Prevalence of Dental Caries in Tamil Nadu State, India: A Comprehensive Umbrella Analysis

ABSTRACT

Dental caries is a major public health concern among other oral diseases in most developing and industrialized countries, particularly in those nations where preventative programs have not yet been developed. Adults and the elderly population in Tamil Nadu also face significant challenges related to dental caries beyond children and adolescents. This systematic review examined the comprehensive epidemiology of dental caries in all age groups in Tamil Nadu. The articles were collected using various electronic databases. From the 4509 initially collected articles, 22 articles were chosen for the current umbrella analysis. The collective dental caries prevalence for Tamil Nadu state, India, from 22 studies with 33,584 study participants was 42.8%, with a 95% confidence interval (CI) of 42.3–43.4%. Among the four regions of Tamil Nadu, Eastern Tamil Nadu showed the highest dental caries prevalence of 82.2%. Thus, the strategies by the government of Tamil Nadu should focus on raising awareness about improving oral hygiene practices, seeking access to timely oral healthcare treatments, and strengthening the oral healthcare infrastructure.

INTRODUCTION

Oral health holds a vital role in an individual’s overall health. Among other oral diseases, dental caries is an important public health concern in most developing and industrialized countries, particularly in those nations where preventative programs have not yet been developed.[1] Dental caries affects individuals of all age groups and has substantial consequences for oral health and quality of life.[2,3] In the context of Tamil Nadu, a populous state in southern India with unique socio-demographic characteristics, exploring the prevalence and determinants of dental caries becomes even more pertinent. Adults and the elderly population in Tamil Nadu also face significant challenges related to dental caries beyond children and adolescents. Several studies have indicated high prevalence rates among adults, with varying rates depending on factors such as socioeconomic status, oral hygiene, and access to dental care.[4] These findings suggest that dental caries is a pervasive oral health concern affecting individuals across the lifespan in Tamil Nadu. Several risk factors lead to the high prevalence of dental caries in Tamil Nadu such as low socio-economic status and limited access to oral healthcare services, play a significant role. Individuals from disadvantaged backgrounds often face barriers to accessing timely dental care, resulting in delayed diagnosis and treatment of dental caries. Additionally, cultural practices, dietary habits, and oral hygiene practices can influence the development and progression of dental caries. Diets rich in sugars and poor oral hygiene practices, including inadequate brushing and lack of regular dental check-ups, contribute to the higher prevalence rates.[5,6,7,8] The purpose of this present study is to conduct a systematic review in Tamil Nadu to determine the prevalence of dental caries, aiming to gather valuable data that can contribute to addressing this significant health issue effectively.

MATERIALS AND METHODS

This systematic review examined the comprehensive epidemiology of dental caries of all age groups in Tamil Nadu. The articles were collected using electronic search databases such as Google Scholar, PubMed, Science Direct, Medline, Cochrane Library and Wiley Online Library. The MeSH terms used were Dental caries and prevalence, Dental Caries and Tamil Nadu, and Dental caries in children, adolescents, and adults.

Inclusion criteria

1. Only cross-sectional studies were carried out in the state of Tamil Nadu.

2. Articles published between the year 2008 and 2023.

3. Full-text articles.

Exclusion criteria

1. Review articles.

2. Articles other than English language.

The guidelines followed for this review were Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS

Figure 1 depicts that a comprehensive search was conducted to gather articles concerned with the prevalence of dental caries in Tamil Nadu among children, adolescents, and adults. A total of 4509 were initially collected. After removing 4109 articles, a set of 400 unique articles remained. Further screening was based on the titles, resulting in the exclusion of 377 articles for various reasons. Eventually, a final selection of 22 complete text articles was made meeting the inclusion criteria for relevance and quality. These 22 articles were chosen to be incorporated into the present systematic review.

Figure 1.

PRISMA flow chart

Table 1 depicts the specific characters of the study.

Table 1.

Characteristic of the study based on prevalence of dental caries in Tamil Nadu state

Author	Duration of study	Sample size and age group	Place of study	Methodology
Dasar Pralhad et al.,[9]	2011	292 6–20 years	Tiruvannamalai district	DMFT Index
Prabu et al.,[10]	2022	100 19–50 years	Madurai district	DMFT Index
Mohan et al.,[11]	2011–2012	650 12–15 years	Kanchipuram district	WHO Oral Health Assessment form-1997
Shivakumar, Gopinath et al.,[12]	2011	1205 4–17 years	Kanchipuram district	WHO Oral Health Assessment form-1997
Punithvathy et al.,[13]	2011	362 3–16 years	Erode and Cuddalore district	WHO Oral Health Assessment form-1997
Ganesh et al.,[14]	2013	2000 15–17 years	Salem, Dharmapuri, and Krishnagiri district	DMFT Index
Karunakaran et al.,[15]	2014	850 4–6 years	Namakkal district	dmft Index
George et al.,[16]	2015	1060 All age groups	Chennai district	WHO Oral Health Assessment form-1997
John et al.,[17]	2015	1028 9–12 years	Salem, Namakkal, and Erode district	WHO Oral Health Assessment form-1997, DMFT, dft, and SiC Index were recorded.
Murugan, Sakthi et al.,[18]	2015	714 12 years	Chennai district	DMFT, SiC Index
Veerasamy et al.,[19]	2016	974 12–15 years	Chennai district	WHO Oral Health Assessment form-1997
Naziya et al.,[20]	2017	721 3–12 years	Chennai district	DMFT, dft Index
John et al.,[21]	2017	404 NS	Chennai district	DMFT, dmft Index
Nasser, Rupkumar et al.,[22]	2018	20,007 3–19 years	Chennai district	NS
Aurlene et al.,[23]	2017–2018	500 15 years and above	Chennai district	WHO Oral Health Assessment form-2013
Anusha et al.,[24]	2018	92 <12 years to 20 years	Chennai district	DMFT, dft Index
Arunkumar et al.,[25]	2017–2018	430 5–10 years	Kancheepuram district	Pre-tested, structured questionnaire
Gunaseelan et al.,[26]	2020	174 12–14 years	Mayiladuthurai district	WHO Oral Health Assessment form-2013, pre-tested questionnaire
Naveenraj, Deivanayagi et al.,[27]	2018	1320 12–15 years	Virudhunagar district	WHO Oral Health Assessment form-2013, pre-tested questionnaire
Amudha et al.,[28]	2020–2022	2080 5–15 years	Chennai district	WHO Oral Health Assessment form-1987, Kuppuswamy scale
Shilpa et al.,[29]	2022	607 3–12 years	Chennai district	DMFT, dft Index
Guhanraj, Dhanasekaran et al.,[30]	2022	300 NS	26 cities in Tamil Nadu	Pre-tested, structured questionnaire

NS=Not specified

Table 2 depicts the outcome characteristics and bias assessment of the studies included in the review.

Table 2.

Outcome characteristics and bias assessment of studies included in the review

Author	Results	P	Bias assessment
Dasar PL et al.,[9]	Dental caries prevalence among 6–10 years was 21.23% with a mean DMFT score was 1.92. Dental caries occurrence in the 11–15 years age group was 57.33% with a mean DMFT score was 1.76. Dental caries occurrence in the 16–20 years age group was 21.44% with a mean DMFT score was 1.57. The overall mean DMFT score was 1.75.	NA	Low risk
Prabu et al.,[10]	The mean DMFT score was 5.06. The DMFT score was found to increase with age with a highest score of 9 between the age 41 and 50 years.	NA	High risk
Mohan et al.,[11]	The mean DMFT scores of 12 and 15 years were 2.14 and 2.72, respectively. Dental caries occurrence in 12 years children was 68.8% and dental caries occurrence in 15 years children was 71%.	P=0.001	Low risk
Shivakumar, Gopinath et al.,[12]	The overall prevalence of dental caries in the 4–17 years age group was 64.22%. The prevalence rate is higher in females and with government-aided school children.	NA	Low risk
Punithvathy et al.,[13]	The mean deft score in primary dentition was found to be 3.74±2.34. The mean DMFT score in permanent dentition was 2.67±1.69. Dental caries occurrence was higher in handicapped children than in normal children.	P≤0.05	Low risk
Ganesh et al.,[14]	The prevalence of dental caries among group I (fluoride level 1–2 ppm) was 203 (27.1%) and the DMFT score was 2.5. Dental caries prevalence for group II (fluoride level 2–3 ppm) was 244 (31.3%) and the DMFT score was 3. The prevalence of dental caries among group III (fluoride level 3–4 ppm) was 164 (34.9%) and the DMFT score was 3.5.	P<0.05	Low risk
Karunakaran et al.,[15]	Dental caries occurrence among females and males were 69.57% and 61.5%, respectively. Mean dmft score among boys was 2.89±2.22. The mean dmft score among girls was 2.82±2.12.	NA	High risk
George et al.,[16]	The prevalence of dental caries among male and female prisoners was 58.2% and 54.2%, respectively. The mean DMFT score among males was 3.9. The mean DMFT score among females was 5.1. The prevalence of males and females with filled teeth was 4.1% and 2.9%, respectively. The dental caries prevalence was higher in prisoners<24 years of age.	P<0.05	Low risk
John et al.,[17]	Dental caries prevalence among suburban, urban, and tribal school-going children was 89.3%, 77%, and 55%, respectively. The mean DMFT scores among tribal, suburban, and urban schoolchildren were 2.88, 2.42, and 1.22 respectively. The mean dft score among tribal, suburban, and urban school children were 1.83, 0.86, and 1.81, respectively.	P≤0.001	Low risk
Murugan, Sakthi et al.,[18]	Dental caries occurrence was 31%. The mean DMFT score was 0.57±1.03 and the mean SiC score was 1.73±1.10. Girls had higher dental caries prevalence than boys.	NA	Low risk
Veerasamy et al.,[19]	The collective dental caries occurrence in adolescents in urban and rural areas was 61.4%. The mean DMFT score was 2.03. Dental caries occurrence in male and female school kids was 58.5% and 65%, respectively. The mean DMFT score among males was 1.76. The mean DMFT score among females was 2.39.	P=0.05	Low risk
Naziya et al.,[20]	The mean dft scores among males and females were 0.07±1.88, and 1±1.81, respectively. The mean DMFT scores among males and females were 0.05±0.33, and 0.11±0.48, respectively. Dental caries was most prevalent among females than males and its prevalence was higher in the 6–12 years age group than the 3–5 years age group.	P<0.05	Low risk
John et al.,[21]	The prevalence of dental caries was high among visually impaired individuals. The overall mean DMFT score was 4.5±2.7. The average number of decayed teeth was found to be 3.1±2.2.	NA	High risk
Nasser, Rupkumar et al.,[22]	The overall prevalence of dental caries was 34.72%. Pain due to dental caries was exhibited in 58.55% of participants. 13.23% of participants had grossly decayed teeth. The prevalence of one, two, and more than two teeth dental caries was 23.94%, 4.22%, and 0.06%.	NA	Low risk
Aurlene et al.,[23]	The overall prevalence of dental caries in patients with SLE was 87.6%. Patients with active SLE had a higher dental caries prevalence rate than inactive SLE.	P=0.01	Low risk
Anusha et al.,[24]	The mean DMFT scores in males and females were 1.47±2.31 and 2.57±4.57, respectively. The mean dft score in males and females were 0.49±1.37 and 0.43±1.09, respectively. Dental caries occurrence was highest in females with permanent dentition.	P<0.05	High risk
Arunkumar et al.,[25]	The collective dental caries occurrence was 52.9%. Dental caries occurrence in males and females was 51.92% and 53.85%, respectively.	P<0.05	Low risk
Gunaseelan et al.,[26]	The prevalence of dental caries in rural schoolchildren was 80%. The prevalence of dental caries in urban schoolchildren was 84%.	NA	High risk
Naveenraj, Deivanayagi et al.,[27]	The overall prevalence of dental caries was 54.6%. dmft score and fluoride concentration in drinking water had a negative correlation.	P=0.05	Low risk
Amudha et al.,[28]	Dental caries occurrence was highest among 12–15 years of age in permanent dentition (67.2%). Dental caries occurrence was highest among 5–8 years of age in permanent dentition (74%).	P<0.05	Low risk
Shilpa et al.,[29]	The mean dft score of males and females were 0.08±1.86 and 1.01±1.80 respectively. The mean DMFT score of males and females were 0.06±0.34 and 0.12±0.49, respectively. Dental caries occurrence was highest in females and in primary dentition.	P<0.05	Low risk
Guhanraj, Dhanasekaran et al.,[30]	The collective dental caries prevalence was 40%.	NA	High risk

NA=Not Available, SLE=Systemic Lupus Erythematosus

Figure 2 depicts the geographic distribution of studies included in the analysis.

Figure 2.

Geographic distribution of studies included in the analysis

Study description

Table 3 describes the collective prevalence of dental caries in Tamil Nadu state, India from 22 studies with 33,584 study participants was 42.8% with a 95% confidence interval (CI) of 42.3% to 43.4%. The geographic location analysis shows the maximum number of studies were conducted in Northern Tamil Nadu (10 studies, 27912 participants) with a dental caries prevalence of 41% (95% CI of 40.5% to 41.6%). The collective prevalence of dental caries in Western Tamil Nadu from three studies with 3878 study participants was 50% with a 95% CI of 48.5% to 51.6%. The collective prevalence of dental caries in Eastern Tamil Nadu from a study with 174 study participants was 82.2% with a 95% CI of 75.8% to 87.2%. The collective prevalence of dental caries in Southern Tamil Nadu from a study with 1320 study participants was 54.6% with a 95% CI of 51.9% to 57.3%. Sub-group analysis based on the sampling method showed a collective prevalence of 54.8% (95% CI: 53%–56.5%) for random sampling with 3323 study participants out of four studies and a collective prevalence of 24% (95% CI: 23.6%–24.5%) for non-random sampling with 30261 study participants out of 12 studies.

Table 3.

Collective prevalence of dental caries based on proportion

	Categories	No. of studies	Total samples	Samples affected	Pooled prevalence %	Lower CI (%)	Upper CI (%)
	Overall	16	33584	14380	42.8	42.3	43.4
Geographic locations	North Tamil Nadu	10	27912	11455	41	40.5	41.6
	East Tamil Nadu	1	174	143	82.2	75.8	87.2
	West Tamil Nadu	3	3878	1941	50	48.5	51.6
	South Tamil Nadu	1	1320	721	54.6	51.9	57.3
Types of sampling methods	Random sampling	4	3323	1820	54.8	53	56.5
	Non-random sampling	12	30261	7278	24	23.6	24.5

DISCUSSION

Many studies have focused on examining the presence of dental caries in children and adolescents in Tamil Nadu. However, there is a lack of comprehensive understanding regarding the occurrence rates of dental caries, based on the geographic distribution of the study site, type of tooth decay, and diagnostic criteria. Consequently, this systematic review aims to address these gaps by providing a thorough examination of these factors.

Dental caries is considered a major public health issue in several countries. The increased prevalence of dental caries in developed countries may be due to its population dwelling in low socio-economic status. Dental caries untreated at an early stage has multiple consequences as it can lead to problems in mastication and speech and other problems like unesthetic appearance due to teeth loss. Treatment of dental caries at a later stage becomes expensive, which in turn adds to the burden on the quality of life. The 2002 National Oral Health Survey[31] is the only National Survey to access the burden of dental caries in India. Thus, a comprehensive review of these studies was conducted to estimate the burden of dental caries in Tamil Nadu. According to our estimates, 42.8% population has been affected by dental caries. A previous systematic review done in India in 2016 estimated the prevalence of dental caries as 49.6% which is comparable to our present observation of 42.8%.[32] This difference could be due to the wider search strategy and a number of area-specific included studies used in this review. A similar prevalence of dental caries was observed in Karnataka which is 40% among adults.[33] In contrast to this review, the dental caries prevalence in Karnataka among children was 27.40%.[34]

A regional analysis clearly states that most of the studies were carried out in Northern Tamil Nadu, especially in and around the Chennai district. This may be due to the fact that this geographical location has many dental colleges[35] and most of today’s researchers come from educational institutions. Few studies on East Tamil Nadu and South Tamil Nadu showed a high prevalence of 82.2% and 54.2%, respectively. Further research is needed in these regions to accurately assess the results. The included studies were from 14 (geographic) districts out of 38 districts in Tamil Nadu, and the number of included studies (n = 23) was higher than the caries prevalence in Tamil Nadu. With the high burden of dental caries in Tamil Nadu, it is imperative to adopt measures to control and prevent the same. Early and periodic dental visits could contribute to its prevention.[36] The World Health Assembly also recommends a shift from a curative approach to a preventive approach beginning from family, schools, and workplaces including comprehensive and inclusive care within the primary health-care system for improving oral health.[37]

The study has its restrictions. Only 16 studies had data on caries affected population. Most of the studies did not report individual male and female caries status. So, the pooled prevalence for all 22 studies could not be evaluated.

CONCLUSION

This umbrella analysis confirms the high dental caries prevalence (42.8%) in the state of Tamil Nadu. Understanding the prevalence and determinants of dental caries in Tamil Nadu is essential for developing effective preventive and treatment strategies. By examining reliable studies, this review revealed associated risk factors of dental caries and the challenges faced in addressing this health concern. This will pave the path for evidence-based interventions and policies that promote oral health and improve the overall well-being of the population. Thus, the strategies by the government of Tamil Nadu should focus on raising awareness about improving oral hygiene practices, seeking access to timely oral healthcare treatments, and strengthening the oral healthcare infrastructure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.