Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 2 - Apr/Jun - 2019

Original Article Imprimir 

Páginas 93 a 101


Dental caries, eating habits and oral hygiene in schoolchildren in a city in the interior of Rio Grande do Sul: epidemiological survey

Carie dental, hábitos alimenticios e higiene bucal en escolares de una ciudad del interior de Rio Grande do Sul: encuesta epidemiológica

Cárie dentária, hábitos alimentares e de higiene bucal em escolares de um município do interior do Rio Grande do Sul: levantamento epidemiológico

Autores: Milena Milan1; Maitê Michel Piazza Willig2; Michele Natara Portilio3; Lilian Rigo4

1. Graduated in Dentistry by the Meridional College (IMED). Passo Fundo, RS, Brazil
2. Especialist in Radiological Dentistry e Imaging by the São Leopoldo Mandic Dentistry College (SLMANDIC). Graduated in Dentistry by the Meridional College (IMED). Passo Fundo, RS, Brazil
3. Mastering in Dentistry by the Meridional College (IMED). Specialization in progress in Periodontium by the Graduate Center Passo Fundo (ODONTOCENTER). Passo Fundo, RS, Brazil
4. Doctorate in Dentistry by the Pernambuco University (UPE). Post-Doctorate  by the Federal University of Rio Grande do Sul (UFRGS). Teacher by the Meridional College (IMED). Passo Fundo, RS, Brazil

Correspondência:
Milena Milan
IMED Campus Passo Fundo
R. Sen. Pinheiro, 304 - Vila Rodrigues
Passo Fundo - RS, Brasil. CEP: 99070-220
(milenamilan@hotmail.com)

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How to cite this article

Keywords: Dental Caries; DMF Index; Oral Health.
Palabra Clave: Carie Dental; Índice CPO; Salud Bucal.
Descritores: Cárie Dentária; Índice CPO; Saúde Bucal.

Abstract:
INTRODUCTION: Dental caries is one of the oldest oral pathologies and it is still a highly prevalent disease, being considered a public health problem.
OBJECTIVE: The objective of the study was to verify the prevalence of dental caries in schoolchildren of a municipality, and to compare the average of caries of adolescents from private and state schools.
METHODS: The approach of the study was quantitative, descriptive and of prevalence, in which the sample was composed of all schoolchildren with ages between 11 to 13 years, totaling 105 students. Data were collected from the application of a questionnaire and for the evaluation of the presence and average of dental caries and clinical exams were performed using the CPOD index for caries average and visual examination for the biofilm.
RESULTS: The data analyzed showed a prevalence of untreated dental caries in 44.7% of the schoolchildren and the CPOD index was of 1.22, with no difference among the schools investigated. The majority (86.7%) of the students presented biofilm in the dental elements. The amount of soda consumed daily by the students was 62.8%, 98.1% ate biscuits 1 to 2 times a day and of these, 69.5% were stuffed biscuits.
CONCLUSION: The prevalence of dental caries is high in schoolchildren of both schools. However, the average CPOD index is low, according to World Health Organization parameters. There is a high daily intake of sugary foods, beverages and oral hygiene among schoolchildren was deficient when biofilm was present in the teeth.

Resumen:
INTRODUCCIÓN: La carie dental es una de las más antiguas patologías bucales y todavía hoy es una enfermedad de alta prevalencia, siendo considerada como un problema de salud pública.
OBJETIVO: El objetivo del estudio fue verificar la prevalencia de carie dental en escolares de un municipio y comparar el promedio de carie de los adolescentes de las escuelas particulares y estaduales.
MÉTODOS: El abordaje del estudio es cuantitativo del tipo descriptivo y de prevalencia, cuya muestra fue compuesta por todos los escolares de 11 a 13 años del municipio, totalizando 105 escolares. La colecta de datos fue realizada a partir de la aplicación de un cuestionario y fueron realizados exámenes clínicos utilizando el índice CPOD para la evaluación de presencia, del promedio de la carie dental y de la presencia de biopelícula dental. Resultados: Hubo prevalencia de carie dental no tratada en 44,7% de los escolares y un índice CPOD de 1,22, no habiendo diferencia entre las escuelas investigadas. La mayoría (86,7%) de los escolares presentó biopelícula en los elementos dentales. La cantidad de bebida ingerida diariamente por los escolares fue de 62,8%, 98,1% comen galletas de 1 a 2 veces por día y de esos, 69,5% eran rellenos.
CONCLUSIÓN: La prevalencia de carie dental es alta en los escolares de ambas escuelas, no obstante, el promedio del índice CPOD es bajo, según parámetros de la Organización Mundial de Salud. Hay un gran consumo diario de alimentos y bebidas azucaradas y la higiene bucal de los escolares se mostró deficiente cuando se observa la presencia de biopelícula en los dientes.

Resumo:
INTRODUÇÃO: A cárie dentária é uma das mais antigas patologias bucais e ainda hoje é uma doença de alta prevalência, sendo considerada como um problema de saúde pública.
OBJETIVO: O objetivo do estudo foi verificar a prevalência de cárie dentária em escolares de um município, e comparar a média de cárie dos adolescentes das escolas particular e estadual.
MÉTODOS: A abordagem do estudo é quantitativa do tipo descritiva e de prevalência, cuja amostra foi composta por todos os escolares de 11 a 13 anos do município, totalizando 105 escolares. A coleta de dados foi realizada a partir da aplicação de um questionário e foram realizados exames clínicos utilizando o índice CPOD para a avaliação da presença, da média da cárie dentária e da presença de biofilme dental.
RESULTADOS: Houve prevalência de cárie dentária não tratada em 44,7% dos escolares e um índice CPOD de 1,22, não havendo diferença entre as escolas investigadas. A maioria (86,7%) dos escolares apresentou biofilme nos elementos dentários. A quantidade de refrigerante ingerida diariamente pelos escolares foi de 62,8%, 98,1% comem bolachas de 1 a 2 vezes por dia e desses, 69,5% destes eram recheados.
CONCLUSÃO: A prevalência de cárie dentária é alta nos escolares de ambas as escolas, porém, a média do índice CPOD é baixa, segundo parâmetros da Organização Mundial de Saúde. Há um grande consumo diário de alimentos e bebidas açucaradas e a higiene bucal dos escolares mostrou-se deficiente quando observada a presença de biofilme nos dentes.

INTRODUCTION

Dental caries is a multifactorial disease that basically depends on three fundamental factors: the presence of cariogenic bacteria, a substrate and a susceptible host1. Currently, the disease is characterized as a mineral loss of dental structure due to acids produced by bacterial metabolism and, consequently, the fall of ph and demineralization of dental tissue2.

At the beginning of the 21st century, dental caries continue to be classified as the main oral health problem, affecting 60 to 90% of school children and most adults. The disease is one of the main causes of tooth loss and toothache, limiting work and school activities, and thus undermining the overall quality of life of those affected3.

The most recent national data on dental caries, 2010, showed that at five years old, only 46.6% of Brazilian children were caries-free in deciduous dentition and at 12 years old, only 43.5% in permanent dentition4.

In Brazil, the prevalence of caries in 12-year-olds fell from 96.3% to 68.9% between 1980 and 2003, reaching 56% in 2010, mainly due to the use of fluoride toothpaste and water4.

Dental caries can cause suffering and pain in people, being considered a public health problem5. Both caries and periodontal disease are the most prevalent oral diseases from the public health point of view, thus having a major impact on the quality of life of individuals6.

The occurrence of dental caries can be influenced by socioeconomic factors, demographic, behavioral, biological and clinical conditions, where avoiding dental treatment is one of the main reasons for the impairment of oral health7. It can also be influenced by environmental factors and lifestyle8.

There is evidence that the distribution of caries in populations is uneven and commonly associated with socioeconomic status5. Low income, associated with difficult access to hygiene products, is associated with the severity and prevalence of dental caries9.

Dental caries and gingivitis have in dental biofilm (plaque) an important common etiological component, where dental biofilm can be understood as a diverse community of microorganisms that develops on the dental surface10.

Adolescents have the best rates of general health, but when related to their oral condition this age is considered a difficult phase11. When considering sugary food consumption and poor biofilm control, adolescence can be characterized as a period of risk to oral health12. Kaewkamnerdpong and Krisdapong13 highlight that daily consumption of sweets by children and adolescents is positively associated with food sales and sugary drinks in schools, and state that the creation of supportive environments for oral health in schools is an important strategy for promoting oral health at school age.

The aim of the present study is to verify the prevalence of dental caries in adolescents from two schools in the city of Nova Araçá-Rio Grande do Sul, to know the mean of the CPOD index and to compare it among the students.


METHODOLOGY

This research complied with the guidelines of Resolution No. 466/12 of the Health Council and the approval of the Research Ethics Committee (CEP) of Southern College IMED, being the same approved by the number 2.014.434. All adolescents and parents/guardians signed the Informed Consent Form and the Consent Form accepting participation in the research.

Study design and sample

The present study is an epidemiological survey of quantitative approach of descriptive and prevalence type, whose sample was the total of students enrolled in the two schools of a municipality, considered as a census. Thus, the sample totaled 132 students from 11 to 13 years old students from private and state schools located in the city of Nova Araçá, region of the Upper Northeastern Rio Grande do Sul, composed of a population of 4,429 inhabitants, distributed in an area of 74.704 km14.

Procedures and instruments for data collection

For data collection was applied to the students a questionnaire with questions related to age (11, 12 and 13 years); gender (female and male); if you have been to the dentist (yes or no), school you attend (Private and State); frequency of brushing (once a day, twice a day or three times or more a day); mother's education (elementary school, high school or college): mother works outside (yes or no); live in urban or rural areas; frequency of sugary drinks (no drinks, one to two drinks a day or three or more drinks a day) type of drink (soda, sugared juice or both); frequency of crackers a day (not once, once or twice a day or three or more times a day); and the cookie type (stuffed or not).

Data collection was performed in November and December 2016 in the morning and afternoon shifts. The questionnaires were completed by students in their classrooms with the presence of the researcher and a teacher to help with logistics and organization.

Subsequently, a clinical examination was performed to collect dental caries data using the CPOD index (decayed, lost and filled teeth index), and was subdivided into C (decayed), P (lost), O (sealed) and the unit measure that is D (tooth), which was proposed by Klein and Palmer (1937).15 The biofilm was collected from the visual examination with a wooden spatula on the buccal surface of the upper anterior teeth (elements 11, 12, 21 and 22). Clinical examinations were performed before snack time in order to verify the presence of biofilm before the food provided in the schools.

The evaluator calibration process verified the level of intra-examiner agreement for the use of the CPOD index, and the evaluator underwent previous training. For the theoretical framework, the SB 20004 Calibration Instruction Manual was used. The result of the Kappa coefficient test generated a value of 0.94 (p <0.001), which is considered as an excellent agreement. A descriptive statistical analysis was performed to describe the relative and absolute frequencies of all variables using the Statistical Package for the Social Sciences (SPSS) version 20.0.


RESULTS

Table 1 shows the data regarding the variables of the students, and the predominant age was 12 years (47.6%), where most are students of the state school (72.4%). It is also possible to observe that the vast majority (93.3%) of the students had already attended the dentist. In the vast majority (86.7%) the presence of biofilm in the dental elements was detected.

The amount of soda ingested daily by students is 62.8%, and some still drink sugary juice, in addition to soda (43.8%). The frequency of schoolchildren who eat cookies 1-2 times a day is 98.1%. Of these, 30.5% eat stuffed cookies and 39% eat with and without stuffing (Table 1).




The total mean CPOD index of the students was 1.22 (SD0.34), whose minimum value was 0 and the maximum value was 6 (Figure 1).


Figure 1. Distribution of CPOD of students from Nova Araçá, RS, 2016.



The dental caries averages of the schools were 1.14 and 1.25, respectively for the Private and State schools (Table 2), with no statistically significant difference between the averages of the CPOD index of the students (p = 0.66).




When the CPOD components were analyzed separately, it was found that the presence of dental caries was 39% and in restored teeth, but with caries was 5.7%. Thus, the total prevalence of untreated dental caries is 44.7%. Figure 2 shows the frequencies of the CPOD components (decayed, caries-free and caries-restored).


Figure 2. Distribution of CPOD components (restored with and without caries and decay) of students from Nova Araçá, RS, 2016.



DISCUSSION

When investigating the mean CPOD index of the analyzed sample, the data presented low caries index. However, when the components of the CPOD index were checked separately, there was a high prevalence of untreated caries in the investigated students. The study found an average CPOD of 1.22, which corresponds to a low caries severity, being similar to the results found in the city of Ponta Grossa-PR, where the mean CPOD was 1, considered very low16.

Contrary to the results of previous studies, a moderate CPOD index of 3.38 was found in 12-year-old schoolchildren in a municipality in the same region of the present study7. This municipality, however, is larger, which perhaps influenced the higher value of the index. Similarly, in other states, such as Rio Claro in the state of São Paulo, the index found was 2.7117 and in Araucaria in Paraná, the average was 2.418.

The prevalence of untreated caries in the present study was 44.7%, which is similar to the study by Moller et al.19, whose result was 34%, being considered moderate. When compared to other studies, such as Frazão et al.3, 62.9% of the schools had at least one permanent tooth attacked by caries, with no statistically significant difference between sex.

Regarding the index used in other studies, the CPOD (decayed, lost or filled teeth) was analyzed by intraoral clinical examination20,19,7,12. However, some studies used the Significant Caries Index (SIC) to measure caries severity. The SiC index is intended to focus attention on the individuals with the highest caries rates in each population. The index is calculated as follows: individuals are classified according to their CPOD values. The third of the population with the highest caries score is selected and the average CPOD for this subgroup is calculated21,22,23.

In the present study, most students (86.7%) had biofilm accumulation on the dental surface. The verification method used in the study was visual only. Proper oral hygiene is necessary to prevent oral pathologies that are frequent in school children10. It is important to inform adolescents about the need for correct removal of the dental biofilm by performing proper oral hygiene. Preschoolers begin learning about the concepts and principles that will be part of their education, so food and oral health education, like any other educational activity, should be introduced as early as possible by parents and teachers, preferably in child age25.

In the present study it was possible to verify the excessive consumption of sugary foods (cookies), and consumption of sugary drinks and/or soda at least once a day. The result verified in another study, reports that 60.8% of the students consumed stuffed cookies and 73.9% consumed sweetened juice, a fact that the authors attributed as contributing to a high prevalence of caries in adolescents26. Culturally, individuals residing in Brazil have a habit of consuming too much sugar, perhaps remnant of the era of high sugar cane consumerism. In addition, there is a poor intake of fermentable carbohydrates available in typical foods of each region of the country25.

Oral hygiene habits and access to dental services are important factors for the prevention of dental caries, as pointed out by Rigo et al.7, in a study conducted in a municipality located in the northern region of Rio Grande do Sul. In order to oral hygiene and frequency of brushing, in the present study most students (50.5%) reported brushing their teeth twice a day. Similar result to that obtained by Cypriano et al.27, in which 50.9% reported brushing their teeth twice a day.

The present study has its design as a limitation, since it does not allow the long-term follow-up of selected students to observe the evolution of carious lesions or treatment of untreated decayed teeth, as occurs with cross-sectional studies5,16,23,18. Therefore, it is suggested that a cohort study be conducted in adolescents from this municipality with a longitudinal design that allows cause-effect inferences with the determinants of dental caries. Even so, it can be affirmed that the present research is extremely important for the knowledge of the current oral conditions of the students of the researched municipality.


CONCLUSION

From the findings of this study, we conclude that the prevalence of untreated dental caries is high in students from both schools analyzed, although according to WHO parameters, the average caries measured by the CPOD index is considered low in these students, with no difference between the private and state schools of the township investigated.

There is a high daily consumption of sugary foods and drinks and the oral hygiene of the students was poor when the presence of biofilm in the teeth was observed.


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