Social and Behavioral Determinants of Early Childhood Caries in the Aseer Region of Saudi Arabia

¹Bachelor in Dental Surgery, Abha, Kingdom of Saudi Arabia.

Corresponding Author: Abdulrahman Alshehri, Bachelor in Dental Surgery, Abha, Kingdom of Saudi Arabia, Tel: +966507090251; E-Mail: [email protected]

Received Date: 7 June 2016 Accepted Date: 12 July 2016  Published Date: 21 July 2016 Copyright © 2016 Alshehri A

Citation: Alshehri A. (2016). Social and Behavioral Determinants of Early Childhood Caries in the Aseer Region of Saudi Arabia. Mathews J Dentistry. 1(2): 008.

ABSTRACT

Introduction: Early childhood caries is a multi-factorial disease that involves the susceptible tooth and host, fermentable carbohydrates in the diet, cariogenic micro-organisms and time. The aim of this study was to analyze the influence of socio-behavioral variables on the prevalence of dental caries among children of 4-5 years old.

Method: A cross-sectional survey was performed on a sample of 422 children presented to selected five Primary Health Care Centre Aseer region of Saudi Arabia. The investigation was made using the decayed, missing, and filled teeth index (World Health Organization Methodology) and detection criteria for non-cavitated lesions. A tested, self-administered questionnaire was administered to parents to obtain information about their socio-behavioral characteristics.

Results: A cross-sectional survey was performed on a sample of 422 children presented to selected five Primary Health Care Centre Aseer region of Saudi Arabia. The investigation was made using the decayed, missing, and filled teeth index (World Health Organization Methodology) and detection criteria for non-cavitated lesions. A tested, self-administered questionnaire was administered to parents to obtain information about their socio-behavioral characteristics.

Conclusion: A high caries prevalence (77.73%) and a lack of caries treatment are revealed among Saudi pre-school children in the Aseer region in this study. The current study has identified risk factors for presence of ECC in pre-school children within a Saudi community. ECC risk can significantly be increased by living with occupied mother (p = 0.00811), consuming more sweets and chocolates (p = 0.00001), absence of oral health educators and oral health promotion programs (p = 0.0012). These factors could be modified through public health strategies, such as effective publicity concerning general dental health, practical health advice and develop effective strategies to promote awareness amongst Saudi community.

KEYWORDS

Social; Behavioral; Oral; ECC; Caries; Saudi; Children.

INTRODUCTION

Early childhood caries is a multi-factorial disease that involves the susceptible tooth and host, fermentable carbohydrates in the diet, cariogenic micro-organisms and time [1, 2]. Early childhood caries (ECC) has been defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surface on any primary tooth in children up to 71 months of age. In recent decades, there have been considerable improvements in the oral health of pre-school goers in many developed countries [3]. However, dental caries still affect a considerable number of children. Recent studies have shown that dental caries have decreased in Latin America and the Caribbean [4]. In Brazil, there was a 17% decrease in dental caries from 2003 to 2010, and the decayed, missing, and filled teeth index (dmft index) for 5-year-old children decreased from 2.80 to 2.30 [5].

Researchers have attempted to expand the basic microbiological models for ECC development to include various social, demographic and behavioral factors such as ethnicity, family income, maternal education level, family status, tooth brushing habits and parental knowledge and beliefs [6, 7]. Although the predictive power of the variables studied so far was inconsistent, the high disease experience within selected community groups reflects the importance of factors other than the presence of Mutants streptococci alone in contributing to ECC development. Other cross-sectional models demonstrate the complex interaction between socio-economic status (SES), ethnicity, immigrant status, infant feeding, fluoride exposure, oral hygiene and ECC presence in preschool children [8-17]. However, because most studies of ECC have been conducted among specific ethnic, immigrant and lower socio-economic communities, extrapolation of current risk assessment models to the general population is still problematic.

In Saudi Arabia, recent studies have shown the high prevalence of dental caries among pre-school children and adults. Most of the studies that have been conducted in Saudi Arabia have shown significant association between the high prevalence of early childhood caries and some social and behavioral factors [18-21]. Although these factors have shown significant association, there are still other non-investigated factors that have not been reported previously in Saudi child population. The purpose of this study, therefore, was to discover and investigate the association between selected social and behavioral variables and the presence of ECC in the 4-5 years old Saudi child population.

OBJECTIVE

The objective of this study was to analyze the influence of selected socio-behavioral variables on the prevalence of dental caries in the 4-5 years old pre-school children within Aseer region of Saudi Arabia

METHOD AND DESIGN

A cross-sectional study including young pre-school Saudi child population in Aseer region, a region located at South part of Saudi Arabia, aged between 4 to 5 years was conducted. For this purpose, information was obtained using prevalence (percentage with caries). In the present study, the participants were children aged between 4 to 5 years attended to dental clinics at selected five Primary Health Care Centers in Aseer region, Saudi Arabia with their parents or at least one of them throughout the period between March to May 2015. For this, a self-administered questionnaire to obtain information regarding selected social and behavioral variables was prepared. The questionnaire consisted of 24 items vary between Multiple Choices Questions (MCQs), Likert scale and short essay questions. Moreover, it is pretested on 30 randomly selected individuals attended at Alkhoush Primary Health Care Center, one of the previously selected centers. The investigators were the dentists working at the selected dental clinics after we assured that they were aware about WHO criteria for detecting caries by mean of interviews. The investigation was made using the decayed, missing, and filled teeth index (World Health Organization Methodology) and detection criteria for noncavitated lesions. A tested, self-administered questionnaire was administered to one of the parents among all the participants to obtain information about their socio-behavioral characteristics. Then, the data were modelled using chi square test at the 5 per cent level of significance using SPSS software.

RESULTS

Of the 422 children examined, the prevalence of caries was seen in N = 328 (77.73%).The prevalence of caries in female children was higher i.e., 96% compared to those among male children, which was 68%.The difference in the prevalence of caries was statistically significant viz. X2 = 43.13 , df = 1, Pvalue = .00001 (see Table 1& Figure 1). Children aged between 24-36 months showed a higher caries prevalence of 89% (N = 124) and there was a statistically significant relation between age of children and the prevalence of dental caries viz. X2 = 15.32, df = 2, Pvalue = 0.000471 (see Table 2.1). With regard to occupation of mothers, more than 70% (N = 299) of children recorded with employed mothers and 29.14% with housewife, out of which 80.27% of the children with employed mothers had caries. There was a statistically significant relation between occupation of mothers and the prevalence of dental caries viz. X2 = 7.009, df = 1, Pvalue = 0.00811 (see Table 2.2)

Table 1: Distribution of Children According to Gender and Caries Experience

Table 2: Knowledge in Regard of Dental Caries and Social Factors, and ECC Experience.

Of the sample, 69.2% (N = 292) favored sweets in meals and during day over salts, while 30.8% (N=130) and 53.79% had eaten chocolates everyday at least once. In addition, 92.12% of children, who favored sweets, had caries. There was a statistically significant correlation of dental caries prevalence with type of favored meals viz. X2 = 113.50, df = 1, Pvalue = 0.00001 and with eating sweets and chocolates X2 = 125.11, df = 2, Pvalue = 0.00001 (see Table 2.3 and Table 2.4) According to data, only 25.36% of children (N = 107) brushed their teeth, 63.55% of them had no caries while 78 out of 422 children used Siwak to brush their teeth, 82.1% of them had caries. The majority of children in this study (N = 191) recorded in "Mixed group", those who used both toothbrush and Siwak to brush teeth. It is found that 94.76% of children in "Mixed group" had caries. There was a statistically significant correlation between caries prevalence and the method to apply oral hygiene viz. X2 = 144.17, df = 3, Pvalue = 0.00001 (see Table 2.5). The majority of sample (N=291) 68.96% chose soft drinks, out of which 94.16% of them had caries. There was statistically significant relation between prevalence of dental caries and type of drinks viz. X2 = 159.76, df = 2, Pvalue = 0.00001 (see Table 2.7& Figure 2).

A total of 97.87% (N = 413) of the final sample recorded that there were not attended or invited to any lecture or campaigns in relate to oral health care, out of which 78.7% of them (N = 325) had caries. A statistically significant correlation was found between caries prevalence and attending to oral health care programs and participating in oral health care campaigns viz. X2 = 10.46, df = 1, Pvalue = 0.0012 (see Table 2.9). Although most of the final sample (N = 420) had no dentist at school or didn't know about it in this regard, there was no statistical significant correlation between dental caries prevalence and presence of dentist at school X2 = 4.76 , df = 2, Pvalue = 0.0926 (see Table 2.8) .

DISCUSSION

This study is very important since it is the first epidemiological study for ECC presence conducted within the Aseer region. The new findings in the present study can be utilized in the development of more effective strategies for oral health promotion and prevention of ECC within this community. As compared with the previous studies in Saudi Arabia, prevalence of ECC among the children aged between 4-5 years in the Aseer region was found to be lesser than some studies conducted at Riyadh, Tabuk and Alahsa and higher than some other studies conducted at Jeddah and Tabuk [21-28].

In this study, significant association was found between the sex of the child and ECC. The prevalence of ECC among female children (95.5%) was more than that of male children (68%), which is contrary to many studies conducted in Saudi Arabia and other parts of the world [29-35]. Significant association was also found between the age of the child and ECC. This finding counteracts with the findings by Alkarimi HA, Khristine Marie G. in Philippines, Seval Olmez in Turkey and Wendt L.K. in Sweden. It was shown that the lower age is associated with higher prevalence of ECC, whereas they found that higher age is associated with higher prevalence of ECC among the children [36-39].

Influence of family variables on the presence of ECC reported to be high in previous studies conducted in this regard [40-46]. In this study, children of employed mothers have shown higher prevalence of ECC than those living with housewife mothers. Hence, there is significant association between occupation of mother and the prevalence of ECC. The highly significant role of sweets, chocolates, and soft drinks in higher prevalence of ECC is evident from the findings of this study which are supportive to the findings by Ghanim, Jose B. in Kerala, Rosenblatt, Bankel and others. [47-54].

The notable issues like poor oral health services, absence of oral health educators at schools and villages, and loss of oral health campaigns have been shown to be major determinants of ECC in the present study. Findings such as method of cleaning teeth and frequency of eating sweets and chocolates have shown significant relationship in the current study.

CONCLUSION

A high caries prevalence (77.73%) and a lack of caries treatment are revealed among Saudi pre-school children in the Aseer region in this study.

The current study has identified risk factors for presence of ECC in pre-school children within a Saudi community. ECC risk can significantly be increased by living with occupied mother (p = 0.00811), consuming more sweets and chocolates (p = 0.00001), absence of oral health educators and oral health promotion programs (p = 0.0012).

These factors could be modified through public health strategies, such as effective publicity concerning general dental health and practical health advice. The oral health promotion and education programs should address these risk factors to fight ECC and develop effective strategies to promote awareness amongst Saudi community.

REFERENCES

1. Jose B and King M. (2003). Early Childhood Caries Lesions in Preschool Children in Kerala, India. Pediatr Dentist. 25(6), 594-600.
2. Ripa LW. (1988). Nursing Caries: A Comprehensive Review. Pediatr Dent. 10(4), 268-282.
3. Marthaler TM. (2004). Changes in Dental Caries 1953-2003. Caries Res. 38(3), 173-181.
4. Bonecker M and Cleaton-Jones P. (2003). Trends in Dental Caries in Latin American and Caribbean 5-6 and 11-13-yearold Children: A Systematic Review. Community Dent Oral Epidemiol. 31(2), 152-157.
5. Brazil. (2011). Ministry of Health. National Coordination of Oral Health of the Brazilian population. SB Project Brazil 2010: main results. Brasilia (DF): Ministry of Health.
6. Reisine S, Litt M and Tinanoff NA. (1994). Biopsychosocial Model to Predict Caries in Preschool Children. Pediatr Dent. 16(6), 413- 418.
7. Tinanoff N and O'Sullivan DM. (1997). Early Childhood Caries: Overview and Recent findings. Pediatr Dent. 19(1), 12-16.
8. Schroder U and Granath L. (1983). Dietary Habits and Oral Hygiene as Predictors of Caries in 3-year-old Children. Community Dent Oral Epidemiol. 11(5), 308-311.
9. Holt RD, Joels D, Bulman J, Maddick IH, et al. (1988). A Third Study of Caries in Preschool Aged Children in Camden. Br Dent J. 165(3), 87-91.
10. Silver DH. (1992). A Comparison of 3-year-olds' Caries Experience in 1973, 1981 and 1989 in a Hertfordshire Town, Related to Family Behaviour and social class. Br Dent J. 172(5), 191-197.
11. Verrips GH, Kalsbeek H and Eijkman MA. (1993). Ethnicity and Maternal Education As Risk Indicators for Dental Caries, and The Role of Dental Behaviour. Community Dent Oral Epidemiol. 21(4), 209-214.
12. Grindefjord M, Dahlof G, Ekstrom G, Hojer B, et al. (1993). Caries Prevalence in 2.5 year Old Children. Caries Res. 27(6), 505-510.
13. Litt MD, Reisine S and Tinanoff N. (1995). Multidimensional causal model of dental caries development in low-income preschool children. Public Health Rep. 10(5), 607-617.
14. Evans DJ, Rugg-Gunn AJ, Tabari ED, Butler T, et al. (1996). The Effect of Fluoridation and Social Class on Caries Experience in 5-year-old Newcastle Children in 1994 Compared with Results over The Previous 18 Years. Community Dent Health. 13(1), 5-10.
15. Hallett KB and O'Rourke PK. (1998). Early Childhood Caries and Infant Feeding Practice. Brisbane: The University of Queensland. MPH thesis.
16. Ramos Gomez FJ, Tomar SL, Ellison J, Artiga N, et al. (1999). Assessment of Early Childhood Caries and Dietary Habits in a Population of Migrant Hispanic Children in Stockton, California. ASDC J Dent Child. 66(6), 395-403, 366.
17. Vanobbergen J, Martens L, Lesaffre E, Bogaerts K, et al. (2001). Assessing Risk Indicators for Dental Caries in the Primary Dentition. Community Dent Oral Epidemiol. 29(6), 424- 434.
18. AlDosari AM, Akpata ES and Khan N. (2010). Association among Dental Caries Experience, Fluorosis and Fluoride Exposure from Drinking Water Sources in Saudi Arabia. J Public Health Dent. 70(3), 220-226.
19. Wyne AH. (2004). The Bilateral Occurrence of Dental Caries among 12-13 and 15-19 year Old School Children. J Contemp Dent Pract. 5(1), 42-52.
20. Al-Sadhan SA. (2006). Dental Caries Prevalence among 12- 14 year-Old School Children in Riyadh: A 14-year Follow-up Study of the Oral Health Survey of Saudi Arabia Phase 1. Saudi Dent J. 18, 2-7.
21. Al-Wazzan KA. (2004). Dental Caries Prevalence in 6-7 year-old School Children in Riyadh Region: A Comparative Study with the 1987 Oral Health Survey of Saudi Arabia Phase I. Saudi Dent J. 16, 54-60.
22. Mansour M, Anwar S and Pine C. (2000). Comparison of Caries in 6-7 year Old Saudi Girls Attending Public and Armed Forces Schools in Riyadh, Saudi Arabia. Saudi Dent J. 12(1), 33-36.
23. Brown A. (2009). Caries Prevalence and Treatment Needs of Healthy and Medically Compromised Children At a Tertiary Care Institution in Saudi Arabia. East Mediterr Health J. 15(2), 378-386.
24. Stewart BL, Al-Juhani TS, Al-Akeel AS, Al-Brikeet HA, et al. (2002). Caries Experience in Grades 1 and 6 Children Attending Elementary Schools at King Abdul-aziz Military City, Tabuk, Saudi Arabia. Saudi Dent J. 12, 140-148.
25. Khan NB, Al-Ghannam NA, Al-Shammery AR, Wyne AH, et al. (2001). Caries in Primary School children: Prevalence, Severity and Pattern in Al-Ahsa, Saudi Arabia. Saudi Dent J. 13, 71-74.
26. Farsi N. (2010). Developmental Enamel Defects and Their Association with Dental Caries in Preschoolers in Jeddah, Saudi Arabia. Oral Health Prev Dent. 8(1), 85-92.
27. Al-Malik MI, Holt RD and Bedi R. (2002). Erosion, Caries and Rampant Caries in Preschool Children in Jeddah, Saudi Arabia. Community Dent Oral Epidemiol. 30(1), 16-23.
28. Sabbah WA, Stewart BL and Owusu-Agyakwa GB. (2003). Prevalence and Determinants of Caries among 1-5 year-old Saudi Children in Tabuk, Saudi Arabia. Saudi Dent J. 15(3), 131-135.
29. Al-Agili DE. (2013). A Systematic Review of Populationbased Dental Caries Studies among Children in Saudi Arabia. Saudi Dent J. 25(1), 3-11.
30. Al-Shamrani AS, Bassuoni MW, Mohamed MA, Mohamed RN, et al. (2015). Caries Prevalence and Treatment Need Among Primary School Children in Taif, Saudi Arabia. Indian Journal of Applied Research. 5(7), ISSN-2249-555X.
31. Taifour HTA, Abdelrhman M, Nasir IB and Ahmed A. Assessment of Dental Caries Prevalence in Deciduous and Permanent Student Teeth in Khamis Mushait-KSA. Indian Journal of Applied Research. 5(2), ISSN - 2249-555X.
32. Prabhu P, Rajajee KT, Sudheer KA, Jesudass G, et al. (2014). Assessment of Caries Prevalence among Children Below 5 years old . J Int Soc Prev Community Dent. 4(1), 40-43.
33. Santhosh KT, Jyothi T, Harish T, Duraiswamy P, et al. (2012). Dental Caries in Relation to Socio-behavioral Factors of 6-yearold School Children of Udaipur district. India Dent Res J (Isfahan). 9(6), 681-687.
34. Datta1 P and Datta PP. (2013). Prevalence of Dental Caries among School Children in Sundarban, India. Datta and Datta, Epidemiol. 3(135).
35. Rahman SS, Rasul CH, Kashem MA, Biswas SS, et al. (2010). Prevalence of Dental Caries in the Primary Dentition among Under Five Children. Bang Med J (Khulna). 43, 7-9.
36. Alkarimi HA, Watt RG, Pikhart H, Sheiham A, et al. (2014). Dental Caries and Growth in School-age Children. Pediatrics. 133(3), 616-623.
37. Khristine MG, Shinada K and Kawaguchi Y. (2003). Early Childhood Caries in Northern Philippines. Community Dent Oral Epidemiol. 31(2), 81-89.
38. Olmez S, Uzami M and Erdem G. (2003). Association between early Childhood Caries and Clinical, Microbiological, Oral Hygiene and Dietary Variables in Rural Turkish Children. Turk J Pediatr. 45(3), 231-236.
39. Wendt LK, Hallonsten AL and Koch G. (1991). Dental Caries in One- and Two-year Old Children Living in Sweden. Swed Dent J. 15(1), 1-6.
40. Alshehri A and Nasim VS. (2015). Infant Oral Health Care Knowledge and Awareness among Parents in Abha City of Aseer Region, Saudi Arabia. Saudi J Dent Res. 6(2), 98-101.
41. EissaAl-Hosani and Rugg-Gunn JA. (2006). The Relationship between Diet and Dental Caries in 2 and 4 Year Old Children in the Emirate of Abu Dhabi. Saudi Dent. 348-352.
42. Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalhati MM, et al. (2006). Early Childhood Caries and Dental Plaque among 1-3 year-olds in Tahran, Iran. J Indian Soc Pedod Prev Dent. 24(4), 177-181.
43. Inayat N, Mujeeb F, Shad MA, Rashid S, et al. (2010). Experience of Early Childhood Caries (ECC) in Children at Fatima Jinnah Dental College Hospital, Karachi and Its Relationship with Feeding Practices. JPak Dent Assoc. 19(1), 34-41.
44. Hallett KB and O'Rourke PK. (2003). Social and Behavioural Determinants of Early Childhood Caries. Australian Dental Journal. 48(1), 27-33.
45. Abdullah S, Maxood A, Khan NA, Khan W, et al. Risk Factors for Dental Caries in Pakistani Children. Oral Dent J. 28(2), 257-266.
46. Prakash P, Subramaniam P, Durgesh BH, Konde S, et al. (2012). Prevalence of Early Childhood Caries and Associated Risk Factors in Preschool Children of Urban Bangalore, India: A cross-sectional study. Eur J Dent. 6(2), 141-152.
47. Al-Ghanim NA, Adenubi JO, Wyne AA, Khan NB, et al. (1998). Caries Prediction Model in Preschool Children in Riyadh, Saudi Arabia. Int J Pediatr Dent. 8(2), 115-22.
48. Jose B and King NM. (2003). Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent. 25(6), 594- 600.
49. Rosenblatt A and Zarzar P. (2004). Breast-feeding and Early Childhood Caries: An Assessment among Brazilian Children. Int J Paediatr Dent. 14(6), 439-445.
50. Bankel M, Eriksson UC, Robertson A, Kohler B, et al. (2006). Caries and Associated factors in a Group of Swedish Children 2-3 Years of Age. Swed Dent J. 30(4), 137-146.
51. Johansson Ak, Johansson A, Birkhed D, Omar R, et al. (1996). Dental Erosion, Soft-drink Intake, and Oral Health in Young Saudi Men, and the Development of A System for Assessing Erosive Anterior Tooth Wear. Acta Odontol Scand. 54(6), 369-378.
52. Ehlen LA, Marshall TA, Qian F, Wefel JS, et al. (2008). Acidic Beverages Increase the Risk of In vitro Tooth Erosion. Nutr Res. 28(5), 299-303.
53. Maganur P, Satish V, Prabhakar AR, Namineni S, et al. (2015). Effect of Soft Drinks and Fresh Fruit Juice on Surface Roughness of Commonly Used Restorative Materials. Int J Clin Dent. 8(1), 1-5.
54. Bowen WH and Lawrance RA. (2005). Comparison of the Cariogenicity of Cola, Honey, Cow Milk, Human Milk, and Sucrose. Pediatrics. 116(4), 921-926.