1. health and fitness
2. disease

Original Article
PREVALENCE OF DENTAL CARIES AMONG STUDENTS OF
KHAIRPUR DISTRICT
IRFAN AHMED SHAIKH, BDS, FCPS
FEROZE ALI KALHORO, BDS, FCPS
3
MUHAMMAD SULLEMAN PIRZADO, MBBS, PhD
4
ABDUL BARI MEMON, BDS, MSc
5
MOHAMMAD AMIN SAHITO, BDS
6
WAHEED MURAD DAHRI, BDS
7
PERMANAND MALHI, BDS, MSc
1
2
ABSTRACT
A cross sectional study was done to investigate the prevalence of dental caries and calculate the
DMFT score among (primary to higher secondary) school children of District Khairpur.
The sample size was 384 children from both male and female from public and private sector
schools. Oral examination was carried out using mouth mirror and a blunt ball-ended probe .No
radiographs were taken. The results showed that there were 51% boys and 49% girls. The prevalence
of dental caries was 14 %.The mean DMFT score was 0.30. It is concluded that mean DMFT for boys
and girls was 0.26 and 0.34 respectively. The children from government and private schools were
affected by caries 13.7% and 14.4% respectively.
Key Words: DMFT, Khairpur, Prevalence of caries.
INTRODUCTION
Dental caries (DC) is a multi-factorial chronic
disease of microbiological origin affecting hard tissues
of the tooth, characterized by alternating phases of demineralization and remineralization.1 It can be arrested
restricted and potentially reversed in its early stages,
but is often not self-limiting and without proper care.
It can progress until the tooth is destroyed.2
DC is the most prevalent oral disease. DC has a
high morbidity rate and is the main focus of the dental
Assistant Professor, Isra Dental College Hyderabad Sindh.
Email: irfanahmedshaikh80@yahoo.com Cell: 0334-2728011
2
Associate Professor, Liaquat University of Medical and Health
Sciences Jamshoro Sindh. Email: feroze.kalhoro@lumhs.edu.pk
Cell: 0300-26641705
3
Assistant Professor, Liaquat University of Medical & Health Sciences, Jamshoro Sindh
4
PhD Scholar (Correspondence Author), Medical Research Center,
Liaquat University of Medical & Health Sciences Jamshoro Sindh.
Email: drabmemon@yahoo.com Cell: +92300 2426578
5
Post graduate student, Liaquat University of Medical & Health
Sciences, Jamshoro Sindh. Email: sahitoamin.dr@gmail.com
Cell: 0333-2764313
6
Lecturer, Bhittai Medical and Dental College Mirpurkhas Sindh.
Email: waheedmuraddahri@yahoo.com Cell Number: 0333-7888060
7
Assistant Professor, Bhittai Medical and Dental College Mirpurkhas
Sindh, Email: kumarsaein@yahoo.com Cell Number: 0334-2959810
Received for Publication:
August 20, 2014
Revision Received:
October 7, 2014
Revision Accepted:
October 10, 2014
1
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
health profession. There is practically no geographic
area in the world whose inhabitant does not exhibit
some evidence of dental caries. It can affect either
sex with all age groups with all socioeconomic conditions.3,4 It causes pain and discomfort to patient and
also financial burden Dental caries affects 60%-90% of
school children and substantial majority of adults across
the globe. Due to DC the patients activities in schools,
work and home are marginally reduced Moreover the
physical, functional, social, psychological and emotional
impacts of dental caries have been well documented to
diminish the quality of life.5-8 In most of the developing countries prevalence of dental caries is on the rise
because of inadequate hygienic conditions and little
access to health services.9 According to World Health
Organizations pathfinder survey which examined
over nine thousand individuals in twenty one districts
of Pakistan, dental caries was found the single most
common chronic childhood disease in the country being
5 times more common than Asthma and 7 times more
common than hay fever.10 Khan reported that more than
50% of children between ages of 12-15 years are caries
free however on the negative side 97% of all carious
lesions are untreated.11 Dental caries is one of the most
common preventable childhood diseases; people are
susceptible to the disease throughout their lifetime.12-14
Therefore, physicians and other health-care providers
680
Caries among students of Khairpur District
should be familiar with dental caries and its causes. No
study regarding prevalence of dental caries has been
conducted in Khairpur district specifically targeting
the large amount of children studying in schools. Hence
the current study was planned to provide the base line
data of prevalence of dental caries among 9 to 18 year
old students of Khairpur district.
RESULTS
METHODOLOGY
The DMFT value by age stratification showed
that the DMFT value was 0.30±0.796 in 9-11 year’s
age group, 0.19±0.555 in 12-15 year’s age group and
0.48±1.102 in 16-18 years age group (Table 2).
A cross sectional dental caries study was conducted from 17th 0ctober to 30th October 2013 among the
students of Khairpur Mirs District, Sindh, Pakistan
studying in primary to higher secondary (private and
public) schools. Schools were selected on convenient
bases. Before starting the study official permission was
obtained from principals, headmasters, headmistresses
and administrators of all the concerned schools. Each
school administration was informed about the aims
and objectives of the study. From the total registered
students (according to SEMIS15) 3,28,648 the sample
size was calculated with a level of significance of 5%,
with an estimated prevalence of dental caries of 50%,
and a sample error of 5%.16 The minimum required
sample size was 384. To compensate for possible refusals, 20 more students were added, with a final sample
size of 406 individuals. The sample size was collected
on simple random sampling. Students of age from 9-18
years of either gender and only permanent teeth were
included in the study.
Oral examinations were conducted using mouth
mirror and a blunt ball-ended probe with an end diameter of 0.5mm. All teeth were examined in a systematic manner using international FDI nomenclature to
identify each tooth. The children were asked to rinse
mouth thoroughly before examination, then the teeth
were dried with cotton swab and the dental caries were
recorded. Clinical data were collected according to the
World Health Organization dental caries diagnostic
criteria.17 The DMFT index, corresponding to the average number of decayed, missing, and filled permanent
teeth, was the outcome analyzed. No radiographs were
taken.
All the information like biographic data, school
type and DMFT were recorded in proforma. Data
were entered and analyzed using the SPSS version
16.0. Sample studied was divided into male and female, public and private school groups and different
age groups. Prevalence of dental caries and mean
DMFT score was calculated. Chi square test was used
to check for association in categorical variables. One
way analysis of variance (Anova) was done to assess
the mean difference of DMFT among different groups.
The level of significance was set to < 0.05 along with
95% Confident Interval.
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
This study was conducted for 406 students of 9-18
years old from different schools of District Khairpur.
Overall mean DMFT score was 0.30 ± 0.796. Out of study
population the mean (+SD) value DMFT for males were
0.26±0.768 and for females were 0.34±0.826 (Table 1).
Prevalence of dental caries was 14%. Boys and girls
TABLE 1: MEAN DMFT SCORE IN DIFFERENT
SEX GROUPS
Gender
Total No. of DMFT score
students (%)
Male
207(51%)
0.26±0.768
Female
199(49%)
0.34±0.826
P-value
0.308
TABLE 1: MEAN DMFT SCORE IN DIFFERENT
AGE GROUPS
Age
groups
No. of students (%)
DMFT score
(±SD)
P-value
9-11
years
117 (28.8%)
0.30 (0.796)
0.308
12-15
years
184 (45.3%)
0.19 (0.555)
16-18
years
105 (25.9%)
0.48 (1.102)
TABLE 3: DISTRIBUTION OF DENTAL CARIES
ACCORDING TO GENDER
Gender
Dental caries
Total
Pvalue
0.044
Yes
No
Male
22
10.6%
185
89.4%
207
100.0%
Female
35
17.6%
164
82.4%
199
100.0%
57
14.0%
349
86.0%
406
100.0%
Total
TABLE 4: DISTRIBUTION OF DENTAL CARIES
ACCORDING TO TYPE OF SCHOOLS
Address of
schools
Total
Dental caries
Total
Pvalue
177
86.3%
205
100.0%
0.823
29
14.4%
172
85.6%
201
100.0%
57
14.0%
349
86.0%
406
100.0%
Yes
No
Public
28
13.7%
Private
681
Caries among students of Khairpur District
10.6% and 17.6% were affected with caries respectively;
statistically insignificant (Table 3). 13.7% and 14.4%
students were affected by caries from public and private
schools respectively (Table 4).
DISCUSSION
Dental caries is the most prevalent chronic disease among children in the global scenario. There are
practically no geographic areas in the world whose
inhabitants don’t exhibit some evidence of dental caries.
Early recognition of the disease is of vital importance.
This is needed in order to prevent the disease and pain
so as to make oral health services more relevant in the
health. Prevalence of dental caries has an increasing
trend among school going children.18
The present study reflects the prevalence of dental
caries in 9-18 years students of district Khairpur Sindh,
Pakistan. It must be pointed out that decalcifications
were not considered as carious lesion in this study,
which is early evidence that the disease process is active
and such teeth may be remineralized by appropriate
preventive measures. Similarly radiographs were also
not used in this study, which may have decreased the
number of untreated proximal lesions undiagnosed.
Its mean true carious lesion could be higher than
reported as caries were diagnosed entirely on visual
examination. The overall mean DMFT score of present
study was 0.30 which is very smaller than the mean
DMFT index used by Leghari MA19 and was also smaller
than the previous national Health Survey of Pakistan
which was 1.6 WHO states that developing countries
have low DMFT status and higher untreated cavities
present due to the large consumption of sugar containing
products.20
The mean DMFT score was higher in girls than boys
which was statistically insignificant. Higher DMFT in
girls can be explained by several factors. Teeth erupt
earlier in girls than boys therefore girls have more
exposure time for cariogenic oral environment. There
is difference in biochemical composition of saliva and
rate of flow in girls and boys. Clinical and experimental caries research done by Lukacs and Largaespada21
validate the effect of hormonal fluctuations on the
quantity and quality of saliva thus on oral ecology.
In the present study, high DMFT was observed in
age group of 16-18 years as compared to 9-11 and 12-15
age groups. It might be due to lack of proper cleaning
and the results of the present study reveal lower figures
than other studies.19,22 In this the DMFT The study
conducted by Wang HY23 was a very comprehensive
study and included people of all walks of life, while in
present study the students of only one geographic area
of the district khairpur have been included.
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
Present study showed lower prevalence of dental
caries than the study conducted by Haleem et al24 and
Malik M25 and from oral health survey that was done
in 2004.24 This might be due to dental caries is a multifactorial disease affected by various factors including
age and sex is reported to influence it.1,26
In the present study, however, there was no significant relation between sex and the dental caries
prevalence. The present study showed 86.0% children
were caries free. The study conducted by Maher R27 and
Shamta S28 reported that caries free children were 42%
and 60% respectively. Variations in different figures,
compared to previous study, may be due to difference
in age group, in which study was done, or target population. But recent studies have reported variations in
dental caries according to the gender and age.29,30
The study conducted by Malik M25 was observed
that children from private schools had 77% caries as
compared to children from government schools and
another study by Haleem et al24 had 71.7% caries in
children studying in public schools. The results of this
study are not in agreement with Haleem and Malik M.
CONCLUSION
In present study prevalence of dental caries was
more in female as compared to male and the students
from public and private schools were almost equally
affected by caries. Within the limitations of this study,
the overall caries prevalence in the study population
was low. It is recommended that this low level be
maintained or even brought lower by promoting school
health education programmers and by adopting cost
effective preventive measures.
REFERENCES
1
Ditmyer M, Dounis G, Howard K, Mobley C, Cappelli D. Validation of a multifactorial risk factor model used for predicting future
caries risk with Nevada adolescents. BMC Oral Health.2011;
20:11-18.
2
Karlsson L. Caries Detection Methods Based on Changes in
Optical Properties between Healthy and Carious Tissue. Int J
Dent. 2010: 270-29.
3
Prakash H, Sidhu SS & Sundaram KR: Prevalence of Dental
Caries among delhi school chidren. J Ind Dent Assoc.1999;
70:12-14.
4
Joyson Moses BNR, Deepa Gurunathan. Prevalence Of Dental
Caries, Socio-Economic Status And Treatment Needs Among
5 To 15 Year Old School Going Children Of Chidambaram. J
Clini and Diagn Resea. 2011; Feb; 5(1): 146-51.
5
Center of Disease Control. Promoting oral health: Interventions
for preventing dental caries, Oral and pharyngeal cancers and
sports related craniofacial injuries. A report on recommendations
of task force on community preventive forces. MMWR 2001;
50:1-13.
6
World Health Organization. Global Oral Health Data Bank
2004, Geneva.
682
Caries among students of Khairpur District
7
Patro BK, Ravi Kumar B, Goswami A, Mathur VP, Nongkynrih
B. Prevalence of dental caries among adults and elderly in an
urban resettlement colony of New Delhi. Indian J Dent Res
2008; 19: 95-98.
8
World Health Organization. The World Oral Health Report.
Continuous improvement of oral health in the 21st century
the approach of the WHO Global oral health program 2003,
(http://www.who.int/oral_health/media/en/orh_report03_en.pdf,
Accessed on 15th January 2014.
9
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye
C. The global burden of oral diseases and risks to oral health.
Bull World Health Organ. 2005 Sep;83 (9):661-9.
10 Maher R. Dental disorders in Pakistan--a national pathfinder
study. J Pak Med Assoc. 1991 Oct;41(10):250-2.
20 World Health Organization. Diet, nutrition and the prevention
of chronic diseases. WHO technical report series. Geneva:
WHO;2003.
21 John R. Lukacs, Leah L. largaespada. Explaining Sex Differences in Dental Caries Prevalence: Saliva, Hormones, and
‘‘Life-History’’ Etiologies. American journal of human biology.
2006; 18: 540-55.
22 Ur Rehman MM, Mahmood N, Ur Rehman B. The relationship
of caries with oral hygiene status and extra oral risk factors. J
Ayub Med Coll Abbottabad. 2008 Jan-Mar; (1): 103-08.
23 Wang HY, Petersen PE, Bian JY, Zhang BX. The second national
survey of oral health status of children and adults in China. Int
Dent J. 2002 Aug; 52(4):283-90.
11 Khan AA. Prevalence of dental caries in school children of Lahore,
Pakistan. Commun Dent Ora Epidemiol. 1992 Jun;20(3):155.)
24 Haleem M, Khan AA. Dental caries and Oral Health status of
12 year old School Children in Pakistan. Pak Jrnl. Med Resr
2011; 40 (4): 138-42.
12 Pitts NB. Are we ready to move from operative to non-operative/
preventive treatment of dental caries in clinical practice? Caries
Res. 2004 May-Jun;38(3):294-304.
25 Malik M, Holt RD, Bedi R. Prevalence and pattern of caries,
rampant caries, and oral health in two to five years old children
in Saudi Arabia. J dent child 2003;70:235-42.
13 Hingorjo MR, Jaleel F, Mehdi A. Oral Health Aspects In Primary
School Children Of Three Major Cities Of Pakistan. J Pak Dent
Assoc. 2010; 19 (4):211-55.
26Addy M. Dummer PMH, Hunter MI, Kigdon A, Shaw WC. The
effect of tooth brushing frequency, tooth brushing hand, sex,
and social class on the incidence of plaque, gingivitis and pocketing in adolescents. A longitudinal cohort study. Community
Development Health 1990; 7: 237-47.
14 US Department of Health and Human Services. Oral Health
in America: A Report of the Surgeon General. Rockville: National Institute of Dental and Craniofacial Research, National
Institutes of Health, 2000: 308.
15 Sindh education management information system (SEMIS)
[internet] 2013.from:http://rsusindh.gov.pk/semis/Khairpur%20
Profile%202012-13.
16 Lwanga SK, Lemeshow S. Sample Size Determination in Health
Studies. A Practical Manual. Geneva: World Health Organization,1991.
17 World Health Organization (WHO). Oral Health Surveys Basic
Methods.Geneva: WHO, 1997.
18 Kalra, Dental caries.http://www.whereincity.com/medical/
articles/129.
27 Maher R, Khan A, Rahimtoola S, Bratthall D. Prevalence of
mutans streptococci and dental caries in Pakistani children. J
Pak Med Assoc. 1992; 42(9): 213-15.
28 Shamta S, Ayyaz A, Saima C. Maternal factors and Child’s
Dental Health. J Oral Health Comm Dent 2009;3(3): 45-48.
29 Mashoto. KO. Dental caries, oral-health-related quality of life and
atraumatic restorative treatment (ART): a study of adolescents
in Kilwa district of Tanzania. Centre for I Health, University
of Bergen. 2011.
30 Dhar V, Bhatnagar M. Dental caries and treatment needs of
children (6-10 years) in rural Udaipur, Rajasthan. Indian J
Dent Res. 2009; 20: 256-60.
19 Leghari MA, Tanwir F, Ali H. Dental caries prevalence and risk
factors among school children age12-15 years in Malir, Karachi.
J Pak Ora & Dent. 2012; 32(3): 484-88.
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
683