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1.  Are immigrant populations aware about their oral health status? A study among immigrants from Ethiopia 
BMC Public Health  2009;9:205.
Background
Evidence from Western countries indicates that there are fundamental discrepancies between self-perceived illness of immigrants and the provision of health care, according to the Western bio-medical health service model. These need to be understood in the planning and implementation stages of public health care programs for new immigrants. The objectives of the present study were to investigate self-perceived versus clinically diagnosed dental and periodontal health status among immigrants from Ethiopia.
Methods
During 2004–2005, dental and periodontal health status was recorded among 340 Ethiopian immigrants, utilizing the DMFT and CPI indices. Additionally, participants were interviewed using a questionnaire which included perceived dental and periodontal health status. Sensitivity and specificity levels of this perception were calculated and compared with the published scientific literature.
Results
Regarding dental caries, according to the three operational cut-off points, sensitivity ranged from 70% to 81%, and specificity ranged from 56% to 67%. Regarding periodontal status, 75% of the subjects clinically diagnosed with periodontal pockets self-perceived a "bad" health status of gums (sensitivity) and 54% of the subjects diagnosed without periodontal pockets, reported a "good" health status of gums (specificity). These indications of perception levels were higher than a previous study conducted among native born Israelis.
Conclusion
Minority ethnic groups should not be prejudicially regarded as less knowledgeable. This is illustrated by the unexpected high level of oral health status perception in the present population. Oral health promotion initiatives among immigrants should be based upon optimal descriptive data in order to accomplish the inherent social commitment to these diverse populations.
doi:10.1186/1471-2458-9-205
PMCID: PMC2709622  PMID: 19558650
2.  Oral Health Status of a Sample of Prisoners in Enugu: A Disadvantaged Population 
Background:
The aim of this study is to determine the oral health status of a sample of prisoners at the Federal Prison in Enugu. The health status of inmates in the prison system needs to be incorporated into data and reports that summarize the state of the nation's health; this will encourage the provision of health care to prisoners and foster development of the nation's health.
Subjects and Methods:
The study involved 230 inmates of the Federal Prison in Enugu. An interviewer-administered questionnaire was used to gather data on the demographic characteristics of the participants, social habits, methods and frequency of cleaning the mouth. Intraoral examination was carried out to determine caries and periodontal statuses employing decayed missing and filled teeth (DMFT) index and community periodontal index of treatment needs respectively. The proportions of participants with other soft and hard tissue conditions were also recorded. Frequency distribution tables with mean values were generated for categorical variables and non-parametric test was used to relate DMFT values with frequency of cleaning the mouth.
Results:
Among the participants, 67.0% (154/230) had decayed teeth or tooth missing due to caries. None of the decayed teeth was restored yielding a 0.0% (0/230) index of restorative provision. Spearman correlation (rho) between ranks of DMFT and frequency of cleaning the mouth was -0.32 (95%CI=-0.43 to -0.19). 5.2% (12/230) participants had community periodontal index (CPI) score of 0 and 94.8% (218/230) had CPI of 1, 2, 3 or 4. Also, 56.1% (129/230) had extrinsic stains on their teeth and 17.3% (40/230) presented with fractured teeth.
Conclusion:
More than half of the participants were affected by dental caries and periodontal health was compromised in the majority of them. Measures to improve their oral health and the establishment of dental health-care facility in the institution are strongly encouraged.
doi:10.4103/2141-9248.139365
PMCID: PMC4160699  PMID: 25221723
Dental needs; Periodontal status; Prisoners
3.  Dental and periodontal status of 12-year-old Bulang children in China 
BMC Oral Health  2014;14:32.
Background
Bulang is an ethnic minority group living in Yunnan in the southwestern part of China. There is little information pertaining to the oral health of Bulang children. This study aims to examine the dental caries and periodontal status of 12-year-old Bulang children in China and the factors affecting their oral-health status.
Methods
12-year-old Bulang school children in Yunnan, China, were recruited through a multi-stage cluster sampling method. Following the recommendation of the World Health Organization, caries experiences were recorded using the DMFT index and periodontal status with the CPI index. A self-completed questionnaire was used to collect information on the background and oral health-related behaviours of the children.
Results
A total of 900 children in primary schools were invited, and 873 (97%) joined the survey. Their caries prevalence was 35%. Their caries experience in mean DMFT (±SD) score was 0.6 ± 1.1, and 94% of the carious teeth had no treatment. Most children (71%) had bleeding gums, and 58% of them had calculus. Girls and those who had visited a dentist in the previous year had higher caries risk.
Conclusions
Dental caries was common among the 12-year-old Bulang children in China. Most of the carious teeth were left untreated. Caries prevalence was associated with gender and dental attendance. Their periodontal condition was poor, and more than half of them had calculus.
doi:10.1186/1472-6831-14-32
PMCID: PMC3978202  PMID: 24708768
Caries; Children; Ethnic; Minority; China
4.  A survey of oral health in a Sudanese population 
BMC Oral Health  2012;12:5.
Background
We aimed to assess the oral health status and risk factors for dental caries and periodontal disease among Sudanese adults resident in Khartoum State. To date, this information was not available to health policy planners in Sudan.
Methods
A descriptive population-based survey of Sudanese adults aged ≥ 16 years was conducted. After stratified sampling, 1,888 adult patients from public dental hospitals and dental health centres scattered across Khartoum State, including different ethnic groups present in Sudan, were examined in 2009-10. Data were collected using patient interviews and clinical examinations. Dental status was recorded using the DMFT index, community periodontal index (CPI), and a validated tooth wear index.
Results
Caries prevalence was high, with 87.7% of teeth examined having untreated decay. Periodontal disease increased in extent and severity with age. For 25.8% of adults, tooth wear was mild; 8.7% had moderate and 1% severe toothwear. Multivariate analysis revealed that decay was less prevalent in older age groups but more prevalent in southern tribes and frequent problem based attenders; western tribes and people with dry mouths who presented with less than18 sound, untreated natural teeth (SUNT). Older age groups were more likely to present with tooth wear; increasing age and gender were associated with having periodontal pocketing ≥ 4 mm.
Conclusions
The prevalence of untreated caries and periodontal disease was high in this population. There appear to be some barriers to restorative dental care, with frequent use of dental extractions to treat caries and limited use of restorative dentistry. Implementation of population-based strategies tailored to the circumstances of Sudanese population is important to improve oral health status in Sudan.
doi:10.1186/1472-6831-12-5
PMCID: PMC3311612  PMID: 22364514
5.  Oral Health Status of Patients with Mental Disorders in Southwest Ethiopia 
PLoS ONE  2012;7(6):e39142.
Background
Psychiatric disorders are known to be a risk factor for the development of different oral health problems especially for dental caries and periodontal diseases. In spite of this fact, no study has been conducted to reveal its magnitude in Ethiopia. Hence, this study was conducted to determine the oral health status of psychiatric patients at Jimma University Specialized Hospital (JUSH), Psychiatric Clinic.
Methods
A hospital based cross- sectional study was used from January to May 2011. A total of 240 participants were included in the study. Dental examination was done to measure indices of oral health: decayed, missing, and filled teeth (DMFT) index and community periodontal index (CPI). Oral examination was performed using mirror, probe and explorer by experienced dental doctors. A simple random sampling technique was implemented to collect data. ANOVA test, binary logistic and multinomial logistic regression analyses were done using SPSS 16.0 statistical software.
Results
The mean DMFT score among the psychiatric patients was 1.94±2.12 (mean±SD) with 1.28±1.69, 0.51±1.19 and 0.14±0.48 (mean±SD) for decayed, missed and filled teeth respectively. Only about 24% of the psychiatric patients had a healthy CPI score. Incorrect tooth brushing technique was significantly associated with a DMFT score greater than 2 (AOR = 3.58; 95% CI: 1.65, 7.79). The habit of sweet intake was also associated with dental caries (AOR = 2.91; 95% CI: 1.43, 5.95). Similarly, patients with a smoking habit also demonstrated statistically significant association with dental caries (AOR = 18.98; 95% CI: 5.06, 71.24).
Conclusion
The oral health status of the psychiatric patients was poor. Thus, health education about oral hygiene should be given for psychiatric patients so they can avoid the frequent intake of sweets, smoking and learn correct tooth brushing technique.
doi:10.1371/journal.pone.0039142
PMCID: PMC3377615  PMID: 22723950
6.  Risk indicators of oral health status among young adults aged 18 years analyzed by negative binomial regression 
BMC Oral Health  2013;13:40.
Background
Limited information on oral health status for young adults aged 18 year-olds is known, and no available data exists in Hong Kong. The aims of this study were to investigate the oral health status and its risk indicators among young adults in Hong Kong using negative binomial regression.
Methods
A survey was conducted in a representative sample of Hong Kong young adults aged 18 years. Clinical examinations were taken to assess oral health status using DMFT index and Community Periodontal Index (CPI) according to WHO criteria. Negative binomial regressions for DMFT score and the number of sextants with healthy gums were performed to identify the risk indicators of oral health status.
Results
A total of 324 young adults were examined. Prevalence of dental caries experience among the subjects was 59% and the overall mean DMFT score was 1.4. Most subjects (95%) had a score of 2 as their highest CPI score. Negative binomial regression analyses revealed that subjects who had a dental visit within 3 years had significantly higher DMFT scores (IRR = 1.68, p < 0.001). Subjects who brushed their teeth more frequently (IRR = 1.93, p < 0.001) and those with better dental knowledge (IRR = 1.09, p = 0.002) had significantly more sextants with healthy gums.
Conclusions
Dental caries experience of the young adults aged 18 years in Hong Kong was not high but their periodontal condition was unsatisfactory. Their oral health status was related to their dental visit behavior, oral hygiene habit, and oral health knowledge.
doi:10.1186/1472-6831-13-40
PMCID: PMC3765426  PMID: 23957895
Dental caries; Periodontal disease; Negative binomial regression
7.  Dentofacial and Cranial Changes in Down Syndrome 
Objectives
This study aimed to determine the prevalence of certain oral characteristics usually associated with Down syndrome and to determine the oral health status of these patients.
Methods
The cross-sectional study was conducted among patients attending a special education program at Faculty of Dentistry, Jamia Millia Islamia, Delhi, India. The study design consisted of closed-ended questions on demographic characteristics (age, sex, and education and income of parents), dietary habits, and oral hygiene habits. Clinical examination included assessment of oral hygiene according to Simplified Oral Hygiene Index (OHI-S), dental caries according to decayed, missing, and filled teeth (DMFT) index, periodontal status according to the Community Periodontal Index of Treatment Needs (CPITN), and malocclusion according to Angles classification of malocclusion. Examinations were carried out using a using a CPI probe and a mouth mirror in accordance with World Health Organization criteria and methods. Craniometric measurements, including maximum head length and head breadth were measured for each participant using Martin spreading calipers centered on standard anthropological methods.
Results
The majority of the patients were males (n = 63; 82%) with age ranging from 6–40 years. The Intelligence Quotient (IQ) score of the patients indicated that 31% had moderate mental disability and 52% had mild mental disability. 22% exhibited hearing and speech problems.12% had missing teeth and 15% had retained deciduous teeth in adult population. The overall prevalence of dental caries in the study population was 78%. DMFT, CPITN and OHI scores of the study group were 3.8 ± 2.52, 2.10 ± 1.14 and 1.92 ± 0.63 respectively. The vast majority of patients required treatment (90%), primarily of scaling, root planing, and oral hygiene education. 16% of patients reported CPITN scores of 4 (deep pockets) requiring complex periodontal care. The prevalence of malocclusion was 97% predominantly of Class III malocclusions. Further 14% presented with fractured anterior teeth primarily central incisor. The percentage means of cephalic index was 84.6% in the study population. The brachycephalic and hyperbrachycephalic type of head shape was dominant in the Down syndrome individuals (90%).
Conclusion
The most common dentofacial anomaly seen in these individuals was fissured tongue followed by macroglossia.
doi:10.1016/j.phrp.2014.09.004
PMCID: PMC4281609  PMID: 25562042
down syndrome; oral Hygiene Index; dentofacial anomaly; macroglossia
8.  The association between dental and periodontal diseases and sickle cell disease. A pilot case-control study 
The Saudi Dental Journal  2014;27(1):40-43.
Objective
This is a pilot case-control study conducted to investigate the prevalence of dental caries and periodontal disease and examine the possible association between oral health deterioration and SCD severity in a sample of Saudi SCD patients residing in the city of Al-Qatif, Eastern Province, Saudi Arabia.
Materials and methods
Dental examination to determine the Decayed, Missing and Filled Teeth index (DMFT), Community Periodontal Index (CPI), and plaque index system were recorded for 33 SCD patients and 33 age and sex-matched controls in the Al-Qatif Central Hospital, Qatif, Saudi Arabia. Self-administered surveys used to assess socio-economic status; oral health behaviors for both SCD patients and controls were recorded. In addition, the disease severity index was established for all patients with SCD. SPSS data analysis software package version 18.0 was used for statistical analysis. Numerical variables were described as mean with a standard deviation.
Results
Decayed teeth were significantly more in individuals with ages ranging from 18 to 38 years with SCD compared to the control group (p = 0.036) due to oral hygiene negligence. The mean number of filled teeth was significantly lower in individuals with SCD when compared to the control group (p = 0.015) due to the lack of appropriate and timely treatment reflected in the survey responses of SCD patients as 15.2% only taking oral care during hospitalization. There were differences between the cases and controls in the known caries risk factors such as income level, flossing, and brushing habit. The DMFT, CPI, and plaque index systems did not differ significantly between the SCD patients and the control group.
Conclusion
Data suggest that patients with SCD have increased susceptibility to dental caries, with a higher prevalence of tooth decay and lower prevalence of filled teeth. Known caries risk factors influenced oral health more markedly than did factors related to SCD.
doi:10.1016/j.sdentj.2014.08.003
PMCID: PMC4273253  PMID: 25544813
Sickle cell disease; Dental caries; Periodontal
9.  Oral health status and behaviours of preschool children in Hong Kong 
BMC Public Health  2012;12:767.
Background
Dental caries is a major public health problem in many countries. Since the last territority-wide dental survey of Hong Kong preschool children was conducted in 2001, a survey to update the information is necessary. This study aimed to describe the dental caries experience of preschool children in Hong Kong and factors affecting their dental caries status.
Methods
A stratified random sample of children from seven kindergartens in Hong Kong was surveyed in 2009. Ethical approval from IRB and parental consent was obtained. Clinical examinations of the children were performed by two calibrated examiners using disposable dental mirrors, an intra-oral LED light and ball-ended periodontal probes. A questionnaire to investigate possible explanatory factors for caries status was completed by the children’s parents. Caries experience was recorded using the dmft index. Multifactor-ANOVA was used to study the relationship between dental caries experience, and the background and oral health-related behaviours of the children.
Results
Seven hundred children (53% boys), mean age 5.3 ± 0.7 years were examined. The mean dmft score of the surveyed children was 2.2 and 51% of them had no caries experience (dmft = 0). Most (>95%) of the decayed teeth were untreated. Statistically significant correlations were found between dental caries experience of the children and their oral health-related habits, family income, parental education level and parental dental knowledge.
Conclusions
Early childhood dental caries was prevalent among the preschool children in Hong Kong. Their caries experience was associated with their oral health-related behaviours, socio-economic background, and parental education and dental knowledge.
doi:10.1186/1471-2458-12-767
PMCID: PMC3490858  PMID: 22966820
Dental caries; Oral hygiene; Oral health; Toothbrushing; Preschool children; Hong Kong; China
10.  Dental Caries and Periodontal Disease in Brazilian Children and Adolescents with Cerebral Palsy 
The aim of the present study was determine the prevalence and factors associated with dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy (CP). This is a cross-sectional study conducted with 80 patients ranging in age from 2 to 18 years old. Oral exams were conducted by an examiner with records of DMFT, dmft, Gingival Bleeding Index (GBI) and Community Periodontal Index (CPI). The statistical analysis used Poisson Regression with robust variance estimation (α = 0.05). The prevalence of dental caries was 59.3%, with DMFT and mean dmft of 1.71 ± 2.42 and 2.22 ± 3.23, respectively. The mean GBI was 22.44%, and in the CPI, the prevalence of gingival bleeding, calculus, shallow and deep pockets were 94.73%, 79.62%, 12.90% and 3.22%, respectively. The caregiver’s educational level of less than eight years were associated with the dental caries experience (PR = 1.439; 95%CI = 1.09–1.89). The periodontal alterations were associated with female sex (PR = 0.82; 95%CI = 0.69–0.97), caregiver’s educational level of less than eight years (PR = 1.15; 95%CI = 1.03–1.29), poor oral perception (PR = 0.89; 95%CI = 0.80–0.98), serious communication problem (PR = 0.87; 95%CI = 0.76–0.99) and athetoid type of CP (PR = 0.85; 95%CI = 0.75–0.97). The patients with CP presented high dental caries experience and periodontal alterations, which were associated with their demographic, socioeconomic, oral health perception and systemic information.
doi:10.3390/ijerph120100335
PMCID: PMC4306865  PMID: 25551517
dental caries; periodontal index; cerebral palsy; epidemiology
11.  Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis 
BMC Public Health  2012;12:773.
Background
Oral health is an important component of general well-being for the elderly. Oral health-related problems include loss of teeth, nonfunctional removable dental prostheses, lesions of the oral mucosa, periodontitis, and root caries. They affect food selection, speaking ability, mastication, social relations, and quality of life. Frailty is a geriatric syndrome that confers vulnerability to negative health-related outcomes. The association between oral health and frailty has not been explored thoroughly. This study sought to identify associations between the presence of some oral health conditions, and frailty status among Mexican community-dwelling elderly.
Methods
Analysis of baseline data of the Mexican Study of Nutritional and Psychosocial Markers of Frailty, a cohort study carried out in a representative sample of people aged 70 and older residing in one district of Mexico City. Frailty was defined as the presence of three or more of the following five components: weight loss, exhaustion, slowness, weakness, and low physical activity. Oral health variables included self-perception of oral health compared with others of the same age; utilization of dental services during the last year, number of teeth, dental condition (edentate, partially edentate, or completely dentate), utilization and functionality of removable partial or complete dentures, severe periodontitis, self-reported chewing problems and xerostomia. Covariates included were gender, age, years of education, cognitive performance, smoking status, recent falls, hospitalization, number of drugs, and comorbidity. The association between frailty and dental variables was determined performing a multivariate logistic regression analysis. Final models were adjusted by socio-demographic and health factors
Results
Of the 838 participants examined, 699 had the information needed to establish the criteria for diagnosis of frailty. Those who had a higher probability of being frail included women (OR = 1.9), those who reported myocardial infarction (OR = 3.8), urinary incontinence (OR = 2.7), those who rated their oral health worse than others (OR = 3.2), and those who did not use dental services (OR = 2.1). For each additional year of age and each additional drug consumed, the probability of being frail increased 10% and 30%, respectively.
Conclusions
Utilization of dental services and self-perception of oral health were associated with a higher probability of being frail.
doi:10.1186/1471-2458-12-773
PMCID: PMC3490998  PMID: 22971075
Elderly; Oral health; Frailty syndrome; Utilization of dental services
12.  Effect of end-stage renal disease on oral health in patients undergoing renal dialysis: A cross-sectional study 
Aims and Objectives:
To evaluate the effect of chronic renal failure on oral health in renal dialysis patients. To assess and improvise awareness of staff regarding oral health care of the patients in hemodialysis unit.
Materials and Methods:
A cross-sectional questionnaire survey and oral health examination study were conducted on 206 end-stage chronic renal failure patients (stage V) who were undergoing renal dialysis in Guntur city. The study included the questionnaire form and modified WHO proforma to record their oral health status. Oral examination was done in American Dental Association (ADA) type III method by using mouth mirror and community periodontal index (CPI) probe. Questionnaire survey was conducted among the nursing staff in the hemodialysis unit.
Results:
Mean age of the study subjects was 46.79 ± 12.78 years; 81.1% were males and 18.9% were females. Candidiasis (8.3%) was the most frequently seen oral mucosal condition in these subjects. Majority of the subjects (44.2%) showed periodontal diseases (CPI score 3: Pocket depth of 4-5 mm). Caries prevalence of 56.3% was seen in this study group. Higher incidence of hepatitis C was significantly associated with higher duration of dialysis. There was very little awareness among the nursing staff regarding dental care.
Conclusion:
There is greater deterioration of periodontal health among dialysis patients with chronic renal disease. Awareness regarding dental care is very less among patients undergoing renal dialysis. These patients should be monitored carefully to maintain their oral health. Awareness must be increased among dialysis patients and nursing staff about the need for primary prevention of dental diseases.
doi:10.4103/2231-0762.142006
PMCID: PMC4209615  PMID: 25374834
Chronic renal failure; oral health status; oral hygiene habits; renal dialysis patients
13.  Immigrant-native differences in caries-related knowledge, attitude, and oral health behaviors: a cross-sectional study in Taiwan 
BMC Oral Health  2014;14:3.
Background
With the growing number of transnational marriages in Taiwan, oral health disparities have become a public health issue. This study assessed immigrant-native differences in oral health behaviors of urban mothers and their children.
Methods
We used the baseline data of an oral health promotion program to examine the immigrant-native differences in caries-related knowledge, attitude, and oral health behaviors. A cross-sectional study was conducted to collect data from mothers in urban area, Taiwan. A total of 150 immigrant and 440 native mothers completed the self-report questionnaires. Logistic regression models analyzed the racial differences in oral health behaviors.
Results
Approximately 37% of immigrant mothers used dental floss, 25% used fluoride toothpaste, and only 13.5% of them regularly visited a dentist. Less that 40% of immigrant mothers brush their children’s teeth before aged one year, 45% replaced child’s toothbrush within 3 months, and only half of the mothers regularly took their child to the dentist. Immigrant mothers had lower level of caries-related knowledge and attitudes than native mothers (p < .001). Compared to native group, the immigrant mothers were less likely to use of dental floss ([Adjusted odds ratio (aOR) =0.35], fluoride toothpaste (aOR = 0.29), visit a dentist in the past 2 years (aOR = 0.26), and take their children to regular dental check-up (aOR = 0.38); whereas, they were more likely to not consume sweeten beverages (aOR = 3.13).
Conclusions
The level of caries-related knowledge, attitudes and oral health behaviors were found lower in immigrant mothers than native ones. The findings suggested cross-cultural caries prevention programs aimed at reducing immigrant-native disparities in child oral health care must be developed for these immigrant minorities.
doi:10.1186/1472-6831-14-3
PMCID: PMC3898042  PMID: 24423385
Attitudes; Behavior; Dental caries; Immigrants; Health care
14.  Dental caries prevalence, oral health knowledge and practice among indigenous Chepang school children of Nepal 
BMC Oral Health  2013;13:20.
Background
Chepang communities are one of the most deprived ethnic communities in Nepal. According to the National Pathfinder Survey, dental caries is a highly prevalent childhood disease in Nepal. There is no data concerning the prevalence of caries along with knowledge, attitude and oral hygiene practices among Chepang schoolchildren. The objectives of this study were to 1) record the prevalence of dental caries 2) report experience of dental pain 3) evaluate knowledge, attitude and preventive practices on oral health of primary Chepang schoolchildren.
Method
A cross sectional epidemiological study was conducted in 5 government Primary schools of remote Chandibhanjyang Village Development Committee (VDC) in Chitwan district. Ethical approval was taken from the Institutional Review Board within the Research Department of the Institute of Medicine (IOM) Tribhuvan University. Consent was obtained from parents for conducting clinical examination and administrating questionnaire. Permission was taken from the school principal in all schools. Data was collected using a pretested questionnaire on 131 schoolchildren aged 8-16-year- olds attending Grade 3–5. Clinical examination was conducted on 361 school children aged 5–16 –year-olds attending grade 1–5. Criteria set by the World Health Organization (1997) was used for caries diagnosis. The questionnaires, originally constructed in English and translated into Nepali were administered to the schoolchildren by the researchers. SPSS 11software was used for data analysis.
Results
Caries prevalence for 5–6 –year-old was above the goals recommended by WHO and Federation of Dentistry international (FDI) of less than 50% caries free children. Caries prevalence in 5-6-year-olds was 52% and 12-13-year-olds was 41%. The mean dmft/DMFT score of 5–6 –year-olds and 12 -13-year -olds was 1.59, 0.31 and 0.52, 0.84 respectively. The DMFT scores increased with age and the d/D component constituted almost the entire dmft/DMFT index. About 31% of 8-16-year-olds school children who participated in the survey reported having suffered from oral pain. Further, the need for treatment of decayed teeth was reported at 100%. About 76% children perceived teeth as an important component of general health and 75% reported it was required to eat. A total 93% children never visited a dentist or a health care service. Out of 56% children reporting cleaning their teeth daily, only 24% reported brushing their teeth twice daily. About 86% of the children reported using toothbrush and toothpaste to clean their teeth. Although 61% children reported to have received oral health education, 82% children did not know about fluoride and its benefit on dental health. About 50% children reported bacteria as the main cause of tooth decay and 23% as not brushing teeth for gingivitis. Frequency of sugar exposure was low; 75% of children reported eating sugar rich food once daily.
Conclusions
Caries prevalence of 5–6 –year- old Chepang school children is above the recommended target set by FDI/WHO. The study reported 31% schoolchildren aged 8-16-year old suffered oral pain and decayed component constituted almost the entire dmft/DMFT index. The brushing habit was reportedly low with only 24% of the children brushing twice daily. A nationwide scientifically proven, cost effective school based interventions is needed for prevention and control of caries in schoolchildren in Nepal.
doi:10.1186/1472-6831-13-20
PMCID: PMC3655880  PMID: 23672487
Dental caries; School children; Oral hygiene
15.  The Effect of Intensive Oral Hygiene Care on Gingivitis and Periodontal Destruction in Type 2 Diabetic Patients 
Yonsei Medical Journal  2009;50(4):529-536.
Purpose
This study aimed to investigate the effects of oral hygiene care by oral professionals on periodontal health in type 2 diabetes mellitus patients.
Materials and Methods
Diabetic participants were recruited at a university hospital and matched at a 1:1 ratio by age and gender, and randomly allocated into intervention (40 people) and control groups (35 people). Tooth brushing instruction, oral health education, and supra-gingival scaling were implemented in all patients at baseline. This program was repeatedly conducted in intervention patients every month for 6 months, and twice at baseline and the sixth month in the control. Oral health was measured by decayed, missing, and filled teeth (DMFT), plaque index, calculus index, bleeding index, patient hygiene performance (PHP) index, tooth mobility, Russel's periodontal index, and community periodontal index (CPI). Diabetes-related factors, oral and general health behaviors, and sociodemographic factors were interviewed as other confounding factors. An analysis of covariance (ANCOVA) was used with SPSS for Windows 14.0.
Results
At baseline, there were no significant differences between the two groups in average of periodontal health (calculus index, bleeding index, Russel's periodontal index, CPI, and tooth mobility), diabetes-related factors (fasting blood glucose, postprandial blood glucose, and HbA1c), and in distribution of sociodemographic factors and health behaviors. In intervention group, plaque index, dental calculus index, bleeding index, and PHP index were reduced fairly and steadily from the baseline. There were significant differences in plaque index, dental calculus index, bleeding index, PHP index, and Russel's periodontal index between the two groups at sixth month after adjusted for baseline status.
Conclusion
Intensive oral hygiene care can persistently improve oral inflammation status and could slow periodontal deterioration.
doi:10.3349/ymj.2009.50.4.529
PMCID: PMC2730616  PMID: 19718402
Dental prophylaxis; oral hygiene; periodontal diseases; type 2 diabetes mellitus
16.  Chair-Side Quantitative Oral-Microflora Screening for Assessing Familial Correlation of Periodontal Status and Caries Prevalence 
PLoS ONE  2014;9(1):e87100.
Aim: Our goal was to investigate the relationship between clinical status and the presence of carious or periodontal pathogens among parent-child familial pairs. Clinical practices of risk assessment with consideration of familial pathogen interaction might reduce the need for therapy, improve patient outcomes, and ultimately reduce oral disease burden. Materials and Methods: In this study, we enrolled 30 parent-child pairs, with the children exhibiting complete deciduous dentition or mixed dentition with only permanent first molars. Clinical statuses were evaluated using caries and periodontal disease indicators, including the sum of decay and the number of missing or filled teeth (DMFT) for adults, decay, extraction caused by dental disease, and filled teeth (deft), for children, probing depth, and plaque control record (PCR). Supra- and sub-gingival bacteria were determined based on semi-quantitative measurements of microbial infection by using data from the Dentocult® SM test (caries-related organisms) and the PerioCheck® test (periodontal disease-related organisms). Results: No statistically significant relationship was detected between the prevalence of periodontal pathogens and that of cariogenic pathogens in the oral cavity. However, the clinical status of caries (DMFT) was negatively correlated with the clinical status of periodontal disease (pocket depth) in parents who were infected with dominant periodontal pathogens (r = −0.59, p<0.01). Parents’ DMFT scores were positively correlated with children’s deft and PCR scores. PCR and deft scores of children appeared to decrease significantly with the parent’s pocket depth. Conclusion: The study showed that the quantity of caries pathogens were not significant related to periodontal pathogens, but the caries clinical outcome is negative related with periodontal clinical outcome between familial pairs.
doi:10.1371/journal.pone.0087100
PMCID: PMC3907388  PMID: 24498022
17.  Dental caries status of Bulang preschool children in Southwest China 
BMC Oral Health  2014;14:16.
Background
Bulang is one of the 55 ethnic minorities in China with a population of around 120,000. They live mainly in Yunnan, which is a less-developed province in southwestern China. Many Bulang people live in remote villages and have little access to dental care. They like hot and sour food and chew betel nut. This study examines the caries status of 5-year-old Bulang children and factors that influence their caries status.
Methods
A sample of 5-year-old Bulang children in Yunnan was selected using a multi-stage cluster sampling method. One trained dentist examined the children using dental mirrors with intra-oral LED light and CPI probes. Caries experience was measured according to the dmft index. Oral hygiene status was recorded according to the visible plaque index (VPI). A parental questionnaire was used to study the children’s oral health-related behaviours.
Results
A total of 775 children were invited and 723 joined the survey. The caries prevalence was 85%, and 38% of them had caries involved in pulp. The mean dmft and dt score were 5.8 ± 4.9 and 5.6 ± 4.8, respectively. Visible plaque was found on 636 children (88%). Multi-factor ANCOVA analysis found that higher dmft scores were found among the children who snacked on sweets daily, had visited a dentist within the last year and had higher VPI scores.
Conclusions
The caries prevalence and experience among 5-year-old Bulang children in Yunnan was high, and most of the caries were left untreated. The caries experience was associated with snacking habits, dental visit habits and oral hygiene.
doi:10.1186/1472-6831-14-16
PMCID: PMC3946148  PMID: 24593701
Caries; Children; Ethnic; Minority; China
18.  Assessment of dental caries predictors in 6-year-old school children - results from 5-year retrospective cohort study 
BMC Public Health  2012;12:989.
Background
This was a retrospective cohort study undertaken to assess the rate and pattern of dental caries development in 6-year-old school children followed-up for a period of 5 years, and to identify baseline risk factors that were associated with 5 years caries experience in Malaysian children.
Methods
This 5-years retrospective cohort study comprised primary school children initially aged 6 years in 2004. Caries experience of each child was recorded annually using World Health Organization criteria. The rates of dental caries were recorded in prevalence and incidence density of carious lesions from baseline to final examination. Risk assessment was done to assess relative risk for caries after 5 years in children with baseline caries status. Simple and multiple logistic regression analysis were performed to identify significant independent risk factors for caries.
Results
The sample consisted of 1830 school children. All components of DMFT showed significant differences between baseline and final examination. Filled teeth (FT) component of the DMFT showed the greatest increases. Results revealed the initial baseline caries level in permanent dentition was a strong predictor for future caries after 5 years (RR=3.78, 95% CI=3.48-4.10, P<0.001). Logistic regression analysis showed significant association between caries occurrence and residence (urban/rural) (OR=1.80, P<0.001). However, it was not significantly associated with gender and ethnicity. The incidence density of caries, affected persons (IDp) observed from baseline and after 5 years was 5.80 persons/100 person-year of observation. The rate of new caries-affected tooth (IDt) in the period from baseline and after 5-years was 0.76 teeth/100 teeth-year of observation.
Conclusion
The majority of 12-year-old school children (70%) were caries-free and most of the caries were concentrated in only a small proportion (30%) of them. We found that the presence of caries in permanent teeth at the age of 6 years was a strong predictor of future caries development in this population. The strong evidence of early permanent teeth caries at six years old to predict future caries incidence at 12-year-olds, which could be obtained at almost no cost, questions the need for and cost-effectiveness of expensive technology-based commercial caries predictions kits.
doi:10.1186/1471-2458-12-989
PMCID: PMC3524020  PMID: 23158416
19.  Discriminative ability of the generic and condition-specific Child-Oral Impacts on Daily Performances (Child-OIDP) by the Limpopo-Arusha School Health (LASH) Project: A cross-sectional study 
BMC Pediatrics  2011;11:45.
Background
Generic and condition-specific (CS) oral-health-related quality-of-life (OHRQoL) instruments assess the impacts of general oral conditions and specific oral diseases. Focusing schoolchildren from Arusha and Dar es Salaam, in Tanzania, this study compared the discriminative ability of the generic Child OIDP with respect to dental caries and periodontal problems across the study sites. Secondly, the discriminative ability of the generic-and the CS Child OIDP attributed to dental caries, periodontal problems and malocclusion was compared with respect to various oral conditions as part of a construct validation.
Methods
In Arusha, 1077 school children (mean age 14.9 years, range 12-17 years) and 1601 school children in Dar es Salaam (mean age 13.0 years, range 12-14 years) underwent oral clinical examinations and completed the Kiswahili version of the generic and CS Child-OIDP inventories. The discriminative ability was assessed as differences in overall mean and prevalence scores between groups, corresponding effect sizes and odd ratios, OR.
Results
The differences in the prevalence scores and the overall mean generic Child-OIDP scores were significant between the groups with (DMFT > 0) and without (DMFT = 0) caries experience and with (simplified oral hygiene index [OHI-S] > 1) and without periodontal problems (OHI-S ≤ 1) in Arusha and Dar es Salaam. In Dar es Salaam, differences in the generic and CS Child-OIDP scores were observed between the groups with and without dental caries, differences in the generic Child-OIDP scores were observed between the groups with and without periodontal problems, and differences in the CS Child-OIDP scores were observed between malocclusion groups. The adjusted OR for the association between dental caries and the CS Child-OIDP score attributed to dental caries was 5.4. The adjusted OR for the association between malocclusion and CS Child-OIDP attributed to malocclusion varied from 8.8 to 2.5.
Conclusion
The generic Child-OIDP discriminated equally well between children with and without dental caries and periodontal problems across socio-culturally different study sites. Compared with its generic form, the CS Child-OIDP discriminated most strongly between children with and without dental caries and malocclusion. The CS Child OIDP attributed to dental caries and malocclusion seems to be better suited to support clinical indicators when estimating oral health needs among school children in Tanzania.
doi:10.1186/1471-2431-11-45
PMCID: PMC3118891  PMID: 21615892
20.  Oral Microbiota of Children in a School-based Dental Clinic 
Anaerobe  2009;16(3):278-282.
Objectives
Dental caries disproportionately affects disadvantaged subjects. This study hypothesized that there were greater caries extent and higher levels of caries-associated and anaerobic subgingival bacterial species in oral samples of Hispanic and immigrant children compared with non-Hispanic and US born children.
Methods
Children from a school-based dental clinic serving a community with a large Hispanic component were examined, and the extent of caries was recorded. Microbial samples were taken from teeth and the tongues of children. Samples were analyzed using DNA probes to 18 oral bacterial species.
Results
Seventy five children were examined. Extent of caries increased with child age in immigrant, but not in US born or Hispanic children. There were no differences in the microbiota based on ethnicity or whether the child was born in US or not. There was a higher species detection frequency from teeth than tongue samples. Levels of Streptococcus mutans and other Streptococcus species increased with caries extent. Prevotella intermedia, Tannerella forsythia and Selenomonas species were detected at low levels in these children.
Conclusions
We conclude that, while there was a high rate of dental caries in disadvantaged school children, there were no differences in the caries-associated microbiota, including S. mutans, based on ethnicity or immigration status. Furthermore, while anaerobic subgingival, periodontal pathogens were also detected in children, there was no difference in species detection based on ethnicity or immigration status. Increased levels of streptococci, including S. mutans, however, were detected with high caries levels. This suggested that while it is beneficial to target preventive and treatment programs to disadvantaged populations, there is likely no additional benefit to focus on subgroups within a population already at high risk for dental disease.
doi:10.1016/j.anaerobe.2009.10.007
PMCID: PMC2881591  PMID: 19879369
Dental Caries; School Children; Hispanic; Streptococcus mutans; Prevotella intermedia
21.  Oral health and the impact of socio-behavioural factors in a cross sectional survey of 12-year old school children in Laos 
BMC Oral Health  2009;9:29.
Background
In recent decades low-income countries experienced an increasing trend in dental caries among children, particularly recorded in 12-year olds, which is the principal WHO indicator age group for children. This increases the risks of negative affects on children's life. Some data exist on the oral health status of children in low-income countries of Southeast Asia. However, information on how oral health is associated with socio-behavioural factors is almost not available. The aims of this study were to: assess the level of oral health of Lao 12-year-olds in urban and semi-urban settings; study the impact of poor oral health on quality of life; analyse the association between oral health and socio-behavioural factors; investigate the relation between obesity and oral health.
Methods
A cross sectional study of 12-year old schoolchildren chosen by multistage random sampling in Vientiane, Lao P.D.R (hereafter Laos). The final study population comprised 621 children. The study consisted of: clinical registration of caries and periodontal status, and scores for dental trauma according to WHO; structured questionnaire; measurement of anthropometric data. Frequency distributions for bi-variate analysis and logistic regression for multivariate analysis were used for assessment of statistical association between variables.
Results
Mean DMFT was 1.8 (SEM = 0.09) while caries prevalence was 56% (CI95 = 52-60). Prevalence of gingival bleeding was 99% (CI95 = 98-100) with 47% (CI95 = 45-49) of present teeth affected. Trauma was observed in 7% (CI95 = 5-9) of the children. High decay was seen in children with dental visits and frequent consumption of sweet drinks. Missed school classes, tooth ache and several impairments of daily life activities were associated with a high dD-component. No associations were found between Body Mass Index (BMI) and oral health or common risk factors. The multivariate analyses revealed high risk for caries for children with low or moderate attitude towards health, a history of dental visits and a preference for drinking sugary drinks during school hours. Low risk was found for children with good or average perception of own oral health. High risk for gingival bleeding was seen in semi-urban children and boys.
Conclusion
Although the caries level is low it causes considerable negative impact on daily life. School based health promotion should be implemented focussing on skills based learning and attitudes towards health.
doi:10.1186/1472-6831-9-29
PMCID: PMC2781791  PMID: 19917089
22.  Periodontal status and its risk factors among young adults of the Sebha city (Libya) 
Dental Research Journal  2013;10(4):533-538.
Background:
The occurrence of periodontal diseases in humans has been a global problem. Certain risk factors affect the initiation, progression, and severity of periodontitis. The present study has been designed to assess the periodontal status in relation to risk factors such as age, gender, oral hygiene practices, and smoking among the young adults of the Sebha city in Libya.
Materials and Methods:
A cross-sectional study was carried out among 1,255 subjects aged between 18 years and 34 years. 1,006 (80.15%) subjects were females and 249 (19.84%) subjects were males. Data was generated by conducting interview and clinical examination. The periodontal status was assessed by using Community Periodontal Index of Community Periodontal Index of Treatment Needs. The Chi-square test and analysis of variance were used for statistical analysis at 5% level of significance.
Results:
A total of 89.08% reported the use of toothbrush and toothpaste for cleaning and 10.91% used other aids, such as finger and Siwak. Of the 1,255 subjects, 3.98% were current smokers (all males). Only 4.7% had healthy periodontium (CPI code 1), while majority of 44.30% were detected with calculus (CPI code 2). Nearly 40.63% had shallow pockets (CPI code 3), 6.29% had bleeding (CPI code 1), and 4.06% had deep pockets (CPI code 4). The overall mean CPI score was 2.33 (0.84). Age and gender showed a statistically significant difference with the CPI codes.
Conclusion:
The result of this study provides baseline information for planning a preventive program. With preventive procedures being implemented at this young age, there is a possibility that the prevalence of periodontal disease will be lesser during adulthood.
PMCID: PMC3793420  PMID: 24130592
CPITN index; epidemiological surveys; oral hygiene practices; periodontal disease; periodontal status
23.  Trends in Oral Health by Poverty Status as Measured by Healthy People 2010 Objectives 
Public Health Reports  2010;125(6):817-830.
SYNOPSIS
Objective
Poverty is a significant social determinant for oral health, yet Healthy People 2010 (HP 2010) does not monitor changes in oral health status by poverty. We assessed recent trends for six HP 2010 oral health objectives by poverty status.
Methods
We used data from the 1988–1994 and 1999–2004 National Health and Nutrition Examination Surveys to analyze trends for HP 2010 age-specific objectives relating to caries experience, untreated tooth decay, dental sealants, periodontal disease, tooth retention, and complete tooth loss by poverty status.
Results
Dental caries significantly increased from 19% to 24% for children aged 2–4 years, but when stratified by poverty, caries only increased significantly for non-poor 2- to 4-year-old children (10% to 15%) (Objective 21-1a). The largest percentage point increase in dental caries was for non-poor boys (9% to 18%). The use of dental sealants continues to grow in the U.S. The largest percentage point increase in sealant use (Objective 21-8) between the two survey periods was for all poor children aged 8 years (3% to 21%). Among adults aged 35–44 years, periodontal disease significantly declined in the U.S. from 22% to 16% (Objective 21-5b) and more adults retained all of their natural teeth (30% to 38%) (Objective 21-3). However, the increase in tooth retention was significant only for non-poor adults, particularly non-poor men (34% to 48%).
Conclusions
Overall, the oral health status of Americans as measured by HP 2010 objectives mostly showed improvement or remained unchanged between 1998–1994 and 1999–2004. However, some changes in oral health status for some traditionally low-risk groups, such as non-poor children, may be reversing improvements in oral health that have consistently been observed in previous decades. These results suggest that poverty status is an important factor for planning and monitoring future national oral health goals.
PMCID: PMC2966663  PMID: 21121227
24.  Dental caries and oral health practice among 12 year old school children from low socio-economic status background in Zimbabwe 
Introduction
Dental caries is one of the most prevalent chronic diseases affecting children in Sub-Saharan Africa. Previous studies show a higher prevalence of dental caries in children from low socio-economic status backgrounds. The purpose of this study was to determine the prevalence of dental caries among 12 year old children in urban and rural areas of Zimbabwe and establish preliminary baseline data.
Methods
A descriptive cross-sectional study was conducted among 12 year old children at primary schools in Harare and Bikita district. A Pre-tested questionnaire was administered to elicit information from the participants on tooth cleaning, dietary habits and dental experience. Dental caries status was assessed using the DMFT index following World Health Organization (WHO) guidelines.
Results
Our results showed a high prevalence of dental caries in both urban (59.5%) and rural (40.8%) children. The mean DMFT in urban and rural areas was 1.29 and 0.66, respectively. Furthermore, our data showed a general lack of knowledge on oral health issues by the participants.
Conclusion
There is high prevalence of dental caries among 12 years old school children in both urban and rural areas of Zimbabwe. This calls for early preventive strategies and treatment services. We recommend incorporation of oral health education in the elementary school curricula.
doi:10.11604/pamj.2013.14.164.2399
PMCID: PMC3696470  PMID: 23819006
Dental caries; children; urban and rural area; Zimbabwe
25.  Prevalence, Severity and Related Factors of Dental Caries in School Going Children of Vadodara City – An Epidemiological Study 
Objective: Among dental diseases, dental caries is an important dental public health problem in India which is irreversible in nature, and is predominantly a disease of childhood. Till date no study has been carried out in Vadodara. As baseline data of caries is required to improve oral health of children, the present study was undertaken to determine the pattern of dental caries in school children of Vadodara city in the mixed dentition period considering age, sex and dietary patterns.
Methods: An epidemiological cross sectional descriptive study was carried out among 1600 school children aged 6-12 years in Vadodara city. A closed ended questionnaire according to World Health Organisation 1997 methodology was used to collect the data. The children were examined for the presence of dental caries using decayed missing filled teeth/decayed missing filled surfaces and Decayed Missing Filled Teeth/Decayed Missing Filled Surfaces index. Related factors which predispose caries such as age, sex and dietary patterns were recorded.
Results: The prevalence of dental caries was 69.12%. The mean dmft/dmfs and DMFT/DMFS were 3.00/4.79 and 0.45/0.56 respectively. The prevalence was higher in deciduous teeth than in permanent teeth. Positive association was found between dental caries and age, sex, frequency of sugar consumption in between meals.
Conclusion: The study concludes that the prevalence and severity of dental caries in Vadodara city is high. So, in developing country like India, it is imperative to introduce primary prevention and increased restorative care for the purpose of both reducing the caries prevalence and maintaining those caries free children.
How to cite this article: 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(4):40-48.
PMCID: PMC3780368  PMID: 24155618
Epidemiology; Dental Caries; Prevalence; Severity; Risk Factors; Odd's Ratio

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