Investigation of Oral Health Status (DMFT-index) among 3-6 Years Old Children in Ilam (Western Iran), 2015

 

Maryam Esmaeilikia1, Elahe Gholami-Parizad2, Zeinab Ghazanfari1,3, Mohammad-Sadegh Abedzadeh1, Mohammad-Ali Roozegar4*

1Public Health Department, School of Health, Ilam University of Medical Sciences, Ilam, Iran

2Clinical Microbiology Research Centre, Ilam University of Medical Sciences, Ilam, Iran

3Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran

4Periodontics Department, School of Dentistry, Ilam University of Medical Sciences, Ilam, Iran

*Corresponding Author E-mail: havasian1991@gmail.com

 

ABSTRACT:

Today, tooth decay is considered as one of the most common infectious diseases in developing countries such as Iran and considering this concept is among the World Health Organization programs in the field of prevention of chronic diseases and promoting health. The mean of primary tooth decay in children under 6 years is equal to 5 in Iran; however, the present study suggests this is 7, indicating an undesirable situation. The aim of this study was to evaluate the oral health status in terms of decayed missing filled teeth (DMFT) for 3-6 year-old children at health care centers of Ilam. In this cross-sectional study, 100 (female and male) children aged 3-6 years referring to urban health care centers were selected for the study. These children's background information was collected using a questionnaire. The DMFT index was used to determine the primary teeth health status. Data obtained was analyzed using independent t-test, Spearman correlation test, and chi-square test. The mean and standard deviation of the DMFT index for all children was 4.13±7.32. The results obtained by independent t-test showed no significant difference between both genders. Chi-square test was used to examine the DMFT index in both female and male children. Regarding the primary teeth for female and male genders, the highest and the lowest DMFT frequencies were associated with decayed teeth (94%) and filled teeth (4%), respectively. Ten percent of boys and 2% of girls have DMFT=0(caries free: CF); and 12 percent of boys and 22 percent of girls also have DMFT≥10 (Rampant caries), respectively. The DMFT index for the study participants was not approximately close to DMFT index reported by the World Health Organization. Hence, it seems that the promoting the knowledge of oral health care providers to inform parents of young children is of paramount importance.

 

KEYWORDS: Oral health, DMFT index, 3-6-year old children, Ilam, Iran.

 

 

 

 

INTRODUCTION:

Despite much progress in medical fields against diseases around the world and increased communication and the presence of individuals in various social situations, observing oral hygiene should be of greater importance than ever before [1]. Overall health is associated with the Oral health and this affects the health status of the body [2,3]. Despite improvement in children and adolescents' oral health, especially the reduction of dental caries, this disease is still one of the prevalent diseases in human communities [4]. One of the most common problems in childhood and adolescents is dental caries which is an infectious multifactorial disease and causes tissue destruction and loss of teeth. This disease is a major oral health problem in industrialized countries and this is the problem with 60-90% of school-aged children and 51 million hours are annually lost in schools because of this illness [5]. The World Health Organization considers the oral hygiene as a necessity and a part of public health throughout life, affecting people's quality of life of [6]. Regarding oral health and care, different techniques such as brushing with fluoride toothpastes twice a day, consuming less sweets and snacks and regular visit to the dentist are recommended [7-10]. Brushing is the most common technique used for dental care by people. Tooth brushing twice a day is a part of self-care recommendations and should be started as soon as possible, when the baby teeth eme .Studies have reported adherence to this standard for several European and American countries [11,12]. Today, it is believe that the most important strategy to reduce dental diseases is prevention and the first step in prevention is also promoting a culture of health and prevention in a society. Oral health promotion is related to efforts made to promote health and prevent oral diseases via three elements: education, prevention and health maintenance [13]. The first epidemiological study in Iran dentistry was conducted in 1951. Since then, several studies are carried out by the World Health Organization and Iranian dentists. In a study conducted in collaboration with the World Health Organization and the Ministry of Health, Treatment and Medical Training in 2004, it was shown that the DMFT index in Iran was 1.67 percent and higher DMFT index was reported for the girls. They also showed that half of the students did not brush their teeth [14]. Oral hygiene program was launched in primary schools in 1999 by the Ministry of Education and it is now in progress as the country's health reform plan by the Ministry of Health, Treatment and Medical Education. The plan covers children above six years old [15,16]. Given the importance of baby teeth and the high prevalence of oral diseases in the country, the present study aimed to evaluate the oral health status in terms of decayed missing filled teeth (DMFT) for 3-6 year-old children at health care centers of Ilam .Obviously, an accurate picture of the status of children's oral health can contributes in planning appropriate interventions and preventing the high prevalence of oral diseases in later life.

 

MATERIALS AND METHODS:

In this cross-sectional study, 100 (female and male) children aged 3-6 years referring to urban health care centers were selected for the study. Inclusion criteria were as follows: being 3-6 years old, living with his/her mother, living in Ilam, non-use of fluoride, and the mother's written consent to participate in the study. With regard to the accuracy 5% and the confidence level 95%, the sample size was determined to be n=100. Population of children referring to the health care centers of Ilam was selected by convenience sampling. In order to provide the instruments used in this study, after conducting library studies and investigating the related resources, the research team prepares a self-made questionnaire measuring the variables affecting the oral health. The questionnaire consisted of 11 questions on children's specifications and family-related factors (namely age, gender, birth order, mother's age, parents' education and occupation, family economic condition) together with mothers' awareness and 4 questions on oral health behaviors including children' frequency of brushing per day (by mothers) and frequency of visit to the dentist. Point 1 and 0 were assigned to proper and improper brushing behaviors, respectively. Proper brushing refers to placing toothbrush at a 45-degree angle to the gums, brushing all tooth surfaces and at least twice a day for 3 minutes). The children's oral examination and evaluation of the DMFT index was performed by the dentist with dental mirror and sharp dentistry explorers, disposable gloves and under natural light. The DMFT measurement was based on the criterion defined by the WHO [17]. Based on the examination of the teeth, the dental caries index (CF) and the index of 10 or more decayed teeth (RC) were determined and the examination results were recorded in the questionnaire. For each child, it took an average of 10 minutes for the questionnaire to be filled in and about 5 minutes for dental examinations to be performed. Given that some of the mothers were illiterate, the whole process of completing the questionnaires for these mothers was conducted by the researcher

 

Ethical considerations:

This study began by the approval of the ethics committee at Ilam University of Medical Sciences and after presenting a recommendation letter from the University and Health Network.Complete information about the purpose and nature of the study was provided for the participants before they took part in the study. In the case they agreed to participate in the study, written informed consent forms were obtained. The information collected was coded and imported into the computer using the SPSS software Version 16. Data was analyzed using descriptive statistics, independent t-test, Spearman's correlation coefficient and chi-square analysis [18-22].

 

RESULTS:

In this study, oral health status (DMFT index) of a hundred 3-6-year-old (female and male) children was examined. The relationship between demographic variables and oral health status was investigated. Considering demographic variables, there was only a statistically significant association between mothers' age, mothers' occupations and economic situation with the DMFT status (P<0.05). No significant association was observed between the DMFT index and parents' education level (Table 1). The prevalence of CF was 10% and 2% for boys and girls, respectively. The prevalence of RC was 24% and 36% for boys and girls respectively. Ninety percent of 50 boys and 98% of 50 had decaying primary teeth and 24% of boys and 22% of girls had lost their primary teeth.Further, 4% of boys and 4 percent of girls had teeth repaired.Using the chi-square test, the relationship between teeth health status (DMFT index) in children and gender was examined and no significant difference was observed (P<0.05) (Table 2). The relationship between health behavior and the DMFT index was examined by using Spearman's correlation coefficient and there was a statistically non-significant (P<0.05) negative correlation (r=.133). The study showed a significant relationship between mothers' awareness and the DMFT index (P<0.05).

 

 

 

Table 1. Comparison the association between demographic variables with DMFT status

-

Low

Average

Good

p-value

Age of mother

34.32(6.68)

29.9.(4.87)

30.59(4.81)

0.090

Age of child

-

-

-

0.347

3 year

4(%16)

10(%40)

11(%44)

-

4 year

6(%24)

9(%36)

10(%40)

-

5 year

10(%38.48)

8(%30.76)

8(%30.76)

-

6 year

6(%25)

13(%54.17)

5(%20.83)

-

Birth order

 

 

 

0.171

First child

10(%19.60)

24(%47.05)

17(%33.35)

-

Other

16(%67.68)

16(%64.31)

17(%68.01)

-

Mother’s education

-

-

-

0.170

High school

10(%92.44)

8(%63.87)

6(%43.70)

-

Diploma

8(%15.68)

25(49.03)

18(%35.29)

-

Higher education

8(%32)

7(%28)

10(%40)

-

Father’s education

-

-

-

0.356

High school

8(%83.34)

8(%63.32)

5(%53.34)

-

Diploma

8(%16.66)

22(%45.84)

3(%20)

-

Higher education

10(%32.25)

10(%32.25)

11(%35.50)

-

Economic status

-

-

-

0.017

Low

12(%28.57)

17(%40.48)

13(%30.95)

-

Average

5(%17.85)

13(%46.42)

10(%35.73)

-

High

9(%30)

10(%33.34)

11(%36.66)

-

Child’s sex

-

-

-

0.295

Male

10(%20)

20(%40)

20(%40)

-

Female

16(%32)

20(%40)

14(%28)

-

Mother’s job

-

-

-

0.044

House keeper

23(%23.95)

39(%40.64)

34(%40.41)

-

Employee

3(%75)

1(%25)

0

-

Father’s job

-

-

-

0.490

Self-employed

18(%26.08)

30(%43.47)

21(%30.45)

-

Employed

7(%22.58)

11(%35.48)

13(%41.94)

-

 

Table 2. Comparison of infants’ teeth health in terms of sex

                                     Sex of Child

 

Tooth health status

Female (n%)

Male (n%)

P-Value

Decayed tooth

49(%98)

45(%90)

0.474

Missing tooth

11(%22)

12(%24)

0.577

Filling tooth

2(%4)

2(%4)

0.572

Decayed, missing, filling tooth

49(%98)

50(%100)

0.425

Caries free index

1(%2)

5(%10)

0.560

Rampant caries

18(%36)

12(%24)

0.630

 

 

DISCUSSION:

This study aimed to check the status of oral health for 3-6-year-old children in Ilam. Based on the results, only 12% of 3-6-year-old children had no decayed primary teeth. However, the program of healthy people proposed by the World Health Organization has stipulated that at least 50 percent of children by 2000 and 90% of 5-6 year-old children by 2010 must be without caries in primary teeth [23]. Regarding the CF index, it was 30.2% children aged 5 years in Gokalp's et al. study [24] and 49.1% in Dawani's et al. study [25]. According to the standard set by the World Health Organization, this index status in the present study is inappropriate. This may be justified by the community's lack of awareness of the importance of maintaining the oral health, governmental dental clinics, relevant educational programs and inadequate community-based programs affecting oral health and dental care costs. This study showed a significant relationship between mothers' employment and decayed teeth in children. In this regard, children with housewife mothers, compared to children with employed mothers, had more favorable oral health status. This may be due to housewives' having sufficient time to care about the health of their children. In this study, no significant relationship was observed between parental education and tooth decay. The study results were similar to the findings of Duijster et al. [26], however, another study conducted in Australia suggested that parents' education plays an important role in oral health [27].

 

In this study there was a significant relationship between family income and tooth decay. Albandar also claimed that children with high socio-economic status are less likely to develop tooth decay disease [28]. McDoland believes that there is an inverse relationship between socioeconomic levels and tooth decay [29]. In this study, the oral health status of girls was at lower oral health status, compare to boys to study. This finding is consistent with the results of the study conducted by Balwant [30]. This result may be explained by parents' paying more attention to male children or other factors including higher consumption of sweets by girls, and so on. Gopinath's study suggested a significant relationship between two variables age and decay with tooth plaque [31]. This study is in line with the present study. In other words, the number of decayed teeth increased with age. In this study, no statistically significant relationship was observed between parent's education and oral health; however, Sander reported the relationship significant [24] and this can be due to age groups. Mothers' knowledge and awareness in the field of dental health is of essence and is the foundation of proper health behavior.This study showed the relationship between mothers' awareness and the DMFT index. Wong and Miller studied children's status of oral health, awareness, and behavior and showed that there is statistically significant relationship between awareness and oral health behavior [32,33] and this is consistent with the results of this study. Parental influences on children's oral health are well proven [34,35]. This influence can be analyzed from several perspectives. During the early stages of socialization in the family, children learn about self-care behaviors including oral health.Therefore, parental behaviors as a model can be effective in this regard. Since children lack the cognitive and motor skills to brush their own teeth, it is recommended that mothers are in charge of this task up to age 6 [36]. The findings of this study showed that only 22% of parents do brushing task for their children and 78% of mothers do not brush their children's teeth. The findings of the study revealed that parents' involvement in this task is less than what Gopinath [32], reported and also less than the results reported for the developed countries [35-39]. This finding suggests that, for many parents, tooth brushing by children is considered as a skill like eating and getting dressed which requires training and monitoring over time to be developed and formed. However, this is not true. It is recommended to start the first visit in the first year of life and continue it per six months [40]. This study showed that 75 percent of children participating in the study had never had a visit to the dentist. In addition to periodic dental examinations and early action and early treatment of dental problems, a visit to a dentist provides the opportunity for parents to be trained on necessary skills such as tooth brushing. In some studies conducted, a significant relationship was observed between the high frequency of DMFT and the visit to a dentist since these visits was not because of oral disease prevention but because of toothache [41,42]. In this study, the relationship between health behavior and the DMFT index was statistically significant and negative. Accordingly, with improving the performance of mothers in terms of their children's oral health, the DMFT index declined in children. In a study conducted by Gao et al., there was a significant and inverse relationship between oral health behavior (brushing) and the DMFT index [41].

 

CONCLUSION:

The results of this study showed the high prevalence of caries in primary teeth for children aged 3-6 years at health care centers of Ilam. Moreover, due to the low index of dental caries (CF) in children, it can be claimed that the status of oral health for the participants in this study is far from international standards. Regarding the significant correlation between mothers' employment and children's oral health status, employed mothers need to pay more attention to their children's oral health. Recommended that, in order to prevent tooth decay and to achieve the objectives of the World Health Organization in planning, two issues should be considered: Retraining the service provider personnel to enhance their health knowledge in the field of oral health; and continuous training for the target mothers at Ilam health care centers with the aim of improving the DMFT index.

 

ACKNOWLEDGMENT:

I am grateful to the financial and spiritual support of the Ilam University of Medical Sciences.

 

SOURCE OF FUNDING:

This paper was developed using funds from the Ilam university of Medical sciences.

 

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Received on 03.08.2019         Modified on 27.08.2019

Accepted on 03.09.2019         © RJPT All right reserved

Research J. Pharm. and Tech. 2020; 13(4): 1876-1880.

DOI: 10.5958/0974-360X.2020.00338.8