ASSOCIATION BETWEEN CAREGIVERS TO PREVENT VERTICAL TRANSMISSION AND DENTAL CARIES AMONG 3-6 YEARS OLD CHILDREN IN CHENNAI,INDIA

Transcription

1 Original Research ASSOCIATION BETWEEN CAREGIVERS TO PREVENT VERTICAL TRANSMISSION AND DENTAL CARIES AMONG 3-6 YEARS OLD CHILDREN IN CHENNAI,INDIA 1, Sunayana Manipal 2 1 Research Assistant, 2 Senior Lecturer SRM Dental college Abstract Objective: The aim of this research is to investigate the effect of trying to prevent the vertical transmission and dental caries in children.this is because of the fact that caries are mostly transmitted from their mother to children before birth itself.this study also deals with investigating the association between caregiver behaviour measures to prevent vertical transmission in their children. METHODS: Children between 3-6 yrs were selected for collecting the sample because of thefact that young children are more prone to caries development given by WHO.Various methods were followed to investigate the vertical transmission prevention.initially data were collected from oral examinations of children.variables like absence of maternal utensils sharing,mouth to mouth feeding were used to prevent vertical transmission. RESULTS: Data sample for 200 children were analysed.this shows caregivers who practised vertical transmission preventionhad better oral health behaviours.this study suggests that caregivers behaviours to prevent vertical transmission were not effective in reducing levels of childhood caries. Key Words: Caries onset, caregiver behaviour, caries prevention, epidemiology, school children INTRODUCTION Dental caries is a multifactorial disease.epidemiologically, it can be modelled as interplay among three primary factors: a favourable environment, microflora, and, a susceptible host. All of these are essential for the initiation and progression of the disease(1).in this paper we describe about the spread of Dental caries through vertical transmission. In India,the vertical transmission tends to play major role in the spread of oral 1organisms.Especially in dentistry the spread of streptococcus mutans(ms)is more common. Maternal factors highly influence the acquisition of Streptococcus mutans in infants(2). This will finally end up in causing dental caries in children.the spread of oral organisms were contributed by various factors which were discussed below. In order to prevent the vertical transmission Association between caregivers to prevent vertical transmission and dental caries was done. In addition, the results are controversial and there is no significant effect on sharing of maternal utensils and streptococcus mutans. The reason for these controversial results is that they did not consider cofounders like socio economic status(ses).it has been found that people with higher SES had lower levels of maternal utensils sharing.few others factors are also used as covariates such as when to start giving sweets and frequency giving sweets. This has been considered due to the fact restricting the intake of carbohydrates especially sugars had significant effect on caries prevalence in children(3). Caregivers smoking habit also influencing dental caries in children(4).therefore this study highlights the prevention of vertical transmission and the spread of dental caries. This study also deals with educating the caregivers and children about severity of dental caries. 4:2[2015]1-8 Page 1

2 MATERIALS AND METHODS This survey was done between January 2012 and July The main subject of this study is obtained from oral examination of children between 3-6years and a self-administered questionnaire from parents STUDY SAMPLES: The study was conducted in Chennai. Chennai city was divided into 4 zones (North,South,East,and West).In each zone, a private consultant of children s hospital was selectedfor this study.50 samples were collected in each zone. A total of 200 samples were collected. DATA COLLECTION: Data collection was done by giving various questionsin a questionnaire pattern in which caregivers were asked to fill it. Children oral health status was examined by DMFT index(number of decayed,missing and filling teeth).the self administered questionnaires include behaviour to prevent vertical transmission,dietary history,oral health behaviour,socioeconomic status(ses) and socio-demographic factors. EXPLANATORY VARIABLE: Information on behaviour to prevent vertical transmission was obtained by the answers given to the questionnaire and were checked whether the caregivers are careful about the occurrence of caries from caregivers due to everyday behaviour such as sharing of maternal utensils and mouth to mouth feeding. OUTCOME VARIABLES: COVARIATES: Covariates are mainly associated with this vertical transmission which many dentists missed to consider as a factor. A child s dietary history was ascertained by 3 questions. 1.When to terminate breast feeding 2.When to start giving sweet 3.Frequency of giving sweets per week. Oral health behaviours were measured by the questions. 1.When to start to tooth brushing 2.Frequency of tooth brushing 3.When to start using tooth paste. Sociodemographic factors used were sex,age in months,birth order of the child,living with or without grandparents,attending nursery school,smoking status of the caregivers,the time a child went to bed and occupation of caregivers.the occupation and income of the caregivers was calculated using Kuppusamy Scale. DATA ANALYSIS: All data were analysed by statistical report.logistic regression analysis was used to assess the association between caregivers to prevent vertical transmission and caries experience.after calculating the non-adjustedor, we included the child s sex,age in months and the covariates in the non-adjusted model by 4 steps. MODEL1: The child s sex and age in months MODEL2: model1+dietary variables MODEL3:model2+oral health behaviours MODEL4: model3+sociodemographic factors. RESULTS: The survey was conducted by oral examinations and questionnaire to 200 childrens and caregiver in each direction of Chennai-Tamil Nadu,India. In this survey out of 200 children, 52 children had experienced caries who practised behaviour to prevent vertical transmission. So there was decreased in caries prevalence of children who practised behaviour to prevent vertical transmission. This shows there was significant association between caregiver behaviours and cause of dental caries in children. Multivariate Logistic Regression: We get the same odds ratio when we run the logistic regression. If we calculated a 95% confidence interval, we would not want this to include the value of 1. When we were considering the coefficients, we did not want the confidence interval to include 0. If we exponent ate 0, we get 1 (exp (0) = 1). Hence, this is two ways of saying the same thing. As you can see, the 95% confidence interval includes 1; hence, the odds ratio is not statistically significant. Because the lower bound of 4:2[2015]1-8 Page 2

3 the 95% confidence interval is so close to 1, the p- value is very close to.05. Table 1 shows p value of children who practised vertical transmission prevention and dental caries (0.025) a. Child attending any nursery school (0.044) b. Tooth brushing (0.07) c. Frequency of brushing (0.004) d. When to start giving sweet (0.003) e. Frequency of giving sweets (0.003) f. Time for children to go to bed (0.059). The first two models are statistically significance as the p-value is less than 0.05 Behavior to prevent Total Chi - Square INDIVIDUAL CHARACTERS vertical transmission (p- value) Yes No Birth order of the child First Born Second Born Third Born or later Child Living with grandparents Yes No Temporarily Child Attending any nursery school Attending not attending sharing utensils maternal any home education Once in a week Daily never done mouth - mouth feeding Once in a week Daily never done Breast Terminated Feeding 12 to 18 months more than 24 months no breast feeding When to start tooth brushing 12 to 18 months to 24 months more than 24 months Frequency of brushing less than once a day once in a day :2[2015]1-8 Page 3

4 more than twice a day start giving sweet 12 to 18 months to 24 months more than 24 months Frequency of giving sweets less than a week one - three day a week every day Time for children to go to bed before 22 hours after 22 hours Irregularly Smoking status of caregiver Smoking since long time smoking started after marriage no smoking Child experienced any caries only one tooth more than two tooth no caries Restoration done on the tooth only one tooth more than two tooth no restoration done no smoking Table 2 shows association between vertical transmission prevention behaviour and caries experience with covariates. In this table, behaviour to prevent vertical transmission and dental caries with non-adjusted modelor and 95%CI( ) and p value(0.036). After adjusting with sex and age in months there is marked reduction in the significance(or model1=1.01),95%ci( )and p value(0.049) In the same way, model 2 shows(or=0.94),95%ci( ) and p value(0.355) Model 3 shows (OR=0.91),95%CI( ) and p value(0.401). Model 4 shows (OR=0.84),95%CI( ) and p value(0.475). All these value suggests that there was reduction in the OR value and 95%CI value with considering the covariates. There is no statistical significant is evident. 4:2[2015]1-8 Page 4

5 Behaviors to prevent vertical transmission Yes No 95% CI P Value Non-Adjusted OR Referent Multivariable OR model 1 Referent Multivariable OR model 2 Referent Multivariable OR model 3 Referent Multivariable OR model 4 Referent DISCUSSION: This research was conducted for investigating the association between caregivers to prevent vertical transmission and dental caries.many studies had proven that caries is the main cause for dental pain in childhood (5). But the result suggests that there are no significant associations.in this cross sectional study,we include other health behaviours and sociodemographic factors into considerations. Other variables like smoking status of caregivers,commencement of tooth brushing,when to start giving sweets and frequency of givingsweets are also included. Among all these factors, maternal sharing of utensils plays a major role in initiation of dental caries because MS play role in causing dental caries. Many studiessuggested that mode of delivery of infants in caesarean section have high risk of caries prevalencethan vaginally delivered infant(2). The next factor coming into role is socioeconomic status(ses).people with high SES had good health behaviours than with lower SES(9).It has been reported that parents behaviour and attitude towards oral health are associated with the child s dental health(8). It also had been reported that hypo calcification of the tooth enamel which is common in low-income population, further increases tooth susceptibility to the expression of dental decay. When to start giving sweets and its frequency also plays a significant role causing dental caries. This factor shows significant results due to the fact that in young children, early MS colonization, plaque accumulation, diet, and mother s education have been shown to be strongly associated with caries development(10) which is similar to this study. When to start tooth brushing and its frequency shows significant results in causing dental caries. Studies showed that tooth-brushing is the primary contributor to good oral hygiene and remains the more reliable method of controlling the risk of caries(13). Smoking status of the caregivers also shows significant results but the previous study did not show any significance about this factor. This was told in detail in introduction part. The previous study reported that there was no significant association between smoking status of caregivers and child caries experience which is not similar to this study (4). Breast feeding termination does not show any significance in children causing caries. Usually breast feeding is recommended by healthcare professionals and paediatricians to be continued as long as mutually desired by mother and child(11) Our results suggest that people with higher SES was tried to prevent vertical transmission and they had low caries prevalence rate.reducing inequalities in oral health has become one of the main health policy issues for caries occurrence(6).this includes age, tooth brushing frequency, water fluoride level were significantly correlated to at least one carious score(7) which shows results similar to this study. It was also stated that the severity of caries progression occurs 4:2[2015]1-8 Page 5

6 with who they are in close contact and mothers with high caries activity in their saliva.this occurs because initially caries does not colonize the deciduousteeth and they spreads from the surroundings (12). CONCLUSION: In conclusion, there is no significant association between behaviours to prevent vertical transmission and the caries experience in children after adjustment for covariates. Certain factors show significant results which can be prevented by developing caregiver behaviours and child oral hygiene practise. REFERENCES: 1.Kopycka-Kedzierawski DT,BillingsRJ:A longitudinal study of caries onset in initially cariesfree children and baseline salivary mutans streptococci levels:a Kaplan-meier survival analysis-community dentistry and oral epidemiology 2004;32: Li Y, Caufield WP, Dasanayake AP, Wiener WH,Vermund SH. Mode of delivery and other maternal factors influence the acquisition of streptococcus mutans in infants.j Dent Res 2005;84: Kristoffersson K,Birkhed D:Effects of partial sugar restriction for 6 weeks on numbers of streptococcus mutans in saliva and interdental plaque in man- Caries Res 1987;21: Kim seow W: Environmental, maternal, and child factors which contribute to early childhood caries: a unifying conceptual model-int J Paediatr Dent 2012;22: Boeria GF, Correa MB, Peres KG, Santos IS,Matijasevrich A et al: Caries is the main cause for dental pain in childhood-findings from a birth cohort. Caries Res 2012;46: Aida J,Ando Y, Oosaka M,Niiki k,morita M:Contributions of social context to inequality in dental caries:a multilevel analysis of Japanese 3 yr old children.community Dent Oral Epidemiology2008;36: Wang X, Willing MC, Marazita ML, Wendell S, Warren JJ, Broffitt B, Smith B, Busch T, et al: Caries Res2012; 46: Goettoms ML, Ardenghi TM, Romano AR, Demarco FF, Torriani DD. Information of maternal dental anxiety on the child s dental caries. Caries Res 2012; 46: Wakaguri S, Aida J, Osaka K, Morita M, Ando Y. Association between caregivers to prevent vertical transmission and dental caries.caries Res 2011;45: Jana Olak, ReetMandar, Sara Karjalainen, Eva Soderling, Mare Saag. Dental health and oral mutans Streptococci in 2-4 year-old-estonian children.int J Paediatr Dent2007; 17: Agarwal M, Ghousia S, Konde S, Raj S. Breastfeeding: nature s safety Net. Int J ClinPaediatr Dent 2012 (1); Berkowitz RJ, Turner J, Green P, Maternal salivary levels of Streptococcus mutans and primary oral infection of infants. Arch Oral Biol 1981; 26: Chadha GM, Kakodhar P, Chaugule V, Nimbalkar V. Dental survey of institutionalized children with autistic disorder. Int J ClinPediatr Dent 2012; 5(1): Address for correspondence Dr Shruthi.A, Research Assistant Department Of Public Health Dentistry sruthia@gmail.com 4:2[2015]1-8 Page 6