Dental caries, oral-health-related quality of life and atraumatic restorative treatment (ART): a study of adolescents in Kilwa district of Tanzania

Abstract

Background: To effectively plan and implement oral-health education and treatment programs targeting school students, information on the social and behavioral correlations of caries and subsequent ailments is important. Such information is limited in developing countries in general and in Tanzania in particular. Objective: This study examined the prevalence of dental caries, its socio-behavioral distribution and its impact on daily life activities in adolescents attending primary schools in Kilwa district, Tanzania. This study also extends the existing literature on OHRQoL by examining for the first time the evaluative properties, in terms of responsiveness and longitudinal validity, of a quality-of-life assessment scale, the Child OIDP, following the implementation of a minimally invasive procedure of ART, extraction and oral health education. Methods: Pre- (2008) and post-treatment (2009) surveys were conducted among 10 – 19- year-old adolescents in the Kilwa district using a stratified one-stage cluster sample design with rural wards as the primary sampling unit. A total of 8 rural wards were selected from a sample frame of 18 rural wards. In addition, 2 urban wards were included in the sample. All sixth graders in all primary public schools that were accessible in the urban and selected rural wards were included in the sample. Data were collected by clinical examination and face-toface interviews. The structured questionnaire captured information on socio-demographics and oral-health behaviors. Oral-health-related quality of life was measured by the Child-OIDP inventory. DMFT was measured according to WHO criteria. Results: An interview was completed by 1,780 (72.1%) students at baseline survey. Out of this number, 1,306 (73.8% follow-up rate) also completed an identical 6-month follow-up interview. The crude prevalence of caries (DMFT>0) was 19.2% (20.4% weighted prevalence estimate). The significant caries index (SiC), which gives the mean DMT of one-third of the most severely affected group, was 1.03. Thirty-six percent of adolescents (41.3% urban and 31.4% rural, p<0.001) reported at least one OIDP. Dental pain, dental caries and oral problems impacted negatively on adolescents’ daily performances. Stepwise logistic regression analyses revealed that social and behavioral variables varied systematically with caries experience, high need for dental treatment and poor self-rated oral health. Sociodemographic disparities in oral-health outcomes persisted after adjusting for oral-healthrelated behaviors. The mean changes in the OIDP total and sub-scale scores were negative within those who reported worsened oral health and positive in subjects reporting improved oral health. Thus, the Child OIDP showed promising evaluative properties and responsiveness to change following treatment with ART fillings, ART fillings and extraction and OHE only. Conclusion: Substantial proportions of students suffer from untreated dental caries, oral impact on daily life and perceived need for dental care. Socio-demographic disparities in oral health and oral-health-related behaviors exist, but the social gradient in subjective and objective measures of oral health has not been fully accounted for by socio-demographic disparities in oral-health-related behaviors. Our results indicate that the Child OIDP inventory is able to detect the oral impact for school-going adolescents with pain-associated dental caries and is responsive to the change following treatment, particularly for tooth extraction. Developing policies targeting social and individual determinants of oral health is an urgent public-health strategy in Tanzania.