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Abstract
Mwakayoka H., et al. J Dent Shiraz Univ Med Sci., 2017 June; 18(2): 104-111. Original Article Dental Caries and Associated Factors in Children Aged 2-4 Years Old in Mbeya City, Tanzania 1 2 3 Hery Mwakayoka , Joyce Rose Masalu , Emil Namakuka Kikwilu Specialist Community Dentist (MDent), Mbeya Referral Hopsital, Tanzania. Senior Lecturer, Dept. of Orthodontics, Paedodontics and Community Dentistry, School of Dentistry, Muhimbili University of Health and Allied Sciences, Tanzania. Dept. of Orthodontics, Paedodontics and Community Dentistry, School of Dentistry, Muhimbili University of Health and Allied Sci- ences, Tanzania. KEY WORDS ABSTRACT Dental caries; Statement of the Problem: Dental caries in infants and young children is prevalent Risk factors; worldwide; its magnitude and associated factors vary between communities because Children; of cultural and social economic differences. No such information was available for Preschool; pre-school children in Mbeya city. Tanzania; Purpose: To determine dental caries status and associated factors in 2 to 4-year-old children in Mbeya city. Materials and Method: A cross sectional study was conducted among 525 children aged 2-4 years and their parents/caregivers. Caries was assessed using caries assess- ment spectrum and treatment index, oral hygiene by visual inspection for visible plaque on index teeth, and dietary and oral hygiene habits by a questionnaire. Kappa statistics was used to test reliability of study instruments, -test and logistic regres- sion was employed for studying associations. Results: Caries free children for dmft1, dmft2 and dmft3 were 79.8%, 83.8% and 94.7% and caries experience was 0.49 (1.23), 0.4 (1.14) and 0.10 (0.53) respectively. Older age [(OR =2.722 (1.617-4.582) p=< 0.001)]; and frequent consumption of fac- tory made sugary foods/snacks at age 1-2 years [(OR=3.061 (1.188-7.887) p=0.021] were associated with caries. Prolonged breastfeeding for more than 1 year and breastfeeding at night had no association with dental caries. Conclusion: The prevalence of dental caries was very low. Older age and frequent consumption of factory made sugary foods at age 1-2 years were associated with higher odds of developing dental caries. Prolonged breasfeeding and breastfeeding at night had no association with dental caries. Prevention of dental caries should be Received January 2016; instituted as soon as primary teeth start erupting, especially through discouraging Received in Revised form March 2016; Accepted October 2016; consumption of factory made sugary foods/snacks. Corresponding Author: Emil N., Kikwilu, School of Dentistry, Muhimbili University of Health and Allied Sciences, P.O. Box 65014, Dar es Salaam, Tanzania. Tel: +255-683692 227 Email: [email protected] Cite this article as: Mwakayoka H., Masalu JR., Kikwilu EN. Dental Caries and Associaed Factors in Children Aged 2-4 Years Old in Mbeya City, Tanzania. J Dent Shiraz Univ Med Sci., 2017 June; 18(2): 104-111. 8-9 and breast feeding practices. 5, 8, 10-11 Howev- Introduction Dental caries in infants and young children is prevalent er, reviews and meta-analysis do not show adequate worldwide, with prevalence ranging from 3.3%- 61.1%. evidence to support breast feeding as a causative factor 1-7 The factors that are currently associated with den- for early childhood caries (ECC). 12-14 Other factors tal caries in children are the life time of dentition; 1, 3, include poor oral hygiene and presence of high counts 8 infant feeding practices related to sugared beverages; of Streptococcus mutans in dental plaque, 15-16 social 104 Dental Caries and Associated Factors in Children Aged 2-4 Years Old in Mbeya City, Tanzania Mwakayoka H., et al. economic status especially low maternal education 6, The CAST is a hierarchical instrument with 9 17 and geographic location. 8 scores ranging from 0=sound tooth surface to 8= miss- Studying the prevalence of dental caries and its ing due to dental caries. In between are 1=surfaces with associated factors in a community assists in determining fissure sealants, 2=restored cavity, 3-enamel lesion, its public health importance and means of controlling it. 4=dentinal caries, 5=dentinal caries with cavitation, Dental caries is behavioural related; therefore, its occur- 6=dentinal caries with pulp involvement, and 7= caries rence and severity is likely to vary between communi- with abscess/ fistula discharging pus. The examiner ties with different risk behaviours. During literature dictated the findings to a trained assistant who recorded search, only three studies from Tanzania that report on the dictated findings onto clinical record forms. factors associated with ECC were retrieved. 1, 18-19 Questionnaire on breast feeding practices and snacking None of these studies was conducted in Mbeya. There- A structured questionnaire was used to interview moth- fore, there was a need to conduct a similar study among ers/guardians on demographic characteristics, breast- children in Mbeya city to ascertain its magnitude and feeding practices and foods/snacks consumed by a child factors influencing its occurrence. The aim of this study when he/she was aged 1-2 and 3-4 years. was to describe the occurrence of dental caries in chil- Data entry, management and analysis dren aged 2-4 years old and associated factors in Mbeya Data were entered and analysed using SPSS version 16. city. The independent demographic variables were geograph- ic location coded as 0= urban, 1 = rural; education cod- Materials and Method ed as: (1) did not complete primary school, (2) complet- ed primary school, (3) completed secondary school, (4) Study design, study area and sampling procedures A cross sectional study was conducted in Mbeya city, collage education and above. Education was later di- Tanzania. The sample size of 322 was calculated for chotomized into primary education or lower and sec- urban and rural areas separately based on the standard ondary education or high and dummy coded as 0= sec- power calculation formula with = 0.31 (prevalence of ondary education or high; 1= primary education or low- caries in children). This gave a total sample size of 644. er. Occupation coded as (1) employed, (2) self- Quota sampling technique based on the rural-urban stra- employed, (3) neither employed nor self-employed. ta and age distribution of 2-4 years old children as per Occupation was later dichotomized into employed (em- 2012 census was used to get study subjects. 20 To ployed and self-employed) and unemployed, and dum- facilitate the examination and interview, the local gov- my coded as 0=employed; 1= unemployed. Age of a ernment leader requested mothers and children to as- child was recorded from 2–4 years. This was later di- semble at suitable places in each street. Children were chotomized into young age (2 years) and older age (3-4 examined for dental caries and oral hygiene, and their years) and dummy coded as 0= young age; 1=old age. mothers/caregivers were interviewed on demographic Gender of child was coded 0=male and 1=female. characteristics, breastfeeding, and weaning practices. Other independent variables Oral hygiene status was recorded as 0=no plaque and Clinical examination for oral hygiene and dental caries The mother/guardian held the child in supine position 1=visible plaque. Count of visible plaque was done for that enabled the researcher (HM) to examine the child. upper posterior teeth (sextants 1 and 3), lower posterior The clinical examination was conducted using natural teeth (sextants 4 and 6) and upper anterior teeth (sextant light. The mouth mirror was used to reflect the lips and 2). Children with counts of 2 in posterior sextants were cheeks and saliva was wiped with gauze to enhance grouped as having poor oral hygiene, and those with visibility during diagnosis of dental caries. Oral hygiene counts of 1 or zero as having good oral hygiene. In ante- was assessed by visual inspection of index teeth for rior sextants, children with count of 1 were grouped as visible dental plaque, and recorded as 0 when dental having poor oral hygiene, and those with score 0 as hav- plaque was not visible and 1 when dental plaque was ing good oral hygiene. These were dummy coded as 0= visible. Dental caries was assessed using caries assess- good oral hygiene; 1= poor oral hygiene. ment spectrum and treatment (CAST) instrument. 21 Duration of breast feeding was recorded as 1 year, 105 Mwakayoka H., et al. J Dent Shiraz Univ Med Sci., 2017 June; 18(2): 104-111. >1 year up to two years and >2 years, it was dichoto- ents/caregivers of the child after they had read and un- mized into 1 years and >1 years and dummy coded as derstood the purpose of the study. Feedback on oral 0=1 years; 1= >1 years. health status of the child was given on the sport to par- Breast feeding at night was recorded using 3 cate- ents. Children found with problem were referred to gories namely (1) once up to twice per night, (2) three Mbeya referral hospital or nearby dental clinic for fur- times up to four times per night, (3) more than four ther investigation and treatment. times per night. It was dichotomized into once up to two times per night= 0; and three times or more per night=1. Results Consumption frequency of factory made sugary The kappa coefficients for reliability of questionnaire foods (biscuit, sweet, juice, ice-cream, soda, cake and ranged from 0.363 to 1.0. Questions on frequency of chewing gum) and home-made sugary foods (porridge, drinking juice and tea with sugar at age of 1-2 years had tea and ubuyu) was recorded either as: (1) never used, the lowest coefficients of 0.363 and 0.446 respectively. (2) not daily but at least once a week, (3) once in day, Reliability for data on dentition status was good (ҡ= (4) twice a day and three times or more. Factory and 0.845-1.0). home-made sugary foods intake were summed separate- The questions on frequency of drinking juice at ly. The frequency of factory made sugary foods was age of 1-2 years and frequency of drinking tea with sug- dichotomized and coded as 0= no factory made sugary ar at age of 1-2 years had lowest kappa coefficient of foods consumption reported and 1= factory made sug- 0.363 and 0.446 respectively, indicating poor reliability ary foods reported to be consumed once or more times a for frequency of drinking juice at age 1-2 years. A total day. Home sugary foods were dichotomized into 0= 0-3 of 525 children aged 2-4 years and their parents/ care- times per day and 1= 4-6 times per day. The categories givers participated in the current study. Caries free chil- with score 0 were taken as referent categories in the dren for dmft1, dmft2 and dmft3 were 79.8%, 83.8% logistic regression analysis. and 94.7% respectively. Mean dmft1, dmft2 and dmft3 were 0.49 (1.23), 0.4 (1.14) and 0.10 (0.53) respectively Dependent variables Dental caries experience (dmft) based on three different (Table 1). caries thresholds (CAST codes 3 to 7= dmft1; 4 to 8= Bivariate analyses revealed that older children dmft2; and 5 to 8= dmft3) were calculated. CAST codes (Table 2); those who were reported to have consumed 0-2 were taken as functional dentition. To determine the factory sugary foods at age of 1-2yrs (Table 3); and prevalence of dental caries, the frequency distributions those who were diagnosed to have good oral hygiene for of children by dmft1, dmft2 and dmft3 were generated. lower posterior teeth (Table 4) were statistically signifi- To allow bivariate and multivariate analyses dmft1, cantly associated with having dmft >0. dmft2 and dmft3 were dichotomized into dmft=0 (caries In multivariate analyses, older children had sta- free) and dmft≥1 (one or more decayed, missing and tistically significantly higher odds of having dmft>0 restored tooth). Category coded 1 was taken as outcome compared to younger children at all three levels of den- of interest. The significant level was set at p 0.05. tal caries diagnosis [at dmft1: OR =2.72 (1.62-4.582); p=< 0.001; at dmft2: OR = 2.73 (1.52-4.87); p= 0.001; Reliability of instruments for data collection The questionnaire was administered twice to a group of and at dmft3: OR = 3.40 (1.15-10.03); p= 0.027]. Chil- th 14 mothers at an interval of two weeks. Every 10 child dren who were reported to have consumed factory sug- was re-examined for dentition status. Due to continued ary foods at age 1-2 years of age had statistically signif- accumulation of dental plaque, its reliability was not icantly higher odds of having dmft2>0 [OR = 3.06 determined. Kappa statistic coefficients were computed (1.19-7.89); p= 0.021]. Children who had good oral to estimate reliability of the data collected. hygiene had higher odds of having dmft3>0 [OR=0.29 (0.10-0.82); p= 0.02] (Table 5). Ethical consideration Ethical clearance was granted by Muhimbili University of Health and Allied Sciences Ethical Committee. Writ- Discussion ten informed consents were obtained from the par- The current study investigated the prevalence and sever- 106 Dental Caries and Associated Factors in Children Aged 2-4 Years Old in Mbeya City, Tanzania Mwakayoka H., et al. Table 1: Distribution of children by caries experience scores, maximum, and mean dmft computed at 3 cut point levels of caries diag- nosis Diagnosis level of dental caries Caries experience scores, maximum, mean dmft Dmft 1* n (%) Dmft 2** n (%) Dmft 3*** n (%) 0 dmft 419 (79.8) 440 (83.8) 497 (94.7) 1-2 dmft 75 (14.3) 57 (10.8) 21 (4.0) 3-4 dmft 20 (3.8) 18 (3.4) 6 (1.2) 5-6 dmft 6 (1.2) 6 (1.2) 0 (0.0) 7-8 dmft 5 (1.0) 4 (0.8) 1 (0.2) Maximum dmft 8 8 7 Mean dmft (SD) 0.49 (1.23) 0.40 (1.14) 0.10 (0.53) Key: * dmft1= (enamel lesions + dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) ** dmft2 = (dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) *** dmft3 = (dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) ity of dental caries at three levels of caries diagnosis: ely to be under reported. enamel lesions, pre-cavity dentinal caries and cavity The oral hygiene was recorded either as present or dentinal caries, and its associated factors in children absent. This led to grouping subjects with heavy dental aged 2-4 years old in Mbeya city. The accuracy of de- plaque score with those with low or moderate plaque tecting enamel and pre-cavity dentinal caries lesions is accumulation. This is likely to distort the association dependent on the cleanliness of tooth surface being ex- between oral hygiene and dental caries. Therefore, the amined. In the field condition under which the current reported association between oral hygiene and dental study was undertaken, it was not always possible to caries in the current study need to be interpreted with have all tooth surfaces clean. This may have led to un- caution. der reporting of initial caries lesions. Therefore the The current study indicate a higher proportion of prevalence and caries experience for enamel and pre- caries free children when caries prevalence is computed cavity dentinal caries lesions in the current study are lik- using frank cavities (dmft3) compared to when caries Table 2: Distribution of children by demographic factors and caries experience determined at three levels of caries diagnosis Caries prevalence determined at three levels of dental caries diagnosis Dmft1* dmft2** dmft3*** Demographic variables Caries free 1+ dmft Caries free 1+ dmft Caries free 1+ dmft n (%) N (%) n (%) n (%) N (%) N (%) Geographic location Urban 200 (79.7) 51 (20.3) 211(84.1) 40 (15.9) 242 (96.4) 9 (3.6) Peri-urban 219 (79.9) 55 (20.1) 229 (83.6) 45 (16.6) 255 (93.1) 19 (6.9) 2 2 2 χ = 0.005; p= 0.994 Χ = 0.023; p= 0.880 χ = 2.909; p= 0.088 Gender Male 212 (79.7) 54 (20.3) 223 (83.8) 43 (16.2) 250 (94.0) 16 (6.0) 207 (79.9) 52 (20.1) 217 (83.8) 42 (16.2) 247 (95.4) 12 (4.6) Female 2 2 2 χ = 0.004; p= 0.946 χ < 0.01; p= 0.987 χ = 0.496; p= 0.481 Age of child 2 years 169 (88.9) 21 (11.1) 174 (91.6) 16 (8.4) 186 (97.9) 4(2.1) 3 years 115 (78.8) 31 (21.2) 125 (85.6) 21 (14.4) 141 (96.6) 5 (3.4) 4 years 135 (71.4) 54 (28.6) 141 (74.6) 48 (25.4) 170 (89.9) 19 (10.1) 2 2 2 Χ = 18.182; p < 0.001 χ = 20.609; p < 0.001 χ = 13.313; p= 0.001 Parents/caregiver education Primary education or lower 330 (78.2) 92 (21.8) 350 (82.9) 72 (17.1) 401 (95.0) 21 (5.0) Secondary education or high 89 (86.4) 14 (13.6) 90 (87.4) 13 (12.6) 96 (93.2) 7 (6.8) 2 2 2 χ = 3.462; p= 0.063 χ = 1.203; p= 0.273 χ = 0.543; p= 0.146 Occupation of parents Employed 354 (79.6) 91 (20.4) 371 (83.4) 74 (16.6) 419 (94.2) 26 (5.8) Unemployed 65 (81.2) 15 (18.8) 69 (86.2) 11 (13.8) 78 (97.5) 2 (2.5.) 2 2 2 χ = 0.122; p= 0.727 χ = 0.414; p=0.520 χ = 1.501; p= 0.221 Key: * dmft1= (enamel lesions + dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) ** dmft2 = (dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) *** dmft3 = (dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) 107 Mwakayoka H., et al. J Dent Shiraz Univ Med Sci., 2017 June; 18(2): 104-111. Table 3: Distribution of children by frequency at which snacking/ breastfeeding/ wining foods are consumed and caries experience determined at three levels of caries diagnosis Caries experience determined at three levels of dental caries diagnosis Dietary behaviour dmft1 * n (%) dmft2 ** n (%) Dmft3 *** n (%) caries free dmft>1 caries free dmft>1 caries free dmft>1 Consumption of factory made sugary foods at age of 1-2yrs No 407 (80.6) 98 (19.4) 428 (84.8) 77 (15.2) 479 (94.9) 26 (5.1) Yes ( ≥1/daily) 12 (60.0) 8 (40.0) 12 (60.0) 8 (40.0) 18 (90.0) 2 (10.0) 2 2 2 Χ = 5.063; p= 0.024 χ = 8.687; p= 0.003 χ = 0.897; p=0.344 Consumption of factory made sugary foods at age 3-4yrs No 239(74.5) 82 (25.5) 255 (79.4) 66 (20.6) 299 (93.1) 22 6.9) Yes ( ≥1/daily) 10 (83.3) 2 (16.7) 10 (83.3) 2 (16.7) 11 (91.7) 1(8.3) Fisher's Exact Test p= 0.487 Fisher's Exact Test p= 0.5 Fisher's Exact Test p= 0.583 Consumption of home-made sugary foods at age of 1-2 yrs 0-3 times daily 384(80.0) 96(20.0) 401 (83.5) 79 (16.5) 45795.2% 23 (4.8) 3-6 times daily 35 (77.8) 10(22.2) 39 (86.7) 6 (13.3) 40 (88.9) 5 (11.1) 2 2 2 Χ = 0.126; p= 0.723 χ = 0.296; p= 0.586 Χ = 3.254; p= 0.071 Consumption of home-made sugary foods at age of 3-4 yrs 0-3 times daily 243 (74.5) 83 (25.5) 259 (79.4) 67 (20.6) 304 (93.3) 22 (6.7) 3-6 times daily 6 (85.7) 1 (14.3) 6 (85.7) 1 (14.3) (85.7)6 1 (14.3) Fisher's Exact Test p= 0.487 Fisher's Exact Test p= 0.564 Fisher's Exact Test p7= 0.3 Duration of breastfeeding 1 year 75 (81.5) 17 (18.5) 79 (85.9) 13 (14.1) 86 (93.5) 6 (6.5) >1 year 323 (80.0) 81 (20.0) 338 (83.7) 66 (16.3) 385(95.3) 19 (4.7) 2 2 2 Χ = 0.117; p= 0.733 χ = 0.272; p= 0.602 χ = 0.518; p= 0.472 Breastfeeding at night 174(79.1) 46(20.9) 182(82.7) 38(17.3) 207(94.1) 13(5.9) 1-2 times/night ≥3 times /night 224(81.2) 52 (18.8) 235(85.1) 41(14.9) 264(95.7) 12(4.3) 2 2 2 χ = 0.33; p= 0.565 χ = 0.534; p= 0.465 χ = 0.623; p= 0.430 Key: * dmft1= (enamel lesions + dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) ** dmft2 = (dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) *** dmft3 = (dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) prevalence computation involve initial caries lesions ventive measures are not taken early enough, more teeth (dmft1 or dmft2). This may indicate that at any particu- would turn out to have open cavities. But it may also lar time of the dentition, different teeth may be at differ- mean that not all initial lesions progress to frank cavi- ent stages of developing dental caries, therefore if pre- ties. Table 4: Distribution of children by oral hygiene status in the posterior and anterior segments of the dentition and caries experience determined at three levels of caries diagnosis Caries experience determined at three levels of dental caries diagnosis Dentition segment oral hygiene status dmft1 * n (%) dmft2 ** n (%) Dmft3 *** n (%) caries free dmft>1 caries free dmft>1 caries free dmft>1 Upper posterior teeth good oral hygiene 32 (82.1) 7 (17.9) 33 (84.6) 6 (15.4) 36 (92.3) 3 (7.7) poor oral hygiene 387 (79.6) 99(20.4) 407 (83.7) 79 (16.3) 461 (94.9) 25 (5.1) 2 2 Χ = 0.131; p= 0.717 χ = 0.020; p= 0.887 Fisher's Exact Test p= 0.454 Upper anterior teeth good oral hygiene 165 (80.5) 40 (19.5) 169 (82.4) 36 (17.6) 190 (92.7) 15 (7.3) poor oral hygiene 254 (79.4) 66 (20.6) 271 (84.7) 49 (15.3) 307 (95.9) 13 (4.1) 2 2 2 Χ = 0.096; p= 0.757 χ = 0.466; p= 0.495 χ = 2.621; p= 0.105 Lower anterior teeth good oral hygiene 153 (80.1) 38 (19.9) 156 (81.7) 35 (18.3) 176 (92.1) 15 (7.9) poor oral hygiene 266 (79.6) 68 (20.4) 284 (85.0) 50 (15.0) 321 (96.1) 13 (3.9) 2 2 2 Χ = 0.016; p= 0.899 χ = 1.008; p= 0.315 χ = 3.776; p= 0.052 Lower posterior teeth good oral hygiene 25(75.8) 8(24.2) 26(78.8) 7(21.2) 28 (84.8) 5 (15.2) 394(80.1) 98(19.9) 414(84.1) 78(15.9) 469(95.3) 23 (4.7) poor oral hygiene 2 2 2 Χ = 0.359; p= 0.549 χ = 0.654; p= 0.419 χ = 6.723; p= 0.01 Key: * dmft1= (enamel lesions + dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) ** dmft2 = (dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) *** dmft3 = (dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) 108 Dental Caries and Associated Factors in Children Aged 2-4 Years Old in Mbeya City, Tanzania Mwakayoka H., et al. Table 5: Odds ratio (95% confidence interval) for logistic regression between ages of children, factory sugary food consumed at age 1-2 years, oral hygiene for lower posterior teeth maternal education by dmft1, dmft2 and dmft3 (reference category in italics). OR(95%CI) P-value Dmft1* 2.722 (1.617-4.582) < 0.001 Age (2yrs/3-4yrs) Factory sugary food age 1-2 years (no factory sugary food consumed/factory sugary food con- 2.257 (0.878-5.798) 0.091 sumed) Oral hygiene for lower posterior teeth (good /poor) 0.849 (0.363-1.988) 0.706 Dmft2** Age (2yrs/3-4yrs) 2.725 (1.524-4.873) 0.001 Factory sugary food age 1-2 years (no factory sugary food consumed/ factory sugary food con- 3.061 (1.188-7.887) 0.021 sumed) Oral hygiene for lower posterior teeth (good /poor) 0.767 (0.313-1.878) 0.562 Dmft3*** Age (2yrs/3-4yrs) 3.40 (1.153-10.027) 0.027 Factory sugary food at age 1-2 years (no factory sugary food consumed/ factory sugary food 1.617 (0.343-7.616) 0.543 consumed) Oral hygiene for lower posterior teeth (good /poor) 0.286 (0.10-0.824) 0.02 Key: * dmft1= (enamel lesions + dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) ** dmft2 = (dentinal lesion without open cavity + dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) *** dmft3 = (dentinal lesion with open cavity + pulp exposure + dental abscess and missing teeth due to caries) The proportion of caries free children (94.7%) the development and progression of dental caries in the recorded in the current study for frank cavitation studied population. Gender is unlikely to have influence (dmft3) is similar to that reported elsewhere by different on caries development and progression in preschool researchers in Tanzania, 1 Nigeria, 3 and Japan 5 children in Tanzania because there are no differences in where caries free children were reported to be 96.3%, feeding practices between infants of different genders. 93.4% and 96.7% respectively. However it is higher Similar findings have been documented in Uganda, than that reported in Iran, 7 China, 22 India, 23 China and USA. 22-25 Residence has been shown to Brazil, 24 and where caries free children were 38.9% be an important factor in early childhood caries among 44.0%, 54.9%, and 46.4%, respectively. preschool children in India where rural residents had In the current study, children aged 3-4 years were more early childhood caries compared to urban children. more likely to have caries than children aged 2 years. 7 These differences are likely to be due to the fact that Low socioeconomic status of parents has been as- caries experience measures the cumulative effects of sociated with high prevalence of early childhood caries dental caries in life time of a particular dentition. There- in India and Switzerland. 6, 26 In Brazil; however, the fore, older children are likely to have higher dmft than association was found to be reversed. 23 younger ones. These findings are in agreement with Children who were reported to have consumed those reported in Tanzania, 1 Nigeria, 3 and among factory sugary foods at age of 1-2 years had higher odd Chinese children aged 3 to 5 years. 22 The fact that of having dmft1 and dmft2 greater than zero. This un- caries was recorded among children aged 2 years indi- derscores the well-established causal relationship of cates that caries development starts well before the age sugar consumption and dental caries. These findings of two years. Therefore, there is a need of instituting point to the need of instituting oral health education to primary prevention for dental caries as soon as primary discourage early commencement of feeding infants with teeth start erupting. factory made sugary foods for prevention of early child- Gender, place of residence, education of parent/ hood caries. This is in line with the findings of a review caretaker and occupation of parent/caregiver had no article by Leong and colleagues in which they conclud- significant association with caries in the current study, ed that dietary habits initiated early at age 6 months indicating insignificant role played by these variables in affected not only an infant’s susceptibility to bacterial 109 Mwakayoka H., et al. J Dent Shiraz Univ Med Sci., 2017 June; 18(2): 104-111. acquisition, levels and ECC experience, but also the between breast feeding practices and development of timing and frequency of the behaviors at both 12 and 18 dental caries among children are recommended. months, suggesting a need for establishing healthy eat- ing patterns early to reduce risk of early childhood car- Acknowledgements ies. 27-28 The authors extend their sincere thanks to the United R- The fact that taking factory made sugary snacks at epublic of Tanzania through the Ministry of Education age of 3-4 years revealed no association with dental and Vocational Training for financial support that caries should be interpreted with caution because the enanabled conduct of this study. We thank also the studied children were aged 1-4 years. Therefore the Mbeya city authority for their moral and logistic support effects of consuming sugary snacks at age 3-4 years during data collection. would manifest in later years of life because develop- ment of dental caries takes time. Conflict of Interest Duration of breastfeeding and frequency of breast- The authors declare no conflict of interest related to the feeding at night had no association with dental caries in conduct of the research and acqusition of data that the current study. The findings indicate that generated the current report. breastfeeding at night and its duration do not pose a risk for dental caries in the population studied. These References findings differ from those reported elsewhere, 7, 10, [1] Masumo R, Bardsen A, Mashoto K, Åstrøm AN. Preva- 27-29 but support the review articles that showed no lence and socio-behavioral influence of early childhood conclusive evidence to support claims that breast feed- caries, ECC, and feeding habits among 6-36 months old ing is associated with development and progression of children in Uganda and Tanzania. BMC Oral Health. dental caries in children. 12-14 This indicates that the 2012; 12: 24. relationship between breast feeding and development of [2] Perera PJ, Fernando MP, Warnakulasooriya TD, early childhood caries is still a contentious issue and Ranathunga N. Effect of feeding practices on dental car- need further investigations. ies among preschool children: a hospital based analytical In the current study, good oral hygiene for lower cross sectional study. 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Journal
Journal of Dentistry – Pubmed Central
Published: Jun 1, 2017