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 Table of Contents  
Year : 2018  |  Volume : 25  |  Issue : 4  |  Page : 239-245

Dental caries and oral hygiene status: Survey of schoolchildren in rural communities, Southwest Nigeria

1 Department of Family Dentistry, University College Hospital, Ibadan, Oyo State, Nigeria
2 Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Oyo State, Nigeria
3 Department of Oral Pathology, University of Ibadan, Ibadan, Oyo State, Nigeria

Date of Web Publication21-Dec-2018

Correspondence Address:
Dr. Clara Arianta Akinyamoju
Department of Family Dentistry, University College Hospital, Queen Elizabeth Road, Oritamefa, PMB 5116, Ibadan, Oyo State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/npmj.npmj_138_18

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Purpose: Dental caries and poor oral hygiene cause pain and have an effect on activities of children such as playing, sleeping, eating and school attendance. Previous studies on the prevalence of dental caries and poor oral hygiene have focused more on urban than rural communities in the developing countries. The objective of the study was to assess dental caries and oral hygiene status of schoolchildren in rural communities. Materials and Methods: It was a cross-sectional study involving 778 schoolchildren from 12 public primary schools. A pre-tested, semi-structured interviewer-administered questionnaire was used to obtain information on socio-demographics and oral health practice. Dental caries was assessed using the decayed, missing and filled teeth (DMFT) index and oral hygiene status by the simplified oral hygiene and gingival indices. Results: The mean age of the children was 11.0 ± 1.8 years, and the prevalence of dental caries was 12.2% with a mean DMFT/dmft of 0.2 ± 0.7. Children aged 10–12 years were 3 times more likely to have caries on ≥1 tooth (P = 0.01, confidence interval = 1.3–6.7). Herbal remedies were more often (35.3%) used to manage dental problems. The mean simplified oral hygiene and gingival indices were 1.7 ± 0.9 and 1.1 ± 0.5, respectively. Conclusion: The occurrence of dental caries appears to be increasing in rural Nigerian schoolchildren, but still within WHO limits. Oral hygiene status was poor and gingivitis was common.

Keywords: Oral health, rural, schoolchildren

How to cite this article:
Akinyamoju CA, Dairo DM, Adeoye IA, Akinyamoju AO. Dental caries and oral hygiene status: Survey of schoolchildren in rural communities, Southwest Nigeria. Niger Postgrad Med J 2018;25:239-45

How to cite this URL:
Akinyamoju CA, Dairo DM, Adeoye IA, Akinyamoju AO. Dental caries and oral hygiene status: Survey of schoolchildren in rural communities, Southwest Nigeria. Niger Postgrad Med J [serial online] 2018 [cited 2022 Jan 27];25:239-45. Available from: https://www.npmj.org/text.asp?2018/25/4/239/248209

  Introduction Top

Dental caries is a common oral health problem in children and occurs in individuals of all socio-economic strata. Poor oral hygiene has also been seen to be quite high in children especially those living in rural areas.[1],[2] Lack of dental services at the primary health-care level is said to account for the poor oral health status of rural children in Nigeria.[2] Rural areas usually have fewer dentists per population and are more deprived, thereby reducing access to dental care for children in these communities.[3],[4]

Furthermore, the disparity in health outcomes between rural and urban areas continues to expand and is very obvious in oral health-care delivery in rural settlements.[5] In a study of a rural community in Nigeria, it was reported that about half of the decayed teeth remained untreated, only 2.8% of the decayed teeth were restored. The authors stated poor utilisation of oral health services as a reason for the latter observations.[6] In view of the aforementioned challenges, school health programmes in combination with other community-based interventions can be considered as means for health promotion in children and adolescents.

This phase of life is the time of change from a deciduous dentition to permanent. At this vital period of development, oral health behaviour can be influenced.[7],[8] At present in Nigeria, there is a scarcity of information that can be used for meaningful planning of oral health-care services, especially in rural communities.[9] Thus, this study aimed to assess the caries experience, oral hygiene status and their association with each other in primary schoolchildren in rural communities to provide adequate epidemiological data necessary for planning oral health promotion activities through a school health programme.

  Materials and Methods Top

This was a cross-sectional survey conducted amongst 778 primary schoolchildren aged 7–17 years in classes 3–6 at Obafemi Owode local government area (LGA) Ogun state, Southwest Nigeria. The communities that make up the LGA are predominantly rural, and the residents are mainly farmers and traders. Ethical clearance for the study was obtained from the joint University of Ibadan/University College Hospital Ethical Review Committee (UI/EC/10/0190) on the 17th March 2011. Approval for the study was obtained from the Schools' Board. Informed consent was obtained from the Parents/Teachers Associations of the various schools and assent was given verbally by the pupils before participation in the study. Data were collected between November and December 2012.

A multistage sampling technique was used: Obafemi zone was purposively selected from the three zones in the LGA because the Aladura Rural Health Outreach Programme of the Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan is located in the zone. The Aladura Rural Health Outreach Programme is a private-public collaboration between the Joseph Ijaola Memorial Foundation, College of Medicine, University of Ibadan and the University College Hospital, Ibadan. The health outpost is a proposed referral and coordinating centre for a school health programme. Ajebo and Ogunmakin were selected out of the four educational sectors in the zone. A list of all the schools in alphabetical order was obtained from the LGA office. The schools to be studied were then randomly selected from the list using a table of random numbers. The accessibility of each school was determined based on the condition of the roads to the school; those that were inaccessible because of poor road condition were excluded from the selection procedure. Twelve schools were selected from a total of 31 schools. All the children present in school on the day their schools were visited participated in the study.

A pre-tested, semi-structured interviewer-administered questionnaire was used to obtain data on their socio-demographic characteristics and oral hygiene practice such as frequency of cleaning the mouth, type of mouth cleaning device used and frequency of change of mouth cleaning device, frequency of sugar snack consumption and action taken by parents to manage dental problems. The questionnaire was pretested among 30 class 4 primary school pupils in a single school. Oral examination was not done for this group of pupils. The questionnaire was translated into the local language (Yoruba) and back-translated into English. It was administered in the local language where this was preferred by the participant. The interviews were conducted by an auxiliary nurse and a dental surgeon; they had good knowledge and were fluent in speaking the English and Yoruba languages. The questionnaire was administered to 779 schoolchildren, but 778 of them had both questionnaire and oral examination.

The oral examination was done with participants sitting on a plastic chair under a tree in the school compound. The procedure was done using a plain mouth mirror and a blunt probe (CPITN periodontal probe) under natural light by three dental surgeons. The examiners were calibrated before the commencement of the study. Measurements of intra- and inter-examiner reproducibility were based on repeated clinical examinations. Measurements of the intra- and inter-examiner agreement using Kappa statistics yielded values ranging from 0.85 to 0.96.

The decayed, missing and filled teeth (DMFT/dmft) index was used to assess the caries experience of the participants; it describes the amount of dental caries in an individual. It numerically expresses the caries prevalence by calculating the number of decayed, missing due to caries and filled teeth using the WHO diagnostic criteria.[10] The sum of the three figures obtained gives the DMFT/dmft value. Lesions in a pit or fissure or on a smooth tooth surface and had a detectable softened floor undermined enamel or softened wall were coded as carious. Teeth having permanent restorations and no caries adjacent to previously filled areas on a tooth or other areas with primary caries were coded as filled without decay. Extractions as a result of caries were regarded as missing due to caries. The DMFT indicates caries prevalence in the permanent dentition while dmft for the deciduous dentition.[10]

The oral hygiene status was assessed using the simplified oral hygiene (OHI-S) index and the gingival index for gingivitis. The OHI-S index is made up of debris and calculus components. The OHI-S score was obtained by summing the debris index and calculus index scores of an individual after examination of the buccal and lingual surfaces of the six index teeth (the upper first molars, lower first molars, upper right central and lower left central incisors). A score of 0–1.2 indicates good, 1.3–3.0: Fair and 3.1–6.0: Poor oral hygiene. For assessment of gingivitis, the scores obtained for the buccal, lingual, mesial and distal surfaces of the index teeth (upper right first molar and lateral incisor, upper left first premolar, lower right first premolar, lower left lateral incisor and first molar) examined were added and divided by the number of teeth (six) examined to derive the gingival index for an individual. A score of 0.1–1 denoted mild gingivitis, 1.1–2: moderate gingivitis and 2.1–3 severe gingivitis. Each study participant was given a toothbrush and toothpaste; oral health education was also given to the schoolchildren as benefits for participating in the study. In addition, children with complications from oral diseases such as dental caries were given referrals to the nearest government dental facility.

The data were analysed using Statistical Package for Social Sciences version 19, (Chicago, IL, USA). Chi-square test was used to determine the association between DMFT/dmft and age, gender; oral hygiene status and age, gender. Multivariate logistic regression analysis was performed to assess the variables which were potentially significant predictors of oral health status. The level of significance was set at 0.05.

  Results Top

A total of 778 primary schoolchildren in 12 primary schools were administered questionnaires and had oral examination. The pupils were made up of 424 (54.5%) males and 354 (45.5%) females. The mean age of the children was 11.0 ± 1.8 years [Table 1]. Ninety-five (12.2%) children had a DMFT/dmft score ≥1 involving 168 teeth. Most 120 (71.4%) of the teeth affected by caries were in the mandible. Ninety-one (54.2%) of them were deciduous teeth while 77 (45.8%) were permanent teeth [Table 2]. The permanent teeth most 70(41.7%) affected by caries were the first permanent molars [Figure 1]. The D/d (decayed) was the dominant component (100%) of the DMFT/dmft score. The mean DMFT/dmft was 0.2 ± 0.7.
Table 1: Characteristics of schoolchildren by sociodemographics and oral health practice

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Table 2: Distribution of the oral health features of the schoolchildren

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Figure 1: Frequency distribution of teeth series affected by dental caries

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More males 50 (52.6%) had a DMFT/dmft ≥1 than females 45 (47.4%). More than half (60.0%) of the children with DMFT/dmft ≥1 were in the 10–12 years age group. The latter group of children was 3 times more likely to have a DMFT/dmft ≥1 compared with those in the 7–9 years age group (P = 0.01, 95% confidence interval = 1.3–6.7) [Table 3]. Children who cleaned their teeth once daily had a higher 71 (74.7%) caries prevalence. Caries prevalence was less in those who replaced their tooth cleaning device more frequently [Table 3]. In addition, the children whose mothers had no formal education had fewer carious lesions 13 (13.8%) compared with children whose mothers had a primary 46 (47.9%) or secondary 36 (38.3%) education. A child's father's level of education was also seen to be significantly associated with the prevalence of caries in the child (P = 0.01) [Table 3].
Table 3: Dental caries of the schoolchildren by sociodemographics and oral health practices

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Concerning their oral hygiene, a little more than half 442 (57.7%) of them had fair oral hygiene. The mean simplified oral hygiene and gingival indices were 1.7 ± 0.9 and 1.1 ± 0.5 respectively, [Table 2]. The mean oral hygiene index by gender was 1.8 ± 0.9 for males and 1.6 ± 0.9 for females (t = 2.75, P = 0.006). Females were 1.4 times more likely to have a good oral hygiene compared with males (P = 0.03). Poor oral hygiene was more common 139 (60.2%) in the 10-12 year old children [Table 4].
Table 4: Oral hygiene status of schoolchildren by sociodemographics and oral health practices

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The percentage of children with good oral hygiene increased as the level of education of their mothers increased; this observation was not statistically significant. Children whose mothers had no formal education 25 (10.8%) were less likely to have good oral hygiene [Table 4].

Improved oral hygiene status did not mean a lower prevalence of caries. There was no significant association between caries prevalence and level of oral hygiene. Children with poor oral hygiene level had fewer carious teeth.

  Discussion Top

Oral health is an essential part of overall health and quality of life; hence requires close monitoring and early treatment where necessary.[11] Amongst this study population, the D/d (decayed) was the predominant component of the DMFT/dmft, which is similar to observations in other rural Nigerian children.[6],[12],[13] Likewise in several studies on rural African children.[14],[15],[16] The high level of untreated dental caries in the above populations reflects a low utilisation of dental services, which may be as a result of limited access to dental care in terms of cost and availability.[17] This corroborates the fact that untreated dental caries is experienced much more often by socio-economically disadvantaged children.[18] Moreover, in developing countries, there is low oral health workforce, inadequate oral health facilities and most dental clinics are located in urban settings; so rural children who need dental care may have to visit a dentist in a major neighbouring town.[3]

The percentage of children (12.2%) with caries in this study was higher than 5.7% reported for some rural schoolchildren in the southwest of Nigeria.[16] Notwithstanding the increase in caries prevalence in this study, it is lower than that observed in similarly aged children residing in rural areas in other countries such as India and Australia.[19],[20] A higher prevalence of caries was seen in the deciduous dentition of the schoolchildren in this study, compared with that seen amongst rural Ugandan children.[21] The children being in the early to late mixed dentition stage may account for this, as the permanent teeth present in their mouths have not been exposed to the same oral environment for as long as the deciduous teeth.

Considering the tooth series most commonly affected by caries, epidemiological survey data have revealed that caries in the permanent dentition is usually found in the first molars.[22] The observations in this study are in agreement with the latter finding. Owino et al.[16] and Mafuvadze et al.[23] also observed a similar pattern in their respective studies. The clinical crown morphology of these teeth is thought to make them more susceptible to decay, as well as the fact that they are the first permanent teeth to erupt and are exposed to the oral environment earlier. With respect to sex, Okoye and Ekwueme[6] reported higher caries prevalence for females amongst rural children in Enugu, Nigeria. Commonly, females have been seen to have higher caries prevalence than males of the same chronological age.[24] The explanation is that girls erupt their teeth earlier than boys, as such are exposed earlier and longer to the risk of attack by caries. However, in this study, more males were affected by caries.[25]

Dixit et al.[26] and Ohalete et al.[27] observed that younger children were more affected by caries, this is in agreement with the findings in this study. Younger children are said to have a higher consumption of sugar and sugary products, and this is important in the pathogenesis of caries.[28] The frequency of consumption of sugar snacks by the schoolchildren in this study was higher than that previously reported in other African children. Mafuvadze et al.[23] stated the pattern of sugar snack consumption in rural Zimbabwean children as 0.0% and 41.6% for daily and occasional consumption, respectively. Ayele et al.[29] also reported that 23.6% of Ethiopian schoolchildren eat sugar snacks daily. However, a higher prevalence of caries was seen in the latter study populations. This may be due to the fact that fewer children used fluoride-containing toothpaste to clean their teeth.[23]

On the other hand, despite reports of high use of the toothbrush and toothpaste by some rural African children, the prevalence of poor oral hygiene is still high.[6],[30] Inadequate knowledge on the proper use of these tooth cleaning aids may account for the poor oral hygiene. The oral hygiene status of the children in this study was similar to that of rural children reported in previous studies in Nigeria[30],[31] and amongst children in Kuwait.[32] Although the frequency with which the children in this study cleaned their mouth differed from that of rural schoolchildren from other climes.[23] In this study and among other rural schoolchildren in Nigeria, irregular cleaning of teeth was practiced by a far lower percentage of children compared with those in Zimbabwe.[31] However, 70% of a population of Filipino schoolchildren were observed to clean their teeth twice or more times a day. Cleaning the teeth twice or more daily was carried out by very few of the children in this study and likewise by other rural Nigerian children.[31],[33] Limited financial resources may account for rural African children cleaning their teeth once daily or less especially those using the toothbrush and toothpaste; as these tooth cleaning aids need to be replaced from time to time.

The oral hygiene status of the participants with respect to sex showed females having better oral hygiene, which was similarly observed in other studies.[32],[34] Females being more meticulous with activities relating to their appearance may be responsible for them taking better care of their mouth. Regarding, the health of their gingivae, the proportion of children with gingivitis in this study was fairly higher than that observed in rural Kenyan children but was comparable with that seen in rural Brazilian children.[14],[35]

  Conclusion Top

Caries prevalence in rural Nigerian children though below the WHO goal of not more than 3 DMF teeth at 12 years of age is on the rise. The oral hygiene status of subjects was poor, and gingivitis was common. There was no association between caries prevalence and oral hygiene. The increase in caries prevalence buttresses the concern that dental caries will continue to be a major oral health issue for children in Sub-Saharan Africa. Oral health is still an unfulfilled need for most children in Nigeria, especially those in rural areas.

Radiographs could not be used to detect non-cavitated and interproximal caries in this study; as a result, the caries experience values may be an underestimation of the caries prevalence. There is a need for continued research that will involve parents, caregivers and others in the community such as teachers, to develop means to improve the understanding and adoption of good oral health behaviours by children in rural communities. It is also important to monitor the oral health trends.

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  [Figure 1]

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

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