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Long and Short Term Effects of Dental Caries in School Age Children Abstract

Longand Short Term Effects of Dental Caries in School Age Children


Amongthe school going children all over the world, dental caries is highlyprevalent. Several studies have been conducted to illustrate thesignificance of the issue among school going children. One notableexample is a study whereby the participants were between the ages of6 to 15 years and attended the public primary schools, and lived atDehiwala-Mount Lavinia (Sheiham,2016). In all the studies, astructured questionnaire was employed, and a qualitative method ofstudy was used for the collection of dietary habits,socio-demographic features, oral health problems and care practices.The data was further analyzed after being entered by use of thestatistical package for social science (SPSS), and in getting thesummary, value percentage and frequency were computed from univariateanalysis. Among others, poor hygiene is the main cause of thedisease, and this is proved because the disease is mostly prevalentamong those who have poor oral hygiene.Sugaryfoods and sweet products are also a cause for concern (Vargaset al., 2011).

Mostof the research found a number of effects of dental caries amongschool going children. One notable effect is the speech impairmentbecause of the pain they experiences on their teeth. This is likelyto affect their academic performance as well. The use of fluoride intoothpaste had shown significant reduction in incidences of theailment. Kids who lived in remote areas were not able to accessfluoride toothpaste. Incidences of dental caries were therefore highamong these children.

Longand Short Term Effects of Dental Caries in School Age Children

Statementof the problem

Mostschool going children are affected by dental caries. Tooth decay alsoreferred to as dental caries is a significant oral health problem,affecting 60 to 90% of school going children and a huge number ofadults in most industrialized countries (Inglehart, &amp Bagramian,2012). An early manifestation of the disease is a small patch ofsoftened enamel which is on the surface of the tooth and is mostlyhidden from sight in between the teeth or in the grooves. Thedestruction of the enamel spreads progressively into the dentinewhich is the softer, sensitive part of the tooth.


Whatare the effects of dental caries in school going children? What isthe prevalence of dental caries? What are the medications of thisailments if any? Does this disease affect their performance? What arethe population affected by this disease?


Drawingfrom Selwitz, Ismail &amp Pitts (2013), several parts of the worldare struggling with the problem of dental caries in children. Theshort term effects include speech impairment, sleeping problems,vision impairment, irritability caused by the pain felt when thechildren with the disease engage in strenuous activities and so on(Bonecker et al., 2014). The school going children are usually notconfident enough to speak in public since they fear the embarrassmentthey may get. Long-term effects revolve around the issue of the childbeing unable to go on with their normal life schedule. It is mainlycaused by the fact that they have to undergo treatment. The diseaserenders the child’s incapable of having a social life, because ofthe many hours they spend in the hospitals. One study conducted by(Bonecker et al., 2014) stipulates that with increasing age, thedisease continuously reduces and that the illness is mostly prevalentin the age bracket of 3 to 5 years, and least prevalent in childrenwho are in the age bracket of 8 to 12 years old.

Adental cavity is formed when the weakened enamel collapses and theteeth are destroyed gradually. Caries sometimes affects the root ofthe tooth when they are exposed by gum recession. Dental caries iscaused as a result of the action of acid on the enamel. This acid isproduced when sugars in drinks or foods react with the bacteria inthe plaque or dental biofilm on the surface of the tooth. Phosphateand calcium are lost in the enamel due to the acid that is produceddue to the reaction, and this process is referred to asdemineralization (Bagramian et al., 2012).

Theacid which causes demineralization is neutralized and diluted bysaliva in the mouth which is a dental caries natural defense. Salivais also a major reservoir of minerals next to the enamel apart fromhalting the demineralization of enamel and buffering plaque acids, itheals and remineralizes once the acids have been neutralizedcompletely. In the course of a day, the enamel remineralizes anddemineralizes many times. Caries progresses when this balance isupset such that demineralization exceeds remineralisation. When thisprocess frequently occurs for many months, then a cavity is formedwhich is because of the breakdown of the enamel surface. Cavitieshave lasting and severe complications in school going children whichinclude tooth abscess, broken teeth, acute infection, pain toothloss, and chewing problems (Bonecker et al., 2014).

Thekinds of caries formed can be classified into two groups pit andfissure caries and smooth surface caries. The pit and fissurecalories are mostly found on the chewing surfaces of the teeth’s`fronts (anterior), and the back teeth (premolars and molars). Teethcomprise of many enamel sections which meet at a particular joint. Inthis joint, the plaque is trapped by the grooves and pits which endup causing decay. The smooth surface caries is usually found wheretwo teeth touch, or even along the gum line. Plaque is formed inthose areas thus causing decay (Bagramian et al., 2012).

Treatmentoptions for dental caries are to put a filling made from differentmaterials such as porcelain, amalgam, and composite resins afterdrilling out the decay. Extensive root decay may warrant a root canaltreatment, a crown, or an extraction of the tooth (Moses et al.,2014). There was a big controversy during the 1990s concerning thepossible damage to health from the use of materials of mercuryamalgam to fill cavities which have come about as a result of decay.According to research carried out by different scholars, there hasnot been any scientific evidence found to support a link betweensystemic disease and amalgam filling in the mouth. The scientificcommittee on newly identified and emerging health risk conducted asafety review confirmed that alternative filling materials such asglass ionomer cement, gold alloys, resins, ceramics and mercuryamalgam are considered safe for teeth restoration (Santos et al.,2014). The purpose of this paper is to discuss long and short termeffects of dental caries in school-age children.

Selwitz,Ismail &amp Pitts (2013) further stipulate that in Uganda,approximated the percentage of school going children affected bydental caries to be 17.8%. The study can be compared to that ofEthiopia, whereby the school going children who have the diseaseaccount for 17.8%. Research has also been conducted in othercountries, and it was noted that the Ethiopia`s and Uganda`s resultswere lower than those of other countries such as Nepal (52.3%), India(77.2%) and Ghana (37%) (Santos et al., 2014). It is worth to notethat most studies conducted by scholars in the field link dentalcaries with poverty because of the lack of incorporating medicalinsurance. However, this particular study neither established a clearconnection between the different variables neither did it providethe justification for such a link. In this sense, Selwitz et al.(2013) stipulate that the prevalence of dental caries in the schoolgoing children is noted in families whose living standards are low.In comparison between the high class and middle-class income earners,the latter’s prevalence of the ailment is lower, as compared tothat of the former this is a conflicting fact, and it can be linkedto issues which revolve around the diet habits of the individuals.

Childrenwho are suffering from the disease perform poorly in classes, ascompared to those who are perfectly healthy. In addition to this,children who have poor habits of cleaning their teeth are at highrisk of getting dental caries, because those that constantly cleantheir teeth rarely get the disease (Bonecker et al., 2014). When thechildren eat, food particles are left in the mouth. So as to preventthe formation of bacteria, proper cleaning is required so that thefood particles are all removed. Cleaning of the teeth ensures thatthe bacteria will not have the ability to metabolize because therewon’t be enough nutrients to do so. As such, the acid required inthe development of dental caries will not be produced.

Dentalcaries is an illness which is very complicated and is considered tobe both a health problem and a social one. Its effects can be notedon individuals of all ages, economic loss, pain and misery can all beattributed to the ailment. Among young children, it is highlyprevalent as they are an extremely vulnerable group. Anothervulnerable group are the children that come from families whoseliving standards are low in the developing nations. A little incomeconstitutes to a family lacking in its needs, which translates to afamily being incapable of buying the children toothpaste whichcontains fluoride. Fluoride is very useful because since peoplestarted using it in the whole world, the number of individuals withdental caries reduced to half. Some of these children arehospitalized because of dental caries, whereby the doctors mostlyadminister medicine and suggest a local anesthesia which aids ineither the tooth’s extraction or restoration (Santos et al., 2014).

Despitethe significant advancements in the health sector concerning dentalcaries, the illness is still a major threat to the children`swell-being. Dental caries makes the children experience a severe caseof decay for the primary teeth, and the upper school going childrensuffer from secondary teeth decay. The effects brought about by theillness are serious both for the children, as well as their families.More specifically, school going children are rendered incapable ofattending their classes because of their worsening health conditions(Jackson et al., 2011). For example, Canada is considered to be oneof the places in the global world that have the least number ofchildren who have dental caries. However, an estimated 118,000 schoolhours is lost in every 120,000 school going children, and this isattributed to the presence of dental issues in the country (Sheiham,2016). Considering that this is a country with low rates of dentalhealth caries, it is quite unimaginable what other nations with highlevels of dental caries experience.

Theother symptoms of dental caries among the children include mild casesof pain, problems in chewing, abscesses, low self-esteem, andgastrointestinal disorders and so on. School going children areaffected psychologically and physically by oral health and it greatlyinfluences how they look, chew, socialize, grow, speak, and tastefood, as well as their social well-being. The quality of life ofchildren can be severely affected by tooth decay because ofdiscomfort and pain which could lead to chronic and acute infections,altered sleeping and eating habits, disfigurement, high treatmentcosts, and risk of hospitalization and loss of school days. Earlytooth loss caused by dental caries has significantly been associatedwith reduced self-esteem, failure to thrive, inability to concentratein and absence from school. In some rare occurrences, the disease hasbeen noted to cause speech impairment. It can be attributed to thefact that the lips, tongue, and teeth play a significant role incommunication and expression because they aid in the regulation ofthe flow of air into the mouth. They make it a possibility for peopleto form words and communicate to each other. In this light, whendental caries destroys the teeth, it becomes impossible for the threeparts to coordinate, thus forming words and making conversationproves to be a challenge for the children. (Bonecker et al., 2014).

Whenchildren get the disease, their self-sense of worth is reducedbecause communicating to other people becomes a problem. In additionto this, the children find it hard to swallow hard and sugary foods,because they cause a lot of pain (Bonecker et al., 2014). Most ofthem start eating food which is in liquid form, hence the imbalanceddiet makes them suffer from disorders and malnutrition. Dental cariesrequires treatment which is costly for most family households,especially when a general anesthesia is required, which may have someserious side effects (Inglehart, &amp Bagramian, 2012).

Dentaldisease is largely preventable by identification of risk factors,education, early examination, parental counseling, preventive careprocedures and initiations such as the application of topicalfluoride. However, the quality of life and the general health ofschool-going children can quickly diminish due to the progressivenature of dental caries (Sheiham, 2016). Failure to prevent dentalcaries after it has been identified is costly and has consequentiallong-term adverse effects. When treatment for tooth decay is delayed,the condition of children with this disease worsens and ultimatelybecomes difficult to treat, the number of doctors who can performthis procedure reduces, and the treatment cost increases (Inglehart,&amp Bagramian, 2012).


  1. Cross-sectional study

Mostof these studies were performed within a specific geographical areaor a given population. It means that the children who were studiedmostly attended a specific health care facility or school. Forexample, a cross-sectional study conducted in the city of BeloHorizonte, Brazil, 549 male and female five year-old children formedthe study sample (Moura-Leite et al., 2011). The participants werechosen from a population of 35,026. Among these children, 58 percentof the children formed the representative sample and were enrolled inpreschools. In another study that was conducted between March 2016and July 2016 using a school-based cross-sectional study amongprimary school going children was conducted in Dehiwala-MountLavinia. The town is 11 km from the capital city, Colombo. The townof Dehiwala-Mount Lavinia has a total population of 245,974 accordingto the country’s national census. Urban school going childrenaccounted for 27,511 who were under the age of 16 years. 20,340 ofthese children were from public schools within the area (Sheiham,2016). The town of Dehiwala-Mount Lavinia has a total of 29 urbanprimary schools. 12 of these were public and 17 were private schools.

  1. Sampling and sample size

Inall the study, sample size were determined before the actual study.In the study conducted in Brazil, the sample size was calculated togive a standard error of 4.5 percent. 23.6 percent prevalence ofdental pain and 95 percent confidence interval were used for thecalculation of sample (Moura-Leite et al., 2011). In the studyconducted in Dehiwala-Mount Lavinia the sample proportion formula wasemployed to calculate the sample size and a 95% confidence levelbeing the assumption, with a 7% degree of proportion and precision ofdental caries, the final sample size was 180. 147 students, however,only provided a complete response (Sheiham, 2016). In order to selectthe study participants, systematic random sampling technique wasused. Four government schools were picked among twelve public schoolswhen systematic random sampling technique was employed. There was aproportional allocation of the sample size according to the number ofchildren in the schools that were selected. The selection of childrenwas random according to the names that were on the respective classrosters (Inglehart, &amp Bagramian, 2012).


Forthe collection of dietary habits, care practices, socio-demographiccharacteristics, and oral health problems, a structured questionnairewas employed using a qualitative method of study. For all thechildren that were selected dental examination was carried out by adental doctor who was well-trained in natural daylight using theWorld Health Organization (WHO) diagnosis guide of dental caries. Forintraoral examination, wooden spatulas that were disposable were used(Featherstone, 2013). Data collectors before the study were givenintensive training for two days on dental caries assessment on how tofill the questionnaires, and on how to interview children as well asfollowing the WHO guideline. During data analysis, incompletequestionnaires were rejected (Inglehart, &amp Bagramian, 2012).

Thepresence of incipient caries contains some types of white spotlesions and hypo calcification.These caries were examined bydiagnostic techniques that were conventional. The existence of hypocalcification type of injury with white spot was inspected by theresearchers on wet teeth, and the wet teeth were dried withcompressed air and gauze and wiped clean, and then the inspection ofincipient caries type of white spot lesion were commenced (Klein etal., 2014). When there was a presence of a white chalky appearancespot on desiccated or dehydrated, then a white spot lesion wasrecorded.


Datawas analyzed after being entered using the statistical package forsocial science (SPSS).to get the summary value Percentage andfrequency were computed from univariate analysis. Logistic regressionanalysis was used to calculate odds ratio that had 95% confidenceinterval (CI) to assess the degree and presence between independentvariables and dental caries. P less than 0.05 are where significancewas set, which was 95%. Those variables that had a p-value that wasless than 0.05 binary multiple logistic regression analysis wascomputed on binary logistic regression? (Featherstone, 2013)


  1. Socio-demographic Features

Inthe study, the total number of children participants was 147. Out ofthis total number, girls were noted to be 55.4% (82). Most of thechildren (69.7%) were between the age-brackets of eleven to 15 yearsold. In addition to this, half of the people who participated in thestudy were between grades one to four. 14% (21) of the children’sparents had studied past the 12th grade. 54.2% (80) of the children’sfamilies all had an income of 6593.46 Sri Lankan Rupee (LKR) on amonthly basis (Vargas et al., 2011).

Outof the total number of the participants in the study, 21.8% (32) haddecayed teeth. In the children who were between the aged of six andten constituted to 33.4%. In comparison to the boys (18.6%), girlshave more prevalence of dental caries (24.5%). The prevalence ofdental caries was 12.1% (9) and 31.8% (23) among the studyparticipants from grade 5 to 8, and 1 to 4 respectively. The studyparticipants who were from the highest group of income had a greaterproportion in comparison to the middle group of revenue. On the otherhand, children who were from the least team of income had the highestpercentage of dental caries. Of all dental caries, most of them 75%(24) were suffering from primary tooth decay. Out of the total numberof children who had dental caries, 21.8% (7) showed that they weremissing some teeth, while 50% (12) had more than one tooth which wasaffected. White spot lesions and toothache were exhibited in 8.2%(12) and 27.2% (40) of the study participants respectively.Nonetheless, in 67.4% (99) of the study participants, dental plaquewas clearly noted. 6.2% (9) of the total number of children who haddental caries had sought the services of a dentist (Vargas et al.,2011).

70.8%(104) of the participants are used to having breakfast as tea andbread. The majority of the participants (85.4%) mostly took tea withsugar. Furthermore, 21.1% (31) of the children were used to takingcoffee with sugar while 37.4% (55) of the participants took softbeverages. The ones who eat foods which are sweet constitute to 48.4%(71) while 71.3% (105) of the participants usually clean their teeth.Among the ones who are used to clean their teeth, 15.3% (16) brushtheir teeth both after and before all meals. Nevertheless, almosthalf of the participants brush their teeth after only one meal. Notably, most of the study participants cleaned their teeth by theuse of an old wood stick which is cut from a distinct type of plant.However, only 4.9% (5) and 9.6% (18) made use of the wooden stick toclean their teeth without toothpaste and sometimes with toothpasterespectively (Vargas et al., 2011).

  1. Dental Caries Risk Factors

Acore relation between the status of education of the participants`parents and dental caries was found, by use of the bivariateanalysis. In the participants whose parents` level of education wasabove the 12th grade, their dental caries were 100% times at theleast risk, in comparison to the ones whose parents were noteducated. Moreover, the participants who were in 5thto 8thgrade were less likely to get dental caries, in comparison to thosewho were in 1stto 4thgrade. The participants who cleaned their teeth were 2.7 times lesslikely to get dental caries, compared to those who did not cleantheir teeth. The study participants who did not have dental plaquewere 5.4 times less likely to get dental caries, in comparison tothose who had dental plaque. Furthermore, the odds of having dentalcaries were noted to be higher among the participants who experiencetoothaches, as compared to those that have never had toothaches asHarris et al., (2014) support this.


Thereis limited data in Sri Lanka on dental caries in school goingchildren. Dental caries is a health problem which is common in thisstudy among school going children. Dental caries prevalence in thecurrent study was comparable to a study that was conducted in Taiwanwhich had 17.5%. It was, however, lower than studies which had beencarried out in different parts of Sri Lanka 36.2%-48%, India 76% andNepal 51% (Featherstone, 2013). This huge difference could be becauseof difference in practices, knowledge, and attitude on oral hygieneas the study that was conducted focused on urban school goingchildren.

Schoolgoing children have a higher prevalence of dental caries according towhat previous studies have shown, if they are living in poverty as aresult of families lacking using a usual source of dental care andshortage of dental insurance, however, in this study a clearassociation dental caries and household income was not observed. Thisstudy that was conducted in Sri Lanka was comparable to a study thatwas undertaken in Ethiopia. However, those groups that had low incomehad high dental caries prevalence rate the high-income group had ahigher prevalence of dental caries compared to the middle-incomegroup. This difference is brought about by factors such as dietaryhabits (Bagramian et al., 2012).

Thegrade levels of school going children were significant statisticallyfor dental caries, meaning when the grades of school going childrenreduced the chance of dental caries increased. The findings that werefound in this study were similar to previous studies that wereconducted in other regions. The habit of consumption of sugary foodson bivariate analysis is significantly associated with dental cariesaccording to the result of study undertaken in Sri Lanka (Bagramianet al., 2012). A similar result was also found in a study conductedin Iran. It is mostly associated with the production of the copiousacid such as streptococcus mutans, which is a cariogenic bacteriumwhich affects teeth when sugary foods ferment on them. It has beenfound that cleaning teeth will remove any debris from the oral whenit is properly done thereby reducing the risk of dental caries. As aresult, bacteria such as streptococcus mutans cannot get adequatetime and nutrients for acid production and growth that causes thedevelopment of dental caries. A toothache is deemed one of the keysymptoms of dental caries (Featherstone, 2013).

Schoolgoing children in this study who had toothaches were 5.8 times morelikely to have dental caries. This study was comparably similar to aparticular study that had been conducted in Hong Kong. 67.7% ofschool going children in this study was reported to clean their teethusing small sticks as a method of maintaining oral hygiene(Featherstone, 2013). The most common methods of maintaining healthaccording to other studies that were conducted were toothbrush andtoothpaste. A large proportion of school going children in this studyhad never visited a dentist. These findings were consistent withstudies carried out in Nepal and Ethiopia (Vargas et al., 2011).


Becauseof all the risk factors of the ailment, several recommendations havebeen put in place. First, schools should embrace the culture ofeducating children as well as grownups about the importance of oralhygiene. In partnership, the government should link up with theschools so as to make the subject included in the school’smandatory syllabus. The knowledge would be about the importance ofcleaning teeth, the number of times to brush teeth and so on.Bagramian, Garcia-Godoy &amp Volpe (2012) stipulate that this willensure that people are equipped with the knowledge they require, andthis would significantly reduce the number of children with dentalcaries. Having this knowledge will make sure that people know thebest way to take care of their teeth. Second, people should changetheir dietary practices and stop consuming sweet food or sugaryproducts. In this light, schools should stop giving children sugarysnacks which eventually make them get dental caries. Healthier snacksshould be provided in schools, and this will ensure that dentalcaries is prevented. Lastly, people should visit a dentist to seekthe knowledge and information they have. In this light, schoolsshould occasionally hire dentists who check up on the children fromtime to time (Klein et al., 2014).


Dentalcaries is a highly prevalent health problem among the school goingchildren all over the world. Various issues facilitate the acquiringof dental carries. For instance, the low grade of an individual isassociated with dental caries. It may be because of the low level ofknowledge that the individual has. A person who has a high degree ofknowledge is less likely to get dental caries. Another factor is poororal hygiene, which leads to a person getting dental caries. In thefindings, it is evident that those individuals who have poor oralhygiene have a higher prevalence of dental caries, in comparison tothose who have good oral hygiene. Another risk factor is dietarypractices. It is evident that people who take sweet food or sugaryproducts are at a higher danger of getting dental caries. It isbecause sugary goods and delicious foods facilitate the creation ofplaque, which causes cavities. Lack of dental visits also leads tothe development of cavities, and the cases get severe as noted insome instances when the children have missing teeth. Most of thereasons for the cases are because of not visiting the dentists andconsequently they will not have the ability to prevent or controldental caries. If these guidelines and recommendations are adhered byparents, the number of school going children with dental caries willbe reduced.


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