A CASE CONTROL STUDY ON DENTAL CARIES AND ORAL HEALTH PRACTICES AMONG SCHOOL
CHILDREN IN A SELECTED SCHOOL IN PALAKKAD DIST, KERALA.
BY
30083613
A DISSERTATION SUBMITTED TO THE TAMILNADU Dr.M.G.R.
MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF
MASTER OF SCIENCE IN NURSING
MARCH – 2010
A CASE CONTROL STUDY ON DENTAL CARIES AND ORAL HEALTH PRACTICES AMONG SCHOOL
CHILDREN IN A SELECTED SCHOOL IN PALAKKAD DIST, KERALA.
BY
30083613
Research Advisor: _____________________________________________________
Prof. Dr. JEYASEELAN MANICKAM DEVADASON,R.N., R.P.N., M.N., D.Lit., Ph.D.,
Clinical Speciality Advisor: ______________________________________________
Dr. Mrs. TAMILMANI, R.N., R.M., M.N., D.Lit., Ph.D.,
SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF SCIENCE IN NURSING FROM THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI.
MARCH – 2010
CERTIFIED THAT THIS IS THE BONAFIDE WORK OF
30083613
AT THE ANNAI J.K.K. SAMPOORANI AMMAL COLLEGE OF NURSING
SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF NURSING FROM THE TAMILNADU DR. M.G.R.
MEDICAL UNIVERSITY, CHENNAI.
Examiners:
1. _______________________
2. _______________________
_________________________________________
Dr. JEYASEELAN MANICKAM DEVADASON,
R.N., R.P.N., M.N., D.Lit., Ph.D.,
DEAN, H.O.D., Nursing Research, Annai J.K.K. Sampoorani Ammal College of Nursing, Komarapalayam.
CERTIFIED THAT THIS IS THE BONAFIDE WORK OF
30083613
AT THE ANNAI J.K.K. SAMPOORANI AMMAL COLLEGE OF NURSING
SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF NURSING FROM THE TAMILNADU DR. M.G.R.
MEDICAL UNIVERSITY, CHENNAI.
_________________________________________
Dr. JEYASEELAN MANICKAM DEVADASON,
R.N., R.P.N., M.N., D.Lit., Ph.D.,
DEAN, H.O.D., Nursing Research, Annai J.K.K. Sampoorani Ammal College of Nursing, Komarapalayam.
ACKNOWLEDGEMENT
“Fear thou not ; for I am with thee: be not dismayed ; for I am thy God;
I will strengthen thee; Yea, I will help thee; yea, I will uphold thee with the right hand of my righteousness.”
Isaiah 41:10
First and foremost I render praise and thanksgiving to the LORD ALMIGHTY for his blessings and abundant grace that enriched me throughout this study.
I express my thanks to Dr. JKK. MUNIRAJAHH, Founder and Managing Trustee, Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam for all the facilities he has provided for the betterment of many aspiring students of this institution.
This study has been undertaken and completed under the able supervision and expert guidance of Prof. Dr. JAYASEELAN MANICKAM DEVADASON, Dean and Research guide, Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam. I express my sincere gratitude for the support, timely and most useful suggestions to lay a strong foundation for this study.
I extend my gratitude and thanks to Dr. Mrs. TAMILMANI, Principal, Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam for her encouragement, excellent guidance and constant support and valuable suggestions rendered during the study.
I express my heart felt and sincere thanks to Ms. SHEELA DEVI and Ms.ALLWIN, faculty of pediatric department, Annai J.K.K. Sampoorani Ammal College of Nursing, Komarapalayam for their efforts, valuable suggestions, timely guidance and personal interest.
I express my sincere gratitude to Mr. JOY. T. GEORGE, Principal, S.D.A Higher Secondary School, Ottapalam, Palakkad District for granting permission to conduct my study.
Special thanks to Mr. STANLEY JOSE, Headmaster of the school and Mrs. SHEEBA STANLEY for all the support and timely help during the data collection.
I would like to extend my grateful thanks to the panel of dental experts namely Dr.ANURADHA SUNIL (M.D.S, Oral Pathology), Dr. ELAVARASU (B.D.S) Sambu Dental
Clinic , Komarapalayam, Dr. SUKUMARI ELAVARASU, (M.D.S, Peridontia), vice principal, JKK Natarajah Dental College, Dr. Mrs. TAMILMANI, Principal, Annai JKK Sampoorani Ammal College of Nursing, Mrs. KAVIMANI, M.Sc., (N), Mrs. THANGAMANI, M.Sc., (N), experts from the field of Nursing, for validating the tool amidst their busy schedule and giving valuable suggestions for the study.
I extend my sincere thanks to Dr. JAYASEELAN MANICKAM DEVADASON, Dean and Prof. DHANAPAL, statistician, Annai JKK Sampoorani Ammal College of Nursing for their guidance in the statistical analysis and interpretation of data.
I extend my thanks to the LIBRARY STAFF of Dr. M.G.R Medical University, Chennai;
CMCH College of Nursing, Vellore and Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam for helping me to build a sound knowledge basis for the study.
I wish to express my heartfelt thanks to Mr. V.MOHANRAJ, Mr. M.SETHURAMAN and Mr.S.MANIKANDAN, who spent their valuable hours of work to shape this thesis neatly.
I also express my thanks for the assistance and support given by the faculty of Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam and my beloved classmates for all the help rendered to me in my most needful times.
I am greatly indebted to my beloved husband, Mr. SAM WILSON for having nurtured his cherished dream into reality through his constant support, wholehearted encouragement and special prayers during this study.
I also express my heartfelt thanks to my loving son RICHARD SAM and my daughter LINITA SAM and my dear friend’s daughter SMITHA SAJJAN for their constant help and support for getting this thesis ready.
I dedicate this dissertation to my beloved mother, Mrs. CHINAMMA THOMAS who always supported me, constantly prayed for me and wanted her daughter to scale high ranks academically. I also extend my sincere thanks to all my kith and kin and friends for their encouragement, support and prayers during the period of study.
30083613
TABLE OF CONTENTS
CHAPTER
NO CONTENT PAGE
NO
I
II
III
INTRODUCTION
- Back ground of study - Need for the study - Statement of problem - Objectives
- Hypothesis
- Operational definitions - Assumption
- Delimitation
- Conceptual Framework
REVIEW OF LITERATURE
1. Studies related to dental caries 2. Studies related to oral health practices
3. Studies related to dental caries and oral health practices.
METHODOLOGY
- Research approach - Research design - Variables - Setting - Population
1-10 1 3 6 6 7 7 8 8 8
11-25 11 16 21
26-35 26 27 29 29 29
CHAPTER
NO CONTENT PAGE
NO
IV
V
- Sample - Sample Size
- Sampling technique - Sample selection criteria - Data Collection instruments - Training of the investigator - Description of the Tool - Content validity - Reliability of the tool - Pilot Study
- Data Collection procedure - Plan for Data Analysis - Ethical consideration
DATA ANALYSIS AND INTERPRETATION
- Data on demographic variables and dental caries among cases and controls
- Data on association between dental caries and oral health practices among cases and controls
- Data on association between dental caries and selected factors.
SUMMARY, FINDINGS, DISCUSSION, IMPLICATIONS, LIMITATIONS, RECOMMENDATIONS AND CONCLUSION
- Summary
- Characteristics of the study sample
30 30 30 30 31 31 32 33 33 33 33 34 35
36-61 37
56
61
62-70
62 63
CHAPTER
NO CONTENT PAGE
NO - Findings
- Discussion - Implications - Limitations
- Personal experience - Recommendations - Conclusion
REFERENCES - Text books - Journals
- Unpublished thesis - Secondary sources
APPENDICES
ABSTRACT
64 66 68 69 70 70 70
71-75 71 72 75 75
LIST OF TABLES
TABLE NO TITLE PAGE
NO
1.
2.
3.
Frequency, percentage, chi-square value and odd’s ratio among cases and controls regarding dental caries and oral health practices.
Logistic regression on determinants related to oral health practices and dental caries.
Logistic regression regarding association of demographic variables and dental caries.
56
60
61
LIST OF FIGURES
FIGURE
NO. TITLE PAGE
NO.
1.
2.
3.
4.
5.
6.
7.
8.
Conceptual framework
Research Design
Schematic research design
Frequency and percentage distribution of cases and controls based on their age.
Frequency and percentage distribution of cases and controls based on sex of the students.
Frequency and percentage distribution of cases and controls based on religion.
Frequency and percentage distribution of cases and controls based on type of family.
Frequency and percentage distribution of cases and controls based on education of mother.
10
27
28
38
39
41
43
45
FIGURE
NO. TITLE PAGE
NO.
9.
10
11
12
13
Frequency and percentage distribution of cases and controls based on occupation of father.
Frequency and percentage distribution of cases and controls based on occupation of mother.
Frequency and percentage distribution of cases and controls based on family income.
Frequency and percentage distribution of cases and controls based on incidence of dental caries among family members.
Frequency and percentage distribution of cases and controls based on initiation of brushing.
47
49
51
53
55
LIST OF APPENDICES
NO APPENDIX
1.
2.
3.
4.
5.
6.
7.
Certificate of training
Content validity permission letter
Content validity certificate
List of experts
Permission letter to conduct research
Certificate of completion of research
Tool developed for data collection in English
CHAPTER – I
INTRODUCTION
“Beloved, I wish above all things that thou mayest prosper and be in health, even as thy soul prospereth.”
- IIIJohn: 2
BACKGROUND OF THE STUDY
A smile is often the mark of the beginning of a great relationship. A smile looks better if it is revealed through a neat, gleaming white set of teeth and healthy gums. Maintaining good oral health is absolutely essential. Healthy teeth are important to child's overall health.
Oral health is concerned with functional efficiency of not only the teeth and its supporting structure but also the surrounding parts of the oral cavity and of the various structures related to mastication and the maxillo facial complex. The mouth is considered as the most essential and versatile one of the human organs. The food needed by the body for life processes enters through it and the first stage of digestion takes place in the oral cavity.
Dental caries is an irreversible microbial disease of the calcified tissues of the teeth characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth which often leads to cavitation. It is a complex and dynamic process where a multitude of factors influence and initiate the progression of the disease. Although effective methods are known for prevention and management of dental caries, it is a major health problem affecting mankind, in that its manifestations persist throughout life despite treatment.
Worldwide most children and an estimated 90% of adults have experienced caries with the disease most prevalent in Asian and Latin American countries and least prevalent in African countries. In the United States, dental caries is the most common, chronic childhood disease being atleast 5 times more common than asthma, despite a decline in prevalence (Office of Disease Prevention and Health Promotion, 2001). Approximately 5% of children in the U.S.A.
have tooth decay by 9 months of age, 15% by 12 months and 17% by age 4. By the time they reach adulthood, 94% of Americans have had tooth decay. While there has been a significant decrease in dental carries in recent years, millions of children in the United States continued to live with painful, untreated oral disease. Dental carries is especially prominent in children from low socio-economic backgrounds who are unable to receive treatment for the disease. Half of the tooth decay in children from low income families goes untreated.
Dental caries and periodontal diseases are the most important oral disease prevalent in Asian and Latin American countries. In developing countries, the availability of oral health service is limited, with little or no access to preventive or restorative dental care; thus periodontal disease and tooth loss are common. In addition to poor living conditions, the major risk factors for poor oral health relate to unhealthy lifestyles (poor diet, nutrition, and oral hygiene and use of tobacco and alcohol) (Pihlstrom, Michalowicz, and Johnson, 2005). Soft- drinks are a significant factor, and controlling the intake of sugars is important for caries prevention. Following global recommendations, encouraging a diet high in starchy staple foods, fruits, vegetables and low in free sugars and fat would go a long way toward protecting both oral and general health.
Oral health is an essential component of total health and well-being, and it affects numerous aspects of a person’s health status. From the ability to eat and speak, to quality of life, including self-esteem, learning, employment and levels of usual activity (Drum, Chen and Duffy, 1988).
NEED OF THE STUDY
WHO (2008) recently published a global review of oral health which emphasized that despite great improvements in the oral health of populations in several countries, global problems still persist. This is particularly so among underprivileged groups in both developing and developed countries. The experience of pain, problems with eating, chewing, smiling and communication due to missing, discolored or damaged teeth have a major impact on people's daily lives and well-being. Furthermore, oral diseases restrict activities at school, at work and at home causing millions of school and work hours to be lost each year throughout the world.
Dental caries also known as tooth decay or cavity is a disease where bacterial process damage hard tooth structure (enamel, dentine and cementum). These tissues progressively break down, producing dental cavities or holes in the teeth. Two groups of bacteria are responsible for initiating caries, Streptococcus mutants and Lactobacilli. If left untreated, the disease can lead to pain, tooth loss, infection and in severe cases death.
Dental caries is caused mainly by bacterial deposits (known as plaque) on the tooth surface. Bacteria uses food especially fermented carbohydrates trapped in-between teeth as an energy source fermenting it to acids which lower the pH of the plaque. If the pH drops below 5.5, the acid reacts with the enamel dissolving sugars and starches and both are fermented by the bacteria. All cavities occur when carbohydrates like sugar or starch in the food left on teeth after every meal or snack and changed to acid demineralization of tooth by plaque bacteria.
Though more than 95% of trapped food is left packed between teeth after every meal or snack, over 80% of cavities develop inside pits and fissures in grooves on chewing surfaces where the brush cannot reach and there is no access for saliva and fluoride to neutralize acid and re- mineralize demineralized tooth. Few cavities occur where saliva has easy access.
Dental caries and periodontal disease have historically been considered the most important global oral health burdens. Dental caries is still a major health problem in most industrialized countries as it affects 60–90% of school-aged children and the vast majority of adults. In 2004, WHO updated the epidemiological information available in the databanks. At present, the distribution and severity of dental caries vary in different parts of the world and within the same region or country. Dental caries experience in children is relatively high in the Americas Decayed Missing Filled Teeth (DMFT) = 3.0 and in the European Region DMFT = 2.6 whereas the index is lower in most African countries DMFT = 1.7
According to the Dental Council of India (DCI) report (2004) the prevalence of dental caries among 12-15 year olds varied between 40-80% and was reported to be very high in Northern States 85-90%. The prevalence of dental caries in 12 year olds was around 48.6%.
The DMFT score in the same age group was 1.15.
Recent studies by the dental council of India have revealed a bleak picture. Decayed teeth are common and increase with age. Nearly 30% of rural people do not have any dental treatment facilities. Leave alone the recommended twice-a-year dental check-up. 50% of urban India do not use tooth brushes. On an average, only about 20 teeth are present in the elderly.
43% of India adults have aesthetically unacceptable teeth. 80% of the people have bleeding gums and tartar. Although 65% of the elderly need some dental prosthesis or other, only a pitiable low percent i.e., 11% have them. Only a tiny number of the population has ever visited a dentist. A large number of adolescence and adults chew tobacco and the incidence of oral sub mucus fibrosis and subsequent cancer is alarmingly high. All these could be prevented by aggressive health education and primary prevention.
Dental health is also depended on eating habits. Earlier people used to eat 2 meals per day and in between tea and coffee were less preferred. Children prefer eating processed food and that too very frequently i.e., with very little gap in between food intake. After eating food
children are expected to brush the teeth or at least rinse the mouth. When children eat chocolates and biscuits, they do not brush their teeth. This leads to tooth decay. Further, most children have the habit of drinking sweetened milk before sleeping .This also further contributes to tooth decay.
Jose et al., (2008) did a study on prevalence of dental health problems on 1068 school children of the age group of 12-15 years in rural Kerala. The findings were 54.3% showed evidence of dental caries and that dental caries was the most prevalent condition affecting the children.
Chatufele et al., (2002) conducted a cross sectional study about oral health in rural area of Loni, western Maharashtra in order to find out the relation between various oral hygienic practices and oral health. It was found that oral health varies significantly with the practices related to cleaning mouth and that oral diseases are strongly related with the frequency of mouth washing, type of cleaning and rinsing of mouth.
Dental caries is expected to increase in many developing countries as a result of the growing consumption of sugars and inadequate exposure to fluorides. WHO’s global oral health program is set out to addressing oral hygiene practices, sugar consumption, lack of calcium and micro-nutrients, and tobacco use. The key elements include addressing poor living condition and low education levels as well as lack of traditions supporting oral health.
Dental health organizations advocate prevention and prophylactic measures such as regular oral hygiene and dietary modifications to avoid dental caries.
Hygiene is embedded in Indian culture and is the way of life. In the indigenous time tested practices of rinsing mouth with plain water after each meal, massaging gums, and teeth,
cleaning mouth with finger after each meal, promoting traditional diets, brushing of teeth, avoiding smoking, chewing pan and tobacco in various forms.
Dental health directly influences the general health of an individual. Inadequate knowledge and ignorance of oral health practices lead to a lot of oral health problems. The most commonly occurring problems are dental carries, root abscess, gingivitis, pyorrhea, mal- occlusion and halitosis. It is well recognized fact that the children of today are the citizens of tomorrow. The prosperity of the nation depends on the health of the future citizens. Dental health should be made priority in children who comprises 40% of our population.
In the process of review of literature, the investigator came across various studies related to factors like nutritional status and dental caries, prevalence of dental caries, association of sociodemographics and dental caries, oral health and knowledge and practice of mothers. The investigator could not find any studies directly related with oral health practices and dental caries. Considering the incidence and prevalence of dental caries, the investigator proposed to conduct a case control study on dental caries and oral health practices among school children.
STATEMENT OF THE PROBLEM
A case control study on Dental caries (DC) and Oral health practices (OHP) among school children in a selected school in Palakkad Dist, Kerala.
OBJECTIVES
1. To describe the association between oral health practices and dental caries among cases and controls.
2. To test the association between dental caries and selected factors among cases and controls.
HYPOTHESES
H1 : There will be a significant association between dental caries and oral health practices among cases and control group.
H2 : There will be a significant relationship between dental caries and selected factors among cases and control group.
OPERATIONAL DEFINITIONS
1) Dental caries: It refers to the presence of any one of the signs and symptoms mentioned in the screening form i.e., brownish grey or black discoloration of the tooth, food impaction, sensitivity to hot/cold and pain among school children.
2) Oral health practices: Oral health practice refers to the responses of the individuals to the items in the self-administered questionnaire that is regarding care of the oral cavity. Oral health practices will be measured in terms of oral health practice scores. The higher the score, the better is the oral health.
3) Cases: Refers to school children both males and females aged between 13-15 years with dental caries in one or more teeth, filled tooth, root canal treatment done or tooth extraction done for dental caries, as identified using the dental caries observation checklist.
4) Controls: It refers to school children similar to cases except the dental caries as measured by the observation checklist.
5) Selected factors: These were the factors thought to influence the oral health status of the child. The selected factors included factors such as age, sex, religion, type of family educational status of mother, occupation of father and mother, economic status, family history of dental caries and the age of initiation of brushing.
ASSUMPTIONS
1) Dental caries is prevalent among school children.
2) The children will have some oral health practices.
3) The participants will be willing to participate and give reliable information.
4) The tools used will be sufficient to measure dental caries and oral health practices.
5) The response of school children to the items in the questionnaire will be the true measure of their OHP.
DELIMITATIONS
The study was delimited to:
1) Children studying in a selected school in Palakkad Dist.
2) Dental screening done using mouth mirror and probe in day light 3) Data collected by self-administered questionnaire method.
4) Cases and control selected by purposive sampling technique.
CONCEPTUAL FRAMEWORK
A conceptual framework is made up of concepts, which are mental images of a phenomenon. These concepts are linked together to express the relationship between them.
In the present study, the conceptual framework is based on knowledge, attitude and practice model. When adequate knowledge combines with positive attitude it results in adequate practices and health of an individual.
Knowledge refers to the awareness of an object or procedure. In this study it refers to awareness of good oral hygiene practices and causes of dental caries. However this was not included in the study.
Attitude refers to the opinion, ideas and feeling towards an object or procedure. In thisvstudy, it refers to attitude to good oral hygiene practices and prevention of dental caries.
However this was not included in the study
Oral health practices refer to the activity, behavior of a person resulted from the combination of knowledge and attitude. In this study it refers to the dental cleaning practices, brushing technique, oral hygiene practices, care against detrimental habits and caries preventive practices. Dental clinic practices refers to number of times of brushing teeth, article used for brushing, type of brush, dentifrice used and brushing duration. Brushing technique refers to brushing the front, inner and chewing surface of the teeth. Oral hygiene practices refers to washing and gargling of mouth after meals and snacks, massaging gums and teeth, changing of brush and the method of removing food particles from in between teeth. Care against detrimental habits refers to avoiding sweets in between meals and avoiding bed coffee before brushing teeth. Caries preventive practices refers to eating fruits, raw vegetables, drinking milk and adequate amount of water and using sugar free chewing gum containing xylitol ( e.g. Orbit).
Poor Dental Health and presence of dental
caries Optimum Dental
Health and absence of dental
caries Health
+
Inadequate oral Health practices* Negative attitude towards
dental hygiene and aesthetics
=
Fig.1. CONCEPTUAL FRAMEWORK BASED ON KAP MODEL
* Adequate knowledge regarding oral
hygiene
*Attitude
*Knowledge
+
+
Practice
+
Adequate oral Health practices
* Positive attitude towards dental
hygiene and aesthetics
+ +
* Inadequate knowledge regarding oral
hygiene
*Not included in the study
CHAPTER – II
REVIEW OF LITERATURE
Review of literature is an important step in the development of a research project. It will help the researcher to develop a deeper insight into the problems and gain information on what has been done before. It serves as a frame work of reference for studies. It focuses on the feasibility of study related findings from one study to another with the hope of establishing a scientific knowledge.
According to Polit and Hungler (2008), review of literature is a critical summary of research on a topic of interest generally prepared to put a research problem in context or to identify gaps and weakness in prior studies so as to justify a new investigation.
The review of literature is organized as follows:-
I. Studies on dental caries II. Studies on oral health practices
III. Studies on dental caries and oral health practices.
I. STUDIES ON DENTAL CARIES
Narksawat K. et.al., (2009) conducted a cross sectional study on association between nutritional status and dental caries in permanent dentition among 862 primary school children in Thailand. Dental hygiene status was evaluated by observation check list and hygiene practices by interview method. Spearman’s correlation and multiple logistic regression analysis
was used for statistical analysis and the result showed a negative relationship between nutritional status and the DMFT index, which increased when the nutritional status decreased.
The normal weight and thin children were more likely to have a DMFT of at least one by 1.94 times (OR=1.94; 95% CI=1.25-3.00, p=0.004) and 2.22. 95% CI=1.20-4.09, p=0.001) respectively compared to overweight and obese children, normal and thin school children had a higher risk for dental caries.
Auad S.M. et al., (2009) conducted a study on 458, 13-14 year old school children on dental caries and its association with socio demographics, erosion and diet from south Brazil.
The schoolchildren completed a questionnaire to provide dietary information and underwent dental examination. Sociodemographic characteristics were collected using a questionnaire completed by parents/guardians. Caries was assessed using decayed, missing, filled teeth/
surfaces (DMFT/DMFS) indices. Erosion was assessed using a previously validated index. The result revealed that of 458 schoolchildren, 78% had caries experience. A statistically significantly lower prevalence of caries was observed in children from a higher economic class and whose parents had higher educational levels. Thirty-five percent of children with caries also had erosion, while 32% with a DMFT of 0 had erosion (P = .72). The frequency of consumption of drinks and foods was not statistically significantly associated with caries. The intake of sugared carbonated drinks was statistically significantly associated with erosion (P = .01). The mothers' educational level was the only variable independently associated with caries experience (P=.04).
Thomson R.K. et al., (2008) did a study on risk indicators for dental caries on 644 young adults from South Australian Electoral roll of the age of 20-24 years. The study showed that the mean number of affected surfaces was 6.05(SD8.44), the median 3.0 surfaces and 20.6% had no cavitated caries experience. The prevalence of untreated cavitated caries was 28.6%. Three quarters of the disease burden was found in 30% of the subjects. Precavitated lesions were observed in 51.4% of subjects. The mean number of affected surfaces was
2.43(SD 5.93) of those who had a DMFS score of zero, 45.1% had at least one surface affected by precavitated decay. As a result only 11.3% of young adults showed no signs of carious experience. 75% of the precavitated surfaces were found in 18.3% of young adults.
The mean number of decayed surfaces (cavitated) was higher among those in receipt of government benefits, persons who were not employed, those whose usual reason for visiting is for a problem, those who last had care at a public clinic, those who brush their teeth less than twice a day, those who reported 5 or more acidic drinks per day and current smokers.
Patro B.K. et al., (2008) did a cross sectional community based study on prevalence of dental caries among 452 adults and elderly in an urban resettlement colony of New Delhi.
Local adaptation of the WHO questionnaire was filled by the respondents and oral examination and dentition status recorded by trained investigators. The result showed the prevalence of dental caries in the 35-44 years group as 82.4% and 91.9% in those >60 years. The decayed missing filled teeth (DMFT) index was 5.7+4.7 in the 35-44 year age group and 13.8+9.6 in >60 years age group. 27.9% were currently using tobacco. A statistically significant association was found between tobacco consumption and dental caries (p=0.026) 1/5th of the individuals with dental problems relied on home remedies.
Jose et al., (2008) did a study on prevalence of dental health problems on 1068 school children of the age group of 12-15 years in Vadavucode block, in rural Kerala. Dental examination was done by dental surgeons on 50-100 children per day; a small brochure on dental hygiene was given to all. The children were examined for dental caries, gingivitis, retained deciduous teeth, fractured teeth and orthodontic problems. The findings were 54.3%
showed evidence of dental caries, 3.18% received treatment, 21% showed evidence of orthodontic problems, 15% had gingivitis, 7% had over retained deciduous teeth and 4% had evidence of trauma to the anterior teeth. It was observed that dental caries was the most prevalent condition affecting the children.
Ahmed N.A. et al., (2007) did a cross sectional study on dental caries prevalence and risk factors among 392 school children of the age group of 12 years in Baghdad, Iraq. Dental examination based on WHO criteria and questionnaire surveys were used for data collection.
Water samples were collected and fluoride concentration assessed. The findings revealed that the mean DMFT and DF were 1.7 and 1.3. The rate of caries experience (DMFT>0) was 62%.
DMFT decreased significantly with higher education of mother, not being embarrassed to smile and between meals mode of drinking. Increased sugar consumption was associated with being a boy, having mothers with low education, living in low socio-economic area and brushing only once a day. Positive oral hygiene practices were higher for girls. Western sweet snacks were preferred and sweet tea was frequently consumed. The fluoride content in drinking water was too low for caries prevention.
Gustavo et al., (2003) conducted a study in New York, USA on factors contributing to oral health problems. The various factors found were financial barriers, language, literacy, culture, acculturation, dietary pattern, substantial effect, cultural belief, values and the individual’s attitudes and experience with the dental care system.
Al-Malik et al., (2001) conducted a cross sectional study on 987 2-5 year old children on the relationship between erosion, caries and rampant caries and dietary habits in Soudi Arabia. The cross sectional study including dental examination and questionnaire survey was carried out at 17 kindergartens. Clinical examinations were carried out under standardized conditions by a trained and calibrated examiner. Information regarding diet and socio- economic factors was drawn from questionnaires distributed to the parents through the schools. These were completed before the dental examination. The results revealed, of the 987 children, 309 (31%) showed signs of erosion. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%). Vitamin C supplements, frequent consumption of carbonated drinks and the drinking of fruit syrup from a feeding bottle at bed- or nap-time when the child was a baby, were all related to erosion. Consumption of carbonated drinks and fruit
syrups was also related to caries but they were part of a larger number of significant factors including socio-demographic measures and oral hygiene practices.
Shekhar et al., (2001) An oral epidemiological survey done on the prevalence of dental caries in Sansary District of Nepal. The survey was done in private and government schools in a rural town. The result showed dental caries prevalence and decayed missing filled teeth (DMFT) score of 5-6 year old children was 52% caries prevalence and the mean DMFT score of 12-13 year old was 24%, caries prevalence and mean DMFT score of 15 years old was 26%. In the 5-6 years old age group 36% of the treatment required could be met through one surface restorations and 33% through 2 or more surface restorations and 18% through extractions for the 12-13 years old and 15 years old, the major treatment need was for single surface fillings (47% and 48% respectively) followed by the need for extractions (13% for both) of two or more surface fillings (9% and8% respectively).
Selvarani R., (2001) did an experimental study to evaluate a structured teaching programme on dental health in terms of knowledge and practice among school children of selected schools in Madurai. The study concluded that in the experimental group 45%of primary school children had poor cleanliness of the oral cavity, 85%had bad breath, 57.5% had dental caries, 55% of children were suffering from bleeding gums, 72.5% had tartar accumulation. In the control group55%of the children had poor cleanliness of oral cavity, 45%
of the children had bad breath and 65% of the children had dental caries. Among whom 38.46% of children had more than 2 caries teeth and 52.5% had bleeding gums and 80% of the subjects had tartar accumulation. Majority of school children had poor knowledge regarding dental health in both experimental and control group. Majority of the students in both group had unsatisfactory practice towards dental health and that the structured teaching programme is an effective means to increase the knowledge and to promote satisfactory practice towards dental health. There was a positive correlation between the knowledge and practice of school children towards dental health.
Sebastian D., (2001) conducted a case control study on oral health problems of school children and the knowledge and practice of their mothers regarding oral health and oral health problems in a school at Trichy. She used random sampling to select 50 cases and 50 controls. A structured interview schedule was used to collect data. Data collected was analyzed using description and inferential statistics and multivariate analysis. The findings revealed that the prevalence of oral health problems is high (70%) among school children.
There was significant association between mother’s knowledge and education among control group. (p<0.001 level).
II. STUDIES ON ORAL HEALTH PRACTICES
Garbin C. et al., (2009) conducted a study to verify the influence of preschool children participating in an oral health education program on daily health practices of their families, through parent’s perception. A sample of 119 parents of 5-6 year old preschoolers was selected. Data was collected using a structured self administered open-ended questionnaire.
The findings revealed that 98% knew about educative and preventive activities developed at school and all of them affirmed that these activities were important. 90.5% of parents reported that they learned something about oral health from their children and among them 47.8% cited tooth brushing as the indicator for better learning. Besides this 87.3% of participants revealed the change in oral health habits of their family members.
Shanthi S. et al., (2009) conducted a study to evaluate the effectiveness of structured teaching programme on oral hygiene in terms of knowledge, attitude and practice among 90 students of 6th standard of Ramasamy Chettiar Higher Secondary School at Chidambaram. An evaluative research approach with pre-experimental one group pre-test and post-test design was used. Subjects were selected through cluster random sampling technique. The investigator used a self-administered questionnaire and the data collection tools were validated and the reliability determined by pilot study. After the pre-test structured teaching programme
(STP), a booklet on oral hygiene was distributed. Two post-tests were conducted with the same tool. First post-test after one week and second post-test after 15 days after STP. The collected data was tabulated and analyzed by using descriptive statistics such as percentage, mean, SD, paired t-test, one way Anova and two way Anova. The major findings revealed an overall prevalence of oral problems as 77.5% among school children. There was significant increase in the level of knowledge, attitude and practice of school children between pre-test and post-test at p<0.001 level. The girls knowledge score was slightly higher than the boys which was significant at p<0.05 level. There was no significant relationship between knowledge, attitude and practice level of the subjects and demographic variables.
Gussy M.G. et al., (2008) did a descriptive study on 294 parent child dyad to examine the oral health related knowledge, attitude and reported behaviors of parents of children 12-24 months living in rural areas of Victoria, Australia. The child’s mother was the most common respondent. The most important cause for tooth decay was identified as not cleaning teeth everyday (40%) or sweet snacks and drinks between meals (39%). 10% thought that infection with bacteria was the primary cause and less believed that the use of bottle at night time was the most important factor (5.5%). 95% of parents believed that they should begin cleaning their child’s teeth when or soon after the teeth appeared. Reported confidence cleaning their child’s teeth was significantly associated with the items regarding parental self sufficiency in managing their child’s oral health(x2=57.500.df=4. P=<0.001) and locus of control with relative to the child’s health(x2=16.064. df =4. P<0.01).
Hilton I.V. et al., (2007) did a qualitative study to identify cultural beliefs, practices and experiences that influence access to preventive oral health care for young children from 6 focused groups in each of the African-American, Chinese, Latino and Filipino communities in San Francisco, California. Participants were carers of children aged between 1 and 5 years.
The sample size was 22 groups (n=177 participants). The findings of the study revealed lack of knowledge and beliefs about primary teeth, created barriers to early preventive care in all
groups. In Chinese groups more than others, health beliefs regarding disease groups, multiple family carers, especially elders influenced access to preventive care. Dental fear, greatly influenced attitudes regarding accessing preventive care.
Poutanen R. et al., (2006), conducted a study on parental influence on children’s’ oral health related behavior. The data were gathered by means of questionnaires from 11-12 year old school children and their parents. Differences between sub groups of children were analyzed by cross-tabulations and the factors related to children’s good or poor oral health- related behavior by logistic regression analysis. The findings were that parents of children who reported good oral health related behavior had better knowledge and more favorable behaviors than those of other parents. Predictors for a child’s poor oral health-related behavior were the child’s poor knowledge, male gender, and the parent’s frequent consumption of sweets and the infrequent use of xylitol gum. The parents of children whose oral health behavior was favorable was more likely to have a high level of occupation and favorable oral health related behaviors.
Kahabuka F. K. et.al (2006) conducted a study to assess the level of knowledge on causes and prevention of dental caries and bleeding gums, oral hygiene and eating practices among institutionalized former street children in Dar-es-Salaam. Structured standardized questionnaire was used to collect data. The findings of the study were that 88% and 83% of children showed the cause of tooth decay and bleeding gums respectively and 17-68% were aware of preventive measures. 92% of the children said they brushed their teeth but 74%
brushed when living on the streets, this difference was significant (χ2 =4.40, p=0.05). About half did not use toothpaste whilst 8% did not use toothpaste at institutions. That difference was significant. (χ2 =5.081, p=0.02). Almost 22% use sweets and biscuits at institutions. About 44%
used the snacks while living on the streets, the difference was significant. (χ2 =3.798, p=0.04 and χ2=3.893, p=0.04). Only 6% use sodas and sweetened juices at institutions while 32-36%
used the drinks during street life, the difference was significant. (χ2=4.38, p=0.05 and χ2=12.87, p=0.01)
Mumghamba E. G. et.al., (2006) conducted a cross sectional descriptive study to determine the oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath (S-BMB) among 302 postpartum mothers of the age group of 14-44 years in Dar-Es-Salaam, Tanzania. The mothers were interviewed using structured questionnaire. Oral hygiene, dentition and periodontal status were assessed using the community periodontal index probe and gingival recession (GR) using William’s periodontal probe. The findings revealed that total toothbrushing practice was 99%, tongue brushing (95%), plastic toothbrush users (96%), chewing stick (1%), wooden toothpicks (76%), dental floss (<1%) and toothpaste (93%). The prevalence of plaque and gingival bleeding on probing was 100%, gum bleeding during tooth brushing (33%), calculus (90%), probing periodontal pocket depth (PPD) 4-5mm (27%), PPD 6+mm (3%), GR 1+mm (27%)and tooth decay (55%). The prevalence of S-BMB was 14%. The S-BMB had higher mean number of sites with plaque compared to the no S- BMB group (p=0.04). factors associated with S-BMB were gum bleeding on tooth brushing (OR=2.4) and PPD 6+mm (OR=5.4).
Mahesh K. P. et.al., (2005) conducted a study to assess the oral health status of 1200 students of the age group of 5-12 years in Chennai city. The sample consisted of 600 private and 600 corporation school children from 30 schools, which had been selected randomly. The survey was based on WHO, 1999 oral health assessment which had been modified by including gingival assessment, enamel opacities, hypoplasia for 5 years. Evaluation of the oral health status of these children revealed dental caries as the most prevalent disease affecting permanent teeth more than primary teeth and more in corporation than in private schools, thereby correlating with the socio economic status. The greatest need of dental health education is at an early age including proper instruction of oral hygiene practices and school based preventive programs which would help in improving preventive dental behavior and attitude.
Knishkowy B., Sgan-Cohen H.D., (2005) did a study on oral health practices among 184, 7th-10th graders who attended preventive health visits in Israel. Structured questionnaires were used to collect data on tooth brushing, flossing, visit to dentist and hygienist. Structured counseling by the family nurse was provided following completion of the questionnaire. The findings of the study were 97% of the teenagers brushed their teeth atleast once a day but only 7% used dental floss daily, 44.5% never flossed and another 10% didn’t know what dental floss was. 83% had visited a dentist but only 33% had been to a dental hygienist in the past 2 years.
Zhu L. et.al., (2003) did a national representative study to describe oral health behavior, illness behavior, oral health knowledge and attitudes among 4400 twelve year old and 18 year old Chinese to analyze the oral health behavior profile of the 2 age groups in relation to province and urbanization and to assess the relative effect of socio behavioral risk factors on dental caries experience. The data was collected by clinical examinations (WHO criteria) and self-administered structured questionnaires. The findings revealed that 44.4% of the respondents brushed their teeth at least twice a day but only 17% used fluoridated toothpaste. Subjects who saw a dentist during the previous 12 months or 2 years were 31.3%
and 35.3% for 12 year olds and 22.5% and 20.2% for 18-year-olds respectively. Nearly 1/3rd (29%) of 12-year-olds and 40.5% of 18 year olds visited a dentist in case of signs of caries but only when in pain. The risk of dental caries was high in the case of frequent consumption of sweets and dental caries risk was low for participants with use of fluoridated toothpaste.
Marinho V. C. et al., (2003) conducted a study to determine the effectiveness of fluoride toothpastes for preventing dental caries in children and adolescents. Randomized or quasi randomized controlled trials with blind outcome assessment, comparing fluoride toothpaste with placebo in children up to 16 years for one year. The main outcome was caries increment measured by a change in DMFS. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces D (M) FS. The primary measure of effect was that prevented fraction (PF) that is the difference in caries increments
between the treatment and control group. The results were 74 studies were included. for the 70 that contributed data for meta-analysis (involving 42,300 children) the D(M)FS pooled PF was 24% (95% confidence interval (CI), 21-28%, P<0.0001).this means that 1.6 children need to brush with a fluoride toothpaste over 3 years to prevent one D(m)FS in population with caries increment of 2.6 D(M)FS per year. In populations with caries increment of 1.1 D (M)FS per year, 3.7 children will need to use a fluoride toothpaste for 3 years to avoid one D(M)FS. There was clear heterogeneity, confirmed statistically (p<0.0001). The effect of fluoride toothpaste increased with higher baseline levels of D (M) FS, higher fluoride concentration, higher frequency of use and supervised brushing but was not influenced by exposure.
Rajab L.D.,(2002) did a cross sectional study to assess the level of dental knowledge and attitude towards childcare among 1556 parents of children of the age group of 6-16years in Jordan. Self administered questionnaire was used for data collection. The findings showed 80% of the parents knew about the harmful effects of sugar and 79% thought that poor oral hygiene may induce dental caries. In addition to proper oral hygiene (79%) and restriction of sugar/sweets (42%), 36% of the parents emphasized regular dental visits. However, most children saw a dentist for symptomatic reasons only(86%), while 11% attended for dental checkups. Tooth brushing at least twice a day was reported for 31% of children. 14% of children aged 6-9 years had association from adolescent brushing.
III. STUDIES DONE ON DENTAL CARIES AND ORAL HEALTH PRACTICES
Rehmanet U.R. et al., (2008) conducted a correlational study on dental caries, oral hygiene status and risk factors among 242 adolescents between 11 and 14 years in selected schools in UAE. Oral examination was performed to check for decayed, missing and filled teeth (DMFT) index and simple oral hygiene (OHI-S) score. A questionnaire was used to gather data concerning external modifiable risk factors such as socioeconomic status, oral hygiene practices and snacking habits. The results showed that the DMFT index in 67.77% of students
fell between 0 and 3. The average DMFT was 3.27 and oral hygiene score (OHI-S) was fair.
The major component of the DMFT was the untreated decay (D). Half of the students claimed to be familiar with the benefits of fluoride and toothbrush before bedtime. 16% of the subjects were aware of a bad breath problem.
Amin T.T. et al., (2008) did a cross sectional descriptive study to assess the oral hygiene practices, dental knowledge, dietary habits and their relationship to caries among 1115 Saudi male school students selected by multistage random sample from 18 public primary schools. Subjects were interviewed by closed ended questionnaire gathering data regarding frequency of consumption of cariogenic foods, oral hygiene practices and dental health knowledge. The results showed clinically decayed tooth in 68.9% of the children. Caries incidence was higher in children who consumed cariogenic foods. Only 24.5% of students brushed their teeth twice or more per day and 29% of them never received instructions regarding oral hygiene practices. Step wise logistic regression analysis revealed that maternal working conditions, large family size and poor oral hygiene practices were the chief predictors for dental caries.
Prusty M. (2008) conducted a correlative study on oral health status and oral health practice among tobacco consumers in selected villages in Orissa on 100 samples. Mouth mirror and probe were used to detect dental problems. Interview schedule was used to collect the data. There was significant correlation between oral health practice and oral health status among tobacco smokers r=0.048 (p<0.05) also no correlation between oral health practice and oral health status among tobacco chewers. r= 0.437 (p<0.05)
Gagliarali D.I. et al., (2008) performed a study on impact of dental care on oral health related quality of life and treatment goals among elderly adults receiving care through the south Australian Dental Service (SADS) .The study revealed improvements in oral health related quality of life(OHRQOL) were observed(p<0.05) mean OHIP-14 scores did not change.
Mean goal attainment ratings improved significantly (p<0.05) regardless of treatment goal categories.
Santos N. D. et al., (2007) conducted a cross sectional study to assess the personal hygiene and dental cavities and periodontal disease among 40 adolescents between 10 and 18 years in the cities of Recife and Santana, Brazil. The sample size was 1011 adolescents and 971 12-year-olds in Feira De Santana. Assessment of cavity status through no. of cavitied, missing and filled teeth, visible dental plaque, bleeding gums and periodontal status. The study revealed that most of adolescents followed oral hygiene practices 3 times a day. The DMFT values presented a median of 1.5 in Recife and averages of 1.89 in state schools, 2.17 in municipal schools and 2.39 in private schools in Feira De Santana. The bleeding gum in Recife presented a median of 27% and in Feira De Santana the healthy sextant averages of 4.36, 4.08 and 5.16 in state, municipal and private schools respectively.
Gordon N. (2007) conducted a descriptive study to determine the oral status of 60 children attending a facility based nutrition program and oral health knowledge, attitude and practice of their parents/caregivers and to develop a framework for an oral health component.
The structured administered questionnaire for caregivers and an oral examination for the children was used for data collection. The findings revealed that most parents started cleaning their children’s mouth between 12 and 24 months (64%) add sugar to food and feeding bottles and visit a dentist only when the child is symptomatic. These factors clearly place this group at risk for developing caries and gingivitis. The oral examination revealed plaque deposits, gingivitis, caries and white spots.
Nogueira dos Santor et al., (2002) did a cross sectional exploratory study on oral health and hygiene, dental cavities and periodontal diseases among 971adolescents in the cities of Brazil. The tools used were self administered questionnaire and dental examinations were done to assess the number of cavitated teeth, missing and filled teeth, visible dental
plaque, bleeding gums and periodontal status. The analysis was based on chi-square, Kruskall-Wallis and Fisher tests, with a confidence interval of 95%. The result of the study showed that most of the adolescents followed oral hygiene practices three times a day. The DMFT values presented a median of 1.89 in state schools and 2.17 in municipal schools. The bleeding gums presented a median of 27%. The frequency of the dental cavities were low with most of the adolescents reporting good oral hygiene and favorable periodontal conditions. .
Wierzbuka.M. et al., (2002) conducted a cross sectional study to assess the occurrence of dental caries over time in Polish school children, to analyze the oral health behavior of children and mothers and to compare the levels of dental knowledge and attitudes of mothers and school teachers. The surveys were conducted in children aged 6 and 12 years in 1995, 1997, 1999 & 2000. Questionnaire surveys of a sample of mothers & school teachers were conducted in 1999. Children aged 6 years comprised 1998 (n=1860); 1997 (n=922); 1999 (n=2290); 2000 (n=3391). The surveys of 124 subjects covered 1995 (n=1859); 1997 (n=2743); 1999 (n=3060); 2000 (n=3391), mothers (n=1040) of a randomized sub sample of children and 471 school teachers were identified for the questionnaire surveys in 1999. The findings of the study were the proportion of 6 year old children being caries-free was 13% in 1995, 17% in 1997, 18% in 1999 and 12% in 2000. The mean DMFT of children aged 12 years was 4.2 in 1995, 4.0 in 1997, 4.0 in 1999 and 3.8 in 2000; The decay component was particularly high for rural children. In 1999, tooth brushing at least twice a day was reported for 64% of children and this practice was relatively frequent in urban areas. Dental visits were made by 71% of children and 56% of mothers. Knowledge and attitudes were low particularly in rural areas. Dental care habits of children were highly influenced by dental attendance and level of education of mothers. Knowledge and attitudes were higher for teachers than mothers.
The teachers knew about the poor dental condition in children and wanted to become involved in oral health education.
Petersen P. E. et al., (2001) conducted a cross sectional study to describe the level of oral diseases and to analyze self- care practices and dental visiting habits of 2200, 6-12 year old school children in urban and rural school children in southern Thailand. Clinical recordings of dental caries and periodontal CPI scores 0,1 or 2 according to WHO and a structured interview schedule were used as tool to measure oral health behavior and attitudes. It was found that at age 6, 96.3% of children had caries and mean dmft was 8.1. In experience of pain during the previous 12 months was reported by 53% of 12 year olds, 66% saw a dentist within the previous year 24 % reported that visits were due to troubles in the teeth. Tooth brushing of at least once a day was claimed by 88%, significant numbers of children reported having hidden sugar every day: soft drinks (24%), milk with sugar (34%), and tea with sugar (26%), important predictors of high caries experience were dental visits, consumption of sweets, ethnic group (Muslim) and sex (girls). Whereas lower risk was observed in children with positive oral health attitudes.
Jagadeesan et.al., (2000) did a cross sectional study on oral health status and the risk factors for dental and periodontal diseases among rural women in Pondicherry. The study found that the prevalence of dental caries was 40.55%,missing teeth due to caries was 27.3%, periodontal diseases was 0.8% and 20.1%, 20.6%, and 25.6% for bleeding, calculus, shallow pockets and deep pockets respectively.
CHAPTER - III
METHODOLOGY
Research methodology is a way to systematically solve the research problem.
Methodology for the study is defined as the way pertinent information is gathered in order to answer the research question or analyze the research problem.
The study conducted was a case control study on dental caries and oral health practices among school children at a selected school in Kerala.
This chapter deals with description of the different steps which were undertaken by the researcher for the study. It includes the research approach, research design, variables, setting, population, sample size, sampling technique, sampling criteria, development of tool, description of the tool, content validity, reliability, pilot study, data collection procedure and plan for data analysis and ethical issues.
RESEARCH APPROACH
When the association between two factors is strong and consistent a case control study can be used. If the association is biological in nature and specific in the available time, a retrospective study can be done.
Hence the research approach chosen for the study was a retrospective case control study. Case control study is a design that moves in a reverse direction from known outcome to the exposure factors which are thought to be the cause. Two groups were studied: the case
group is one who had dental caries or tooth extraction or filling or root canal treatment done for dental caries. The control group is one in which the children were free from dental caries, tooth extraction, tooth filling or root canal treatment done for dental caries. The oral health practices of both groups were assessed retrospectively.
RESEARCH DESIGN
Polit and Hungler (2008) state that a research design incorporates the most important methodological decisions that a researcher makes in conducting a research study. It depicts the overall plan for organization of scientific investigation. It helps the researcher in the selection of the subject, manipulation of independent variables and observation of type of statistical method to be used to interpret the data. The selection of design depends on the purposes of the study, research approach and variables to be studied.
The research design selected for the present study was case control design. The school children were screened for dental caries (cases) and two groups were formed. One with presence of dental caries and the other group without dental caries (controls). Oral Health Practice was assessed retrospectively.
Good Oral Health Practice
Time
Cases Children with dental carries Poor Oral
Health Practice
Good Oral Health Practice
Time
Control Children without dental
carries Poor Oral
Health Practice
Fig.2.CASE CONTROL DESIGN
TARGET POPULATION School children between the age of
12 – 15 years Background
factors Age, sex, Religion Type of family Education of Mother Occupation of Father Occupation of Mother Family income Family history of dental caries Age of initiation of brushing.
Assessable population School children between the ages of 12 – 15 years in selected school in Palakkad district
Screening for dental Caries (Mouth mirror and probe)
Sampling technique purposive Sampling
Cases 40 Children with dental caries
Cases 80 Children without
dental caries
Data collection procedure Dental caries
checklist and self administered questionnaire
Analysis and interpretation Description and inferential statistics
Findings
Reporting Thesis
Fig.3. SCHEMATIC RESEARCH DESIGN
VARIABLES
S P Gupta (2004) states that a variable is a characteristic that may take on different values at different times, places or situations. The variables in the study were:
Associate variable : Dental caries (presence or absence) Dependent variable : Oral health practices
Attribute variable : Age, gender, religion, education of mother, socio economic status, type of family, occupation of father, occupation of mother, and incidence of dental caries in family and initiation of brushing.
SETTING
C R Kothari (2004) refers setting as the physical location and condition in which data collection takes place for the study. The setting was selected based on acquaintance of the investigator with the institution, feasibility of conducting the study, availability of subjects and permission and cooperation from authorities. The setting for the study was S.D.A Higher secondary School, Ottapalam, Palakkad Dist.
POPULATION
Population may be of two types, target population and accessible population. Target population is the aggregate of cases on which the investigator would like to make generalizations. Accessible population is the aggregate of cases that conform to the specific criteria and which is accessible to the researcher as a pool of subjects for conducting the study.
The accessible population was school children of the age group of 12-15 years studying in S.D.A Higher secondary School, Palakkad Dist.
SAMPLE
The male and female school children studying in standards 7th to 10th std. in the age group of 12-15 years in S.D.A Higher Secondary School who fulfilled the inclusion criteria were selected for the study.
SAMPLE SIZE
The sample size is determined based on the type of study variables being studied, the statistical significance, required availability of samples, feasibility of conducting the study and level of exposure among the controls. The sample size included 40 cases and 80 controls.
SAMPLING TECHNIQUE
In the present study the children were screened for dental caries and purposive sampling technique was used for selecting the cases and control groups among those who met the criteria of the study.
SAMPLE SELECTION CRITERIA
Eligibility criteria: Specified to school children
1. Who had dental caries, tooth extraction, tooth filling and root canal treatment done for dental caries (cases).
2. Who did not have dental caries (controls).
Inclusion Criteria
Specified school students
• Children who are of the age group of 12- 15 years.
• Both male and female school children.
• Children who can read and write English.
• Children who are willing to participate in the study.
• Children who had tooth extraction for reasons other than dental caries were included in control group.
Exclusion Criteria
• Children with any other oral pathological conditions like dental plaque, periodontal disease and halitosis.
• Children who are absent during data collection.
DATA COLLECTION INSTRUMENTS
Data collection tools are the procedures or instruments used by the researchers to observe or measure the key variable in research problem. A semi structured questionnaire was used to collect the details on background variables and oral health practices. The cases in the present study were identified using the screening form for dental caries and observation using mouth mirror and dental probe in daylight.
.
TRAINING OF THE INVESTIGATOR
After obtaining the permission from the concerned authorities, the investigator underwent a short training program of one week at one of the renowned dental clinic in Komarapalayam for assessing dental caries. She was trained, guided and supervised by Dr. Elavarasu, an experienced dental surgeon. On completion of the training, she was given a certificate on proficiency (Appendix - I).
DESCRIPTION OF THE TOOL
The self administered questionnaire consisted of three parts:
Part 1 - Back ground data: This section sought background information such as age, sex, religion, types of family, education of mother, occupation of father, occupation of mother, family income, incidence of dental caries in family and initiation of brushing.
Part II: Questionnaire on oral health practices: This section sought information regarding oral health practices such as,
1. Dental cleaning practices: 6 items (1,2,3,4,5,6) 2. Brushing technique: 3 items (7,8,9)
3. Oral hygiene practices: 5 items (10,11,12,13,14) 4. Care against detrimental habits: 2 items (15,16) 5. Preventive practices: 6 items (17,18,19,20,21,22)
Totally there were 22 items. This section was administered as a self administered questionnaire. The average time taken to complete the questionnaire was 20 minutes.
Part III: Screening form for dental caries: This form was used to differentiate cases and control group.
SCORING
Oral health practice was measured in terms of oral health practice scores. The maximum oral health practice score was 68. The higher the score, the better the oral health practices. For the purpose of the study, the oral health practice was classified as follows:
Adequate practice - A score 70% and above was considered adequate practice.
Inadequate practice - A score below 70% was considered inadequate practice.
CONTENT VALIDITY
To ensure content validity, the tool was submitted to six experts in the field of dentistry and nursing. Based on suggestions and opinions of the experts, the tool was restructured.
RELIABILITY OF THE TOOL
The tool reliability of an instrument is the degree of consistency with which it measures the attributes it is supposed to measure. The self administered questionnaire was administered to 10 school children (5 cases and 5 controls) and the reliability coefficient was computed using test retest method. The reliability coefficient, r=0.88 was high.
PILOT STUDY
Pilot study is a small scale version of trial run for the major study. Pilot study was done among 10 children in which 5 were cases and 5 were controls, before doing the main study.
Formal permission was obtained from concerned authorities before conducting the study. The tool was administered to10 school children. The self administered questionnaire and screening form was found to be appropriate for the study.
DATA COLLECTION PROCEDURE
The present study was conducted in SDA Higher Secondary School, Ottapalam, Palakkad Dist. The data were collected for 3 weeks in the month of October, 2009. Formal approval was obtained from the school Principal after explaining the objectives and purpose of the study. The investigator familiarized with the subjects and explained the purpose of the study, the method of data collection, the use of mouth mirror and dental probe and the time
