Early Childhood Caries Prevalence and Severity In Relation To Oral Health Behaviors in Lebanese Pre-School Children

Hisham HT

Published on: 2023-05-13

Abstract

The purpose of this study is to assess the impact of selected dental health behaviors on the prevalence and severity of Early Childhood caries (ECC), among a group of Lebanese preschool children. A total of 500 preschool children, age 3 to 5 years were chosen with stratified random sample technique with proportional allocation of the subjects, into different strata. Out of the 500 students chosen, 409 complied and returned the questioner and hence were included in the study. The study was performed in six schools distributed in different areas of Beirut, 3 private and 3 public schools. Every child was examined using a disposable plastic dental mirror under an adequate source of light. Early childhood caries was diagnosed as present when one or more decayed (non cavitated or cavitated lesions), missing (due to caries), or filled tooth surface on any primary tooth in children up to 71 months of age [1] was detected. The severity of ECC was classified according to Whyne AH (1999) [2] Type 1 ECC (mild to moderate); Type 2 ECC (moderate to severe); Type 3 ECC (severe). All eligible children were given a questionnaire to be filled in at home by parents and returned by a specific date. Dental health behaviors included in the questionnaire were as follows: Age of commencement of tooth brushing, Adult supervision of tooth brushing, Amount of tooth paste used, Application of tooth paste, Dummy use with and without sweetener, Previous visits to dentist and selection of labels with no added sugar. The data were collected, tabulated and statistically analyzed, using package for social science "SPSS" version 13. The age of the study sample ranged from 3- 5 years with a mean 4.0 ± 0.9. About half of the sample was males (49.1%). The majority of children were in public schools (60.9%). Nearly all children (93.4%) brushed their teeth. Two thirds (68.8%) however, started brushing at or after 24 months of age. Most of the children (91.1%) were supervised by their parents during brushing and 75.1% of them used an amount of tooth paste that was half the length of the tooth brush. This amount was put on the brush by parents in 73.8% of the cases. Nearly a quarter of the children (23%) used the pacifier whether alone or with sweetener. Only 30.1% choose drinks without sugar. More than half of the examined children (53.3%) had not previously visited a dentist. Of those who had caries, 38.9% had mild caries, 27.1% had moderate caries while only 4.4% had severe caries. The mean age increased significantly (P<0.0001) with increasing severity of caries (for no caries, mild, moderate and severe caries, mean ages= 3.7 ± 0.8, 4.1 ± 0.9, 4.3 ± 0.8 and 4.4 ± 0.7 respectively). No significant difference was observed between males and females in caries severity (P= 0.87). More children in public school had severe caries compared to children in private schools (6.8% and 0.6% respectively). Similarly, more children in private schools were caries free compared to children in public schools (49.4% compared to 16.9% respectively). The difference between children in public and private schools in caries severity was statistically significant (P<O.0001). Significantly more children who brushed were caries free compared to non-brushers (30.6% and 14.8% respectively, P<0.0001). More children who started brushing at 12 and 18 month were caries free compared to children who started brushing at 24 months or later (55.8%, 50.7%, 20.8% respectively, P<0.0001). No relation was observed between caries severity and parental supervision of brushing, amount of tooth paste placed on brush or who places toothpaste on tooth brush (P=0.10,0.06 and 0.10 respectively). Significantly more children who did not use pacifier were caries free compared to those who used pacifier alone or with sweetener (33.7%, 16.7% and 0% respectively, P=0.009). Significantly more children who chose sugarless drinks were caries free compared to those who did not choose sugarless drinks (39.8% and 25.2% respectively, P=0.02). More children who have previously visited a dentist were caries free compared to children with no prior visits (36.1% and 23.9% respectively, P=0.003). These findings deserve further investigation among Lebanese preschool children.