Oral health status associated with sociodemographic factors of Nepalese schoolchildren: a population-based study

Dietary Habits and Oral Hygiene as Determinants of the Incidence and Intensity of Dental Caries-A Pilot Study

OBJECTIVES

The aim of this study was to assess the influence of dietary and hygiene habits on the prevalence and intensity of dental caries. A group of 148 adults participated in the study.

METHODS

A self-administered nutrition and oral hygiene questionnaire was used to assess dietary habits and oral hygiene routine. A preventive diet index (PDI), a cariogenic diet index (CDI), and an oral health hygiene and prevention index (OHHPI) were created based on part of the questions. The intensity of dental caries among the respondents was investigated by the decayed, missing, and filled teeth index (DMFT), which was estimated on the basis of data obtained during the dental examination.

RESULTS

The study showed that 97% of the respondents had filled carious cavities, while untreated carious cavities were observed in up to 78% of the study participants. The respondents had an average consumption of preventive products and a low consumption of caries-stimulating foods. The preventive dietary index (PDI) value was higher in the female group than in the male group. A more frequent consumption of caries-inhibiting products was demonstrated by those declaring that they took various types of dietary supplements. The use of health-promoting sugar substitutes by the respondents was associated with a lower intensity of dental caries and a more frequent consumption of preventive products.

CONCLUSIONS

The analysis of the survey results indicates the need to implement educational activities aimed at increasing public awareness of the prevalence of dental caries among adults.

Non-utilization of oral health services and associated factors among children and adolescents: an integrative review

OBJECTIVE

To review publications exploring non-utilization of oral health services and to identify factors associated with non-utilization of oral health services among children and adolescents.

MATERIALS AND METHODS

An integrative review design was adopted. A search was conducted for research articles published during the period from 2000 to April 2021 in five databases, Medline via Ovid, Scopus, CINAHL, Cochrane Library and Web of Science. Inclusion criteria were original articles examining non-utilization of oral health services among 0-19 years old and studies published in peer-reviewed journals in English. Thematic analysis was undertaken to identify common themes. The Newcastle-Ottawa scale was used to evaluate the quality of the studies.

RESULTS

Twenty-one geographically diverse articles were included. Nineteen studies were cross-sectional, one was a prospective cohort and one a case-control study. Non-utilization of dental health services tended to be higher in children than adolescents. There were predisposing (age, gender, ethnicity, parent's level of education), enabling (family income, dental insurance) and need factors (subjective and objective oral health related parameters) that had been shown to be associated with non-utilization of dental services among children and adolescents.

CONCLUSIONS

This integrative review found predisposing, enabling and need factors to be associated with dental health service non-utilization.

Influence of gender and oral health knowledge on DMFT index: a cross sectional study among school children in Kaski District, Nepal

BACKGROUND

Oral health problems are highly prevalent among school children in Nepal. Poor oral health condition may be influenced by various factors. However, little is known about the sociodemographic and awareness related factors on oral health problems among school children in Nepal. Therefore, this study aimed to assess the association of gender and knowledge on DMFT index among school children.

METHODS

A cross-sectional study was conducted among school children of Grade Seven in 12 schools of Kaski district in Nepal. Schools were randomly selected from the urban and semi-urban areas in the district. Data were collected covering oral health knowledge, socio-demographic characteristics, oral health condition and practices. The factors of poor oral health condition and practices were examined using t-test, one-way ANOVA, and multiple linear regression.

RESULTS

Of the total participants (n = 669), 54.9% were females and their mean DMFT score was 1.82 (SD = 1.07). Total decayed score was higher among those who did not have knowledge that fluoride prevents decay compared to those who had knowledge about it (Being aware of fluoride prevents decay: Mean = 1.21 (SD = 1.54) versus not being aware of that: mean = 2.13 (SD = 2.13); p = 0.029). Females were more likely to have higher DMFT scores compared to males (β-coefficient = 0.43, 95% CI 0.13, 0.73, p = 0.005). In addition, higher knowledge score was negatively associated with higher DMFT score (β-coefficient = - 0.09, 95% CI - 0.20, -0.01, p = 0.047).

CONCLUSION

Being female students and those having lower level of knowledge on oral health attributed to higher DMFT index. Periodic dental check-up coupled with oral health education on regular brushing, use of fluoridated paste, tongue cleaning and care of gum diseases are recommended in schools.

Mean Fluoride Concentration in Drinking Water Sources of a Municipality: A Descriptive Cross-sectional Study

Introduction

Fluoride is essential for the growth and development of teeth and bone. Excess or less fluoride consumption can have harmful effects on our bodies. Fluoride level of 0.5-1.5 mg/l is said to be optimized according to the World Health Organization. The level of fluoride varies among the different geographical regions and water sources. It is essential to find out the fluoride content of various water sources used for drinking purposes. The aim of this study was to find the mean concentration of fluoride in drinking water sources of a municipality.

Methods

A descriptive cross-sectional study was conducted in a Municipality. The study was conducted from 1 December 2021 to 30 December 2021 after receiving ethical approval from the Ethical Review Board (Reference number: 1134). Water samples were collected and the fluoride content was estimated using 2-parasulfophenylazo-1,8-dihydroxy-3,6-napthalene-disulfonate colorimetric method. The data collected from the laboratory were calculated and presented in the form of a table. Point estimate and 95% Confidence Interval were calculated.

Results

The mean value of fluoride content in 160 collected water samples was 0.369±0.275 mg/l (0.33-0.41, 95% Confidence Interval). Among the different wards, the fluoride content was 0.708±0.27 mg/l in ward number 12 followed by a fluoride content of 0.57±0.19 mg/l in ward number 5.

Conclusions

In this study, the mean fluoride levels were lower when compared with similar studies conducted in similar settings. The levels were lower than that recommended by the World Health Organization. The various controlled methods of fluoridation have to be quickly initiated. Other means of fluoride consumption, like the use of fluoridated toothpaste, has to be recommended.

Keywords

dental caries; drinking water; fluoride.

Oral Health in 12- and 15-Year-Old Children in Serbia: A National Pathfinder Study

The aim of the paper is to present the oral health profile of 12- and 15-year-old schoolchildren in Serbia. Basic Methods for Oral Health Surveys of the WHO were implemented to record: Decayed, Missing, and Filled Teeth/Surfaces Index (DMFT/DMFS), gingival bleeding, enamel fluorosis and other structural anomalies, dental erosion, dental trauma, and oral mucosal lesions. In addition, Silness and Löe plaque index and orthodontic status were assessed. A total of 36% of 12-year-olds and 22% of 15-year-olds in Serbia were caries-free. The mean DMFT was 2.32 ± 2.69 for 12-year-olds and 4.09 ± 3.81 for 15-year-olds. DMFT was made up largely by the decayed component. Gingival bleeding was present in 26% of examined 12-year-old and 18% of 15-year-old children. Dental plaque was observed in 63% of both 12- and 15-year-olds. Fluorosis, structural anomalies, dental erosion, dental trauma, and oral mucosal lesion were rarely detected. Low prevalence of malocclusions was found. Oral disease is still a common public health problem among schoolchildren in Serbia. A significant increase in the prevalence of caries disease between 12- and 15-year-old groups implies that preventive care for adolescents requires special attention. Corrective actions and reforms to the current school-based oral health prevention program are needed to further improve oral health in Serbian children.

A Clinical Competency Framework for the Basic Package of Oral Care: Perceptions of Primary Oral Health Providers in Rural Nepal

Introduction

The basic package of Oral Care (BPOC) was developed to improve oral health care for underserved populations worldwide. However, systematic delivery of the BPOC has been difficult to achieve, and training efforts have in some cases contributed to proliferation of malpractice. Standard Competency Frameworks (CF), increasingly used in dental and medical education to improve quality assurance, have not been established to date for the BPOC.

Methods

To evaluate provider perceptions of a BPOC-specific CF, in-depth interviews were conducted with 7 Primary Oral Health Providers (POHPs) and 5 Clinic Assistants working in the Jevaia Oral Health Care project (Jevaia) in Nepal. Participants were limited to providers who have used the CF. Interviews were audio recorded, transcribed in Nepali, and translated into English. A qualitative thematic analysis was applied through a multi-stage review process, and emergent themes were further grouped and categorized to draw final conclusions.

Results

Findings were categorized into four groups: (1) “What is the CF to Me”: Respondents frequently conflated the CF with professional development training. These activities together were essentially felt to offer clear performance guidance and a pathway for learning. (2) “Relationship to the Work”: Respondents reported that the CF's guidelines increased confidence, peer accountability, and job satisfaction. (3) “Practical Improvements”: Providers felt the CF improved their clinical skills, communication, crowd management, and teamwork. (4) “Community Impact”: Many participants felt that improved skills had led to a more efficient workflow, greater community acceptance, and increased utilization of services.

Conclusions

Clinicians broadly felt that the CF improved both their professional satisfaction and the quality of patient care. CFs should be considered integral to BPOC implementation, along with opportunities for continuous professional learning, and these activities will likely be most meaningful and impactful when recognized by government and other licensing bodies.

Different Risk Factors for Erosive Tooth Wear in Rural and Urban Nepal: A National Study

BACKGROUND

Erosive tooth wear (ETW) is of growing concern, but data on ETW among Nepalese children are scarce. The main aim of the study was to investigate the prevalence and severity of ETW among Nepalese schoolchildren. We also aimed to analyse the risk indicators for ETW according to location (rural/urban) and the role of obesity in the risk for ETW.

METHODS

This national study was conducted among 5-15-year-old Nepalese schoolchildren from different regions. Altogether, 1137 out of 1151 schoolchildren participated in both a clinical examination and a survey. ETW was recorded using the Basic Erosive Wear Examination.

RESULTS

The prevalence of ETW was 65%. One-fifth of the examined subjects were in need of preventive or restorative treatment. Living in an urban area and studying in a private school were protective factors for ETW, whereas consuming fruits frequently and using charcoal for tooth cleaning increased the odds for ETW. Central obesity was the strongest risk indicator for ETW among urban residents.

CONCLUSIONS

ETW of low severity is common among Nepalese children and adolescents. Socio-demographic factors influence the prevalence of ETW in Nepal and there seems to be different factors that play a role in the ETW process according to location of residence.

Dental caries among Finnish teenagers participating in physical activity and diet intervention: association with anthropometrics and behavioural factors

Background

An association between childhood anthropometric measurements and dental caries is conflicting. The prevalence and severity of dental caries and its association with anthropometric and behavioural factors, were investigated among Finnish teenagers.

Methods

The study sample comprised 202 15–17-year-old participants in the Physical Activity and Nutrition in Children (PANIC) Study. Dental caries findings were recorded using International Caries Detection and Assessment System (ICDAS) criteria, including activity estimation; numbers of decayed teeth (DT) and decayed, missing and filled teeth (DMFT) were recorded. Body weight, height and waist circumference were measured and respective body mass index (BMI) was calculated. Body fat percentage was assessed by dual-energy X-ray absorptiometry. Health-related behaviours and consumption of food and drinks were assessed using questionnaires, and intake of nutrients using a 4-day food record.

Results

Mean DMFT for all the participants was 2.4 (SD = 2.9), DT 0.6 (SD = 1.3), and 36% had DMFT = 0. No difference between genders was observed. In bivariate analyses, use of sugar-sweetened beverages (SSB) three times or less per week and not having used snuff associated significantly, whereas higher carbohydrate intake (E%), toothbrushing less often than twice a day and higher caries experience at baseline almost significantly with DT > 0. In adjusted regression analyses, frequent use of SSB and higher carbohydrate intake increased the odds for DT > 0. Additionally, higher carbohydrate intake (E%) and infrequent tooth brushing significantly associated with a higher number of DT.

Conclusion

Caries prevalence is still low and similar in Finnish teenage girls and boys. Behavioural factors are, but anthropometric factors are not associated with dental caries.

Life-conditions and anthropometric variables as risk factors for oral health in children in Ladakh, a cross-sectional survey

Background

The aim of this survey was to evaluate the severity of dental caries among children living in Zanskar Valley (Ladakh, India) and its association with anthropometric and background variables.

Methods

This cross‐sectional survey was conducted on schoolchildren divided into four age groups (< 6, ≥ 6 < 11, ≥ 11 < 14 and > 14 years of age). A total of 1474 schoolchildren (607 males, 41.2%) were examined. Actual caries prevalence (dt/DT) and gingival bleeding were recorded by four calibrated dentists. An ad hoc questionnaire evaluated general health, eating habits, oral hygiene and the self-perception of oral conditions. Height, weight, waist circumference, heart-rate and oxygen-saturation were also collected directly by examiners. Responses to questionnaire items were treated as categorical or ordinal variables. The relationship between children’s caries data, gingival bleeding, gender, Body Mass Index (BMI) following the International Obesity Task Force, waist circumference and questionnaire items was assessed using the Kruskal–Wallis test and Pearson correlation. Conditional ordinal logistic regression was used to analyse associations among caries severity, gender, BMI, waist circumference, oxygen saturation and questionnaire items. A forward stepwise logistic regression procedure was also carried-out to estimate the ORs of gingival bleeding prevalence and the covariates derived from examination or questionnaire.

Results

Caries was almost ubiquitarian with only 10.0% of caries-free children (dt/DT = 0). Caries severity, in both primary and permanent dentitions, was statistically significantly related to gender, waist circumference, BMI, oral hygiene frequency and self-reported chewing problems (p < 0.01 in both dentitions). An increasing relative risk for caries in permanent dentition compared to caries-free subjects was observed in children with a low BMI (RRR = 1.67, _95%CI = 1.54/2.83 for subjects with 1–3 caries lesions and RRR = 1.52, _95%CI = 1.36/1.74 for subjects with > 3 caries lesions); also, children with reduced waist circumference had a higher relative risk to have 1–3 caries lesions (RRR = 2.16, _95%CI = 1.84/2.53) and an even higher risk to have more than 3 caries lesions (RRR = 4.22, _95%CI = 3.33/5.34).

Conclusions

A significant impact of untreated caries lesions was observed in Ladakh schoolchildren; low BMI values and reduced waist circumference showed to be the main caries risk predictors. Preventive and intervention programmes should be implemented to improve children's oral health.

Associations between Child Snack and Beverage Consumption, Severe Dental Caries, and Malnutrition in Nepal

The global nutrition transition and increased consumption of sugar-sweetened beverages and ultra-processed snacks have contributed to increasing rates of child obesity and dental caries in developing countries. In Nepal, where child malnutrition rates are high, the relationship between malnutrition and dental caries is poorly understood. This cross-sectional study aims to assess this relationship among a convenience sample of 273 children age six months to less than 12 years in three communities in Nepal, using parent/caregiver interviews, child dental exams, and anthropometric measurements. Fisher’s exact test and independent t-tests examined associations between dietary practices and severe caries and between severe caries and malnutrition, respectively. Children consumed sugar-sweetened beverages and processed snacks frequently: 80% consumed tea with sugar, 60% consumed sweet snacks, and 65% consumed processed savory snacks daily. Overall, 74% of children had untreated tooth decay, and 21% exhibited stunting malnutrition, 14% were underweight, and 6% presented wasting. Significant associations were found between daily consumption of sweets and processed snacks with severe caries and between severe caries and poorer nutritional status. These findings underscore the need to incorporate nutrition and oral health promotion and dental treatment into maternal–child health services and schools and to strengthen policies to reduce children’s access to junk food.

Influence of dental caries on oral health-related quality of life, school absenteeism and school performance among Nepalese schoolchildren

OBJECTIVES

To evaluate the impact of untreated dental caries and its consequences on oral health-related quality of life (OHRQoL), school absenteeism and school performance in Nepal.

METHODS

This is a population-based, national cross-sectional study. This study was conducted among three WHO index age groups (5-6, 12- and 15-year-olds) of schoolchildren from 18/75 randomly selected districts of Nepal. Clinical findings on untreated dental caries lesions (decay in primary and permanent dentition, dt/DT) and its consequences (pufa/PUFA) were recorded, and the participants were graded into four categories based on the severity of untreated dental caries (GUDC). The Nepali version of Child-Oral Impacts on Daily Performances (C-OIDP) was used to assess the information on OHRQoL. Similarly, school-related information (school absenteeism and school performance) was collected from the school registry. Generalized linear mixed models with random effects were used to evaluate the association between dental caries and OHRQoL, school absenteeism and school performance.

RESULTS

Among the study sample, the mean (SD) C-OIDP score was 2.4 (5.0). It was observed that the 15-year-olds, those belonging to the Newari ethnic group, and children with high GUDC grades had poor OHRQoL. After adjusting for confounding factors, high dt + DT or pufa + PUFA was associated with higher impact on OHRQoL. Similarly, lower grades of GUDC (Grade 1 and Grade 2) also had less impact on OHRQoL than the most severe Grade 4. High dt + DT or pufa + PUFA were associated with maximum school absenteeism. Furthermore, high C-OIDP and a grade of GUDC ≥2 score were associated with poor school performance.

CONCLUSION

Untreated dental caries and its consequences have a considerable impact on OHRQoL. These conditions may contribute to high school absenteeism and poor school performance.

Body mass index and dental caries experience in Nepalese schoolchildren

OBJECTIVES

The aim was to investigate the severity of untreated dental caries among Nepalese schoolchildren and its association with their body mass index (BMI) using IOTF, WHO and Nepalese growth reference systems.

METHODS

This school-based clinical cross-sectional study was conducted with three WHO index age groups (5- to 6-, 12- and 15-year-olds) in 18 out of 75 districts of Nepal, selected using stratified random sampling. A total of 1135 schoolchildren were included in the study. A validated structured questionnaire was used to assess the children's oral hygiene practices and dietary habits. Clinical oral examinations investigated the status of untreated dental caries in primary and permanent teeth (dt/DT) along with its consequences (pufa/PUFA). Later, the grade of severity of untreated dental caries (GUDC) was determined using both dt/DT and pufa/PUFA. Height (cm), weight (kg), waist circumference (cm) and hip circumference (cm) were measured, and the body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. The findings were presented as proportions, and the chi-square test was performed to compare differences between groups. Generalized linear mixed models with random effects assessed the association between the severity of untreated dental caries and the BMI.

RESULTS

According to the IOTF, WHO and Nepalese growth reference systems, the overall proportions of children with a low BMI were 38.6%, 15.4% and 12.8%, and those with a high BMI were 7.9%, 4.6% and 8.4%, respectively. Untreated dental caries was common among the youngest age group and those with infrequent tooth brushing habits or frequent consumption of sweet bakery products, sweets or candy, or tea with sugar. Neither a low nor a high BMI was associated either with dt + DT or with pufa + PUFA, after adjusting for confounders. However, both a low and a high BMI (all three references) were associated with the severity of dental caries or GUDC.

CONCLUSION

Regardless of the growth reference system used, children with either low or high BMI may be at risk of developing untreated dental caries lesions and related consequences. Both underweight and overweight/obese and dental caries share common risk factors, mostly dietary. Preventive and intervention approaches/strategies such as behavioural and dietary modifications should be implemented to improve both children's oral health and their nutrition in Nepal.