Factors Associated with Dental Caries in Patients Attending GMU Dental Centers in UAE

Transcription

1 Factors Associated with Dental Caries in Patients Attending GMU Dental Centers in UAE Najat Abdulla Al-Hasani 1, Masoumeh Golshahr 1, Maryam Giahi 1, Mai Hindi Al-Shamsi 1*, Mariam Hashim 1, Rizwana Burhanuddin Shaikh 2 1DMD students, 2 Department of Community Medicine, Gulf Medical University, Ajman, UAE *Presenting Author ABSTRACT Objectives: To determine the frequency and factors that affect dental caries and its association with oral hygiene practice in the participants. Materials & Methods: A cross-sectional study was conducted among 246 patients attending the OPDs in GMC hospital, Ajman & Sharjah using an interviewer administered questionnaire. After collecting data, participants had been educated on oral hygiene practice. Data was entered on MS excel and coded on Statistics Program for Social Science (SPSS). Data had been analyzed with SPSS program and presented in percentage tables and graphs chi square test was done for associations. Results: 57% of the participants had dental caries, 57.2% of the males and 59.2% females had caries. Marital status has a significant effect on dental caries, between the married and unmarried; 64.7% of married and 47.9% of unmarried participants had dental caries. In the two major occupation categories more laborers (62.6%) had dental caries when compared with those having office jobs (52.3%). Frequency of caries was 50.5% for insured participants and 63.6% for un-insured participants 46.3% of patients with dental caries have regular visits to a dentist, whereas 61.4% had dental caries in which they don t have regular visits. Beverage intake has a significant effect on dental caries; in which 61.1% of patients have dental caries and 38.9% of patients have no dental caries. Smoking and non-smoking participants had equal percent of dental caries. Three fourths of the participants that did not receive education on oral hygiene practice have dental caries Conclusion: In conclusion, dental caries was seen in more than half of the patients who attended GMU/ OPD centers. Participants who had regular visits to the dentist had lower incidence of dental caries that indicates the need for education on oral hygiene practices and preventive care in this population Keywords: Dental caries, labourers, insurance, UAE INTRODUCTION Page 142

2 The most prevalent and widespread oral disease is dental caries. No gender nor race and socioeconomic status are safe from this epidemic 1. Dental caries is an infectious disease that causes localized dissolving of the calcified tissues. It is an irreversible microbial disease of calcified tissue, which caused by demineralization of inorganic portion of tooth and destruction of organic portion, which will leads to cavitation 2. Dental caries are associated with several signs and symptoms, such as: pain and discomfort, sensitivity, discoloration, presence of cavities and swelling of gingival 3. Epidemiological data from many countries showed that prevalence of dental caries has been increasing. This global increase has affected both children and adults 4. In 2004, data reported of American Dental Association Council on Scientific Affairs showed, 42 % of people aged between 6 and 19 years had carious permanent teeth. 21% of 6-11 years and 67% of adolescent aged had dental caries, which shows the prevalence of dental caries increases with age 5. In 2008, Deyu Hu presented a review of three National Health Surveys conducted in more than subjects aged 5-74 years. The surveys showed that in the past 10 years there was no improvement in the untreated tooth caries for children aged 5-6 years old, while the adults aged and years had more decay commonly on the root surface and fewer restorations 4. According to an oral hygiene project executed by Abu Dhabi Health Service Company (SEHA) Ambulatory Health Care Services in 2009, dental caries is the most prevailing chronic disease amongst children, adolescents and adults affecting 80% of the UAE residents 6. The etiology of dental caries is due to three main factors 7-9. These factors include: microbial factors, dietary factors and host salivary factors 7,8, Each one of these factors has a great impact on development and progression of dental caries when they interact in the oral environment at a certain time 7,8,9,13. Microbial factors are microorganisms that are present in the oral microbiota by nature 7, 8,15. However, the consumption of fermentable carbohydrates lead to the interaction of the microorganisms resulting in tooth structure decalcification, proposed Willoughby Miller 7,8, 14. Besides, the plaque research done by William and Black contributed in the evolution of this concept in our present understanding of dental caries etiology 7,8,13. Therefore, dental caries etiology is dependent on the proportions and pathogenicity change of the etiologic bacteria in the response to the environmental conditions taking into consideration that they are normal constituents of the oral flora 10,14,8. Becks et al; suggested that there is a relation between elevation of fermentable carbohydrates resulting in elevation of lactobacillus count and vice versa, meaning that the reduction of fermentable carbohydrates result in reduction of lactobacillus count 10,8,14,15. On the other hand, Sims investigated that Lactobacilli in the oral cavity does not cause dental caries because caries can develop in the absence of Lactobacilli 10,8,14,16. Therefore, there was no evidence of cause and effect when it came to Lactobacillus microorganism. Streptococcus Mutans (S. Mutans) was the main point of interest and the most researched among other etiological organisms 7,8,10,13,16. Although there are more than 500 species of cariogenic microorganisms found in dental plaque 7,8,10,13,16. S. Mutans has up to 8 serotypes that are now known as the mutans streptococci 7,8,13,16. Acidogenesis and acid tolerance, intracellular polysaccharide storage and extracellular glucan formation that promote mutans streptococci attachment and increases plaque s ph-lowering ability are the fundamental caries- associated microbial virulence traits 7,8,13,14,16. Dietary factors also play a major role in the process of caries 7,8, Dental caries has been recognized as a dietobacterial disease 7,8, Fermentable carbohydrates can be either sugar or starch 8,11,16. The main determinants of cariogenecity of foods are: sugar Page 143

3 consumption frequency, retention time, food form, potential of saliva stimulation, nutrient composition and food combinations 8,12,16,21,22,23. Host related factors contributes to one's susceptibility and resistance of dental caries (7,8,16). Saliva has a major role in maintaining a healthy oral environment. In relation to that an association with high caries risk and low salivary flow rate was found to be true 7,8,16. Hyposalivation is an indication for assessment and management of the salivary flow to avoid caries risk 7,8,16. Saliva acts to neutralize the acids that dental plaque produces (7,8,12,16). When plaque ph reaches below 5.5 saliva repairs the demineralization occurring in the tooth structures acting as a host defence mechanism 8,12,16,26. This concept was first introduced by Backer Dirksin when clinical evidence was given about saliva's ability to remineralize enamel 11,8,16. Prevention of dental caries has various methods 7,8. These methods include: risk assessment, fluoride application, sealants and diet control 7,8,25. By the availability of these methods dental caries became a preventable disease 7. Oral Hygiene Practice is one of the main risk factors influencing progression of dental caries 20,24. Taking into consideration that both sugar and dental biofilm are etiologic factors of dental caries 24. A study by Von Der Fehr et al. has proven that high sugar exposure along with lack of oral hygiene practice for the period of 23 days formed a clinically detectable carious lesion 24. Fluoride is an element that has a great effect on bone growth and teeth 7,8,16,25. It has chemical and antibacterial actions 8,9,16,25. Protection against caries is attainable by a variety of fluoride products 8,9,16,25. Recommendation of fluoride use state that only one type of systemic fluoride (e.g. fluoridated water) should be utilized, and fluoride supplements (e.g. fluoride toothpaste) are only given to children who are found to be at high caries risk 8,16,25. Reducing the amount and frequency of sugar consumption is a way of prevention from dental caries by dietary control 7,8,28,26. Individuals at high risk must control their sugar intake to reduce their susceptibility to dental caries 7,8,28,26. Moreover, properties that protect teeth have been found in dairy products (e.g. cheese) since they rapidly neutralize plaque acidity 7,8. Dental sealant is a preventive measure that prohibits food collection in pit and fissures of molar teeth, preventing the development of caries 7,8,27. This method of prevention regress the development of carious lesions 7. The purpose of this study is to assess the knowledge and hygiene practice of patients attending GMC hospital and the factors associated with increase in the risk of caries. Although a number of studies done on this topic worldwide, no similar studies have been published from the northern emirates. MATERIALS & METHODS A cross sectional study was conducted including 246 participants. After obtaining the approval from ethics committee and directors of GMC hospital, Ajman & Sharjah, data was collected using interviewer-administered questionnaires from patients who attended the OPDs in the two centers. The questionnaire had three sections, section A included socio demographic variables, section B included variables on risk factors of caries and section C included questions on prevention of caries. Data was entered on MS excel and coded on Statistics Program for Social Science (SPSS). Data had been analyzed with SPSS program and presented in percent, tables and graphs RESULTS Page 144

4 The research design followed is cross-sectional study with a sample size of 246 participants. Figure 1 shows the frequency of patients with and without dental caries who attended GMU/OPD centers of 230 patients, where 128 patients (57%) found to have dental caries in which 104 (46%) have 1-4 affected teeth, 16 (7%) have 5-8 affected teeth, and 8 (4%) have >=9 affected teeth. No Caries Caries 1-4 Teeth Involved 5-8 Teeth Involved >=9 Teeth Involved Figure 1: Frequency of Dental Caries. Socio-demographic profile includes gender, age, marital status, nationality, education, occupation, insurance status, and living status (Table 1). Dental caries was seen in 57.2% of the male and 59.2% females. In different age groups the frequency of dental caries is as follows, years old 53.8%, years old 59.3%, years old 55.4%, 45 years old and above 63.6%. Marital status is presented as married and unmarried; 64.7% of married and 47.9% of unmarried participants had dental caries (Table 1). Occupation was presented as laborer and office job with 62.6% and 52.3% of dental caries, respectively. The insurance status was 50.5% for insured participants and 63.6% for un-insured participants. Page 145

5 Table 1 Socio-demographic factors of participants with and without dental caries Gender Age Marital Status Nationality Education Level Caries No Caries No. (%) No. (%) Total P- value Male * Female Total Years Years Years > 45 Years Total Married <0.05 Unmarried Total Arabs Non-Arabs Total Primary Secondary High Higher Education Illiterate Total Occupation Laborer Insurance Status Office Job Total Insured Un-Insured Total Family Alone Living Roommate Total Some contributing factors play a major role in dental caries, such as having a regular visit to a dentist, suffering from any systemic disease, taking medications, which were included in the study (Table 2). About 46.3% of patients with dental caries have regular dental visits, whereas 61.4% suffer from dental caries that they don t have regular visits. Table 2: Factors affecting dental caries Caries No Caries No. (%) No. (%) Total Regular Visit Yes to a No Dentist Total Yes Systemic No Disease Total Yes Medication No Total P- value < Page 146

6 Table 3: Personal habits and the effect on dental caries Caries No Caries Total P- value No. (%) No. (%) Yes Chewing No Tobacco Total Yes Smoking No Total Yes Chewing No Betel Quid Total Beverage Yes No < Total From table 3, beverage intake has a significant effect on dental caries; in which patients who responded yes 61.1% of them have dental caries and 38.9% of patients have no dental caries but they drink beverages. Table 4: Oral hygiene practice in relation to dental caries Caries No Caries No. (%) No. (%) Total Yes Brushing No Teeth Total Vertical Technique Horizontal Used in Circular Brushing Total Yes Use No Toothpaste Total Yes Floss No Total Yes Mouthwash No Total Yes Preventive Measures No Total P- value <0.05 Oral hygiene practices influence the presence of dental caries. Participants were asked on oral hygiene practices and measures taken by them (Table 4). The included practices were brushing 58.3%, technique used in brushing (vertical 57.4%, horizontal 58.6%, circular 48.4%), toothpaste use 57.4%, flossing 44.8%, and the use of mouthwash 47.2%. Figure 2 shows when participants seek dental treatment, who attended GMU/OPD centers of 230 patients. Total responds was n=360 due to multiple response question. 173 (48%) seek when they have pain, 41 (11.40%) when they have sensitivity, 37 (10.30%) for Page 147

7 25, 14 % 25, 14 % 12, 7 % 9, 5 % 6, 3 % No of Participants 103, 57 % 41, % 37, 10.30% 28, 8 % 23, 6.40 % 18, 5 % 16, 4 % 11, 3 % 9, 2.50 % 4, 1.10 % No of Participants 173, 48 % GULF MEDICAL JOURNAL check up, 28 (8%) for cleaning, 23 (6.40%) when there is free camp, 18 (5%) when they have swelling, 16(4%) when they have cavity or hole in their teeth, 11(3%) for esthetics, 9(2.50%) for bad breath and, 4 (1.10%) when they have burning sensation will seek dental treatment. Figure 3 shows the preventive measures taken by participants to enhance oral hygiene status, who attended GMU/OPD centers of 230 patients. Total responds was n= (57%) brush, 25(14%) use mouthwash, 25 (14%) have regular visit, 12 (7%) have regular flossing, 9 (5%) do professional cleaning, and 6 (3%) use Miswak for reduce dental caries and enhance oral hygiene status. 200 n= Figure 2: When Participants Seek Dental Treatment n=180 Figure 3: Preventive Measures Taken by Participants to reduce dental caries. DISCUSSION Frequency of dental caries was quite high 57.8%. More females than males had dental caries. Similar results were revealed in other studies that have proven that females are more susceptible to dental caries than males. The reason is that females have a different salivary Page 148

8 composition and flow rate than males. Moreover they are more prone to hormonal fluctuations. Besides they have different dietary habits, genetic variations and particular social roles among their family 34,35,36. In age the category >45 showed the highest incidence of dental caries. This result may be due to the small number of participants from this age group. However, other studies showed that this age group is at higher risk of dental caries 35,36 (Table 1). Marital status was found to be significant in relation to dental caries where married participants had a higher percentage than unmarried. On the other hand, no significance was found in similar studies conducted 37. In relation to insurance status the result revealed significance where insured participants presented a lower percentage than uninsured participants. The reason may be due to the very high dental expenses that may prevent the uninsured participants to seek dental treatment to resolve the problem of dental caries. The participants' occupations were presented as laborers and office job. The study goal was to analyze dental caries in participants that are seeking treatment in our dental centers and to identify the factors that affect whether they do or do not seek dental treatment. Laborers' frequency of dental caries was higher than that of office job participants. High dental expenses play a major role in the possibility of seeking dental treatment due to laborers' low income. Other studies as well have showed similar results with regard to insurance status 38,39. Studies have proven that having regular visits to the dentist is an important factor that affects the occurrence of dental caries. A similar study has shown that individuals who do not have regular visits are 3.5 times at higher risk of dental caries. The results revealed lower frequency of dental caries in participants having regular visits to their dentist than those who do not. This result was very much expected where visiting the dentist regularly aids in prevention of dental caries 7,8,25,30. Dental caries and the consumption of sugar were associated in many studies 7,8,28, 29. The consumption of beverages containing sugar revealed very high significance in this study. Sugars are potentially cariogenic due their ability for prolonged retention on the tooth surface (Table 4). There are various methods of oral hygiene practices that can prevent the occurrence of dental caries. Preventive measures taken by participants including: brushing, mouthwash use, regular flossing, professional cleaning and Miswak use have revealed significance. In which participants who followed oral hygiene practice had a higher percentage in dental caries. The result found was not expected, since oral hygiene practice is meant to decrease the risk of having dental caries. The reason for this result may be the improper method in doing those practices 12,31. With regards to the reason for visiting the dentist the highest percent was due to pain followed by sensitivity, check-up, cleaning and free dental camps. The least results were for bad breath, aesthetics, presence of a hole and swelling. The majority of participants would visit the dentist only in case of pain indicates lack of awareness about the complications that may occur if they did not pay attention to their oral health. Similarly many studies have shown that individuals visit the dentist only in case of pain 32,33. As for education on oral hygiene practice, we found that ¾ of the participants who have not received education on oral hygiene practice had dental caries. CONCLUSION Page 149

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