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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 24  |  Issue : 1  |  Page : 37-43

Self-reported dental pain and dental caries among 8–12-year-old school children: An exploratory survey in Lagos, Nigeria


1 Department of Preventive Dentistry, Faculty of Dentistry, LASUCOM, Lagos, Nigeria
2 Department of Community Health and Primary Health Care, Faculty of Clinical Sciences, LASUCOM, Lagos, Nigeria

Date of Web Publication9-May-2017

Correspondence Address:
Abiola A Adeniyi
Department of Preventive Dentistry, Faculty of Dentistry, Lagos State University College of Medicine, P.O. Box 21266, Ikeja, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_7_17

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  Abstract 

Background: Dental pain is considered an important public health problem because it affects the daily life of children. This study was designed to assess the prevalence, associated factors, and impact of dental pain among 8–12-year-old school children in Lagos, Nigeria. Subjects and Methods: A cross-sectional survey to determine self-reported dental pain among 8–12-year-old school children using an interviewer-administered questionnaire was conducted. This was followed by a clinical examination to determine the child’s oral hygiene status and dental caries status. Chi-square and Fisher’s exact tests were used for comparing proportions. Binary logistic regression analysis was also conducted. Statistical significance was set at P < 0.05. Results: Of the 414 children included in the survey, 254 (61.4%) children and 103 (24.9%) children reported experiencing dental pain 3 months and 4 weeks before the survey, respectively. Caries prevalence was 21.0%, whereas mean decayed, missing, and filled tooth index score was 0.4420 (±1.078). A report of pain up to 3 months before the survey was significantly associated with the child’s age [odds ratio (OR) = 1.254; confidence interval (CI) = 1.037–1.516; P = 0.019], whereas the type of school attended (OR = 1.786; CI = 1.124–2.840; P = 0.014) and the presence of dental caries (OR = 1.738; CI = 1.023–2.953; P = 0.041) were significantly associated with reporting pain 4 weeks before the survey. Conclusion: The prevalence of self-reported dental pain was high among the children surveyed. Report of dental pain was associated with the presence of dental caries. The provision of school oral health services could be useful in reducing the level of untreated caries and possibly dental pain among school children.

Keywords: Dental caries, dental pain, school children


How to cite this article:
Adeniyi AA, Odusanya OO. Self-reported dental pain and dental caries among 8–12-year-old school children: An exploratory survey in Lagos, Nigeria. Niger Postgrad Med J 2017;24:37-43

How to cite this URL:
Adeniyi AA, Odusanya OO. Self-reported dental pain and dental caries among 8–12-year-old school children: An exploratory survey in Lagos, Nigeria. Niger Postgrad Med J [serial online] 2017 [cited 2020 Sep 18];24:37-43. Available from: http://www.npmj.org/text.asp?2017/24/1/37/205979


  Introduction Top


Dental diseases are common in children, and have been reported as a major cause of lost school hours.[1],[2] It is also a factor contributing to lower academic achievements among children.[3] In particular, dental caries has been identified as the most common dental condition in children affecting 60–90% of children globally.[4],[5] Dental caries reportedly occurs 5–8 times more frequently than asthma and is rated the second most common condition in school-aged children.[4] It is a microbial disease, which results in the demineralization of dental hard tissues that is the enamel, dentine, and cementum. In Nigeria, research also confirms that dental caries is the most common dental disease in children and is a common reason for seeking dental attention.[6] Typically, dental caries does not cause pain unless it is left untreated, and the lesion spreads to the dental pulp, which is an innervated tissue.

Dental pain is described as a pain originating from innervated tissues within the tooth or immediately adjacent to it[7] and is considered synonymous with toothache. The experience of pain could lead to avoidance of certain types of food, disturbance of play and sleep patterns, and decreased school performance.[3] These impacts are important because they are constructs in the measurement of quality of life.[10] Dental pain is, therefore, considered an important public health problem because it could lead to considerable restrictions in the daily life of children.

Studies have reported the widespread prevalence of dental pain among school children; in Europe, the prevalence reported were 47.5%[3] and 61%,[7] in Brazil, 31.7%[11] and 33.7%,[12] in Sri Lanka 49%,[13] and in Pakistan 30.1%.[14] A study in Nigeria also reported that 84.5% of pediatric dental clinic attendance was due to pain.[15] The prevalence of dental pain and its impact on daily living have been the subject of recent research because it gives an indication of subjective oral health status. It is also an important tool in the planning of oral health care services and advocacy for improving oral health status especially among children.[16] This is important in low-income nations, where achieving oral health is not yet a priority.

Nigeria is a low-income country, where the majority of the population, especially children, have a limited access to oral health care services.[17] Research reports have consistently reported that dental caries occurs among Nigerian children with the prevalence rates ranging between 11.2 and 48%, and majority of the lesions are untreated.[18],[19] Research reports also shows poor dental visiting patterns among children in Nigeria.[18],[19] Therefore, it is likely that many children affected by dental caries will experience pain without seeking dental care. This is important, as pain has been identified as the most common motivation for seeking dental care. However, to our knowledge, no study has explored the subjective report of pain among children in Nigeria. There is also little information regarding the factors associated with dental pain, and its impact on daily life among children in Nigeria. Thus, this study was designed to assess the prevalence, associated factors, and impact of oral pain in 8–12-year-old school children in Lagos, Nigeria. We specifically sought to determine the relationship between a report of dental pain and the occurrence of dental caries in the study population.


  Subjects and Methods Top


Study location and methodology

A cross-sectional survey of children aged 8–12 years attending primary schools was conducted using an interviewer-administered questionnaire in Lagos State, Nigeria. The study was conducted in Lagos State, Nigeria, which is the smallest state by landmass; it is one of the most populated states and is the economic nerve center of the country. The state is socially and economically diverse and comprises persons from the majority of the over 250 ethnic groups in the country. The state is divided into 20 Local Government Areas (LGAs), and each area is the smallest unit of governance in the country. The study was conducted in Suru-Lere LGA, which comprises both residential and commercial areas.

Ethical considerations

Ethical approval was obtained on 30th August 2016 from Lagos State University Teaching Hospital Health Research and Ethics Committee, GRA, Ikeja, Lagos (Ref. No.: LREC, 06/10/805), and permission to conduct the study was also obtained from the school authorities. Written parental consent was obtained before enrolling children in the study, and all the children included also agreed verbally to participate in the study before inclusion.

Sample selection

A multistage sampling method was adopted for conducting this study. In the first stage, Suru-Lere LGA was selected by a simple, random method (balloting) from the 20 LGAs in the state. The sampling frame was a list of public and private primary schools in the LGA obtained from the Local Education Department. One public and one private school were then selected by the simple random method. All the consecutive children aged 8–12 years present during data collection in the selected schools were eligible to participate in the survey. We limited our data collection to 8–12-year-old school children because the data collection tool utilized for the study had been previously validated in this age group only. A letter was sent to the parents of the children in the schools explaining the aim, characteristics, and importance of the study and asking for parental approval. Using the selected schools’ registers, a total of 488 children were found to be eligible to participate in the study. Of this figure, 187 and 301 students were eligible from the selected private and public schools, respectively. Children without signed, parental consent forms or who declined to participate were excluded from the study, which was conducted from September to November 2016.

Data collection and data collection tool

Data collection was executed using a structured interviewer-administered questionnaire followed by a clinical dental examination. A minimum sample size of 384 children was calculated based on an assumed prevalence of reported dental pain of 50% and a standard error of 5%. The data collection tool was an interviewer-administered questionnaire developed from a previously validated instrument,[7] and a dental examination record was formed based on the WHO oral health survey guidelines.[20] The tool was pretested on 30 children at a public school in Ikeja LGA. Three trained interviewers administered the instrument. The instrument comprised both closed-ended and open-ended questions and had three sections. Section one included questions on the sociodemographic characteristics such as age and gender, as well as dental clinic attendance in the 3 years preceding the study. Section two explored the children’s satisfaction with their dental appearance, and their subjective report of dental pain experience 3 months and 4 weeks before the study. Further questions to determine the number of episodes experienced, the characteristics of the pain, severity, and early management of the pain experience were also included. We regarded the pain that resulted in the child crying as severe pain. The third section contained the dental record form used to record observations from the clinical examination.

Clinical examination

Clinical examinations were conducted under field conditions in the classroom setting by one dentist (AAA), and a trained assistant recorded the observations. Students were examined using mouth mirrors and wooden spatulas while seated on a chair, using natural light. Oral hygiene status was assessed using the Simplified Oral Hygiene Index of Greene and Vermillion (1964).[21] The oral hygiene score was computed from the debris and calculus scores. The oral hygiene status was graded as follows: a score of 0–1.2 was considered good, 1.21–3.0 fair, and 3.1–6.0 poor. Caries status was assessed using the decayed, missing, and filled tooth index (DMFT) as described by the World Health Organization.[20] Caries was recorded as being present when a lesion in a pit/fissure or on a smooth surface had obvious cavitation. A tooth was considered missing if there was a history of extraction due to pain and/or the presence of a cavity. Any tooth with a restoration was considered filled.

Data analysis

Data were processed for analysis using the Statistical Package for the Social Sciences version 20.0 software for Windows (SPSS Inc., Chicago, IL, United States). Self-reported oral pain prevalence (the outcome variable) was estimated, and an association with sociodemographic/economic factors and dental caries occurrence was sought. Confidence intervals (95%) were calculated for the prevalence of dental pain and for caries experience. The chi-square and Fisher’s exact tests were used to evaluate the relationship between nonclinical/clinical data and dental pain prevalence. Binary logistic regression was used to evaluate the factors associated with dental pain.


  Results Top


Sociodemographic characteristics and dental visit history of children surveyed

A total of 414 children participated in this survey giving a response rate of 84.8%. The mean age of the study participants was 9.68 (±1.10) years; in that, 214 (51.7%) were male. A slightly higher proportion of the children surveyed (244 or 58.9%) attended the public school. Majority of the children (323; 78.0%) reported being satisfied with their dental appearance. A total of 130 children representing 31.4% of the study population reported a previous dental visit prior to the conduct of this survey.

Pattern of self-reported dental pain

A total of 254 (61.4%) children reported dental pain in the 3-month period preceding the survey; out of which, 158 (38.2%) considered the pain severe because it made them cry [Table 1]. Furthermore, 103 (24.9%) children reported experiencing dental pain 4 weeks before the survey; out of which 70 (16.9%) reported crying from the severity of the pain. Regarding the number of episodes, majority (131; 51.6%) experienced pain five times or less, whereas 11 (0.4%) reported more than six episodes of pain; the remaining were unsure of the number of times they experienced pain in the 3-month period before the study. A significantly higher proportion of 8-year-old children reported dental pain in the 3 months preceding the conduct of this survey (P = 0.010), whereas a significantly higher proportion of public school children reported dental pain 4 weeks before the study (P = 0.008).
Table 1: Prevalence of pain among study participants at 3 months and 4 weeks

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[Figure 1] depicts the factors identified by the children as worsening their pain experience. The factor most reported was sweet foods (34.3%) closely followed by chewing (33.5%). Regarding the impact of dental pain on their daily activities, the highest proportion of the children surveyed reported that their experience of dental pain affected their ability to eat (35.8%) while the lowest proportion (7.5%) reported that the pain disturbed their ability to attend school [Figure 2]. Among children who experienced pain, 78 (30.7%) reported waking up at night due to the pain.
Figure 1: Aggravating factors of self-reported pain among surveyed children

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Figure 2: Impact of pain on daily activities

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Management of pain experience

In the management of their pain experience, majority of the children reported seeking help from their parents, and a slightly higher number reported seeking help from their mother [Figure 3]. In the early management of the pain experience, a large number of people reported the use of medicines at home (81; 31.9%), and a few others reported using other home therapies such as warm saline mouth baths. Other measures reported were a visit to the dentist by 55 children (21.7%), a visit to a medical doctor by 31 children (12.2%), a visit to a nurse by 17 children (6.7%), and a visit to a chemist by 33 (13.0%) children. Only 92 (36.2%) children reported the initial management strategies effectively relieved their pain.
Figure 3: Caregiver who provided support for child’s pain experience

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Dental caries and oral hygiene status

Overall, 21.0% of the children had at least one carious lesion in the primary or permanent teeth. Majority of the carious lesions affected the primary dentition as 15.7% of the study population had lesions in the primary dentition, whereas only 6.5% of the population had lesions in the permanent dentition. Majority had one or two (65 or 15.7%) teeth affected by dental caries, whereas only a small number (22 or 5.3%) had more than three teeth affected by caries. Untreated, decayed teeth accounted for 85.8% of the total DMFT score. The mean DMFT score was 0.4420 (±1.078). Using the simplified OHI score, 78.7% had good oral hygiene while 20.5% had fair OHI scores. The presence of dental caries was not statistically related to the child’s age category, gender, type of school, satisfaction with dental appearance, or oral hygiene status [Table 2].
Table 2: Dental caries experience of the study population by their sociodemographic characteristics, satisfaction with dental appearance, and oral hygiene status

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Factors associated with dental pain

Among children who reported dental pain in the 3 months preceding the survey, the relationship among the child’s age category, gender, type of school, satisfaction with dental appearance, oral hygiene status, and dental caries occurrence was not statistically significant [Table 3]. Similarly, a report of dental pain up to 4 weeks before the survey was not statistically related to the child’s age category, gender, type of school, satisfaction with dental appearance, oral hygiene status, and dental caries occurrence [Table 3].
Table 3: Dental caries experience among children who reported dental pain within 3 months of data collection by their sociodemographic characteristics, satisfaction with dental appearance, and oral hygiene status

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The result of the binary logistic regression analysis is presented in [Table 4]. A report of pain up to 3 months before the survey was significantly associated with the child’s age. The odds for reporting dental pain increased by 25.4% (P = 0.019) for the increase of every year in a child’s age.
Table 4: Factors associated with dental pain

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In addition, a child attending public school was 78.6% more likely to report pain up to 4 weeks before the survey than a child attending a private school. The relationship was statistically significant (P = 0.014). Children with dental caries were 73.8% more likely to report dental pain 4 weeks before the survey (P = 0.041) than children without caries.


  Discussion Top


The results from this study show that the prevalence of dental pain among 8–12-year-old school children in Lagos 3 months before the survey was high (60%). In addition, almost a quarter of the children experienced pain up to 4 weeks before the survey. Moreover, the severity and impact of the pain were substantial; more than one-third of the children reported crying from dental pain 3 months before the survey, whereas 16.9% reported crying 4 weeks before the survey. Many of the children reported that the pain impacted their daily activities such as eating and playing, although only a small proportion of children missed school because of dental pain. The prevalence of dental pain in this study is higher than which was reported in the UK[7] and Uganda[22] but is similar to a report among South African children.[23] It is, however, lower than the result of an earlier study conducted in Nigeria. This is probably because the former study was conducted in the clinic.[14] These results indicate that dental pain is a major concern among school children in Lagos State.

Several dental conditions can result in pain among children such as trauma to the teeth, eruption of permanent teeth or exfoliation of the deciduous teeth, and dental caries.[7] Dental caries is the most common dental condition in children and is likely to be a major cause of dental pain in children. The prevalence of dental caries in this study was 21%, which is within the range reported in earlier researches.[6],[18],[19] A finding also reported in previous studies that majority of the carious lesions were untreated (85.8%).[18],[19] This finding was also reported among school children in Uganda[22] and is consistent with the findings from other developing countries. This pattern may be the reason for the seemingly high report of pain in our study population.

The mean DMFT score in the study population was also low, and this result is also consistent with the recent findings among Nigerian children.[18],[19] Surprisingly, our results show that age and oral hygiene status were not important determinants of dental caries. This conflicts with results from earlier studies in Nigeria and may be explained by the fact that our study focused on 8–12-year-old pupils. Many of the other studies assessing the relationship between age and caries occurrence focused on either a wider age range usually 6–12 years or only specific age such as 12 years.

Further analysis to identify factors that were associated with a report of dental pain among children in Nigeria revealed that the child’s age, type of school attended, and the presence of caries were important factors. For every year increase in a child’s age, the odds of reporting dental pain increased by 25.4%. This is not surprising, as older children with untreated dental caries are more likely to experience an extension of the carious lesion to the pulp, thereby, stimulating pain. However, the children who attended the public school had significantly higher odds of reporting dental pain. Children in public schools tend to be from the lower strata in society; their parents may have more financial difficulties in accessing dental care and are, therefore, more likely to have untreated dental lesions, which would result in pain. Although a bivariate analysis showed no significant association between dental caries occurrence and a report of dental pain, yet a logistic regression analysis indicated that dental caries might be an important predictor of pain. Clearly, any proactive action to reduce the prevalence of untreated caries among school children may be useful in reducing the prevalence of pain among school children in Lagos State.

There are some limitations to the generalization of the results of this study to Nigerian children. First, cross-sectional study designs are weak in establishing temporal relationships and causality; therefore, some prospective studies may be required to establish the relationship between dental caries and dental pain. The use of an interviewer-administered questionnaire as was performed in this study is associated with certain limitations, namely the recall bias and the risk of providing socially desirable responses. In addition, the self-reported dental pain among children is quite challenging, as they often fail to identify that the pain was dental in origin, and they might include some other conditions in their reports.[3] Kiwanuka and Astrom[22] in their research, however, affirmed the validity of a self-report, particularly, when a question on more recently experienced dental pain is included as was considered in this study. The results, therefore, provide an overview of the dental pain experience of school children in Lagos, Nigeria. In addition, only one dentist performed the examinations, and efforts were made to make sure that all examinations were conducted under optimum conditions to reduce intraexaminer variability.


  Conclusion Top


This study indicates that the prevalence or self-reported dental pain was high among 8–12-year-old children in Lagos. Untreated caries accounted for a large proportion of dental caries experience, although the caries prevalence and DMFT scores were low. Caries preventive activities in schools, especially, the provision of treatment services would be useful in reducing the level of untreated caries and very likely dental pain in Lagos.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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