Aspects of Dental Caries in Sudanese Schoolchildren

Abstract

Background: Effective delivery of dental services must be based on reliable information about the level of disease and treatment need in the target population. Evaluation of the relative impact of various factors known to influence disease severity and progression is fundamental to identification of those whose quality of life is most likely to be impacted by the disease. Little is known about the current oral health status of Sudanese schoolchildren. Recent changes in socioeconomic status and dietary habits, particularly with respect to availability of sugary snacks, may have influenced trends in disease prevalence and severity. Aim: The overall aim of the present study was to assess oral health status and oral health related quality of life in 12-year-old schoolchildren in Khartoum State, Sudan, and to investigate factors of importance for predicting caries experience and promoting good oral health related quality of life, including the impact of non-biological determinants such as intake of sugary snacks, socio-demographic factors and biological determinants such as salivary microbiology. Methodology: A school-based survey was conducted on 1109 schoolchildren, selected by stratified random cluster sampling from 58 private and public schools. Data were collected by clinical examination, saliva sampling and structured and pretested questionnaires administered by face to face interview. The questionnaires covered socio-demographics, Child-OIDP, Food Frequency Questionnaire (FFQ) and Food Behaviour Checklist (FBC). Saliva samples were obtained from 140 of the subjects, including 30 from individuals with caries experience. The saliva samples were analysed by quantitative real time polymerase chain reaction (qRT-PCR) with specific oligonucleotide primers. DMFT was measured according to WHO criteria. Gingival index (GI) of Loe & Silness, Plaque index (PI) of Silness & Loe and Dean’s Index of fluorosis were recorded. Results and conclusions: The mean DMFT for 12-year-olds was 0.42. Private school attendees had significantly higher DMFT (0.57) than public school attendees (0.40). The untreated caries prevalence in the sample (deciduous and permanent teeth) was 30.5%. Furthermore, the SiC was 1.4 when adjusted to the population and 1.6 and 1.4 for private and public school attendees respectively. The DMFT disclosed that 24% of the children had caries in permanent teeth. The mean GI for the six index teeth was 1.05 (95% CI 1.03 – 1.07) and the mean PI was 1.30 (95% CI 1.22 – 1.38). . In a multivariate model, higher socioeconomic status (SES) was found to be a risk indicator of caries experience in all the children (IRR 1.23 (95% CI 1.02-1.47)), and an indicator of poor oral health related quality of life in public school attendees (OR 1.4 (95% CI 1.1-1.8). The seven sugary snacks and beverages were run in a multiple variable logistic regression model (Nagelkerke 0.026) alongside sociodemographic variables, with the Higher Caries Experience Group (DMFT > 1) as the dependent variable. For this group, the results supported the hypothesis that frequency of intake of sugary snacks or beverages is associated with caries experience and sociodemographics in 12-year-old schoolchildren in Khartoum, suggesting that frequent consumption of soft drinks (OR 1.5 95% CI 1.0 – 2.4) might be a risk indicator for disease. The mean ratio of fold differences of Streptococcus mutans to Streptococcus sobrinus was 0.77 (sd 5.4) and 2.29 (sd 6.0) for samples obtained from caries-free and caries-active individuals respectively, suggesting a higher proportion of S. sobrinus than S. mutans in the caries-active group than in the caries-free group. The Arabic Child-OIDP showed acceptable psychometric properties and is considered a valid, reliable and practical inventory for use in this population. Almost half the sample perceived a moderate impact of oral status on quality of life, mostly with respect to eating. The most commonly cited impacting factors were erupting teeth and toothache. The results of this study may be used to assess the need for health promotion and dental care among schoolchildren in Khartoum State. It may be useful for purposes of evaluation, setting priorities, planning and allocation of resources for oral health promotion and treatment programmes.