Dentistry: Advanced Research (ISSN: 2574-7347)

Article / research article

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

Abdulrahman Alshehri* 
Bachelor in Dental Surgery Kingdom of Saudi Arabia, Abha, Saudi Arabia 
*Corresponding author: Bachelor in dental surgery Kingdom of Saudi Arabia, Abha, Saudi Arabia, Tel: +966554120081; E-mail: d7mee-2013@hotmail.com
Received Date: 11 July, 2016; Accepted Date: 26 July, 2016; Published Date: 09 August, 2016

Introduction

Early childhood caries is a complex, serious and multi-factorial origin disease that involves the susceptible tooth and host, fermentable carbohydrates and cariogenic micro-organisms with the passage of time. The aim of this study and discuss was to analyze the influence of socio-behavioral variables on the prevalence of dental caries among children between four and five years old.

Method

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

Results

It was found that caries have been significantly more prevalent in children from families with employed mothers (p=0.00811). The presence of dental caries was found to be associated with the absence of oral health educators, oral health improving programs and oral health campaigns (p=0.0012).

Conclusion

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 present study has identified risk factors of ECC in pre-school children within a Saudi community. ECC risk can significantly increase for children living with an occupied mother (p=0.00811), consuming more sweets (p=0.00001), and an absence of oral health educators and oral health promotion programs (p=0.0012). These factors could be modified through public health strategies, such as practical health advice, effective publicity concerning general dental health and developing effective strategies to promote awareness amongst the Saudi community.

Keywords: Behavioral; Caries; Children; Oral; Saudi; Social; ECC

Early childhood caries is a complex, serious and multi-factorial origin disease that involves the susceptible tooth and host, fermentable carbohydrates and cariogenic micro-organisms with the passage of time [1,2]. Early Childhood Caries (ECC) has been defined as a rampant dental disease that affects mostly young children up to 71 months of age. In recent decades, there have been significant betterments 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 decay has diminished in the Caribbean and Latin America [4]. In Brazil, there was a 17% decrease in dental caries between 2003 and 2010, and the (dmft index), decayed, missing, and filled teeth 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 behavioral, demographic and social factors such as family status and income, tooth brushing habits and parental knowledge and beliefs, maternal education level [6,7]. Although the predictive power of the variables studied so far was inconsistent, the high disease experience within selected community groups suggests the potential impact of factors other than the existence of Mutants streptococci unique in contributing to ECC up growth. Other cross-sectional models manifest the complex interfere between ethnicity, Socio-Economic Status (SES), fluoride exposure, oral hygiene, infant feeding and ECC presence in preschool children [8-17]. However, extrapolation of current risk assessment models to the general population is still problematic because most studies of ECC have been conducted among lower socio-economic communities and specific ethnic.

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 discuss the relationship between the presence of ECC in the 4-5 years old Saudi child population and selected social and behavioral variables.

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 age group of pre-school children within the Aseer region of Saudi Arabia.

Method and Design

A cross-sectional study involving the young pre-school Saudi child population, aged between 4 and 5 years in the Aseer region – a region located in the Southern part of Saudi Arabia, was conducted. For this purpose, information was obtained using prevalence data – percentage with caries. In the present study, the participants were children aged between 4 and 5 years who were treated at dental clinics in five selected Primary Health Care Centers in the 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 varying between Multiple Choices Questions (MCQs), Likert scale and short essay questions. Moreover, the questionnaire was divided into three sections each of them consisted of eight items and pretested on 30 randomly selected individuals who came to the Although Primary Health Care Center, one of the previously selected centers. Additionally, the first section of the questionnaire was prepared to investigate Parents’ knowledge in regard of dental caries, the second section to gain information regarding selected social and behavioral variables and the third section to inspect ECC experience and practices. The investigators were the dentists working at the selected dental clinics after we assured that they were aware of the WHO criteria for detecting caries by means of interviews. The parents were asked to complete the questionnaire in the clinic while dentists were screening their kids. The investigation was conducted 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 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.

Permission to conduct the study obtained from the Institutional Review Board, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. Also, verbal consent obtained from all the participants.

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 i.e., X2=43.13, df=1, Pvalue=.00001 (Table 1and 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 (Table 2). With regard to occupation of mothers, more than 70% (N=299) of children had employed mothers and 29.14% with mothers who were house wives, 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 i.e., X2=7.009, df=1, Pvalue=0.00811 (Table 2)

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 sweets 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 X2=125.11, df=2, Pvalue=0.00001 (Table 2).

According to data, only 25.36% of children (N=107) brushed their teeth, 63.55% of them had no caries; whereas, of the 78 out of 422 children who used Siwak to brush their teeth, 82.1% of them had caries. The majority of children in this study (N=191) recorded in the “Mixed group”, used both toothbrush and Siwak to brush their teeth. It is found that 94.76% of children in the “Mixed group” had caries. There was a statistically significant correlation between caries prevalence and the method to apply oral hygiene i.e., X2=144.17, df=3, Pvalue=0.00001 (Table 2). The majority of sample (N=291) 68.96% chose soft drinks, out of which 94.16% had caries. There was a statistically significant relation between prevalence of dental caries and type of drinks i.e., X2=159.76, df=2, Pvalue=0.00001 (Table 2).

A total of 97.87% (N=413) of the final sample recorded that they had not attended or were not invited to any lecture or campaigns related to oral health care; in this group, 78.7% (N=325) had caries. A statistically significant correlation was found between caries prevalence and attending oral health care programs and participating in oral health care campaigns i.e., X2=10.46, df=1, P value=0.0012 (Table 2). Although most of the final sample (N=420) had no dentist at school or did not know about dental health, there was no statistical significant correlation between dental caries prevalence and presence of a dentist at school; X2=4.76, df=2, P value=0.0926 (Table 2).

Discussion

This study is a desired 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 [21-23], Tabuk [24] and Alahsa [25] and higher than some other studies conducted at Jeddah [26,27] and Tabuk [28].

In this study, significant association was found between the gender of the child and ECC. The prevalence of ECC among female children (95.5%) was more than that in male children (68%), which is contrary to many studies conducted in Saudi Arabiaand other parts of the world [29-35]. Taking into account customary habits in this community like the possibility of male children to go out with their fathers and remain under care for a longer time than female children, this could shed the light on the cause of increased prevalence of ECC among female children.

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, SevalOlmez 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 a significant association between the occupation of the mother and the prevalence of ECC. This may attributed to that children with employed mothers always spend the most of the day time without supervisor and to difficulty of finding a kindergarten in this area.

The highly significant role of sweets 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 the method of cleaning teeth and frequency of eating sweets 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 increase by the child living with an occupied mother (p=0.00811), consuming more sweets (p=0.00001) and absence of oral health educators.

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

The establishment of kindergartens in mother’s workplaces and taking into account the employed mothers by employers could participate in the reduction of ECC.

 

 

 

 Gender

 

Caries free to population

 

Caries affected to population

 

Total number of participants according to gender

Frequency

% to same gender % to final sample Frequency % to same gender % to final sample Frequency %

Male

88 32 20.85 187 68 44.31 275 65.17

Female

6 4 1,4 141 96 33.41 147 34.83

Total

94   22.27 328   77.73 422 100

 

Table 1: Distribution of children according to gender and caries experience.

X2=43.13, df=1, Pvalue= .00001

 

  Caries free

to population

Caries affected

to population

Total X2 df Pvalue
Frequency

%

Frequency %

1.Age (months)

24-36

14 11 113 89 127

15.32

2

0.000471

37-48

27 22.88 91 77.11 118

49-60

53 30 124 70 177

2.Mother occupation

Housewife

39 32 84 68 123 7.009 1 0.00811

Employed

59 19 240 81 299

3.Favored meals

Sweets 23 8 269 92 292 113.5 1

 

0.00001

 

Salts 71 55 59 45 130

4.Eating sweets

Everyday

16 7 211 93 227

125.1

2

0.00001

Once wice per week 29 23 97 77

 

 

 

126

No 49 71 20 29

 

 

69

5.Oral hygiene

Toothpaste and brush

68 64 39 36 107

144.17

3

0.00001

Siwak

14 18 64 82 78

Mixed

10 5 181 95 191

Nothing

2 4 44 96 46

6.Diary drinks

Sweetened tea and coffee 2 17 10 83 12

159.76

2

 

0.00001

 

 

Soft drinks 17 6 274 94 291
Only water 75 63 44 37 119

7.Importance of dental treatment

Very important 11 19 46 81 57

 

 

36.11

 

 

 

2

 

 

 

 

0.00001

 

It depends 27 12 191 88 218
Not important 56 38 91 62 147

8.Is there dentist at school where your kid study

Yes

1 50 1 50 2

 

 

4.76

 

 

2

 

 

0.0926

No

31 29 76 71 107

I don’t know

62 20 251 80 313

9.Did you attended to oral health lectures or campaigns at your village

Yes

6 67 3 33 9 10.46 1 0.0012

No, there is not

88 21 325 79 413

 

Table 2: Knowledge in regard of dental caries and social factors, and ECC experience.

 

  1. Jose B, King NM (2003) Early Childhood Caries Lesions in Preschool Children in Kerala, India. Pediatr Dent 25: 594-600.
  2. Ripa LW (1988) Nursing Caries: A Comprehensive Review. Pediatr Dent 10: 268-282.
  3. Marthaler TM (2004) Changes in Dental Caries 1953-2003. Caries Res 38: 173-181.
  4. Bönecker M, Cleaton-Jones P (2003) Trends in Dental Caries in Latin American and Caribbean 5-6 and 11-13-year-old Children: A Systematic Review. Community Dent Oral Epidemiol 31: 152-157.
  5. Brasil (2010). Ministério da Saúde. Coordenação Nacional de Saúde
    Bucal da População Brasileira. Projeto SB Brasil: resultadosprincipais. Brasília (DF): Ministério da Saúde.
  6. Reisine S, Litt M, Tinanoff N (1994) A Biopsychosocial Model to Predict Caries in Preschool Children. Pediatr Dent 16: 413-418.
  7. Tinanoff N, O’Sullivan DM (1997) Early Childhood Caries: Overview and Recent findings. Pediatr Dent 19: 12-16.
  8. Schroder U, Granath L (1983) Dietary Habits and Oral Hygiene as Predictors of Caries in 3-year-old Children. Community Dent Oral Epidemiol 11: 308-311.
  9. Holt RD, Joels D, Bulman J, Maddick IH (1988) A Third Study of Caries in Preschool Aged Children in Camden. Br Dent J 165: 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: 191-197.
  11. Verrips GH, Kalsbeek H, Eijkman MA (1993) Ethnicity and Maternal Education as Risk Indicators for Dental Caries, and The Role of Dental Behavior. Community Dent Oral Epidemiol 21: 209-214.
  12. Grindefjord M, Dahlof G, Ekstrom G, Hojer B, Modeer T (1993) Caries Prevalence in 2.5 year Old Children. Caries Res 27: 505-510.
  13. Litt MD, Reisine S, Tinanoff N (1995) Multidimensional causal model of dental caries development in low-income preschool children. Public Health Rep 110: 607-617.
  14. Evans DJ, Rugg-Gunn AJ, Tabari ED, Butler T (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: 5-10.
  15. Hallett KB, O’Rourke PK (2002) Early Childhood Caries and Infant Feeding Practice. Community Dent Health 19: 237-242.
  16. Ramos-Gomez FJ, Tomar SL, Ellison J, Artiga N, Sintes J, 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: 395-403.
  17. Vanobbergen J, Martens L, Lesaffre E, Bogaerts K, Declerck D (2001) Assessing Risk Indicators for Dental Caries in the Primary Dentition. Community Dent Oral Epidemiol 29: 424-434.
  18. AlDosari AM, Akpata ES, Khan N (2010) Association among Dental Caries Experience, Fluorosis and Fluoride Exposure from Drinking Water Sources in Saudi Arabia. J Public Health Dent 70: 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: 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, 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: 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: 378-386.
  24. Stewart BL, Al Juhani TS, Al Akeel AS, Al Brikeet HA, Al Buhairan WH, et al. (2000) 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 (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: 85-92.
  27. Al-Malik MI, Holt RD, Bedi R (2002) Erosion, Caries and Rampant Caries in Preschool Children in Jeddah, Saudi Arabia. Community Dent Oral Epidemiol 30: 16-23.
  28. Sabbah WA, Stewart BL, Owusu-Agyakwa GB (2003) Prevalence and Determinants of Caries among 1-5 year-old Saudi Children in Tabuk, Saudi Arabia. Saudi Dent J 15: 131-135.
  29. Al Agili DE (2013) A Systematic Review of Population-based Dental Caries Studies among Children in Saudi Arabia. Saudi Dent J 25: 3-11.
  30. Al Shamrani AS, Bassuoni MW, Mohamed MA, Mohamed RN, Hussein YM (2015) Caries Prevalence and Treatment Need Among Primary School Children in Taif, Saudi Arabia. Indian Journal of Applied Research 5: 2249-555X.
  31. Ahmed HT, ElRahman MD, Ali Omer MA, Nasir IB, ElKarim Ahmed A (2015) Assessment of Dental Caries Prevalence in Deciduous and Permanent Student Teeth in KhamisMushait-KSA. Indian Journal of Applied Research 5: 2249-555X.
  32. Prabhu P, Rajajee KT, Sudheer KA, Jesudass G (2014) Assessment of Caries Prevalence among Children Below 5 years old . J Int Soc Prev Community Dent 4: 40-43.
  33. Tadakamadla SK, Tadakamadla J, Tibdewal H, Duraiswamy P, Kulkarni S (2012) Dental Caries in Relation to Socio-behavioral Factors of 6-year-old School Children of Udaipur district, India. Dent Res J 9: 681-687.
  34. Datta P, Datta PP (2013) Prevalence of Dental Caries among School Children in Sundarban, India. Epidemiol 3: 4.
  35. Rahman SS, Rasul CH, Kashem MA, Biswas SS (2010) Prevalence of Dental Caries in the Primary Dentition among Under Five Children. Bang Med J 43: 7-9.
  36. Olmez S, UzamiÅŸ M, Erdem G (2003) Association between early Childhood Caries and Clinical, Microbiological, Oral Hygiene and Dietary Variables in Rural Turkish Children. Turk J Pediatr 45: 231-236.
  37. Wendt LK, Hallonsten AL, Koch G (1991) Dental Caries in One- and Two-year Old Children Living in Sweden. Swed Dent J 15: 1-6.
  38. Alshehri A, 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: 98-
  39. Al-Hosani E, Rugg-Gunn AJ (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.
  40. Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM (2006) Early Childhood Caries and Dental Plaque among 1-3 year-olds in Tahran, Iran. J Indian Soc Pedod Prev Dent 24: 177-181.
  41. Inayat N, Mujeeb F, Shad MA, Rashid S, Hosein T (2010) Experience of Early Childhood Caries (ECC) in Children at Fatima Jinnah Dental College Hospital, Karachi and Its Relationship with Feeding Practices. J Pak Dent Assoc 19: 34-41.
  42. Hallett KB, O’Rourke PK (2003) Social and Behavioural Determinants of Early Childhood Caries. Aust Dent J 48: 27-33.
  43. Abdullah S, Maxood A, Khan NS, Khan WU (year) Risk Factors for Dental Caries in Pakistani Children. Oral Dent J 28: 257-266.

46.    Prakash P, Subramaniam P, Durgesh BH, Konde S (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: 141-152.

  1. Al Ghanim NA, Adenubi JO, Wyne AA, Khan NB (1998) Caries Prediction Model in Preschool Children in Riyadh, Saudi Arabia. Int J Pediatr Dent 8: 115-122.
  2. Jose B, King NM (2003) Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent 25: 594-600.
  3. Rosenblatt A, Zarzar P (2004) Breast-feeding and Early Childhood Caries: An Assessment among Brazilian Children. Int J Paediatr Dent 14: 439-445.
  4. Bankel M, Eriksson UC, Robertson A, Köhler B (2006) Caries and Associated factors in a Group of Swedish Children 2-3 Years of Age. Swed Dent J 30: 137-146.
  5. Johansson Ak, Johansson A, Birkhed D, Omar R, Baghdadi S, 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: 369-378.
  6. Ehlen LA, Marshall TA, Qian F, Wefel JS, Warren JJ (2008) Acidic Beverages Increase the Risk of In vitro Tooth Erosion. Nutr Res 28: 299-303.
  7. Maganur P, Satish V, Prabhakar AR, Namineni S (2015) Effect of Soft Drinks and Fresh Fruit Juice on Surface Roughness of Commonly Used Restorative Materials. Int J Clin Dent 8: 1-5.
  8. Bowen WH, Lawrance RA (2005) Comparison of the Cariogenicity of Cola, Honey, Cow Milk, Human Milk, and Sucrose. Pediatrics 116: 921-926.
  1.  
Citation: Alshehri A (2016) Social and Behavioral Determinants of Early Childhood Caries in the Aseer Region of Saudi Arabia. Dent Adv Res 1: 108. DOI: 10.29011/2574-7347.100008
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