Oral health status among the under five children attending at OPD of Dhaka Dental College Hospital

Oral health status among the under five children attending at OPD of Dhaka Dental College Hospital *Dr. Md. Ashraful Alam, Dr. Umme Salma Abdullah, Dr. Monoara Mofiz, Dr. Salma Aktar, Dr. Asaduszaman, Dr. Mohoshina Karim, a. Consultant, Enam Medical College & Hospital, Savar, Dhaka.Research Officer , CIPRB. b. Associate Professor & H.O.D, Department of Children Preventive & Community Dentistry, Dhaka Dental College &Hospital. c. Senior Lecturer, Department of Dental Public Health, SamajVittik Dental College, Savar, Dhaka, d. BDS, MS (Orthodontics) e. BDS, MS (Phase-A Resident) f. Lecturer, Department of Community Medicine, Dhaka Community Medical College, Dhaka


Introduction:
Oral health and overall health and wellbeing are inextricably connected.The lips, tongue, gum (gingiva), oral mucosa and salivary glands are responsible to maintain the oral health.Oral diseases affect the most basic human needs: the ability to eat and drink, swallow proper nutrition.Many systemic conditions such as AIDS, diabetes, and osteoporosis have important oral symptoms, manifestations or complications.It is considered to be localized infections only, periodontal or gum diseases are now being investigated as potential risk factors for the development of systemic disease.For instance, accumulating evidence now points to a possible link between periodontal diseases and the incidence of premature, low-birth weight babies, cardiovascular disease and pulmonary disease.Oral disease affects not only the health of the oral cavity and associated craniofacial structures, but can be detrimental to the overall health and well-being of individuals. 1 Oral health means much more than healthy teeth.It means being free of chronic oro-facial pain, oral soft tissue lesions, oral and pharyngeal cancers, birth defects such as cleft lip and palate, and sources of other diseases and disorders that affect the oral, dental and craniofacial tissues, collectively known as craniofacial complex. 2 Oral hygiene is the practice of keeping the mouth clean and healthy by brushing and flossing to prevent tooth decay and gum disease.The purpose of oral hygiene is to prevent the buildup of plaque, the sticky film of bacteria and food that forms on the teeth.Plaque adheres to the crevices and fissures of the teeth and generates acids that, when not removed on a regular basis, slowly eat away, or decay, the protective enamel surface of the teeth, causing holes (cavities) to form.Plaque also irritates gums and can lead to gum disease (periodontal disease) and tooth loss.Fluoride in toothpaste, drinking water or dental treatments also helps to protect teeth by binding with enamel to make it stronger.In addition daily oral care, regular visits to the dentist promote oral health.Preventative services include fluoride treatments, sealant application and scaling (scraping off the hardened plaque, called tartar) that are helpful to maintain the oral health. 3hen infants are born, almost all of their primary teeth already have formed .These teeth are still hidden in the gums.They usually begin to erupt or cut through the gums at about 6 months of age.Some babies get teeth earlier, and some get later.Early childhood caries is a serious form of cavities.It can quickly destroy child's teeth.Children typically start to lose their baby (primary) teeth and replace them with adult teeth when they are 6 or 7 years old.Some children start losing teeth earlier, others start later.Most often, the first permanent teeth to come in are the lower front four teeth.However, some children get their first permanent molars (sometimes called 6 years molars) first.The 6 years molars come in behind the primary teeth.They do not replace primary teeth.Around age 11 or 12, the second permanent molars (also called 12 years molars) come in behind the 6 year molars.By the time of the child is 13 years old, most of his permanent teeth will be in place.Wisdom teeth, or third molars, come in between ages 17 and 21.However, some people don't get any wisdom teeth, or don't get all four.More often, wisdom teeth develop, but there may not be room in the mouth for them.We should continue to help the children brush their teeth twice a day until they are 8 years old or can show that they can do a good job on their own.Brushes after breakfast and before bed, keep the children's teeth free of food particles, especially the molars.Molars have lots of little grooves and crevices.Food particles can hide there and act as food for bacteria. 4 high-meat low carbohydrate diet often causes constipation followed by bouts of diarrhea.This results in a sluggish colon, with the excess protein accelerating water loss, and eventually a diminished supply of beneficial intestinal bacteria.The accelerated water loss, if not replenished, will cause more plaque buildup in the oral cavity as well.Children and young adolescents are the group that requires oral health care.Several studies were conducted in Bangladesh to have an idea of prevalence of dental caries and periodontal diseases.

Methods and materials:
This was a descriptive type of cross-sectional study conducted among the under five children attending at OPD of Dhaka dental college hospital from January to June, 2011.Sample size was 120 taken by the technique of non probability purposive sampling technique.After explaining the purpose of the study data were collected through face to face interview of the guardians using a structured questionnaire and checklist for clinical examination of the children to find out the DMFT score.After completion of data collection, data were checked, verified entered into the computer and edited for consistency to reduce error.Data were analyzed by using Statistical Package for Social Science (SPSS) version 17 software.The important variables were considered and analyzed to fulfill the objectives of the study.The results were fashioned in tabular form and explained according to the findings.

Discussion
This cross sectional study on under five children was undertaken to assess their oral health status.Purposively chosen 120 respondents were participated having primary teeth in their mouth.Their parents accompanying the children, answered most of the questions of a structured questionnaire, after that their oral health status was evaluated through an examination checklist.Dhaka Dental College hospital was selected as the study place.
The present study revealed of 120 patients 83(69.17%)were 4-5 years old and 22(18.33%)was 3-4 years old.Petersen PE, Danilia I ct al. had found in their study that 37% of the Romanian children brushed their teeth at least twice a day; 26% had their teeth cleaned by their mothers every day. 7More than seventy percent respondents said that their child clean teeth before breakfast, 7(5.83%) after breakfast,8(6.67%)before breakfast & before going to bed and 17(14.17%)after breakfast & before going to bed.100% respondents said that, their child use toothbrush and toothpaste for brushing teeth (table-2b).10(08.33%)children brush teeth from above downwards,39(32.50%)brush teeth from side to side movement and 71(59.17%)both from above downwards & from side to side movement(table-3).Zhu and Peterson in their study had reported slightly higher level of correct tooth brushing practice among Chinese children and adolescents. 8ajority 118(98.33%)children who ate sweet/biscuit/chocolate had higher DMFT and the rest 2(01.67%)who did not eat sweet/biscuit/chocolate had lower DMFT (table-4).A study was conducted by Rashid 9 in the OPD of Rajshahi Medical College Hospital among 200 preschool children aged between 2-5 years.The children were examined of dental chair with mouth mirror and dental probe.The attendants of the children were asked questions regarding sugar consumption, frequency of breast-feeding and feeder use, consumption of lozenges, chewing gums, ice cream etc. the children were divide into high sugar consumption (N121) and low sugar consumption groups (N79) according to the amount and frequency of sugar intake.Children who consumed more sugar had a mean dm of 4.5 compared to mean DMFT of 1.5 among the low sugar consumption group.were caries free at recruitment.The incidence of developing a first carious (into dentine) lesion in caries free children increased with age at four, the incidence of the first carious lesion was 95 per 100 person years and at age seven it was 196 per 100 person years.The tooth specific incidence of caries was found to be approximately 5-6 times greater in children with caries at recruitment than in caries free children.The DMFT status is the summation of decayed, missing, and filled teeth in the primary dentition.The DMFT status 0 was assessed as healthy primary dentition and DMFT 1 or higher was assessed as presence of decayed, missing and filled teeth.In this study, regarding DMFT score and overall oral hygiene status of the children, DMFT 0 in 5 (4.17%) cases, DMFT 1 in 18(15.00%)cases and DMFT higher in 97(80.83%)cases.In present study, DMFT 1 & higher score in 115(95.83%)cases.(figure-01).Necmi N. Vehit HE et al. 5 in their study had found dmft score of 0 was recorded in 28% of the children, while 77(72%) children demonstrate dmft score of 1 or higher .A similar study was done by Sayegh A, Dini EL et al 13 revealed that 67% in Amman 4 to 5 years old children had some caries experience and 33% had DMFT greater than 4. The present study revealed that overall oral health status was good in most cases that were 104(86.67%)and bad in 16(13.33%)cases.

Conclusion
This cross sectional study among the under 5 children attending at OPD of Dhaka Dental College Hospital was under taken to assess their oral health status.Purposively selected 120 under five children's parents were interviewed through a structured questionnaire followed by oral examination through a check list.The children were from middle and well to do families of Dhaka and seemed to practicing oral hygiene well in terms of tooth cleaning.Most of them used to clean their teeth themselves with brush and paste, once daily spending 1-3 minutes.They were habituated with fast foods and snacks, sugar added milk etc.Their parents seemed to be aware of the importance of dental health and participated with eagerness.They further ask few questions on dental health even.The prevalence of Dental Caries among the children was 96.67%.The study revealed positive relation with monthly family income, mother's educational status with over all oral health status.More income and better parent

Table - 2(a): Distribution of the respondents by their opinion regarding cleaning teeth
Table:2(b)

Table : 3
show the distribution of the child's method of cleaning teeth.10(08.33%))children brushed teeth from above downwards, 39(32.50%)from side to side and 71(59.17%)both from above downwards & from side to side movement.

Table 5 : Distribution of variables on dental caries and DMFT score
Upper jaw is affected in case of 29(24.17%)children, lower jaw is affected in case of 31(25.83%)children and both upper & lower jaw is affected in case of 44(36.67%)children.Missing teeth due to

Table 6 :
shows the distribution of variables on overall oral health status of the children.Overall oral health status is good in most cases that are 104(86.67%)and bad in 16(13.33%)cases.