Prevalence of dental caries in the permanent dentition amongst 12-year-olds in Africa: a systematic review and meta-analysis

BACKGROUND

Dental caries (DC) is highly prevalent condition affecting mostly young children. There has been no systematic review done on the prevalence of DC amongst 12-year -olds in Africa. Although some African countries have reported a decrease in DC prevalence, others have shown an increase and it is essential to measure current trends in order to identify strategies and programmes that could assist in reducing DC in Africa. The aim of this systematic review was to determine the prevalence of DC (condition) amongst the permanent dentition of 12-year-old children (population) in Africa (context).

METHODS

A systematic review and meta-analysis was performed. Peer reviewed cross-sectional articles from January 2000 until December 2021 was searched and this included the following databases: Pubmed (Medline); SCOPUS; CINAHL (via EBSCOhost); Academic Search Complete (via EBSCOhost); Dentistry and Oral Sciences Sources (via EBSCOhost); and Science Direct. The search was last updated on the 10th January 2022. Joanna Briggs Institute critical appraisal tools were used to assess risk of bias. Prevalence figures were stratified by Urban/Rural status, country and time using a random-effects model. All studies performed on children 12-year-olds on the African continent were included. The prevalence of DC and the DMFT scores were the primary and secondary outcome measures, respectively. Only articles consisting of 12-year-old children who reside in Africa were included in this study. The systematic review was registered with Prospero CRD42021293666.

RESULTS

18,080 participants were included in this review. A total of thirty studies were included in the review. The pooled effect size of dental caries severity was 1.09 (CI 0.91-1.27) and the overall prevalence was 36% (CI 29.4-41.7%). Eritrea (78%) had the highest prevalence of DC while Zambia had the lowest (11%); Eritrea also had the highest DMFT score (2.5) with Sudan having the lowest score (0.49). Urban cities had the highest DMFT score (1.32, CI 0.97-1.68), compared to rural cities (1.13, CI 0.86-1.4) and there was an increasing trend in DC prevalence over time from 28% (CI 23-34%) in 2000 to 2005 to 57% (CI 43-72%) in studies conducted after 2015. The risk of bias was very low where majority of the studies scored more than 50% in the JBI critical appraisal tool.

CONCLUSIONS

There was a wide discrepancy in the DC prevalence and scores across the different countries, settings (rural versus urban) and there was an increase in the prevalence over time. This review was self-funded.

Association between body mass index, diet and dental caries in Grade 6 boys in Medina, Saudi Arabia

The prevalence of obesity is increasing in Saudi Arabia and although caries is associated with obesity, this association has not been investigated in Medina. This study aimed to determine the association between dental caries, body mass index (BMI) and dietary habits of 12-year-old boys from four geographically distinct schools in Medina. Mean BMI was 22.17 kg/m² (± 5.15); 41% had normal BMI, 25% were overweight and 30% were obese. The mean Decayed, Missing and Filled Teeth (DMFT) score was 1.46 (± 2.04). Those in the normal BMI range had a significantly higher prevalence of caries (57%) and DMFT score (1.92) compared with the overweight and obese groups (P < 0.05). These differences remained significant after controlling for possible confounders via linear regression. Mean BMI was significantly lower in boys with severe compared with mild or no caries. Normal and underweight participants had an almost 2 times greater risk of developing caries compared with their overweight and obese counterparts. The children had poor dietary habits and there were no significant associations between dietary variables and caries.

Oral health status of 12-year-old male schoolchildren in Medina, Saudi Arabia

Studies from Saudi Arabia have reported that the prevalence of dental caries among children is relatively high compared with other developing countries The aim was to determine the oral hygiene status and significant caries (SiC) index of 12-year-old males in Medina . In a cross-sectional, analytical study 360 students participated from 4 boys' schools. Dental caries, plaque, gingivitis, fluorosis and malocclusion were recorded using standard methods and indices. The mean DMFT score was 1.53 (SD 1.88). Caries prevalence was low (57.2%) but the mean SiC index was relatively high [3.63 (SD 1.66)]. The prevalences of plaque and gingivitis were high (82.8% and 70.8% respectively). Lower molars had the highest rate of caries. No children presented with dental fluorosis and 82.5% had a class I jaw relationship. Oral hygiene awareness programmes at schools, together with brushing and flossing programmes, are recommended in order to maintain and improve the oral health of young children in Medina.

Validity and reliability of the Arabic short version of the child oral health-related quality of life questionnaire (CPQ 11-14) in Medina, Saudi Arabia

The Arabic version of the Child Perception Questionnaire for assessing oral health-related quality of life in 11-14 year olds (CPQ 11-14) has been validated previously. This study tested the validity and reliability of a short version of the Arabic CPQ 11-14 in the general population of Medina, Saudi Arabia. A total of 268 schoolchildren completed the questionnaire and were examined to determine the prevalence of caries and malocclusion. The mean total score was 8.53 (SD 8.18), and 7% of children scored zero. There was a significant association between malocclusion and oral symptoms and between DMFT score and functional limitations. The test-retest reliability (0.78) and Cronbach alpha (0.82) were excellent. The construct validity was acceptable for oral health (ρ = 0.37) and overall well-being (ρ = 0.40). The Arabic version of the short form CPQ 11-14 was reliable and valid for this general population of children.

Services rendered and barriers faced by public sector oral hygienists in two provinces of South Africa

Oral hygienists (OHs) drive oral disease preventive programmes and promote good health practices. South Africa (SA) has a shortage of this cadre of health worker especially in the public sector. This 2009 project was the first effort to determine the professional activities performed, barriers faced and work- related issues that affected OHs employed at that time in Gauteng and in KwaZulu-Natal. The cross-sectional descriptive study used a self-administered questionnaire developed after a comprehensive literature review. The response rate was 78% (N = 32). Almost all (94%) respondents gave "providing a service to the community" as the main reason for working in the public sector, where they were committed to offering preventative oral and dental services at clinics and in the community. Common employment problems were poor salaries (94%), lack of resources (81%) and the perception that opportunities for promotion are limited (78%), compounded by poor recognition of the services provided by OHs. In order to more effectively utilise the skills and commitment of OHs in delivering preventive dentistry in the public sector, such problems facing the profession should be addressed.

Caries status among children in the West Rand District of Gauteng Province, South Africa

INTRODUCTION

There is a lack of data about the prevalence and clinical consequences of dental caries in the West Rand. However dental caries does appear to be a substantial public health problem in Gauteng.

OBJECTIVE

This study set out to determine the prevalence and clinical consequences of dental caries among school children in the West Rand district of Gauteng.

METHODOLOGY

This was a cross-sectional study comprised of 800 pre-school and primary school children six to eight years old. Cluster sampling was used to select the participating schools. The oral health status was determined by using the DMFT/dmft and PUFA/pufa indices.

RESULTS

Of the 800 children, 282 were in the four to five year old age group and 518 were six to eight years old. For four to five year olds the mean dmft score was 2.24 and the prevalence of caries 49%. The clinical consequence of caries was scored with a mean pufa index of 2.9 and the percentage of untreated decay was 47%. For six to eight year olds the mean DMFT/dmft scores were 0.1 and 2.4 respectively and the prevalence of caries 46%. The clinical consequence of caries scored with the PUFA/pufa index was 0.0 and 3.4 respectively and the percentage of untreated decay was 44%.

CONCLUSION

There are high levels of untreated caries in children in this district. The pufa scores ndicate that children suffer serious consequences of untreated decay.

Oral lesions, HIV phenotypes, and management of HIV-related disease: Workshop 4A

The workshop considered 5 questions related to oral lesions, HIV phenotypes, and the management of HIV-related disease, with a focus on evidence and challenges in resource-poor settings. First, are oral lesions unique with respect to geographic location or phenotype? Second, how useful would an oral lesion index be to predict HIV in resource-poor countries with no access to CD4 counts or viral load? Third, what are the latest methods and delivery modes for drugs used to treat oral lesions associated with HIV? Fourth, what is the role of the oral health care worker in rapid diagnostic testing for HIV? Fifth, what ethical and legal issues are to be considered when managing the HIV patient? The consensus of the workshop was the need for additional research in 4 key areas in developing countries: (1) additional investigation of comorbidities associated with HIV infection that may affect oral lesion presentation and distribution, especially in pediatric populations; (2) the development of region-specific algorithms involving HIV oral lesions, indicating cumulative risk of immune suppression and the presence of HIV disease; (3) well-designed clinical trials to test new therapies for oral lesions, new treatments for resistant oral fungal and viral diseases, effectiveness of therapies in children, and new drug delivery systems; and (4) the role of the oral health care worker in rapid diagnostic testing for HIV in various regions of the world.

Pediatric Oral HIV Research in the Developing World

This article is a review of the literature between 2003 (since the last workshop) and April 2009 (Beijing workshop). It focuses on the prevalence of oral lesions associated with HIV infection, oral lesions as predictors of HIV infection, oral lesions as markers of the efficacy of highly active antiretroviral treatment and quality of life, caries risk, the management of oral lesions, and epidemiologic tests for clinical significance of oral lesions.

Salt fluoridation: a meta-analysis of its efficacy for caries prevention

The aim of this meta-analysis was to assess the caries preventive effect of Salt fluoridation (SF) in the permanent dentition in children. THE OBJECTIVES WERE TO COMPARE: (1) the caries preventive effects of SF versus no exposure in different age cohorts (6-8; 9-12; and 13-15 years old); (2) SF versus other community based interventions (milk or water fluoridation [WF]).

METHODS

9 English and 2 non-English databases were searched for papers that reported on the caries preventive effect of groups (with controls) that were exposed to SF in the form of mean DMFT scores with standard deviations. Differences in exposed and nonexposed groups were computed on the basis of weighted mean differences (WMDs) with 95% confidence intervals (CIs).

RESULTS

For 6-8 year olds, the pooled reduction in DMFT scores was -0.98 [95% CI: -1.68 to -0.29]; for 9-12 year olds, it was -2.13 [95% CI: -2.55 to -1.70] and for the 13-15 year old groups, -4.22 [95% CI: -6.84 to -1.55]. All the analyses favoured the SF groups (p <0.001). For SF versus WF, there was no difference (-0.11 reduction [95% CI: -0.29 to +0.07]).

CONCLUSION

Within limitations, the pooled estimates of the WMDs for the different age cohorts favoured SF versus no exposure.

Predicting HIV in a public dental facility using group I oral lesions

Group I oral lesions have been strongly associated with HIV and in resource-poor settings could be useful predictors of HIV. No study has evaluated the predictability of these lesions in diagnosing HIV/AIDS in patients who attend dental public facilities in South Africa.

OBJECTIVES

To determine the HIV status, prevalence of Group I oral lesions and their predictive value amongst patients attending a dental clinic in Soweto, South Africa.

METHODS

This cross sectional analytical study comprised of adult patients attending a dental facility over one week in 2006. All patients underwent a clinical examination by calibrated dentists.

RESULTS

A total of 165 patients (100% response) were screened of which 87 (53%) were female. The HIV prevalence was 28% (n = 46) and of those who tested positive, 15% (7) manifested with Necrotizing Ulcerative Gingivitis (NUG). This proved to be highly predictive for HIV (positive predictive value = 93.8%, specificity = 99.6% and likelihood ratio = 40).

CONCLUSION

The high prevalence rate of HIV in dental facilities confirms the heavy burden of the HIV epidemic. NUG proved to be a good predictor of HIV in this setting.