Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2006  |  Volume : 24  |  Issue : 3  |  Page : 146--151

Oral cleanliness of 12-13-year-old and 15-year-old school children of Sunsari District, Nepal


R Yee1, J David2, R Khadka3,  
1 Department of Health Service, Ministry of Health, His Majesty's Government, Nepal
2 Oral Health Researcher, Institute of Oral Sciences - Pedodontics and Centre of International Health, University of Bergen, Norway
3 Department of Oral and Maxillofacial Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

Correspondence Address:
J David
Institute of Oral Sciences - Pedodontics, Arstadveien 17, No - 5009, Bergen, Norway

Abstract

The aim of the study was to evaluate the oral cleanliness of school children in the District of Sunsari, Nepal. A multi-stage random sampling oral epidemiological survey was conducted in private and government, urban, rural town and rural village schools in 15 illakas of Sunsari District, Eastern Nepal. A total of 600, 12-13-year-old and 600 15-year-old school children were examined by trained examiners using the simplified oral hygiene index (OHI-S). The average age-group, debris and calculus index scores were combined to obtain the simplified oral hygiene index (OHI-S). The mean OHI-S scores were compared and evaluated using the parametric t-test for two independent samples. The mean OHI-S for urban 12-13-year-old school children was 0.98 compared to 1.34 for school children of rural towns and 1.44 for school children of rural villages and these differences in mean OHI-S were statistically significant ( P <0.005). In the 15-year-old age group, urban school children had a mean OHI-S score of 1.00 compared to 1.37 for rural towns and 1.43 for rural villages. The variance in the mean OHI-S scores were statistically significant ( P <0.005). The overall level of cleanliness in the school children surveyed was good. Children of urban schools had the lowest scores followed by school children from rural towns and then rural villages. When the mean OHI-S scores were compared with the DMFT scores, there was an inverse relationship between oral cleanliness and dental caries. Frequency of sugar consumption and the availability and affordability of fluoridated toothpaste may be important factors in the development of dental caries than oral cleanliness.



How to cite this article:
Yee R, David J, Khadka R. Oral cleanliness of 12-13-year-old and 15-year-old school children of Sunsari District, Nepal.J Indian Soc Pedod Prev Dent 2006;24:146-151


How to cite this URL:
Yee R, David J, Khadka R. Oral cleanliness of 12-13-year-old and 15-year-old school children of Sunsari District, Nepal. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2022 Oct 7 ];24:146-151
Available from: http://www.jisppd.com/text.asp?2006/24/3/146/27896


Full Text

 Introduction



Sunsari district in the Terai region of eastern Nepal has a total population of 6,28, 405 (males: 3,15, 819; females: 3,12, 586).[1] Life expectancy of this area averages 60.5 years, which is above the national average for Nepal. Adult literacy rate is 45.18% and the per capita income is 8,130 Nepali rupees.[2] The prominent castes in this district include Tharus, Muslims, Brahmin Pahadis, Chettris, Rais, Yadavs, Newars and Mushers.

An emerging health problem amongst the child population in Nepal is dental caries. A series of cross sectional surveys conducted on school children by the united mission to Nepal Oral Health Programme between the period of 1999 and 2000 in Central and Western Nepal show that the caries prevalence and mean dmft score of 5-6-year-olds (n=2, 177) was 67% and 3.2 while the caries prevalence and mean DMFT score of 12-13-year-olds (n=3, 323) was 41% and 1.1.[3] A recent district-wide survey of Sunsari reveals that the caries prevalence and mean DMFT score of 12-13-year-olds and 15-year-olds was 24% and 0.49; and 26% and 0.67, respectively.[4]

Very little information is available concerning the oral cleanliness of children and adults on a national and the district level. With the trend towards increasing prevalence and severity of dental caries[5] and a concern for the periodontal health of young adults, information concerning the oral hygiene status of young children would assist in the development of oral health policies, strategic plans, monitoring and surveillance systems for oral health.

The aim of the study was to gain information concerning the oral cleanliness of children as it is lacking at a district level throughout Nepal. Collection of such data in the district of Sunsari serves as a baseline to monitor the impact of oral health activities carried out by the College of Dental Surgery at the B. P. Koirala Institute of Health Sciences in Dharan, Sunsari. The aim of this study was to describe and analyze the level of debris and calculus in the permanent dentition of 12-13-year-old and 15-year-old school children in the District of Sunsari.

 Materials and Methods



Multi-stage random sampling method was used to select the subjects for the survey. The study population was selected from government schools and private (boarding) schools from each of the 15 illakas in Sunsari. The first stage units were all the government schools and private schools from each illaka. From the two separate lists, one government school and one private school were selected at random from each illaka. When private schools were not available in an illaka, private schools were randomly selected from another illaka. The second stage units were three separate lists of students of the age groups of interest from each of the selected government schools and a similar list compiled from each of the selected private schools. The required number of school children in each of the interested age groups were then selected at random by lottery system. For each of the government schools and private schools there were three separate draws, one for each age group.

The same subjects surveyed in a previously reported study[4] were examined for debris and calculus prior to examination for dental caries.

In that study the sample size for each age group was calculated using the following formula:

Sample size = p(1-p)/e 2

p = prevalence of disease in the population

e = required size of standard error = 0.02

Calculation of the sample size for the 12-13-year-old population was based on the average prevalence of dental caries in the respective populations found in recent surveys conducted by the UMN Oral Health Programme[3] and by Petersen, Mohr and Geddes.[6] Sample size for the 15-year-old population was based on the average prevalence of disease in the 12-13-year-old population. It was assumed that the prevalence of dental caries in the 15-year-old population would be similar to that in the 12-13-year-old population. Prevalence (p) used for the calculation of sample size for the both 12-13-year-olds and 15-year-olds was 40%. Calculated sample size for each of the two age groups was 600. From each of the 15 government schools and each of the 15 boarding schools, 20 children from each of the three age groups were randomly selected.

Dental examinations were carried out by two dentists (JD and RK) from the College of Dentistry, B. P. Koirala Institute of Health Sciences. Children between the age of 12-13 years and at 15 years were examined in school during class hours in an orderly fashion. Students were positioned supine on a bench or table and were examined by the gloved and masked dental examiners using torchlight. All instruments were brought back to the dental college, washed and sterilized in an autoclave. A trained assistant recorded the data on a standardized form.

Training of the dentists using school children was accomplished over a two-day period in the B. P. Koirala Institute of Health Sciences prior to the survey. The examiners were trained to use the criteria for debris and calculus outlined in the Simplified Oral Hygiene Index (OHI-S).[7] Oral debris and calculus was estimated by running the side of an explorer along the tooth surfaces examined. The surfaces and teeth examined were the buccal aspects of the upper first molars (16, 26), the lingual aspects of the lower first molars (36, 46) and the labial aspects of the upper right (11) and lower left (31) incisors. Procedure for quick selection and screening of the study subjects for entry into the study was also conducted. Inter-examiner and intra-examiner calibration was not feasible for the OHI-S Index. The survey was completed over six months (April-September, 2001). Consent for the survey was gained through the District education officer of Sunsari and the individual head masters of the selected schools.

Data entry and data analysis was performed with SPSS version 10.0. Plaque and calculus are graded on a numeric scale from 0 to 3, depending on the severity and extent of the deposits. The debris scores are totaled and divided by the number of surfaces scored for each individual, which provided the debris index. The same methods were used to obtain the calculus index. The average age-group debris and calculus index scores were combined to obtain the simplified oral hygiene index (OHI-S). The OHI-S values range from 0 to 6 and the scores are categorized as follows:

Good: score 0.0 to 1.2

Fair: score 1.3 to 3.0

Poor: score 3.1 to 6.0

The mean OHI-S scores were compared and evaluated using the parametric t-test for two independent samples with the level of statistical significance set at P P P P P 36>26>16) followed by the incisor index teeth (31>11). This may be a reflection of the greater difficulty in cleaning the surfaces of posterior teeth relative to the anterior teeth. A toothbrush with a smaller head would aid in gaining access to the lingual surfaces of the lower molars and the buccal surfaces of the upper molars for the removal of plaque.

The overall OHI-S score for both 12-13-year-olds (1.21) and 15-year-olds (1.22) in the District of Sunsari were almost identical and are indicative of good oral hygiene. However, a close examination of the OHI-S scores based on the type of school attended by the children shows statistically significant differences in mean OHI-S scores for both age groups ( P P P P reported on evidence-based treatment for dental caries in 1994 and concluded that brushing without fluoridated toothpaste to remove plaque was not cariostatic but brushing was essential for the application of fluoridated toothpaste and the prevention of gingivitis. In a systematic review and up-date of the effectiveness of mechanic oral hygiene practices, Brothwell et al[16] reported that there was good evidence to recommend tooth brushing twice daily with a fluoride toothpaste in the prevention and control of gingivitis and dental caries. The fluoride in toothpaste contributed largely to caries reduction. There is also evidence to show that brushing with non-fluoridated toothpaste is ineffective in reducing dental caries.[13],[17] Controlling the frequency and amount of sugar consumed as well as fluoridation of the teeth are more important preventive measures than mere mechanical plaque control. Oral health education should emphasize brushing twice a day with fluoridated toothpaste and reducing the frequency of consumption of sugar between meals. The following conclusions can be drawn from this evaluation of oral cleanliness in 12-13-year-old and 15-year-old school children in the District of Sunsari:

Overall, the oral hygiene of these two age groups is good.15-year-old females have significantly better OHI-S scores than their male counterparts.School children attending private schools have significantly better OHI-S scores than children attending government schools.Urban school children have significantly better OHI-S scores than rural school children of the same age.The differences in OHI-S of children attending private schools versus government schools may be due to socio-economic status.The variation in the OHI-S scores of urban and rural children may also be related to socio-economic status or the availability and affordability of toothbrushes.

When data from this study is analyzed in light of the data concerning prevalence and experience of dental caries in the same subjects in the District of Sunsari[4] the following conclusions and recommendations can be made:

Urban school children, 12-13-years and 15-years, have better oral cleanliness but experience more dental caries than rural school children.15-year-old female school children have significantly cleaner teeth than males of the same age, but they also experience more decay.Even though 12-13-year-old and 15-year-old school children of private (boarding) schools have significantly better oral hygiene than their counterparts attending government schools, they experience relatively more decay.

 Acknowledgement



Our sincere thanks to the office of the World Health Organization, Nepal for funding the study

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