Print this page Email this page | Users Online: 265
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 5  |  Issue : 3  |  Page : 155-162

Prevalence of dental caries, the effect of sugar intake and tooth brushing practices in children aged 5-11 years in Bangalore North


Department of Pedodontics and Preventive Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, International Airport Road, Hunasamaranahalli, SMVIT Post, Bangalore, Karnataka, India

Date of Web Publication14-Aug-2014

Correspondence Address:
Deepak Viswanath
Department of Pedodontics and Preventive Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, International Airport Road, Hunasamaranahalli, SMVIT Post, Bangalore - 562 157, Karnataka
India
Login to access the Email id


DOI: 10.4103/0976-433X.138721

Rights and Permissions
  Abstract 

Background: Dental caries is the most prevalent disease worldwide, and is caused by a complex interaction of tooth susceptibility, nutrition, and oral environment. The relationship between sugar intake, which includes the type of sugar being consumed, and the prevalence of dental caries has long been a subject of dispute. Aim: Aim of this study was to determine the effect of sugar types, frequency of sugar intake and oral hygiene practices on dental caries among school children of both genders aged 5-11 years from Bangalore North. Methods: A specially designed questionnaire was used to collect information regarding type of sugar intake, frequency of sugar consumption and the regularity of tooth brushing among children. All the children were examined clinically to assess their dmft/DMFT score. The obtained data was analyzed using ANOVA and Student's t-test. Results: The mean ± SD values of dmft and DMFT in children taking candies were 3.03 ± 2.66 and 0.33 ± 0.64 respectively. The mean ± SD value of dmft and DMFT in children with tooth brushing once daily was 2.55 ± 2.51 and 0.28 ± 0.77 respectively, while that in children with tooth brushing twice daily was 1.67 ± 1.98 and 0.21 ± 0.66 respectively. Hard candies were found to be more risky in causing dental caries than soft drinks or ice cream. Conclusion: From the results of our study, there was a direct association between the frequency of sugar consumption and dental caries and tooth brushing practice can minimize the severity and prevalence of dental caries.

Keywords: Dental caries, DMFT, frequency of sugar intake, sugar, tooth brushing


How to cite this article:
Viswanath D, Sabu N. Prevalence of dental caries, the effect of sugar intake and tooth brushing practices in children aged 5-11 years in Bangalore North. SRM J Res Dent Sci 2014;5:155-62

How to cite this URL:
Viswanath D, Sabu N. Prevalence of dental caries, the effect of sugar intake and tooth brushing practices in children aged 5-11 years in Bangalore North. SRM J Res Dent Sci [serial online] 2014 [cited 2022 Jan 24];5:155-62. Available from: https://www.srmjrds.in/text.asp?2014/5/3/155/138721


  Introduction Top


Dental caries, also known as tooth decay, affects the vast majority of adults and 60-90% of children in industrialized countries. [1] It has a complex etiology; it occurs under conditions related to the tooth itself, sugars present in food and drinks, and the oral environment. The dental plaque forms continuously on the tooth surfaces, and when exposed to fermentable carbohydrates, bacteria present in the plaque form acid which lowers the pH in the mouth leading to demineralization of the teeth. Overtime, remineralization occurs naturally, but demineralization overlaps remineralization, forming caries.

Many factors influence caries development, including the presence of plaque-producing bacteria, innate susceptibility of tooth surfaces, frequency of eating, snacking, oral hygiene measures, availability of fluorides, and lastly, the salivary flow and its composition. Saliva contains minerals that buffer the bacterial acids and promote demineralization. The greater the salivary flow, the more rapid the demineralization; it is the balance between acid production and salivary recovery that determines caries susceptibility. The increased rate of dental caries among school children in recent years has been a major problem in many developing countries. [2] Also, the increasing availability of assorted cariogenic foods to the public in the form of candies, biscuits, or sticky chocolates is another cause for the increase in dental caries, and the individual's drive for the consumption is controlled by a combination of biologic, psychologic, and social factors. Some investigators have contemplated that taste perceptions may be one of the major factors responsible for the amount, type, and frequency of sugar/salt consumed. [3]

So, the consumption of sugar in small amounts, along with other fermentable carbohydrates consumed frequently during the day will increase the caries risk rather than large amounts eaten occasionally. Added to this is the clearance factor, in other words, it is not the amount of sugar consumed, but the rate of clearance from the mouth. Sticky foods can stay in the mouth for longer periods, thus increasing the potential for caries. Consumption of sugar-containing foods is believed to be on the increase in developing countries, particularly among urban residents from higher socio-economic background. [4] It has been suggested that variation in dietary and oral hygiene habits might account for the social and regional distribution of caries experience. [5] Research in industrialized and developed countries has revealed that children of high social class families experience less caries than those of lower social classes; [6] however, this relationship appears to be converse in the developing countries.

Therefore, the present study was undertaken to determine the effect of sugar types, frequency of sugar consumption, and tooth brushing practices on dental caries among children of both sexes aged 5-11 years in Bangalore North, Karnataka, India.


  Materials and methods Top


Ethical aspects

The study was approved by the ethical committee of Krishnadevaraya College of Dental Sciences and Hospital, Bangalore, Karnataka. Along with the questionnaire, an informed consent form was handed out to the school authorities so as to obtain the parents' permission.

Study design

A cross-sectional study was conducted in four government schools from Bangalore North. Prior permission was obtained from the school authorities to conduct the study.

Sample

Six hundred and twenty school-going children of both genders from four different schools of Bangalore North in the age group of 5-11 years were chosen for the present study. A random sampling method was followed in each designated school by the concerned teacher.

Questionnaire

A specially designed questionnaire was used in the present study that had a set of seven questions. The questions ranged from general questions on demographic information, the school attended, basic information regarding father's name and occupation to specific questions related to intake and frequency of sweets/sugar consumption and also the regularity of tooth brushing.

The questionnaire included the following:

  • Type of sugar consumed: Children consume different types of sugary products like snacks (cookies, candies, chocolate), fruit juice, or other sugar-containing drinks. The different forms are classified as candy (hard sugar), ice cream (soft sugar), and sugar drinks (liquid sugar), or others if it does not belong to any of the above-mentioned categories.
  • Frequency of eating sweets: A question was included in our study where each child was asked individually about the frequency of eating sweets. The explanations given by the child were recorded as low (once daily), medium (2-3 times a day), and high (more than 4 times daily).
  • The child was questioned regarding the brushing practices and the child's views were recorded.


All the information was collected in a questionnaire from the children who participated in the study. [7]

Examination

All the subjects were clinically examined by one trained dentist under field conditions that included gloves, disposable mirrors, and probes for every child. The study was performed under natural light and the examination of caries was carried out in a systematic fashion using Federation Dentaire Internationale FDI tooth numbering system. Caries experience was assessed using the DMFT/dmft index according to the World Health Organization (WHO) caries diagnostic criteria. A tooth was diagnosed as "sound" if there was no evidence of treated caries (filling) or untreated caries (decay), white chalky spots (incipient enamel lesion), staining, calculus or rough spots, a deep pit or fissure (stained or unstained) that was caught on the probe but had no detectable softened dentin floor, undermined enamel or softened walls, fluorosis, or any questionable lesion which could not reliably be diagnosed as caries. [8]

Confidentiality was maintained throughout the study and the collected data were subjected to statistical analysis.


  Results Top


Descriptive and inferential statistical analyses were carried out in the present study. Results on continuous measurements are presented as Mean ± SD (Min. - Max.) and results on categorical measurements are presented as number (%). Significance was assessed at 5% level of significance.

Analysis of variance (ANOVA) was used to find the significance of study parameters between three or more groups of patients. Student's t-test (two-tailed, independent) was used to find the significance of study parameters on a continuous scale between the two groups (inter-group analysis of the metric parameters).

The sample examined in this study was consisted of school children of Bangalore North, aged 5-11 years.

Among the 620 children surveyed, 190 (100 females and 90 males) belonged to the age group 5-7 years, 193 (101 females and 92 males) were of the age group 8-9 years, and 237(132 females and 105 males) belonged to the age group 10-11 years. [Table 1] 53.7% of the children were females and 46.3% were males. [Figure 1] shows a graphic representation of the gender distribution among the population studied.
Figure 1: Graph of gender distribution

Click here to view
Table 1: Gender distribution of patients studied

Click here to view


Of the 620 children surveyed, 4.4% did not eat sweets and the remaining 95.6% children consumed sweets in different forms [Table 2].
Table 2: Eating sweets

Click here to view


[Figure 2] shows a graphic representation of the percentage of subjects that ate sweets in different age groups.
Figure 2: Graph of eating sweets

Click here to view


Out of the 593 children who ate sweets in different forms, a total of 340 children (54.8%) ate candies, 158 (25.5%) had ice cream, and 80 children (12.9%) had cold drink. [Table 3] The remaining small percentage of children (2.4%) ate sugar in some other form.
Table 3: Type of sweets

Click here to view


[Figure 3] shows a graphic representation of the percentage of different types of sugar consumed by the students.49.7% of the children showed low sugar intake (i.e. eating sugar once daily), 32.7% had medium intake of sugar (i.e. 2-3 times daily), and 13.2% had high sugar intake (i.e. consumed sugar more than 4 times daily) [Table 4].
Figure 3: Graph of types of sweets

Click here to view
Table 4: Frequency of sweet

Click here to view


[Figure 4] shows the frequency of sugar intake in different age groups.
Figure 4: Graph of frequency of eating sweets

Click here to view


All the children had brushing habit. 79.2% of them brushed only once daily and 20.8% brushed twice daily [Table 5].
Table 5: Brushing frequency

Click here to view


[Figure 5] shows the brushing frequency of children in different age groups.
Figure 5: Graph of brushing frequency

Click here to view


Out of the 620 children surveyed, 157 children (25.3%) had a dmft score of 0, 235 (37.9%) had a dmft score between 1 and 2, 161 (26%) had a score between 3 and 5, 57 (9.2%) had a score between 6 and 10, and only 6 of them (i.e. only 1%) had a dmft score more than 10 [Table 6].
Table 6: dmft distribution

Click here to view


[Figure 6] is the graphic representation of the dmft distribution in different age groups.
Figure 6: Graph of dmft distribution

Click here to view


Out of the 620 children surveyed, 525 (84.7%) had no caries, 78 (12.6%) had a DMFT score between 1 and 2, 16 (2.6%) had a score between 3 and 5, and none had a score above 5 [Table 7].
Table 7: DMFT distribution

Click here to view


[Figure 7] is the graphic representation of the DMFT distribution in different age groups.
Figure 7: Graph of DMFT distribution

Click here to view


[Table 8] shows a comparison between the mean dmft and DMFT in different age groups studied.The mean ± SD values of DMFT were 0.03 ± 0.16 (5-7 years), 0.25 ± 0.74 (8-9 years), and 0.47 ± 0.95 (10-11 years), while those of dmft were 3.12 ± 2.87 (5-7 years), 2.51 ± 2.26 (8-9 years), and 1.66 ± 1.96 (10-11 years), with a statistically significant difference (P < 0.001**). [Figure 8] shows that mean dmft were higher in the 5-7 age group while mean DMFT was higher for children belonging to 10-11 yrs.
Figure 8: Graph of comparison of dmft and DMFT

Click here to view
Table 8: Comparison of dmft and DMFT in age groups studied

Click here to view


[Table 9] shows an overall comparison of mean dmft and DMFT with respect to the type of sweets, frequency of sweets and brushing frequency.The mean ± SD values of dmft in children taking candies, cold drink, and ice cream were 3.03 ± 2.66, 1.25 ± 1.31, and 1.82 ± 2.05, respectively. ANOVA showed there was significant statistical difference between the mean ± SD values of dmft.
Table 9: Mean dmft and DMFT according to eating to sweet, type of sweet , frequency of sweet and Brushing frequency

Click here to view


The mean ± SD values of DMFT in children taking candies, cold drink, and ice cream were 0.33 ± 0.64, 0.089 ± 0.36, and 0.25 ± 0.69, respectively. ANOVA showed there was significant statistical difference between the mean of dmft.

The mean ± SD values of dmft in children with low, median, and high frequency of intake were 1.48 ± 1.43, 2.87 ± 2.19, and 4.91 ± 3.76, respectively; ANOVA showed there was significant difference between the mean values.

The mean ± SD values of DMFT in children with low, median, and high frequency of intake were 0.19 ± 0.58, 0.36 ± 0.88, and 0.40 ± 0.97, respectively; ANOVA showed there was significant difference between the mean values.

The mean ± SD value of dmft in children with tooth brushing once daily was 2.55 ± 2.51, while the that in children with tooth brushing twice daily was 1.67 ± 1.98; statistical analysis showed significant difference between tooth brushing and dental caries in primary teeth.

The mean ± SD value of DMFT in children with tooth brushing once daily was 0.28 ± 0.77, while that in children with tooth brushing twice daily was 0.21 ± 0.66; statistical analysis showed significant difference between tooth brushing and dental caries in primary teeth.

[Figure 9] shows the graphical representation of mean dmft according to the type of sugar consumed, frequency of sugar consumption and brushing frequency.
Figure 9: Graph of mean dmft according to eating habits

Click here to view


[Figure 10] shows the graphical representation of mean DMFT according to the type of sugar consumed, frequency of sugar consumption and brushing frequency.
Figure 10: Graph of mean DMFT according to eating habits

Click here to view



  Discussion Top


Caries prevalence varies from country to country and from region to region in the same country. Geographic variables like race, climate, diet, culture, and economic factors also affect the caries prevalence. In spite of these variations, an attempt has been made to compare the findings of the present study with the findings of other studies from within and outside the country. Voluminous literature exists on the status of dental caries in the Indian school children by different investigators (e.g. Vaish, [9] Nagaraja Rao, [10]

Mahesh Kumar et al., [11] Joshi, [12] Gauba et al.,[13] and Joshi et al. [14] )

The present study showed higher caries prevalence in primary teeth than in permanent teeth. This could be attributed to the fact that the permanent teeth have a lower susceptibility to dental caries. It may also be due to the lower calcium content and structural differences in primary teeth. [9] This result was in accordance with that of Joshi et al. [14] In permanent teeth, no child showed high severity of caries; majority of the children showed low severity. The findings of this study were similar to those reported by Villalobos-Rodelo et al., [15] Carlo Medina et al.[16] and Mello et al. [17]

Food habits play an important role in the causation of dental caries. The introduction of refined sugar (sucrose) into the modern diet has been associated with increased caries prevalence. Since the time of early Greek philosophers, diet has been suspected of influencing the etiology of caries. The direct relationship of frequency of intake of sweets and sticky snacks and the incidence of dental caries has been proved by Gustaffson (1954) in the Vipeholm study. [18] In the present study, an effort was made to find the relationship between the type of sugar consumed, the frequency of sugar consumed, and brushing habits, and hard candies was the sweet form consumed by majority of the children. The same findings were recorded by Yabao [19] and Hanan. [20] In this study, the mean values of DMFT and dmft in children taking hard candies were higher than in children taking soft drinks or ice cream. ANOVA showed significant difference between the mean values of DMFT with different sugar types, which means the risk of dental caries with hard candies is more than that with soft drinks or ice cream. Similar results were reported by Hanan. [20] But according to a study conducted by Yabao, [19] there was no significant difference between the mean values of DMFT and dmft with different sugar types.

In the present study, the mean values of DMFT and dmft increased with increasing frequency of sugar intake. ANOVA showed significant correlation between the mean of DMFT and frequency of sugar intake, which means that there was a significant association between sugar consumption and dental caries. This is in agreement with the reports of Riva et al., [21] who found a direct relationship between the frequency of sugar consumption and dental caries, Sahoo, [22] Cecile et al., [23] Sreebny, [24] and Hanan. [20] But the results differed from that of Yabao et al.[19] where they reported non-significant relationship between sugar intake and dental caries. McDonald and Weisenbach [25] found no significant relationship between sugar consumption and caries prevalence.

In the present study, children with tooth brushing practice had lower mean of DMFT and dmft than the children with no tooth brushing practice. So, teeth cleaning has a direct effect on dental caries. Other studies that recorded the same finding were those of Kusum [26] and Hang et al. [27]


  Conclusion Top


The results of this baseline study indicate that dental caries is a major public health problem and there is a lack of preventive and restorative dental care facilities as well as awareness in the population. Hard candies are more risky in causing dental caries than soft drinks or ice cream. A direct association was observed between the frequency of sugar consumption and dental caries. Tooth brushing practice minimizes the severity and prevalence of dental caries.

 
  References Top

1.Petersen PE. The world oral health report 2003: Continuous improvement of oral health in the 21 st Century - the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.  Back to cited text no. 1
[PUBMED]    
2.Adenubi JO. Extraction of deciduous teeth in preschool and school children in Lagos. Nigerian Med J 1974;4:251-5.  Back to cited text no. 2
    
3.Pfaffmann C. The pleasures of sensation. Psychol Rev 1960;67: 253-68.  Back to cited text no. 3
[PUBMED]    
4.Ismail AI, Tanzer JM, Dingle JL. Current Trends of sugar consumption in developing societies. Community Dent Oral Epidemiol 1997;25:438-43.  Back to cited text no. 4
    
5.Addo-Yobo C, Williams SA, Curzon ME. Oral hygiene practices, oral cleanliness and periodontal treatment needs in 12-year old urban and rural school children in Ghana. Community Dent Health 1991;8:155-62.  Back to cited text no. 5
    
6.Milen A, Hausen H, Heinonen OP, Paunio I. Caries in primary dentition related to age, sex, social status and, country of residence in Finland. Community Dent Oral Epidemiol 1981;9:83-6.  Back to cited text no. 6
[PUBMED]    
7.Zahara AM Jr, Fashihah MH, Nurul AY. Relationship between Frequency of Sugary Food and Drink Consumption with Occurrence of Dental Caries among Preschool Children in Titiwangsa, Kuala Lumpur. Malays J Nutr 2010;16:83-90.  Back to cited text no. 7
    
8.Andaleeb U, Afsheen U. Prevalence of caries among the primary school children of urban Peshawar. Journal of Khyber College of Dentistry (JKCD) 2011;2:1-6.  Back to cited text no. 8
    
9.Vaish RP. Prevalence of caries amongst school going tribal children in Ganjam District, Orissa. J Indian Dent Assoc 1982;54; 375-7.  Back to cited text no. 9
    
10.Nagaraja Rao G. Oral health status of certified school children of Mysore state - A report. J Indian Dent Assoc 1985;57:61-4.  Back to cited text no. 10
[PUBMED]    
11.Mahesh Kumar P, Joseph T, Verma RB, Jayanthi M. Oral health status of 5 years and 12 years school going children in Chennai city - An epidemiological study. J Indian Soc Pedod Prev Dent Mar 2005;23;17-22.  Back to cited text no. 11
    
12.Joshi N, Rajesh R, Sunitha M. Prevalence of Dental Caries among school children in Kulasekharam village. J Indian Soc Pedod Prev Dent 2005;23:138-40.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.Goyal A, Gauba K, Chawla HS, Kaur M, Kapur A. Epidemiology of dental caries in Chandigarh school children and trends over last 25 years. J Indian Soc Pedod Prev Dent 2007;25:115-8.  Back to cited text no. 13
[PUBMED]  Medknow Journal  
14.Joshi N, Sujan SG, Joshi K, Parekh H, Dave B. Prevalence, Severity and Related Factors of Dental Caries in School Going Children of Vadodara City - An Epidemiological Study. J Int Oral Health 2013;5:40-8.  Back to cited text no. 14
    
15.Villalobos-Rodelo JJ, Medina-Frechero N, Vallejos-Sanchez AA, Pontigo-Loyola AP, Espinoza-Beltran JL. Dental caries in schoolchildren aged 6-12 years in Navolato, Sinaloa, Mexico: Experience, prevalence, severity and treatment needs. Biomedica 2006;26:224-33.  Back to cited text no. 15
    
16.Downer MC. The 1993 national survey of children′s dental health. Br Dent J 1995;10:407-12.  Back to cited text no. 16
    
17.Gustafsson BE, Quensel CE, Lanke LS. The Vipeholm dental caries study; the effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontol Scand. 1954 Sep;11:232-64.  Back to cited text no. 17
    
18.Mello T, Antunes J, Waldman E, Ramos E, Relvas M, Barros H. Prevalence and severity of dental caries in schoolchildren of Porto, Portugal. Community Dent Health 2008;25:119-25.  Back to cited text no. 18
    
19.Yabao RN, Duante CA, Velandria FV, Lucas A. Prevalence of dental caries and sugar consumption among 6-12 years old schoolchildren in Benguet, Philippines. Eur J Clin Nutr 2005;59:1429-38.  Back to cited text no. 19
    
20.Abaas HF. Prevalence of dental caries and the effect of sugar′s types, frequency of sugar intake and tooth brushing practice on dental caries among children aged 7-9 years in Wassit governorate-Iraq. J Bagh Coll Dent 2011;23(special issue).  Back to cited text no. 20
    
21.Riva TD, Corvan L. Sugars and dental caries. Am J Clin Nutr 2003;78:881-92.  Back to cited text no. 21
    
22.Sahoo PK, Tewari A, Chawla HS, Sachdev V. Interrelationship between sugar and dental caries - a study of child in child population of Orissa. J Indian Soc Pedod Prev Dent 1996;14: 37-44.  Back to cited text no. 22
    
23.Rodrigues CS, Watt RG, Sheiham A. Effects of dietary guidelines on sugar intake and dental caries in 3-year-old attending nurseries in Brazil. Health Promot Int 1999;14:329-30.  Back to cited text no. 23
    
24.Sreebny LM. Sugar availability, sugar consumption and dental caries. Community Dent Oral Epidemiol 2006;10:1-7.  Back to cited text no. 24
    
25.Weisenbach M, Chau N, Benamghar L, Lion C, Schwartz F, Vadot J. Oral health in adolescents from a small French town. Community Dent Oral Epidemiol 1995;23:147-54.  Back to cited text no. 25
    
26.Kusum P, Kannan AT, Sarna A, Aggarwal K. Prevalence of dental caries and associated teeth cleaning habits among children in four primary schools. Int J Epidemiol 1986;15:581-3.  Back to cited text no. 26
    
27.Liu HY, Huang ST, Hsuao SY, Chen CC, Hu WC, Yen YY. Dental caries associated with dietary and tooth brushing habits of 6-12 year old mentally retarded children in Taiwan. J Dent Sci 2009; 4:61-74.  Back to cited text no. 27
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]


This article has been cited by
1 Caries prevalence and associated risk factors in school children at Kannur in Kerala, India: A cross-sectional study
K Nithya,FaizalC Peedikayil,TP Chandru,Soni Kottayi,Shabnam Ismail,TP Aparna
Journal of Indian Association of Public Health Dentistry. 2021; 19(1): 32
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed3492    
    Printed66    
    Emailed0    
    PDF Downloaded453    
    Comments [Add]    
    Cited by others 1    

Recommend this journal