs 8- 9 yrs 9-10 yrs 10-11 yrs 11-12 yrs 12-13 yrs 13-14 yrs
Total No. of children with caries
Dental Caries in Primary School Children of Tirupati 'by K. INDIRA BAI* Professor of Paediatrics, S.V. Medical College and Paediatrician, S.VJUi. Hospital, Tirupati. 517502 and P. RATNAMALIKA Medical Officer, School Health Clinic attached to Paediatric Department, S. VA..R. Hospital, Tirupati. 517502
caries in well developed countries like United States is as high as 98% and is the most prevalent disease of all the diseases.4 Mathew et als reported the incidence of dental caries to be as high as 49.1% in children among the age group of 6 months to 12 years.
Introduction Dental caries is a widely spread chronic disease. Its prevalence varies from 98% in United States of America to practically nil figure in Papua (New Guinea). Though it has been extensively studied and many of the etiological factors are traced out, the nature of its great variation from region to region still remains to be discovered. WHO has been spending much of its resources on the study of dental caries particularly in New Guinea. We present a comprehensive study of dental caries in school children of Tirupati.
Sex Boys were more involved than girls (Table II). As per the available statistical data on dental caries in United States, the girls were more affected than boys, and the explanation given for it by John B. and Dunbar 3 is the earlier eruption of teeth in girls than in boys. In Indian children at least in the present study the experience was different. Probably the incidence varies as per the exposure to the adverse conditions and the beginning of tooth decay rather than the time of tooth eruption. In that case the Indian boy has more chances to develop caries as he is cared more and bribed with sweets and money than the girl who is usually more docile and less demanding.
Material and methods A total of 4,500 school children from the age group of 4-14 years attending various primary and upper primary schools in Tirupati were examined for evidence of dental caries. Examination by standard methods with probe and mirror under clear daylight was done. Information regarding the dietary habits, socio-economic status and oral hygiene was collected and correlated along with the assessment of general health and association of any other disease.
Table II Sex Total No. of children with dental caries 450
Boys
Girls
247 (54.9%)
203 (45.1%)
Observations and discussion Among the 4,500 children examined, 450 children showed evidence of dental caries (Table I). The incidence was 10 per cent. The incidence of dental
Age _ In Bombay School children according to Sehgal6 the peak incidence was round about the age of 7 years (Table III).
Table I Incidence
Diet Relationship of dietary habits to the incidence of dental caries is stressed by many authors. It is reported to be more in non-vegetarian families than
Total children examined
Dental caries present
Dental caries absent
4,500 (100%)
450 (10%)
4,050 (90%)
Environmental Child Health, December 1976
Acknowledgement •We wish to record our grateful thanks to the Superintendent, S.V.R.R. Hospital, Tirupati for his kjnd permission to use the hospital records and for his kind permission to publish this article. 285
Downloaded from http://tropej.oxfordjournals.org/ at University of Michigan on July 5, 2015
Abstract A survey of 4,500 primary and upper primary school children was conducted for evidence of dental caries. The results were tabulated and compared with the results of others.
K. INDIRA BAI A N D P. RATNAMALIKA
vegetarians, probably because of the accumulation of remnants of the non-vegetarian food stuff in between the teeth after taking non-vegetarian diet. In the present study the difference was not very spectacular though there was small difference (Table IV). Table III Age No. of children showing dental caries
4- 5 5- 6 6- 7 7- 8 8- 9 9-10 10-11 11-12 12-13 13-14
12 59 78 75 77 78 39 15 9 8
Total
450
Type of teeth involved Dental caries usually starts very early. The deciduous teeth usually are short lived, their value is under estimated and neglected and hence they easily show signs of destruction very early. As Milton penned "The childhood shows the man as morning shows the day". These destroyed teeth in the childhood are perhaps the early signs of later dental troubles. John B. Dunbar's experience is many children at the age of 6-7 years develop caries in the first permanent tooth even before it is fully erupted. In the present study both deciduous and permanent teeth were involved and many of the children showed involvement of both (Table VI). Table V Socio-economic status
Table IV Diet Total No. of children
No. of children with dental caries
No. of children free of dental caries
Nonvegetarians
3,500
Vegetarians
1,000
360 (10.28%) 90 (9%)
2,900 (89.72%) 910 (91%)
Type of Diet
A detailed study of dietary habits revealed that these children had to be considered as practically vegetarians as many of the families were taking nonvegetarian diet only once in a week or once in 2 or 3 weeks. Even during those non-vegetarian meals the share that the children got was very very negligible. Socio-economic status In this study dental caries was more prevalent in low income group in contrast to the published data of Mathew et al. Where the incidence was more in higher socio-economic group and the reason given was the chances were more for consumption of refined foods particularly sweets. In the present study all the children who were having dental caries had the habit of consuming more sweets but they were not the refined sugars (Table V). They were the locally made cheap sweets which were very sticky and stay hours together in the mouth sticking to the teeth. These small mobile sweet meat shops with this particular variety of sticky sweets are a constant sight at every school. The children easily become a prey for these because they are cheap and also satisfy them for a long time. The 286
Income per month Rs. 100-200 200-300 Above Rs.300
Dental caries
Percentage
178 152 120
39.6 34.1 26.3
Association of other diseases Many of the children with dental caries also showed signs of" other deficiency disorders. Bibby and Shaw2 reported that susceptibility was significantly increased among the offsprings as a result of protein deficiency in the mothers. In the present study we could not assess the nutritional status of the mothers during conception; but in general the children with dental caries also showed signs of other deficiencies (Table VII). As per Anatoly Rybakov1 of U.S.S.R. dental caries just cannot be treated as a local disturbance. It is the result of the systemic changes, disturbance in carbohydrate metabolism bringing considerable changes in mineral metabolism. Dental caries can occur only when both external and internal factors simultaneously act on the teeth. Thus the Central Research Institute for Stomatology of U.S.S.R. stresses on the diet and general health of the people in the prevention and treatment of dental caries. The role of fluorides Fluoride deficiency is supposed to be the cause for dental caries. John C. Greene2 states that two of three cavities can be prevented by providing children with the right amount of fluorides (IPPM). Many of the treatment measures also include supplying fluorides to Environmental Child Health, December 1976
Downloaded from http://tropej.oxfordjournals.org/ at University of Michigan on July 5, 2015
Age in years
common slogan is "A clean tooth will never decay". Early introduction to dental hygiene, careful brushing and clean habits are essentials for prevention of dental caries; which are very much lacking in the low socioeconomic group of children.
K. INDIRA BAI A N D P. RATNAMALIKA
Table VI Type of teeth involved Age in years
Only deciduous teeth involved
12 59 78 75 77 78 39 15 9 8
12 40 31 21 14 11 4
Table VII Association of other diseases Other deficiency and infective diseases associated 1. 2. 3. 4.
Xerophthalmia Angular stomatitis Glossitis Signs of protein calorie malnutrition 5. Phrenoderma 6. Peridontal diseases like pyorrhoea
Environmental Child Health, December 1976
No. of children with dental canes 391 298 241 112 90 21
Both _ 19 30 35 41 47 30 13 8 7
17 19 22 20 5 2 1 1
—
the teeth. In the present study the role of fluorides could not be studied. Though dental caries is seen in almost all communities to a greater or lesser extent it is peculiar to note the complete "immunity" from the disease in a group of people in Papua New Guinea amongst whom the disease is virtually non existent. WHO has been studying these people and their environment including various trace elements in the soil, water and food, in the hope of discovering why dental caries does not
Only permanent teeth involved
exist even in the complete absence of conscious attempts to prevent it. When WHO efforts will shed light on the reasons it may be possible to completely eradicate the disease. Table VIII Regional Peculiarities Place U.S.A. U.S.S.R. Trivandrum Hyderabad Tirupati
Percentage 98 25-98 49.1 48 10
References 1. Anatoly Rybakov, Health Indivisible — caries studies in USSR, World Health, 16,18,1973. 2. Bibby, B. G. and Shaw, J. H., Intern. Dental J., 15, 1, 1965. 3. John B. and Dunbar, Epidemiology of Oral Health, Harvard University Press, 1,14,1969. 4. John C. and Greene, First teeth foundation for health, World Health, 6,9,1973. 5. Mathew, O., Joseph, J. and Koshi, J., Indian Pediatr., 7, 2,1970., pp.131-135. 6. Sehgal, U., J. All India Dental Ass., 32, 97, 1960.
287
Downloaded from http://tropej.oxfordjournals.org/ at University of Michigan on July 5, 2015
4- 5 yrs 5- 6 yrs 6- 7 yrs 7- 8 yrs 8- 9 yrs 9-10 yrs 10-11 yrs 11-12 yrs 12-13 yrs 13-14 yrs
Total No. of children with caries
