|Year : 2022 | Volume
| Issue : 4 | Page : 144-150
Dental health status in Chennai corporation schools – An evaluative and comparative study
KS Gamal Abdul Nasser1, P Rupkumar2, Madhu Narayan3
1 Former Principal, Tamil Nadu Government Dental College, Chennai, Tamil Nadu, India
2 Department of Prosthodontics, Tamil Nadu Government Dental College, Chennai, Tamil Nadu, India
3 Department of Oral Pathology, SRM Dental College, Chennai, Tamil Nadu, India
|Date of Submission||06-Oct-2022|
|Date of Decision||08-Nov-2022|
|Date of Acceptance||27-Nov-2022|
|Date of Web Publication||15-Dec-2022|
Dr. Madhu Narayan
Department of Oral Pathology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Schools in Chennai are run publicly by the government or run privately, some with financial aid from the government in Tamil Nadu, a southern state of India. There are various systems of education – CBSE, Anglo Indian Board, ICSE Board, NIOS Board, Matriculation, Montessori, and State Board. From these, a massive study was conducted among 100,620 corporation school (state-run) students in the district of Chennai to find the prevalence of various dental diseases among them. Aim: To evaluate and compare the prevalence of various dental diseases among the corporation school children from different zones of Chennai city. Materials and Methods: The study was carried out for a period of about 15 months. It involved diagnosis, therapeutics, and referral to the state-run dental hospital for further follow-up. The district of Chennai was divided into ten zones. The school students, zone-wise, were screened, diagnosed and the required treatments were done at the venue or were referred to the higher center for further examination or treatment. The data collected were divided into zone-wise categories on the basis of disease occurrence and treatment/referral done and were tabulated. Results: The result obtained was that an astounding 74.36% of corporation school students were afflicted with some form of dental disease. Conclusion: Various associated factors such as lower socioeconomic status of the parents, educational background of the parents, dental education, and awareness among the school students could play major roles in the status of dental health among the corporation school children.
Keywords: Children, corporation school, dental disease, prevalence
|How to cite this article:|
Gamal Abdul Nasser K S, Rupkumar P, Narayan M. Dental health status in Chennai corporation schools – An evaluative and comparative study. SRM J Res Dent Sci 2022;13:144-50
|How to cite this URL:|
Gamal Abdul Nasser K S, Rupkumar P, Narayan M. Dental health status in Chennai corporation schools – An evaluative and comparative study. SRM J Res Dent Sci [serial online] 2022 [cited 2023 Feb 7];13:144-50. Available from: https://www.srmjrds.in/text.asp?2022/13/4/144/363798
| Introduction|| |
Dental diseases such as gingivitis and dental caries (DC) are common conditions affecting the global population. The most frequent dental condition in children is DC. Caries is still a significant public health issue even in the face of reliable scientific advancements and the fact that the condition is avoidable. The incidence of caries is significantly rising in emerging nations due to changing food habits and lifestyles. Lifestyle can also mean the socioeconomic status the children belong to, which may be directly related to the level of their nutrition, the access to health care that they have, their exposure to knowledge about the various oral pathologies, and the ways to prevent and cure them.
One of the important aspects of this study is that we selected the corporation (state-run) schools in the district of Chennai, Tamil Nadu State, India, mainly because most of the children studying in the corporation schools are with a poor socioeconomic status.
Hence, to ascertain the above factors, a study was conducted with a whopping number of 100,620 students chosen exclusively from corporation schools, the state-run schools, belonging to different zones of the district of Chennai in Tamil Nadu, India.
| Materials and Methods|| |
The study used a descriptive study design and analyzed the observations made. The study was done after obtaining approval from the institutional ethical committee. All procedures performed in the study were conducted in accordance with the ethical standards given in the 1964 Declaration of Helsinki, as revised in 2013. Written informed consent for the participation in the study was provided by the parents of the school children.
The study was intended to be diagnostic, therapeutic, referred and followed up, and encompassed students from different state-run schools scattered throughout the district of Chennai in Southern India.
These schools were divided into a total of 10 zones. In each zone, the children were divided into different categories based on the dental disease that they had and the treatment or referral that was done.
Study size calculation
As it was a massive observational study planned, convenience sampling method was employed in which all the students in the respective zonal schools were incorporated into the study.
A total of 100,620 students were examined in all the zones put together. Among these, 52,978 were males and 47,642 were females. The age range was 3–19 years. The ten zones were ten different geographical locations of Chennai that were T. H. Road, Appaswamy Lane, Varadharajapuram, MH Road, Market Street, Perambur, G. Koil street, Lloyds Road, Puliyur, and Saidapet in order from zone one to ten. Of these, zones 1-9 were in North Chennai and zone 10 was in the outskirts of North Chennai.
The type of dental disease present in each student was documented. Accordingly, the type of management done-extraction, restoration, scaling, referral for orthodontic opinion and management, etc., were documented. About 12 clinicians were involved every day in the entire process.
The most important aspect of this study was that, at all the schools, before commencing the clinical examination, everyday oral hygiene procedures such as proper brushing, proper gargling, and the type of food that they were supposed to take and types of foods that they were supposed to avoid were taught.
The data collected were divided into:
- Zone-wise-zone report
- Disease-zone report.
The data obtained were subjected to statistical analysis. Statistical analysis was carried out using Nonparametric test (Kruskal–Wallis test) to find the significance in difference of types of dental interventions among various zones.
| Results|| |
The different treatment modalities carried out at the venue were filling (with zinc oxide, silver amalgam, or glass ionomer cement), scaling, extraction, and referral to Tamil Nadu Government Dental College (TNGDC) [Table 1].
In this zone, a total of 12,561 children were examined/treatment done. Among these, the treatment types were filling – 1901, scaling – 2791, extraction – 241, special cases – 30, referral to state-run dental hospital – 4456, and no abnormality detected (NAD) –3142 children.
In this zone, a total of 16,251 children were examined/treatment done. Among these, the treatment types were filling – 3446, scaling – 3999, extraction – 159, special cases – 38, referral to state-run dental hospital – 5023, and NAD – 3586 children.
In this zone, a total of 5199 children were examined/treatment done. Among these, the treatment types were filling – 1030, scaling – 1062, extraction – 154, special cases – 14, referral to state-run dental hospital – 1932, and NAD – 1007 children.
In this zone, a total of 9499 children were examined/treatment done. Among these, the treatment types were filling – 1562, scaling – 2334, extraction – 270, special cases – 18, referral to state-run dental hospital – 2955, and NAD – 2360 children.
In this zone, a total of 8068 children were examined/treatment done. Among these, the treatment types were filling – 1499, scaling16361, extraction – 264, special cases – 16, referral to state-run dental hospital – 2682, and NAD – 1971 children.
In this zone, a total of 13288 children were examined/treatment done. Among these, the treatment types were filling – 2467, scaling – 3115, extraction – 185, special cases – 14, referral to state-run dental hospital – 4087, and NAD – 3420 children.
In this zone, a total of 7550 children were examined/treatment done. Among these, the treatment types were filling – 1421, scaling – 1481, extraction – 200, special cases – 7, referral to state-run dental hospital – 2588, and NAD – 1853 children.
In this zone, a total of 4325 children were examined/treatment done. Among these, the treatment types were filling – 770, scaling – 703, extraction – 117, special cases – 4, referral to state-run dental hospital – 1714, and NAD – 1017 children.
In this zone, a total of 10997 children were examined/treatment done. Among these, the treatment types were filling – 2139, scaling – 1824, extraction – 153, special cases – 4, referral to state-run dental hospital – 4421, and NAD – 2452 children.
In this zone, a total of 21803 children were examined/treatment done. Among these, the treatment types were filling – 4943, scaling – 4858, extraction – 286, special cases – 35, referral to state-run dental hospital – 6691, and NAD – 4990 children.
Thus, in summation, all the zones put together, a total of 21178 fillings, 23803 scaling, 2029 extraction, 184 special cases, and 36549 referrals were done and no abnormality was detected in 25798 cases.
The results obtained by tabulating the data are given in [Table 1].
The students were screened for different types of dental ailments present in them and the observations made were carefully tabulated. It is to be noted that this study was performed in such a way that even if a single subject was found to be suffering from a condition, it was considered, making the study, all inclusive. A total of 59 different types of dental ailments were recognized among the screened population in all the zones put together. The actual numbers and their respective percentages are given in [Table 2].
It was found that the difference in various types of treatments done in each zone had an asymptotic significance of 0.288 (significance value = or <0.05). It was also found that the difference among the ten zones for a particular type of treatment was highly significant with an asymptotic significance of 0.001 (significance value = or <0.05).
| Discussion|| |
Analysis of data in [Table 1]
Whatever be the zone, the number of extractions due to advanced dental disease resulting in loss of teeth at a very young age contributed only to a smaller percentage of the entire treatment done in the respective zones. This can be taken as a positive indicator of dental health maintenance. But it could have been also possible that the extractions could have been more because we had to get the parents' consent before extraction, which was difficult and because of that the extractions were less in number. Among the cases referred, many could have been extractions.
Scaling constituted the maximum percentage of treatment done at the venue in all zones except zones 8, 9, and 10. This shows that gingival health is compromised and not easily sought after for treatment by majority of the children or their parents. In zones 8, 9, and 10, filling or restoration constituted the maximum percentage of treatment done at the venue followed by a close second, in the other zones. Thus, it can be safely inferred that whatever caries was diagnosed was in the initial or easily restorable stages without proceeding to referral stage for advanced restorative techniques such as root canal treatments – again a positive sign of dental health.
Special cases with unique diagnosis constituted the least percentage in all zones, which were referred to the state-run dental hospital (TNGDC) for further opinion and management. Although the percentage is minimal, it is a matter of concern because the nature, degree of severity, and the peculiarity of the dental diseases in these children that made them categorized under special cases must be taken into consideration before overlooking them as a minor constituent of dental diseases in the examined children. These special cases include (1) fluorosis, (2) aphthous ulcer, (3) hypoplasia, (4) pink teeth, (5) tonsillitis, (6) Turner's teeth, (7) high frenal attachment, (8) amelogenesis imperfecta, (9) pan parag chewing, and (10) skeletal abnormalities.
Overall, in all the zones, the highest percentage was contributed in the individual zones by the referral cases to TNGDC. This again is an alarming sign as only those cases got referred which were not simple or mild enough to be treated at the venue with the facilities available or were special cases. The differences in the location of the zones must also be considered. It could be inferred that the more the zones were in the northern parts of the city of Chennai, the more the prevalence of the dental diseases were. This could a direct indicator of the link between the socioeconomic status of the people and the prevalence of the dental disease.
Many studies have been done in the past correlating the prevalence of dental disease and socioeconomic strata of the children. Our study depicted that the lower the socioeconomic status the children belong to, (based on the annual income of the parents), the higher the disease prevalence, particularly that of DC. Similar observations have been made by studies done by Mahesh Kumar et al., Reddy et al. (77.41%), George and Mulamoottil et al. (41.5%), Gopal et al., Rasidi et al., and Youssefi and Afroughi (P < 0.001). These authors observed that the prevalence of oral diseases, especially that of DC was very high among the rural children and in lower socioeconomic pockets of the society that is very similar to our study.
But contrasting results were achieved by studies done by Saravanan et al. (44.4%), Shwethashree et al. (96.5%), Alhabdan et al. (83%), and Kolay and Kumar. (89.63%) who observed that the diseases, DC in particular, showed a surprisingly higher prevalence among the upper socioeconomic class. This might shed light on additional factors such as education and awareness level of the parents, being responsible for the oral disease other than the financial stability of the children's parents.
Acharya et al. observed that despite the lower socioeconomic status, good awareness of dental hygiene was present among the study population. Nasser et al. stressed on the special attention to be given to the children from less-affluent families for the maintenance of their oral care. Thus, the above literature review suggests that almost all of the studies correlate with the findings of our study which depicted that an inverse relationship exists between the socioeconomic strata and the prevalence of the dental disease, not only among the general population but also among the school-going children.
Analysis of data in [Table 2]
The next category is the disease report which shows the different types of pathologic conditions, the children presented with, in each zone.
From [Table 2], it can be inferred that irrespective of the zone, the order of occurrence or the prevalence of some pathology, in descending order are- DC (45.32%), presence of calculus (13.56%), malocclusion (5.9%), gingivitis (4.32%), presence of stains (1.6%) and fracture of teeth (1.34%). Lower incidences were noted for conditions such as delayed eruption, unilateral cross-bite, discolored teeth, periapical abscess, Down's syndrome, Herpes simplex, malposition of teeth, internal resorption, anterior spacing, palatally inclined teeth, tonsillitis, Turner's teeth, unerupted teeth, buccally placed teeth, deep bite, deep palatal bite, and palatally erupted teeth.
The zones with greater number of fluorosis cases (zones- 10, 2, 1, 6) were noted. It should be noted from the table that the DC including the rampant form and the periodontal diseases (gingivitis, calculus, periodontitis) continue to pose a huge health burden among the pediatric and adolescent population. Malocclusion is also an issue of concern because if not intervened earlier, it not only leads to esthetic compromise but also may predispose the patient to other dental diseases such as the mal-aligned teeth serving as nidi for plaque and calculus retention and thence contributing to carious and periodontal diseases.
Many studies among the school-going children in the past have found the same result as ours, with the prevalence of the DC being the highest among the dental diseases (49.1%) followed by gingival disease and malocclusion such as the studies done by Mahesh Kumar et al., Saravanan et al. (DC-44.4%), Somasekhara et al. (DC – 73.3% and gingival disease – 66.66%), Aparna et al. (DC – 63.5%), Prasad et al. (DC – 63.5% and periodontal dieseas – 13.6%, and mal-occlusion – 25.1%), Pai et al. (DC – 78.3%), Alhabdan et al. (DC – 83%), Kolay and Kumar. (DC – 83.71%), Mehta et al. (retrospective study showed an increase in caries prevalence in a 5-year interval from 50.84% to 62.41%).
The study by Shwethashree et al. showed that aphthous ulcer (0.25%) constituted the most common oral comorbidities. Even in our study, aphthous ulcer (0.09%) was found to be a component of dental disease. According to them, the prevalence's of DC and dental fluorosis were 27.40% and 1.8%, respectively. In our study, they were 45.32% and 0.22%, respectively.
Different results from ours were obtained by studies done by Nasser et al. that showed a higher prevalence of gingivitis than DC among the school children (gingivitis – 41.28% and DC – 34.72%). In our study, they were 4.32% and 45.32%, respectively. Similarly, Al Hussaini et al. reported a higher prevalence of calculus (41.4%) and gum disease (26.72%) than DC (22.22%). Interventional studies also show a similar trend as that our study. Chandrashekar BR et al. showed that the Oral Hygiene Index-S, plaque index, and gingival index scores decreased with the use of oral hygiene aids such as fluoridated toothpaste and toothbrush. But a study by Al-Darwish says that only 25.8% of 2200 school-going children had oral health knowledge.
Through the statistical analysis of our data, we found that the difference in various types of treatments done in each zone had an asymptotic significance of 0.288 (significance value = or <0.05). Therefore we concluded that there is no significance among zones in terms of the types of treatments. This means that all the ten zones were almost similar to each other in the overall dental interventions carried out (filling, scaling, extraction, special cases, referral to TNGDC, and NAD-put together). Although this result hints at the zonal factors not playing a role in the dental interventions and hence the dental disease, multiple studies along the same lines may prove otherwise, in future.
Most of the examined subjects were referred to TNGDC and the least was the special cases. It must be noted that the subjects who were referred to TNGDC were those who couldn't be treated at the venue. It means that they were suffering from more serious conditions that required a higher level of intervention. This indirectly suggests the extent of severity of dental disease prevalence among the corporation school students in all the ten zones put together, i.e., a major part of Chennai city. Thus, from the data available in the tables, it is clear that of the 100,620 students examined, a total of 109,541 different types of dental treatment were performed, with more than one treatment type for a particular student carried out in many cases. Of the 100,620 students examined, no abnormality was detected in 25798 students. Hence, excluding them, a total of 74,822 students have undergone some form of dental intervention or referral to higher centers for further treatment or follow-up.
Thus, it can infer that 74,822 students suffered from at least one type of dental disease which mandated a therapeutic intervention such as filling, scaling, extraction, referral, or further follow-up as a special case.
It shows that a staggering 74.36% of students from the corporation schools in Chennai, included in the study, suffered from at least one type of dental ailment.
| Conclusion|| |
By having conducted such a massive study, the aim is to turn the spotlight on the preventive and early interventional methods in dentistry that will greatly reduce the occurrence or progression of the dental disease burden from our society. By educating them at a smaller age we can reduce the dental disease in a sequential way and hence the disease for the total population can be controlled. An important aspect of this study was that in every school brushing methods were taught and only then screening and treatments were commenced. The dental diseases should receive a government aid so that every individual is taken care of. The Government also must take care of continuous eradication of this disease in a progressive way, as it is a known fact that "Prevention is better than Cure."
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]