Abstract
Objective: Among dental diseases, dental caries is an important dental public health problem in India which is irreversible in nature, and is predominantly a disease of childhood. Till date no study has been carried out in Vadodara. As baseline data of caries is required to improve oral health of children, the present study was undertaken to determine the pattern of dental caries in school children of Vadodara city in the mixed dentition period considering age, sex and dietary patterns.
Methods: An epidemiological cross sectional descriptive study was carried out among 1600 school children aged 6-12 years in Vadodara city. A closed ended questionnaire according to World Health Organisation 1997 methodology was used to collect the data. The children were examined for the presence of dental caries using decayed missing filled teeth/decayed missing filled surfaces and Decayed Missing Filled Teeth/Decayed Missing Filled Surfaces index. Related factors which predispose caries such as age, sex and dietary patterns were recorded.
Results: The prevalence of dental caries was 69.12%. The mean dmft/dmfs and DMFT/DMFS were 3.00/4.79 and 0.45/0.56 respectively. The prevalence was higher in deciduous teeth than in permanent teeth. Positive association was found between dental caries and age, sex, frequency of sugar consumption in between meals.
Conclusion: The study concludes that the prevalence and severity of dental caries in Vadodara city is high. So, in developing country like India, it is imperative to introduce primary prevention and increased restorative care for the purpose of both reducing the caries prevalence and maintaining those caries free children.
How to cite this article: Joshi N, Sujan SG, Joshi K, Parekh H, Dave B. Prevalence, Severity and Related Factors of Dental Caries in School Going Children of Vadodara City – An Epidemiological Study. J Int Oral Health 2013; 5(4):40-48.
Key Words: : Epidemiology, Dental Caries, Prevalence, Severity, Risk Factors, Odd's Ratio
INTRODUCTION
In a developing country like India, dental caries still exists as a smoldering disease that has engrossed its tentacles deep into those regions where there are inadequate resources for dental treatment, lack of public awareness and motivation and increase in the consumption of the sugar.1
Voluminous dental literature exists about dental caries levels in the Indian population. The overall impression is that dental caries has increased in prevalence and severity over the last couple of decades.2 Preventive approaches seems to be a viable alternative to tackle the seemingly overwhelming problem of dental caries. However data necessary to plan such a preventive measure is found lacking.
During mixed dentition period oral hygiene is poor because of care free age, emotional stresses of the child, frequent intake of refined sugars, soft and sticky foods, shedding of deciduous and eruption of permanent teeth. But this period is considered as the critical stage from the point of view of development of normal occlusion, preservation of permanent first molar from hazards of dental caries is one of the most important responsibilities of the profession.3 So, this epidemiological study was planned in school going children of Vadodara city with the following aim and objectives:
To assess the prevalence and severity of dental caries in 6 to 12 years old school children of Vadodara city.
To determine the age at which the children are most susceptible to dental caries in mixed dentition period.
To find the relation between sugar consumption and dental caries.
To provide base line data for planning of dental services in Vadodara city.
MATERIALS AND METHODS
An epidemiological cross sectional descriptive study was carried out among 1600 school children aged 6-12
years in Vadodara city. Multistage sampling technique was used. The city was divided into five zones and from each zone two schools were selected randomly using simple random sampling method (lottery method). Permission was obtained from concerned authorities of respective schools and Ethical Committee of Sumandeep Vidyapeeth University, then informed written consent was taken from the parents before examining children. Stratified random sampling technique was used to select children excluding Subjects who were physically or mentally challenged, medically compromised or with gross dental / orofacial defects like cleft lip or cleft palate.
A closed ended questionnaire according to WHO 1997 methodology4 was used to collect the data. Before conducting survey all the examiners were calibrated at department of Pedodontics and Preventive Dentistry, K.M. Shah Dental College & Hospital, Vadodara under the guidance of a Professor in order to limit examiner variability. The children were examined according to ADA type III examination technique5 for the presence of dental caries using dmft/dmfs and DMFT/DMFS index. Related factors which predispose caries such as age, sex and dietary patterns were recorded.
Data was entered in Microsoft excel and analyzed using SPSS (version 12). Qualitative data was presented as frequency and percentages. The results were subjected to statistical analysis using prevalence test, chi-square test, Pearson’s correlation coefficient and bivariate dfgodd’s ratio. For all tests the level of significance was set at p ≤ 0.05.
RESULTS
The data obtained from the study was subjected to statistical analysis. The results are presented under the headings of various parameters considered for the study.
Figure 1 shows distribution of sample according to age and gender. Total sample size comprised of 1600 students, with 807 boys and 793 girls almost equally distributed in each age group.
Fig. 1: Distribution of Sample Size.
Total dental caries prevalence was 69.12% with higher prevalence in boys (70.01%) than in girls (68.22%) which was not statistically significant. There was highly significant relation (p ≤0.0001) between age and
prevalence of caries as shown in Table 1. In deciduous teeth, the caries prevalence was 70% as given in Figure 2 whereas in permanent teeth the caries prevalence was 25% depicted in Figure 3.
Table 1: Distribution of Children According to Age and Gender with Respect to Prevalence of Dental Caries.
| Age | Children Examined | Children with Caries (%) | Boys n (%) | Girls n (%) |
| 6 | 225 | 153 (68) | 77 (65.81) | 76 (70.37) |
| 7 | 227 | 165 (72.69) | 84 (70) | 81 (75.70) |
| 8 | 226 | 168 (74.33) | 79 (70.54) | 89 (78.07) |
| 9 | 228 | 177 (77.63) | 84 (75) | 93 (80.17) |
| 10 | 233 | 173 (74.24) | 94(81.74) | 79 (66.95) |
| 11 | 230 | 154 (66.95) | 91 (81.25) | 63 (53.39) |
| 12 | 231 | 116 (50.21) | 56 (47.06) | 60 (53.57) |
| Total | 1600 | 1106 (69.12) | 565 (70.01) | 541 (68.22) |
| Chi-square=54.16, df=6, p < 0.0001, HS | Chi-square=0.6, df=1,p > 0.05, NS | |||
Fig. 2: Distribution of Children According to Age and Gender with Respect to Prevalence of Dental Caries in Deciduous Dentitio.
Fig. 3: Distribution of Children According to Age and Gender with Respect to Prevalence of Dental Caries in Permanent Dentitio.
In total sample, the mean dmft was 3.00 (Table 2) and mean dmfs was 4.79 (Table 3) respectively. The mean DMFT was 0.45 (Table 4) and mean DMFS was 0.56 (Table 5) respectively.
Table 2: Distribution of Children According to Age and Gender with Respect to Mean dmft in Deciduous Dentition.
| Age | Mean dmft ± S. D. | |||||
| Total | Boys | Girls | ||||
| Mean dmft | S. D. | Mean dmft | S. D. | Mean dmft | S. D. | |
| 6 | 3.46 | 2.12 | 3.55 | 2.23 | 3.37 | 2.43 |
| 7 | 3.58 | 2.05 | 3.56 | 2.33 | 3.59 | 2.37 |
| 8 | 3.19 | 2.43 | 3.25 | 2.52 | 3.12 | 2.09 |
| 9 | 3.29 | 2.02 | 3.24 | 2.09 | 3.34 | 2.60 |
| 10 | 2.95 | 1.76 | 3.19 | 2.00 | 2.72 | 1.42 |
| 11 | 2.02 | 1.00 | 2.59 | 1.06 | 1.47 | 0.78 |
| 12 | 1.93 | 0.92 | 1.98 | 0.79 | 1.86 | 0.87 |
| Total | 3.00 | 1.90 | 3.15 | 1.96 | 2.85 | 1.29 |
Table 3: Distribution of Children According to Age and Gender with Respect to Mean dmfs in Deciduous Dentition.
| Age | Mean dmft ± S. D. | |||||
| Total | Boys | Girls | ||||
| Mean dmfs | S. D. | Mean dmfs | S. D. | Mean dmfs | S. D. | |
| 6 | 5.16 | 3.65 | 5.23 | 3.47 | 5.0 | 3.23 |
| 7 | 5.63 | 3.09 | 5.87 | 3.74 | 5.37 | 3.48 |
| 8 | 4.88 | 2.56 | 4.98 | 2.88 | 4.79 | 2.51 |
| 9 | 5.54 | 3.18 | 5.46 | 3.00 | 5.63 | 3.67 |
| 10 | 5.08 | 2.99 | 5.34 | 3.23 | 4.32 | 2.61 |
| 11 | 3.32 | 1.87 | 3.96 | 2.00 | 2.71 | 1.24 |
| 12 | 2.81 | 0.96 | 2.84 | 0.89 | 2.78 | 1.21 |
| Total | 4.79 | 3.12 | 5.0 | 3.76 | 4.52 | 2.83 |
| Correlation co-efficient for dmft & dmfs – 0.95, p - < 0.0001, HS | ||||||
Table 4: Distribution of Children According to Age and Gender with Respect to Mean DMFT in Permanent Dentition
| Age | Mean dmft ± S. D. | |||||
| Total | Boys | Girls | ||||
| Mean DMFT | S. D. | Mean DMFT | S. D. | Mean DMFT | S. D. | |
| 6 | 0.05 | 0.03 | 0.06 | 0.02 | 0.04 | 0.02 |
| 7 | 0.11 | 0.09 | 0.08 | 0.04 | 0.16 | 0.06 |
| 8 | 0.14 | 0.1 | 0.14 | 0.08 | 0.13 | 0.08 |
| 9 | 0.29 | 0.17 | 0.29 | 0.12 | 0.27 | 0.12 |
| 10 | 0.49 | 0.28 | 0.45 | 0.23 | 0.52 | 0.24 |
| 11 | 0.73 | 0.36 | 0.78 | 0.34 | 0.67 | 0.34 |
| 12 | 1.1 | 0.75 | 1.06 | 0.67 | 1.15 | 0.64 |
| Total | 0.45 | 0.23 | 0.44 | 0.21 | 0.46 | 0.24 |
Table 5: Distribution of Children According to Age and Gender with Respect to Mean DMFS in Permanent Dentition
| Age | Mean dmft ± S. D. | |||||
| Total | Boys | Girls | ||||
| Mean DMFS | S. D. | Mean DMFS | S. D. | Mean DMFS | S. D. | |
| 6 | 0.05 | 0.02 | 0.05 | 0.02 | 0.04 | 0.02 |
| 7 | 0.15 | 0.09 | 0.1 | 0.05 | 0.2 | 0.08 |
| 8 | 0.15 | 0.08 | 0.15 | 0.08 | 0.15 | 0.06 |
| 9 | 0.37 | 0.23 | 0.36 | 0.13 | 0.39 | 0.18 |
| 10 | 0.58 | 0.3 | 0.55 | 0.32 | 0.62 | 0.29 |
| 11 | 0.91 | 0.54 | 1.00 | 0.47 | 0.83 | 0.47 |
| 12 | 1.42 | 0.81 | 1.35 | 0.61 | 1.47 | 0.86 |
| Total | 0.56 | 0.27 | 0.55 | 0.28 | 0.58 | 0.30 |
| Correlation co-efficient for DMFT & DMFS – 0.99, p - < 0.0001, HS | ||||||
Figure 4 reveals distribution of children according to severity of dental caries in deciduous dentition. Low severity (dmft>0) of caries was observed in 46.51% children, Moderate severity (dmft≥4) was observed in 39.05% children and High severity (dmft≥7) was observed in 14.44% children suggesting low to moderate severity of caries in majority of children.
Fig. 4: Distribution of Children According to Severity of Dental Caries in Deciduous Dentition.
Figure 5 depicts distribution of children according to severity of dental caries in permanent dentition. 91.15% children had low severity (DMFT>0) of caries, 8.85% children had moderate severity (DMFT≥4) and no child
Fig. 5: Distribution of Children According to Severity of Dental Caries in Permanent Dentition.
(0%) had high severity (DMFT≥7) indicating low severity of caries in majority of children.
Figure 6 shows relation between frequency of sugar intake between meals and dental caries. It was found that as the frequency of sugar consumption between meals increased the dental caries prevalence also increased. It implies a very significant positive correlation between frequency of sugar consumption between meals and dental caries.
Fig. 6: Distribution of Children According to Frequency of Sugar Consumption in Between Meal and Dental Caries Status.
Table 6 shows results of bivariate odd’s ratio for caries on primary dentition. In present study when bivariate analysis was applied; the possibility of caries was more in children who consumed sugar between meals (OR = 0.15; 95% CI = 0.07-0.34) and frequency of sugar consumption between meals was positively associated with caries (OR = 0.46; 95% CI = 0.33-0.65).
Table 6: Bivariate Odd’s Ratio for Caries on Deciduous Dentition. The Dependent Variables – dmft was dichotomized (dmft=0 versus dmft>0)
| Variable | Odd’s ratio (CI 95%) | P value |
| Sugar consumption Yes, no | 0.15 (0.07 – 0.34) | <0.001* |
| Frequency of sugar consumption Occasionally, frequently | 0.46 (0.33 – 0.65) | <0.001* |
| * Significant at 5% level of significance (p<0.05) | ||
Table 7 shows results of bivariate odd’s ratio for caries on permanent dentition. The children who consumed sugar between meals were more likely to have caries (OR = 0.47; 95% CI = 0.09-2.28) and frequency of sugar consumption between meals was positively associated with caries experience (OR = 0.6; 95% CI = 0.44-0.81).
Table 7: Bivariate Odd’s Ratio for Caries on Permanent Dentition. The Dependent Variables – DMFT was dichotomized MFT=0 versus DMFT>0)
| Variable | Odd’s ratio (CI 95%) | P value |
| Sugar consumption Yes, no | 0.47 (0.09-2.28) | 0.3 |
| Frequency of sugar consumption Occasionally, frequently | 0.6 (0.44-0.81) | 0.001* |
| * Significant at 5% level of significance (p<0.05) | ||
DISCUSSION:
Caries prevalence varies from country to country and from region to region in same country. Geographic variables like race, climate, diet, culture and economic factors also affect the caries prevalence. In spite of these variations an attempt has been made to compare the findings of present study with the other studies within and outside the country.
Voluminous literature exists on the status of dental caries in the Indian school children by different investigators e.g. Vaish Ram Prasad6 (1982), Nagaraja Rao7 (1985), Maheshkumar P et al8 (2005), Misra & Shee9 (1999), Joshi N10 (2005) and Gauba et al11 (2007) etc. Hence review of the past data for caries and prediction of the future is the need of the hour12
The present study showed caries prevalence of 69.12% in 6 to 12 years old children. The prevalence is similar to study done by Retnakumari N.13 (1999), lower than Damle & Patel14 (1994), Rao et al15 (1999), Joshi N10 (2005) and higher than Misra and Shee9 (1979), Chopra et al3 (1983), Mahesh P et al8 (2005), Jain A et al16 (2005), and Lina Naomi et al17 (2006).
In present study boys showed higher caries prevalence than girls. Similar findings were reported by Ram Prasad Vaish18 (1983), Mahesh P et al8 (2005), Rao et al15 (1999), Saravanan et al2 (2004), Jain A et al16 (2005). The increased prevalence in boys confirms the view that there is a marked preference for sons regardless of the socio-economic class, which manifests itself in the longer feeding of sons compared to daughters. It also may be due to their habits of taking soft drinks and other sweetened snacks during their longer outside stay. These results are not supported by Misra and Shee9 (1979) as they found higher prevalence in girls than in boys.
In the present study caries prevalence increased as the age increased from 6 years to 9 years and then decreased with lowest being at age of 12 years. The results are supported by Misra and Shee9 (1979), Ram Prasad Vaish18 (1983), Mahesh P et al8 (2005), Rao et al15 (1999). This is because of longer exposure of primary molars in 8-10 years of age. After that there is exfoliation of these teeth and eruption of permanent teeth occur which have lower susceptibility to dental caries and not exposed to the factors responsible for caries for a longer time. Another reason is improper cleaning of teeth in early childhood and frequent intake of carbohydrate rich and sticky foods. These findings are contradictory to the study done by Retnakumari N13 (1999)
The said study showed higher caries prevalence in primary teeth than in permanent teeth. This could be attributed to the fact that the permanent teeth have a lower susceptibility to dental caries. It may also be due to the lower calcium content and structural differences in primary teeth (Vaish R. P.)6.
The caries prevalence in primary teeth was higher in boys than the girls. This may be attributed to the fact that boys are given more importance than girls in Asia societies (Shanti Gosh 1986)19. The caries prevalence in primary teeth increased from 6 years to 9 years of age and then decreased with lowest being at 12 years age. This may be that by 12 years most of the primary teeth exfoliate.
In permanent teeth, the girls showed more prevalence than the boys. This may be due to the fact that in girls the permanent teeth erupt earlier than the boys and therefore they are exposed to the oral environment for a longer time. (Megas B. F. et al 1989)20. The caries prevalence showed steady increase from 6 years to 12 years, with highest being at 12 years in this study. The similar findings are reported by Retnakumari N21 (1999), Bhaskar et al22 (2000) and Saravanan et al2 (2004).
The mean dmft values in present study were higher than the values obtained from the studies of Chopra et al3 (1983), I. Ahtanassouli et al23 (1991), Ratnakumari N13 (1999) and Gopinath24 (1999) while they were lower than the studies of Villalobos JJ et al25 (2006) and Gauba et al11 (2007).
The mean DMFT values in present study were lower than the values obtained from studies of Chopra et al3 (1983), I. Ahtanassouli et al23 (1991), Ratnakumari N13 (1999), Villalobos JJ et al25 (2006) and Gauba et al11 (2007) while they were equal to studies of Bhaskar et al22 (2000) and Lina Naomi et al17 (2006).
The mean counts of dmfs and DMFS in the present study were lower than reported by Navin Shetty & Shobha Tandon26 (1988), J. A. Hargreaves et al27 (1996), I.M. Jamieson28 (2004) and Gauba et al11 (2007). The variations in the prevalence could be related to racial, climatic, dietary, cultural and economic conditions. In deciduous teeth, the results of this study are similar to the findings of Peres MA et al29 (2006), Villalobos et al25 (2006) but differs from the findings of Retnakumari N13 (1999) who observed high severity of caries in majority of children.
In permanent teeth no child showed high severity of caries, majority of children showed low severity. The findings of this study are supported by Villalobos et al25 (2006), Carlo Medina et al30 (2007) and T Mello et al13 (2008).
The food habits play an important role in the causation of dental caries. The introduction of refined sugar (sucrose) into the modern diet has been associated with the increased caries prevalence. Since the time of early Greek philosophers diet has been suspected of influencing the etiology of caries. The direct relation of frequency of sweet, sticky snacks and dental caries incidence has been proved by Gustaffson31 (1954) in Vipehome study.
To study the association between the sugar in diet and dental caries the children were divided into three groups depending upon the total number of sugar exposures/day i.e. Frequently (more than 4 sugar exposures/day), Moderately (2-3 sugar exposures/day) and Occasionally (1sugar exposure/day). However the reliability and accuracy of such an anamnestic history for measuring the contribution of diet to prevalence of caries is questionable. In spite of these factors an effort was made to find the relation between sweet consumption and dental caries.
The findings of this study showed considerably higher caries prevalence in sweet eating group compared to those who did not eat sweets. A direct association was observed between the frequency of sugar consumption and dental caries. The findings of present study reconfirm the importance of sugar (sucrose) as one of the prime etiological factors which are consistent with the findings of Winter and Rule32 (1971), Shetty and Tandon26 (1988), Gupta A et al33 (1988), Kalsbeek and Verrips34 (1994) and Szpunar S35 (1995). However, McDonald and Weisenbach M36 (1995) found no significant relationship between sugar consumption and caries prevalence.
CONCLUSION
It is concluded that the prevalence and severity of dental caries in the present study is on the higher side, with more decayed than filled teeth.
The results of this baseline study indicate the dental caries is a major public health problem and lack of preventive and restorative dental care facilities as well as awareness among population in this region. Results make it imperative to introduce primary prevention and increased restorative care for the purpose of both reducing the caries prevalence and maintaining those caries free children as the ultimate goal is to produce a caries free childhood.
Footnotes
Source of Support: Nil
Conflict of Interest: None Declared
REFERENCES:
- 1.SS Kulkarni, SD Deshpande. Caries prevalence and treatment needs in 11 – 15 year old children of Belgaum city. J Indian Soc Pedod Prev Dent. 2002;20(1):12–15. [PubMed] [Google Scholar]
- 2.S Saravanan, V Kalyani, MP Vijayarani, JWA Felix, P Arunmozhi, V Krishnan, P SampathKumar. Caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, South India. Indian J Dent Res. 2008;19(3):186–190. doi: 10.4103/0970-9290.42948. [DOI] [PubMed] [Google Scholar]
- 3.S Chopra, BR Vacher, JR Taneja. Dental Caries experience during the period of mixed dentition. J Indian Dent Assoc. 1983;55(3):99–104. [PubMed] [Google Scholar]
- 4.World Health Organization, Oral Health survey, Basic methods, 4th Ed. Geneva: WHO. 1997 [Google Scholar]
- 5.Hiremath SS. Textbook of preventive and community dentistry, 1st Ed. Elsevier. 2007:173. [Google Scholar]
- 6.RP Vaish. Prevalence of caries amongst school going tribal children in Ganjam District, Orissa. J Indian Dent Assoc. 1982;54(10):375–377. [PubMed] [Google Scholar]
- 7.G Nagaraja Rao. Oral health status of certified school children of Mysore state – A report. J Indian Dent Assoc. 1985;57(2):61–64. [PubMed] [Google Scholar]
- 8.P Mahesh Kumar, T Joseph, RB Verma, M Jayanthi. Oral health status of 5 years and 12 years school going children in Chennai city – An epidemiological study. J Indian Soc Pedod Prev Dent Mar. 2005;23(1):17–22. doi: 10.4103/0970-4388.16021. [DOI] [PubMed] [Google Scholar]
- 9.FM Misra, BK Shee. Prevalence of dental caries in school going children in an urban area of South Orissa. J Indian Dent Assoc. 1979;51(9):267–270. [PubMed] [Google Scholar]
- 10.N Joshi, R Rajesh, M Sunitha. Prevalence of Dental Caries among school children in Kulasekharam village. J Indian Soc Pedod Prev Dent. 2005;3(3):138–140. doi: 10.4103/0970-4388.16887. [DOI] [PubMed] [Google Scholar]
- 11.A Goyal, K Gauba, HS Chawla, M Kaur, A Kapur. Epidemiology of dental caries in Chandigarh school children and trends over last 25 years. J Indian Soc Pedod Prev Dent. 2007;5(3):115–118. doi: 10.4103/0970-4388.36559. [DOI] [PubMed] [Google Scholar]
- 12.P Sudha, S Bhasin, RT Aneguni. Prevalence of dental caries among 5-13 year-old children of Mangalore city. J Indian Soc Pedod Prev Dent June. 2005;23(2):74–79. doi: 10.4103/0970-4388.16446. [DOI] [PubMed] [Google Scholar]
- 13.Mello T, Antunes J, Waldman E, Ramos E, Relvas M, Barros H. Prevalence and severity of dental caries in schoolchildren of Porto, Portugal. Community Dent Health. 2008;25(2):119–125. [PubMed] [Google Scholar]
- 14.SC Damle, AR Patel. Caries prevalence and treatment need amongst children of Dharavi, Bombay, India. Community Dent Oral Epidemiol. 1994;22(1):62–63. doi: 10.1111/j.1600-0528.1994.tb01572.x. [DOI] [PubMed] [Google Scholar]
- 15.A Rao, SP Sequeira, S Peter. Prevalence of dental caries among school children of Moodbidri. J Indian Soc Pedod Prev Dent. 1999;17 (2):45–48. [PubMed] [Google Scholar]
- 16.V Dhar, A Jain, TE Van Dyke, A Kohli. Prevalence of dental caries and treatment needs in school going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent. 2007;25(3):119–121. doi: 10.4103/0970-4388.36560. [DOI] [PubMed] [Google Scholar]
- 17.LN Hashizume, K Shinada, Y Kawaguchi. Dental Caries prevalence in Brazilian school children resident in Japan. J Oral Sci. 2006;48(2):51–57. doi: 10.2334/josnusd.48.51. [DOI] [PubMed] [Google Scholar]
- 18.RP Vaish. Prevalence of caries among tribal school children in Phulbani District, Orissa. J Indian Dent Assoc. 1983;55(11):455–457. [PubMed] [Google Scholar]
- 19.S Gosh. Discrimination begins at birth. Indian Pediatr. 1986;23(1):9–15. [PubMed] [Google Scholar]
- 20.BF Megas, TN Athanassouli. Dental caries prevalence in the permanent teeth in Greek school children related to age, sex, urbanization and social status. Community Dent Health. 1989;6(2):131–137. [PubMed] [Google Scholar]
- 21.N Retnakumari. Prevalence of dental caries and risk assessment among primary schoolchildren of 6-12 in the Varkala municipal area of Kerala. J Indian Soc Pedod Prev Dent. 1999;17(4):135–142. [PubMed] [Google Scholar]
- 22.DJ Bhaskar, S Saravanan, KP Anuradha. Prevalence of dental caries and treatment needs among school going children of Pondicherry, India. J Indian Soc Pedod Prev Dent. 2003;21(1):1–12. [PubMed] [Google Scholar]
- 23.Athanassouli I, E Mamai-Homata, H Panagopoulos, Koletsi-Kounari, Apostolopoulos A. Dental caries changes between 1982 and 1991 in children aged 6-12 in Athens, Greece. Caries Res. 1994;28(5):378–382. doi: 10.1159/000262005. [DOI] [PubMed] [Google Scholar]
- 24.VK Gopinath, VK Barathi, A Kannan. Assessment and treatment of dental caries in semi-urban school children of Tamilnadu (India) J Indian Soc Pedod Prev Dent. 1999;17(1):9–12. [PubMed] [Google Scholar]
- 25.JJ Villalobos- Rodelo, N Medina-Frechero, AA Vallejos-Sanchez, AP Pontigo-Loyola, JL Espinoza-Beltran. Dental caries in schoolchildren aged 6-12 years in Navolato, Sinaloa, Mexico: experience, prevalence, severity and treatment needs. Biomedica. 2006;26 (2):224–233. [PubMed] [Google Scholar]
- 26.Shetty NS, Tandon S. Prevalence of Dental Caries as related to risk factors in school children of South Kanara. J Indian Soc Pedod Prev Dent. 1988;6(1):30–37. [PubMed] [Google Scholar]
- 27.Hargreaves JA, Cleanton-Jones PE. Dental caries changes in the Scottish Isle of Lewis. Caries Res. 1990;24(2):137–142. doi: 10.1159/000261256. [DOI] [PubMed] [Google Scholar]
- 28.Jamieson LM, Thomson WM. Caries prevalence and severity in urban Fijian school children. Int J Pediatr Dent. 2004;14(1):34–40. doi: 10.1111/j.1365-263x.2004.00512.x. [DOI] [PubMed] [Google Scholar]
- 29.MA Peres, R de Oliveira Latorre Mdo, A Sheiham, KG Peres, FC Barros, PG Hernandez, AM Maas, AR Romano, CG Victoria. Social and biological early life influences on severity of dental caries in children aged 6 years. Community Dent Oral Epidemiol. 2005;33(1):53–63. doi: 10.1111/j.1600-0528.2004.00197.x. [DOI] [PubMed] [Google Scholar]
- 30.Downer MC. The 1993 national survey of children’s dental health. Br Dent J. 1995;10:407–412. doi: 10.1038/sj.bdj.4808787. [DOI] [PubMed] [Google Scholar]
- 31.BE Gustaffson, CE Quensel, LS Lanke. The Vipeholm dental caries study The effect of differet levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odont Scand. 1954;11(3-4):232–264. doi: 10.3109/00016355308993925. [DOI] [PubMed] [Google Scholar]
- 32.GB Winter, DC Rule, GP Mailer. The prevalene of dental caries in pre school children aged 1-4 years. Br Dent J. 1971;130(10):434–436. doi: 10.1038/sj.bdj.4802676. [DOI] [PubMed] [Google Scholar]
- 33.A Gupta, A Tiwari, HS Chawla. Relationship of dental caries and diet, An epidemiological study in Andhrapradesh. J Indian Soc Pedod Prev Dent. 1988;6(1):1–11. [PubMed] [Google Scholar]
- 34.H Kalsbeek, G Verrips. Consumption of sweet snacks and caries experience of primary school children. Caries Res. 1994;28(6):477–483. doi: 10.1159/000262023. [DOI] [PubMed] [Google Scholar]
- 35.S Szpunar, SA Eklund, BA Burt. Sugar consumption and caries risk in schoolchildren with low caries experience. Community Dent Oral Epidemiol. 1995;23(3):142–146. doi: 10.1111/j.1600-0528.1995.tb00218.x. [DOI] [PubMed] [Google Scholar]
- 36.M Weissenbach, N Chau, L Benamghar, C Lion, F Schwartz, J Vadot. Oral health in adolescents from a small French town. Community Dent Oral Epidemiol. 1995;23(3):147–154. doi: 10.1111/j.1600-0528.1995.tb00219.x. [DOI] [PubMed] [Google Scholar]