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Dietary habits and dental caries status
   in 12-13 years age group school
     children in Kathmandu valley
Shakya P1, Acharya A1, K.C. U 1, Subedi B1, Jnawali M1, Paudyal BD1, Koirala S2 and
Singh A1
1 Central   Department of Microbiology, Tribhuvan University (CDM-TU), Kirtipur,
Nepal
2   National Dental Hospital, Panipokhari, Kathmandu


Conducted under the technical and financial support of Nepal Dental Association 2008
Introduction
Dental caries
• multi-factorial disease
• prevalent and chronic oral diseases, common
  in children.
• Diet one of the prime factors
• changing dietary habits
• Use of Epidemiological tools
Objective
• To assess the impact of diet on dental caries
  status in children
Materials and methods

• Ethical approval
 –NHRC,
 –written consent from schools
  and Guardians of the students
Materials and methods
• Study subjects
  – 30 private and government schools
  – Students of age group 12-13 years
• Study design
  – Cross-sectional
• Free dental check ups for all participating
  schools
Materials and methods
• Clinical examination
  – WHO caries form
  – Done by trained and calibrated volunteer dentist
  – provided by Nepal Dental Association
  – Cross check in each 5 students
  – DMFT/DMFS was used as a standard tool
• Questionnaire survey
  – semi-structured questionnaire
• Statistical Analysis
  – Done by SPSS 16
Result
• Mean DMFS 1.60
• Prevalence 53.23 %
• Age
  – 325 students of age group 12-13 years
  – average age of 12 years 4 months
  – high decayed teeth surfaces than other
    component
• Gender
  – Female (1.97) (60%)> Male (1.26) (47.06%)
  – High decayed component
Result
Dietary habits    D (SE)        M (SE)        F (SE)        DMFS (SE)     p-value
Chewing paan      2.07 (0.58)   0             0             2.07 (0.58)   p=0.43
(n=14, 4.3%)
Beetles nut       0.68 (0.17)   0             0.03 (0.02)   0.70 (0.18)   p=0.00
chewing (n=37,
11.4%)
No such habits    1.46 (0.13)   0.11 (0.06)   0.13 (0.06)   1.7 (0.16)    p= 0.56
(n=274, 84.3%)
                                    Chocolate (n, %)
Everyday (n=35,   2.23 (0.34)   0.11 (0.11)   0.11 (0.09)   2.46 (0.35)   p= 0.02
10.8 %)
Weekly (n=65,     1.34 (0.3)    0             0             1.34 (0.27)   p=0.34
20 %)
Monthly           1.33 (0.16)   0.13 (0.08)   0.17 (0.09)   1.64 (0.22)   p=0.87
(n=187, 57.5 %)
Never (n=38,      1.05 (0.24)   0             0.03 (0.02)   1.08 (0.24)   p=0.04
11.7 %)
Result
                                              Sugar (n, %)

Everyday (n=30,       1.60 (0.31)   0                  0             1.60 (0.31)    p=1.00
9.2%)
Weekly (n=28, 8.6%)   1.21 (0.39)   0                  0             1.21 (0.39)    p=0.33

Monthly (n=252,       1.40 (0.14)   0.12 (0.06)        0.12 (0.07)   1.64 (0.18)    p=0.82
77.5%)
Never (n=15, 4.6%)    1.27 (0.32)   0                  0.40 (0.40)   1.67 (0. 43)   p=0.88

                                              Sour (n, %)

Everyday (n=28,       1.21 (0.23)   0.14 (0.14)        0.04 (0.03)   1.39 (0.25)    p=0.41
8.6%)
Weekly (n=99,         1.10 (0.17)   0.05 (0.05)        0.04 (0.04)   1.19 (0.21)    p=0.05
30.5%)
Monthly (n=180,       1.63 (0.18)   0.11 (0.08)        0.18 (0.09)   1.92 (0.23)    p=0.16
55.4%)
Never (n=18, 5.5%)    1.00 (0.45)   0                  0             1.00 (0.45)    p=0.20

                                          Veg/non-veg (n, %)

Veg (n=132, 40.6%)    2.04 (0.21)   0.11 (0.08)        0.05 (0.03)   2.19 (0.24)    p= 0.012

Non-veg (n=193,       0.96 (0.13)   0.08 (0.06)        0.16 (0.09)   1.20 (0.17)    p= 0.021
59.4%)
Discussion
• DMFS found below the recommended value
  by WHO
• High prevalence, high decayed and untreated
  teeth
• Indicates lack of awareness
• Can invite future complication
Discussion
• Female higher caries status and prevalence
  than male
  – Females more prone to caries
  – early tooth eruption
  – differences in dental attendances
  – difference in dietary pattern
• Chewing paan high DMFS
Discussion
• Beetles nut chewing low dental caries
  – Antibacterial properties
  – Risk of developing fissures
  – Lead to caries
• Chocolate no significant difference found
• Sugary foods
  – High DMFS found in those who consumes every
    day than those who never
Discussion
• sour foods consumption
  – No significant difference found
• vegetarian / non-vegetarian
  – High DMFS found in vegetarian than in non-
    vegetarian
  – Carbohydrate foods – acid production – metabolic
    activity of cariogenic bacteria – decalcification
  – In absence of fermentable carbohydrate,
    putrefaction – alkaline pH – no decalcification
Discussion
• School
  – important platform for promoting health
  – reach to their family and community as a whole
  – lifelong sustainable attitudes and skills
Limitation
• cross-sectional type of study
• lack of sufficient statistical power
Conclusion
•   Low caries status, high prevalence
•   Females more prone to caries
•   Diet have important role in causation of caries
•   Vegetarian have higher risk of caries
References
1.   Peterson PE. World oral health report 2003, continuous improvement of oral health in the 21st century –
     the approach of the WHO global oral health programme, Geneva, Switzerland: World Health Organization;
     2003. p. 1-16.
2.   Bagg J. Essentials of microbiology for dental students. New York: Oxford University Press; 1999. p. 1-326.
3.   Burnett GW, Scherp HW. Oral microbiology and infectious disease. 2nd ed. Baltimore: Oxford Book
     Company; 1964. p. 45-90,173-270,273-401,578-613.
4.   Moynihan PJ. The role of diet and nutrition in the etiology and prevention of oral diseases. Bull World
     Health Organ 2005 Sep;83(9):694-99.
5.   Messer LB. Assessing caries risk in children. Aust Dent J 2000;45(1):10-6.
6.   Burt BA, Kolker JL, Sandretto AM, Yuan Y, Sohn W and Ismail AI. Dietary patterns related to caries in a low-
     income adult population. Caries Res 2006;40(6):473-80.
7.   Tinanoff N, Kanellis MJ and Vargas CM. Current understanding of the epidemiology, mechanisms, and
     prevention of dental caries in preschool children. Pediatr Dent 2002;24(6):543-51.
8.   World Health Organization. Oral health surveys. Basic methods. Geneva, Switzerland: World Health
     Organization; 1997.
9.   Watt RG. Strategies and approaches in oral disease prevention and health promotion. Bull World Health
     Organ 2005 Sep:83(9):711-8.
10. Petersen PE. World health organization global policy for improvement of oral health-world health
    assembly 2007. Int Dent J 2008;58:115-21.
Acknowledgement
• Nepal Dental Association
• Central Department of Microbiology, TU
• participating schools, students and their
  guardians
• Volunteer dentists and enumerators
• Dr. Sudin Shakya and Dr. Sudhamshu KC
• Mr. Anil Thapa, Visiting lecturer CDM-TU

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Dietary habits and dental caries status in 12 13

  • 1. Dietary habits and dental caries status in 12-13 years age group school children in Kathmandu valley Shakya P1, Acharya A1, K.C. U 1, Subedi B1, Jnawali M1, Paudyal BD1, Koirala S2 and Singh A1 1 Central Department of Microbiology, Tribhuvan University (CDM-TU), Kirtipur, Nepal 2 National Dental Hospital, Panipokhari, Kathmandu Conducted under the technical and financial support of Nepal Dental Association 2008
  • 2. Introduction Dental caries • multi-factorial disease • prevalent and chronic oral diseases, common in children. • Diet one of the prime factors • changing dietary habits • Use of Epidemiological tools
  • 3. Objective • To assess the impact of diet on dental caries status in children
  • 4. Materials and methods • Ethical approval –NHRC, –written consent from schools and Guardians of the students
  • 5. Materials and methods • Study subjects – 30 private and government schools – Students of age group 12-13 years • Study design – Cross-sectional • Free dental check ups for all participating schools
  • 6. Materials and methods • Clinical examination – WHO caries form – Done by trained and calibrated volunteer dentist – provided by Nepal Dental Association – Cross check in each 5 students – DMFT/DMFS was used as a standard tool • Questionnaire survey – semi-structured questionnaire • Statistical Analysis – Done by SPSS 16
  • 7.
  • 8. Result • Mean DMFS 1.60 • Prevalence 53.23 % • Age – 325 students of age group 12-13 years – average age of 12 years 4 months – high decayed teeth surfaces than other component • Gender – Female (1.97) (60%)> Male (1.26) (47.06%) – High decayed component
  • 9. Result Dietary habits D (SE) M (SE) F (SE) DMFS (SE) p-value Chewing paan 2.07 (0.58) 0 0 2.07 (0.58) p=0.43 (n=14, 4.3%) Beetles nut 0.68 (0.17) 0 0.03 (0.02) 0.70 (0.18) p=0.00 chewing (n=37, 11.4%) No such habits 1.46 (0.13) 0.11 (0.06) 0.13 (0.06) 1.7 (0.16) p= 0.56 (n=274, 84.3%) Chocolate (n, %) Everyday (n=35, 2.23 (0.34) 0.11 (0.11) 0.11 (0.09) 2.46 (0.35) p= 0.02 10.8 %) Weekly (n=65, 1.34 (0.3) 0 0 1.34 (0.27) p=0.34 20 %) Monthly 1.33 (0.16) 0.13 (0.08) 0.17 (0.09) 1.64 (0.22) p=0.87 (n=187, 57.5 %) Never (n=38, 1.05 (0.24) 0 0.03 (0.02) 1.08 (0.24) p=0.04 11.7 %)
  • 10. Result Sugar (n, %) Everyday (n=30, 1.60 (0.31) 0 0 1.60 (0.31) p=1.00 9.2%) Weekly (n=28, 8.6%) 1.21 (0.39) 0 0 1.21 (0.39) p=0.33 Monthly (n=252, 1.40 (0.14) 0.12 (0.06) 0.12 (0.07) 1.64 (0.18) p=0.82 77.5%) Never (n=15, 4.6%) 1.27 (0.32) 0 0.40 (0.40) 1.67 (0. 43) p=0.88 Sour (n, %) Everyday (n=28, 1.21 (0.23) 0.14 (0.14) 0.04 (0.03) 1.39 (0.25) p=0.41 8.6%) Weekly (n=99, 1.10 (0.17) 0.05 (0.05) 0.04 (0.04) 1.19 (0.21) p=0.05 30.5%) Monthly (n=180, 1.63 (0.18) 0.11 (0.08) 0.18 (0.09) 1.92 (0.23) p=0.16 55.4%) Never (n=18, 5.5%) 1.00 (0.45) 0 0 1.00 (0.45) p=0.20 Veg/non-veg (n, %) Veg (n=132, 40.6%) 2.04 (0.21) 0.11 (0.08) 0.05 (0.03) 2.19 (0.24) p= 0.012 Non-veg (n=193, 0.96 (0.13) 0.08 (0.06) 0.16 (0.09) 1.20 (0.17) p= 0.021 59.4%)
  • 11. Discussion • DMFS found below the recommended value by WHO • High prevalence, high decayed and untreated teeth • Indicates lack of awareness • Can invite future complication
  • 12. Discussion • Female higher caries status and prevalence than male – Females more prone to caries – early tooth eruption – differences in dental attendances – difference in dietary pattern • Chewing paan high DMFS
  • 13. Discussion • Beetles nut chewing low dental caries – Antibacterial properties – Risk of developing fissures – Lead to caries • Chocolate no significant difference found • Sugary foods – High DMFS found in those who consumes every day than those who never
  • 14. Discussion • sour foods consumption – No significant difference found • vegetarian / non-vegetarian – High DMFS found in vegetarian than in non- vegetarian – Carbohydrate foods – acid production – metabolic activity of cariogenic bacteria – decalcification – In absence of fermentable carbohydrate, putrefaction – alkaline pH – no decalcification
  • 15. Discussion • School – important platform for promoting health – reach to their family and community as a whole – lifelong sustainable attitudes and skills
  • 16. Limitation • cross-sectional type of study • lack of sufficient statistical power
  • 17. Conclusion • Low caries status, high prevalence • Females more prone to caries • Diet have important role in causation of caries • Vegetarian have higher risk of caries
  • 18. References 1. Peterson PE. World oral health report 2003, continuous improvement of oral health in the 21st century – the approach of the WHO global oral health programme, Geneva, Switzerland: World Health Organization; 2003. p. 1-16. 2. Bagg J. Essentials of microbiology for dental students. New York: Oxford University Press; 1999. p. 1-326. 3. Burnett GW, Scherp HW. Oral microbiology and infectious disease. 2nd ed. Baltimore: Oxford Book Company; 1964. p. 45-90,173-270,273-401,578-613. 4. Moynihan PJ. The role of diet and nutrition in the etiology and prevention of oral diseases. Bull World Health Organ 2005 Sep;83(9):694-99. 5. Messer LB. Assessing caries risk in children. Aust Dent J 2000;45(1):10-6. 6. Burt BA, Kolker JL, Sandretto AM, Yuan Y, Sohn W and Ismail AI. Dietary patterns related to caries in a low- income adult population. Caries Res 2006;40(6):473-80. 7. Tinanoff N, Kanellis MJ and Vargas CM. Current understanding of the epidemiology, mechanisms, and prevention of dental caries in preschool children. Pediatr Dent 2002;24(6):543-51. 8. World Health Organization. Oral health surveys. Basic methods. Geneva, Switzerland: World Health Organization; 1997. 9. Watt RG. Strategies and approaches in oral disease prevention and health promotion. Bull World Health Organ 2005 Sep:83(9):711-8. 10. Petersen PE. World health organization global policy for improvement of oral health-world health assembly 2007. Int Dent J 2008;58:115-21.
  • 19. Acknowledgement • Nepal Dental Association • Central Department of Microbiology, TU • participating schools, students and their guardians • Volunteer dentists and enumerators • Dr. Sudin Shakya and Dr. Sudhamshu KC • Mr. Anil Thapa, Visiting lecturer CDM-TU