Oral Health Status and Associated Ecological Factors in Mixed Dentition among Early Primary School Students, Nonthaburi Province, Thailand

Abstract

Dental caries was declared to be a major oral health problem in 2010; affecting 2.43 billion people or 35.3% globally. Dental caries is a preventable disease, yet it is increasing in young children especially among early primary school students. Dental caries causes discomfort (tooth pain, eating impairment), and the loss of teeth affects children’s nutritional status and delays their language development. Dental caries also affects children’s concentration in school and imposes a financial burden on families. This study aimed to assess oral health status and to identify the relationship between ecological factors and the oral health status of early primary school students under Pranangklao Hospital Primary Care Unit (PNH-PCU) Network.

This cross-sectional study was conducted from January to March 2019, after obtaining ethical approval from the Human Resource Research Ethics Committee of Thammasat University Number 3 Faculty of Science (COA No. 006/2019).

Oral examinations, face to face interviews, and observations on brushing teeth at school and selling food risky to caries both inside and outside school were performed among 304 early primary school students from 13 randomly selected schools. Twelve teachers who were in charge of oral health programs at the sampled schools, and 11 dental personnel of the health promoting hospital of PNH-PCU network, responded to the self-administered questionnaires.

Data were analyzed by using descriptive statistics to describe all variables. Simple binary logistic regression was applied to identify the relationship between each ecological factor and being completely caries free and cavity free in permanent teeth. Associations with p<0.05 were regarded as statistically significant.

There were 304 students aged 6–9 years old (average age 8.19 years (SD = 0.98 years)), and almost equal proportions of students in grades 1, 2 and 3. There were slightly more girls than boys. A small proportion (2.0%) stated that they did not buy food that increased caries risk, and 26.6% consumed a high level of food that increased caries risk.  Eighty-point six percent of students brushed their teeth 2-3 times a day. Based on teeth-brushing observations at school, 16.8% of students brushed properly.

Only 4.0% and 3.4% of parents brushed their children’s teeth in the morning before going to school and before bed time. All classes in 7 schools had teeth-brushing activities after lunch. Five schools referred students who had oral health problems to the health promoting hospital for treatment. Foods that increased caries risk were sold both inside and outside 10 schools. Overall, 18.4%, 21.4%, 73.4% and 77.6% of the students were completely caries free, caries free in primary teeth, caries free in permanent teeth and cavity free in permanent teeth. The mean ± standard deviation of decayed, missing and filled teeth of primary dentition (dmft) and permanent dentition (DMFT) were 3.6 ± 3.1 teeth per student and 0.5 ± 1.0 teeth per student, respectively. Factors significantly related to being completely caries free were brushing teeth in the morning before going to school, referring students for dental treatment at the health promoting hospital, and sale of foods outside school that increased the risk of dental caries. None of the study factors were associated with cavity free permanent teeth.

Therefore, to improve oral health status among these students, brushing teeth at least 2-3 times a day for 2 minutes each time (assisted by parents) is strongly suggested. Implementation of an oral health care program in all classes and all schools is recommended. Measures should be taken to not sell foods that risk leading to the development of dental caries in school areas and nearby schools.