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Table of Contents
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 3-10

Correlation of caries status and oral health behavior among adolescent school children of Moradabad city, Uttar Pradesh

1 Senior Lecturer, Department of Public Health Dentistry, Institute of Dental Sciences & Hospital, Sector-8, Kalinga Nagar, Bhubaneswar, Odisha-751003, India
2 Professor and Head of Department, Department of Public Health Dentistry, Kothiwal Dental College and Research Centre, Mora Mustaqueem, Kanth Road, Moradabad-244001, Uttar Pradesh, India
3 Assistant Professor, Department of Community Medicine, MGM Medical College & LSK Hospital, Kishanganj-855 107, Bihar, India
4 Additional Professor, Community Medicine and Family Medicine, All India Institute of Medical Science, Jodhpur, Rajasthan-342005, India

Date of Web Publication7-Aug-2018

Correspondence Address:
G Sarker
Assistant Professor, Department of Community Medicine, MGM Medical College & LSK Hospital, Kishanganj-855 107, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-6486.238792

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Introduction: Oral health is an essential component of health throughout life. This study was done to assess the caries status, oral health behaviour and risk correlate in adolescent school children in Moradabad city, Uttar Pradesh, India.
Methodology: 512 twelve year old school children (256 private and 256 government) were selected through multistage random sampling procedure. Dental caries were assessed using Decayed, Missing, Filled teeth (DMFT) / Decayed, Missing, Filled Surface (DMFS) index.
Results: The mean DMFT/DMFS among private school children (1.90±1.46/3.24±3.18) was higher than the government school children (1.54±1.34/2.22±2.42) and the difference was found to be statistically significant. The study revealed that 26.95% of the private and 19.53% of the government school children brushed their teeth regularly (twice a day) with tooth brush and tooth paste. The participants also consumed sweets (34.77% of the private school children and 25% of govt. school children) and tea/coffee with sugar (61.33% of the private schoolchildren and 54.29% of the government schoolchildren) at least once in a day. Dental visits of both private and government school children were poor.
Conclusion: The information obtained from the study can be used for oral health program planning for children to prevent oral disease and promoting oral health, the local health authorities should give priority to school based community-oriented oral health care services.

Keywords: Caries, Children, Oral health behavior.

How to cite this article:
Kabasi S, Tangade P, Sarker G, Pal R. Correlation of caries status and oral health behavior among adolescent school children of Moradabad city, Uttar Pradesh. J Integr Health Sci 2014;2:3-10

How to cite this URL:
Kabasi S, Tangade P, Sarker G, Pal R. Correlation of caries status and oral health behavior among adolescent school children of Moradabad city, Uttar Pradesh. J Integr Health Sci [serial online] 2014 [cited 2022 Aug 12];2:3-10. Available from: https://www.jihs.in/text.asp?2014/2/1/3/238792

  Introduction Top

Health is multifactorial, influenced by factors like genetics, lifestyle, environment, socioeconomic status (SES) and much others.[1] Oral health is an integral part of the general health, rather oral cavity can rightly be called gateway of the body. Caries experience is the sum of decayed, missing and filled teeth. Children who suffer from poor oral health are more likely to have restricted activity days, including missing school.[2] Dental caries is a disease in which cultural and hygienic habits are decisive, so prevalence found in different habitats and different moments could be strongly related with these factors. On the other hand, determining the factors associated with the appearance of caries is of greater interest, given that these factors present high geographical and temporal stability.[3] In India, dental caries has been consistently increasing both in prevalence and severity for last five decades. About 80% of children and 60% of adults suffer from dental caries.[4] The increase in the prevalence of dental caries has been attributed to factors such as high sugar consumption, a shift to a westernized diet, poor socioeconomic status and the rate of urbanization.[5] Many industrialized countries have experienced a dramatic decline in dental caries which can be attributed to improved socio-economic conditions, changing lifestyles, self-care practices, use of fluorides, and effective use of preventive oral health services.[6] Petersen revealed that oral health depend on socio-environmental factors.[7] In the past decades, a large number of research reports have shown that dental caries is linked to social and behavioral factors.[8] In order to control the growing burden of oral diseases, a number of health programme have improved oral health behavior and status of the child population. The initial evaluation from such health projects conducted in Indonesia, Brazil, Madagascar and China have disclosed some encouraging results.[9] In a developing country like India, information on studies of caries and oral behavior in 12 year children is sparse. Thus the study was conducted to find out oral health behaviors in 12-year-old school children in Moradabad city, Uttar Pradesh, India.

  Methodology Top

The present study was undertaken in Moradabad city, Uttar Pradesh, India, where schools are classified as either private or government depending on the source of their funding. The present study was scheduled over a period of 3-months from February 2012 to April 2012. Twelve years old children, who attended private and government schools in Moradabad city were chosen for the study irrespective of socio-demographic pattern.

School going children of 12 years were targeted for an assortment of reasons. Firstly, this is the age at which all the deciduous dentition would have been replaced by permanent dentition and we therefore want to see the health of the early part of the evolving permanent dentition. Secondly, at this age of adolescence, the child identifies oneself, self-awareness in the child becomes intensified and results in a push for independence with less family supervision, as a result appropriate data on oral health behavior could be collected. Thirdly, according to World Health Organization, this age is the representative population for such study that can be obtained easily through the school system and ease of availability.[10] Lastly, similar studies on dental health have been reported on 12 years old school children in India and abroad.[11],[12]

A list of all the schools, with the children aged 12 years, situated in Moradabad city was obtained from District Inspector of Schools and a map of Moradabad city was obtained from Moradabad Development Authority office. In order to collect the representative sample, a multi stage sampling procedure was executed. At the first stage, the city was divided into four zones- North, South, East and West. Later at the second stage, four largest schools (two private and two government) were selected randomly from each zone thus total eight private and eight government schools were selected. At third stage, cluster of sixth standard students were selected from each of 16 the selected schools. As per published study from Gwalior, India, using this prevalence of dental caries as 60 percent, the sample size calculated to be 267.[13] Whereas, in our study we have taken higher than calculated sample size of a total of 512 (256 private and 256 government) school students who were examined in the schools on the day of visit.

Institutional Ethics Committee, Kothiwal Dental College and Research Centre, Moradabad approved the research protocol. Necessary permissions from the Heads of the selected schools were taken. All the concerned administrative persons were briefed about the study in the dedicated meetings organized with the principals, teachers, and members of parents association including the staffs, and students. They were explained about the objectives of the study and were assured that the information collected from their schools would be kept confidential and would be used only for academic purposes. Prior to the start of the study, informed assent from the care givers were obtained. The participants were also given the options not to participate in the study, if they wanted. School camps are held regularly in the department of the institute. One day before going to a particular school, the investigators distributed the consent form to the children to handover to their parents and asked them to get the filled and signed forms back on the next day.

The examiners were trained at Department of Public Health Dentistry, Kothiwal Dental College and Research Centre.

The data collection tool used for the study was an interview schedule that was developed at the Institute with the assistance from the faculty members and statistician. The structured questionnaire was translated into local language and was pre-tested on the children of Moradabad city in order to assess the validity of the questionnaire.[16],[17] The questionnaire included sixteen items designed to evaluate the oral health knowledge through the effects of regular dental visits, brushing and consumption of sugary food stuff along with fluoride usage on the dentition. Items that assessed participant's dental attitudes included questions on effect of tooth decay on appearance and importance of natural teeth. A question on sources of dental health information was also included. Assessment of participant's oral health behavior included brushing frequency, use of oral hygiene aids and usage of tooth paste. Dietary practices were also included to assess the oral health behavior for which frequency of consumption of various sugary foods (fresh fruits and sweets) and sugary drinks (soft drinks, tea or coffee and milk with sugar) were considered.

A predesigned, pretested, semi-structured questionnaire (in local vernacular) used to collect the data on dental caries and other risk factors. By initial translation, back-translation, retranslation followed by pilot study the module was custom-made for the study.

Before dental health examination, questionnaires were administered to assess the oral health knowledge, attitudes and behavior of the children. Questionnaires were administered in the class rooms by the examiner and the questions were read aloud giving time for children to fill up the questionnaires. The participants were encouraged to approach the examiner whenever they needed clarification at any point. School staff was placed under an obligation not to enter the class rooms where the children filled the questionnaire as children tend to answer the questionnaire in favor of socially acceptable Behaviour. The children were also informed that their teachers would not look at the scripts and they would be processed away from school. One class period (approx. 45 minutes) was provided to answer the question. They were informed that their participation was completely voluntary and they could quit at any time. A reference number was given to each of the questionnaire. The children were clinically examined whenever they filled the questionnaire completely at the school premises using DMFT/DMFS index.[14] The children having dental problems were referred to Kothiwal Dental College and Research Centre.

Statistical analysis

The collected data were entered into MS-Excel spread sheets for analysis. The statistical analyses were done using Graph Pad InStat version 3 software. Percentages and t-test were applied in this study to analyze epidemiological variables.

  Results Top

Total 512, 12-year-old children from the private and government schools were examined. The mean DMFT in private school children was found to be 1.90±1.46 while in government school children it was 1.54±1.34. It is evident from the table that, mean DMFT among private school children was higher than the government school children and the difference was found to be statistically significant (p=0.0039). Furthermore, the mean DMFS in private school children (3.24±3.18) was found to be higher than the government school children (2.22±2.42) [Table 1].
Table 1: Dental caries experience in permanent dentition of study participants according to type of school

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Children were distributed, according to their answers to statements on dental diseases and prevention in relation to school type. It was evident from the table that, 67.58% of the private school children agreed that, “regular visits to the dentist keep away dental problems” than 54.69% of the government school children. Moreover, 73.83% of the private school children were aware that, “brushing their teeth can prevent tooth decay”, than 68.75% of the government schools [Table 2].
Table 2: Response of the study participants on dental diseases and its prevention in according to type of schools

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Children received information about dental health from various sources. Most of the subjects (n= 270) received information about dental health from their parents, out of which 139 subjects (54.3%) were from the private schools and 131 subjects (51.20%) were from the government schools [Table 3].
Table 3: Information received by the study participants from various sources on dental health according to type of schools

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It was evident that private school children consumed sweets (34.77%) and tea/coffee with sugar (61.33%) more than the government school children sweets (25.00%) and tea/coffee with sugar (54.29%) [Table 4].
Table 4: Consumption sugary foods by study participants according to type of schools

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It was revealed from the study that children from both the school brush their teeth regularly with brush and and tooth paste. Dental visits were poor for both the school children [Table 5].
Table 5: Distributions of study participants according to various oral health practices and type of schools

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  Discussion Top

The present study provided information on dental caries experience and oral health behavior in a representative sample (n = 512) of 12 year old private and government school children from Moradabad . The present study showed that the probability of having caries experience was significantly associated with the type of school. Ojofeitimi EO et al[15] showed that dental caries were higher in fee paying school, it was similar to the present study. The present study provided an overview of oral health behavior and attitudes of the 12 years old private and government school children. A major proportion of the respondents were not aware of the benefits of fluorides for prevention of dental caries while the positive attitudes towards the importance of tooth brushing were wide spread, in agreement with previous studies among school children of Bangalore city, India[18] and Burkina Faso, Africa.[16]

This study demonstrated that, parents represent the primary source of information about oral health followed by school teachers, in concurrence with previous studies[17], [19] while in contrast to previous studies done by AG Harikiran et al.[18] and Jamjoum H,[20] where children received oral health information primarily from television. Hence future health education programmes should be targeted towards parents and school teachers who can significantly influence children's oral health behavior.

Substantial proportions of private school children of Moradabad city performed regular oral hygiene; in particular oral hygiene practices were infrequent in government school children. This variation in oral hygiene practices according to school type has been observed in many of the previous studies[21],[22],[23] that can be ascribed to the cultural differences between the private and government school children.

The present study showed that majority of the 12 year old school children claimed to brush their teeth regularly with a tooth brush and tooth paste which was similar to the other studies[24],[25] Tooth brushing without appropriate instructions and regular supervision of the children will not prevent dental caries. Brushing of teeth may be done very fast and with a technique greatly reduced in quality[15] which could be the reason for the dental caries experience in the present study.

The consumption of sweets and sugary drinks in the present survey was relatively high when compared to similar surveys from other regions[16],[17] while it was lower than the consumption frequency among previous studies.[15],[18],[19],[22] The probable explanation that the private school children were having more caries than the government school children could be explained by the fact that, the private school children were exposed to cariogenic foodstuffs, which is exacerbated by the chains of birthday parties the children attend both at home and at school, and of the sweet snacks they buy at lunch break. On the other hand, the exposure of the government school children to cariogenic foodstuffs is minimized by the compulsory midday meals, under the supervision of the school authority. Another reason could be that, sweet snacking depended on access to affordability.[26]

Strength of the study:

In the present study, it was revealed that the levels of oral health knowledge and attitude were rather low in government school children of Moradabad city and the oral hygiene and behavior varied with school type.

Limitation of the study:

The data was collected by means of self administered questionnaires and due to school based approach a high response rate was obtained. Meanwhile, the data collection method chosen may have certain limitations. With regard to attitudes towards dental care, oral hygiene habits, frequency of dental visits and consumption of fresh fruits over reporting has to be assumed whereas the consumption of sugary foods and drinks has probably been under-reported. In addition, recall bias has to be considered with respect to consumption of foods.

Future direction of the study:

The present study will help for future planning of promotion of oral health services from the age of 5 years onwards in schools and awareness in community level.

  Conclusion Top

To sum up, parents and school teachers are important informants in oral health, their involvement should be considered in oral health education program for children. The school may serve as an effective platform for promotion of oral health in relation to children as well as families. The local health authorities in addition, priority should be given for promoting oral health in private and government schools as community based efforts.

  References Top

Park K. Concepts of Health and Disease. Textbook of preventive and social medicine. 20th ed. Jabalpur, India: BanarsidasBhanot Publishers; 2009. p. 12-47.  Back to cited text no. 1
Pongpichit B, Sheiham A, Pikhart H, Tsakos G. Time absent from school due to dental conditions anddental care in Thai school children. Journal of Public Health Dentistry Spring 2008;68(2): 76-81.  Back to cited text no. 2
Diehnelt DE, Kiyak HA. Socioeconomic factors that affect international caries levels. Community Dent Oral Epidemiol. 2001; 29: 226-33.  Back to cited text no. 3
National oral health care program implementation strategies. A project of DGHS and Ministry of Health and Family Welfare. Department of Dental Surgery. All India Institute of Medical Sciences. 1998, pg 3.  Back to cited text no. 4
Christensen LB, Petersen PE, Bhambal A. Oral health and oral health behaviour among 11–13-year-olds in Bhopal, India. Community Dental Health. 2003; 20(3): 153-8.  Back to cited text no. 5
Bratthall D, Hänsel-Petersson G, Sundberg H. Reasons for the caries decline: what do the experts believe? European J of Oral Sci. 1996; 104(4); 416-22.  Back to cited text no. 6
Petersen PE. Sociobehavioural risk factors in dental caries: international perspectives. Community Dent Oral Epidemiol. 2005 ; 33(4): 274-9.  Back to cited text no. 7
Peres MA, de Oliveira Latorre Mdo R, Sheiham A, Peres KG, Barros FC, Hernandez PG et al. Social and biological early life influences on severity of dental caries in children aged 6 years. Community Dent Oral Epidemiol. 2005; 33(1): 53-63.  Back to cited text no. 8
Petersen PE, Peng B, Tai B, Bian Z, Fan M. Effect of a school-based oral health education programme in Wuhan city, Peoples Republic of China. Int Dent J. 2004; 54(1): 33-41.  Back to cited text no. 9
World Health Organization (1997): Oral Health Surveys – Basic Methods. 4th ed. Geneva; WHO: pp.15.  Back to cited text no. 10
Jürgensen N, Petersen PE.Oral health and the impact of socio-behavioural factors in a cross sectional survey of 12-year old school children in Laos. BMC Oral Health 2009; 16(9): 29.  Back to cited text no. 11
Saravanan S, Anuradha KP, Bhaskar DJ. Prevalenceof dental caries and treatment needs among schoolgoing children of Pondicherry, India. J Indian SocPedodPrev Dent. 2003;21(1):1-12.  Back to cited text no. 12
Khan AA, Jain SK, Shrivastava A. Prevalence of dental caries among the population of Gwalior (India) in relation of different associated factors. Eur J Dent 2008; 2: 81-85.  Back to cited text no. 13
Klein H, Palmer CE, Knutson JW. Studies on dental caries. I. Dental status and dental needs of elementary school children. Public Health Rep. 1938;53:751-65.  Back to cited text no. 14
Ojofeitimi EO, Hollist NO, Banjo T, Adu TA. Effect of cariogenic food exposure on prevalence of dental caries among fee and non-fee paying Nigerian schoolchildren. Commuuity Dent Oral Epidemiol. 1984; 12: 274-7.  Back to cited text no. 15
Varenne B, Petersen PE, Ouattara S. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J. 2006 ; 56(2): 61-70.  Back to cited text no. 16
Petersen PE, Hoerup N, Poomviset N, Prommajan J, Watanapa A. Oral health status and oral health behaviour of urban and rural school children in Southern Thailand. Int Dent J. 2001; 51(2): 95-102.  Back to cited text no. 17
Harikiran AG, Pallavi SK, Hariprakash S; Ashutosh, Nagesh KS. Oral health related KAP among 11 – to 12-year-old school children in a Government –aided missionary school of Bangalore city. Indian J Dent Res. 2008; 19(3): 236-42.  Back to cited text no. 18
Vigild M, Petersen PE, Hadi R. Oral health Behaviour of 12 year old children in Kuwait. Int J Paediatr Dent. 1999; 9(1): 23-9.  Back to cited text no. 19
Jamjoum H. Preventive oral health knowledge, practice and behaviour in Jeddah, Saudi Arabia: Odonto-StomatologieTropicale: pp.13-8.  Back to cited text no. 20
Agbelusi GA, Jeboda S.O. Oral health status of 12 years old Nigerian children. West African Journal of Medicine 2006; 25(3): 195-98.  Back to cited text no. 21
Sofowora CA, Nasir WO, Oginni AO, Taiwo M. Dental caries in 12-year-old suburban Nigerian school children. African Health Sciences 2006; 6(3): 145-150.  Back to cited text no. 22
Ogundele BO and Ogunsile SE. Dental Health Knowledge, Attitude and Practice on the Occurrence of Dental Caries Among Adolescents in a Local Government Area (LGA) of Oyo State, Nigeria. Asian Journal of Epidemiology 2008; 1(2): 64-71.  Back to cited text no. 23
Smyth E and Caamano F. Factors related to dental health in 12-year-old children: a cross-sectional study in pupils. Gac Sanit. 2005; 19(2): 113-9.  Back to cited text no. 24
Mirza B et al.Oral Health Attitudes, Knowledge and Behaviour amongst High and Low Socioeconomic school going children in Lahore, Pakistan. Pakistan Oral & Dental Journal 2011 ; 31(2): 396-401.  Back to cited text no. 25
Roberts BP, Blinhorn AS, Duxbury JT. The power of children over adults when obtaining sweet snacks. International Journal of Paediatric Dentistry 2003; 13: 76-84.  Back to cited text no. 26


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


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