Prevalence and Treatment Needs of Dental Caries and Gingivitis Among 3-5-year-old Children in Rural Rukungiri, Uganda

Abstract

Introduction The World Health Organisation (WHO) has defined Oral health as the state of being free from mouth and facial pain, throat and oral cancer, oral sores and infections, tooth decay, periodontal disease, tooth loss and other diseases and disorders that limit an individual’s capacity in biting, chewing, speaking, smiling, and psycho-social well-being. Consequently, the health of an individual should be viewed as being inclusive of his/her oral health. An integrated approach to healthcare should therefore be developed with the aim of reducing the risk to oral diseases, as part of the promotion of the health of the individual. Dental caries and gingivitis are the two most prevalent oral diseases affecting children of all ages. This usually is as a result of mainly the inappropriate dietary measures and poor oral hygiene practices. These diseases have been found to cause a lot of pain and discomfort in those affected in addition to affecting their feeding, speech and psycho-social well-being. The studies conducted in Uganda have showed that dental caries and gingivitis are the most common oral health burdens affecting children. However, the studies were conducted in urban and peri-urban communities and the rural communities have not been equally surveyed for the same oral diseases especially among the 3-5 year old children. Since 78.6% of Uganda’s population resides in rural communities, the actual impact these oral diseases have on these communities and the country has not been quantified. Further, these rural communities are usually faced with oral health challenges that go unnoticed due to lack of oral health professionals at the rural health centres. For the oral health provider XIII to be able to plan for oral health-related services in a given region, an assessment to determine the prevalence of oral diseases in that region and their treatment needs is paramount. Further, children are a vulnerable group within any community and their health should be given priority so as to allow for proper growth and enable them live fulfilled lives regardless of their socio-economic standing and background. The findings of this study would therefore provide necessary information about these two diseases in a rural community. It can also help create an understanding of the pattern of dental caries and gingivitis and the related treatment needs among the pre-school children of Nyakagyeme Sub-county in Rukungiri District, Uganda. Study Objective The main aim of the study was to determine the prevalence and treatment needs of dental caries and gingivitis among 3-5-year old nursery school children in a rural community in Rukungiri District, Uganda. Study Area: Primary schools in Nyakagyeme sub-county, Rukungiri District. Study design: This was a descriptive cross-sectional study in which nursery school children aged 3-5 years participated. The children were randomly selected from the eight (8) primary schools, and consent to participate in the study obtained from their parents/guardians. Data Collection: The socio-demographic data (age, gender) was obtained from the school registers and recorded in modified individualised WHO data forms. The Principal investigator (PI) then carried out an intra-oral examination on every child under field conditions using natural light, to assess their oral hygiene status, gingival health status and dental caries experience, using the plaque score, gingival index and dmft index respectively. The related treatment needs were also determined using the

criteria of oral diseases survey as described by the World Health Organisation. All information gathered was appropriately recorded on each child’s data form. Data Analysis: Data obtained were analysed using Windows SPSS Version 23.0. The results were subjected to descriptive and inferential statistical analysis. The tests included Independent samples t-test, ANOVA, Fisher’s exact, Spearman’s Rank-Order correlation coefficient and linear regression model and were used to compare and relate the variables, with the P<0.05 considered to be statistically significant. The confidence interval was set at 95%.The findings were presented in Tables and Figures. Results: The total number of children who participated in the study was 432, with 118 (27.3%), 145 (33.6%), 169 (39.1%) aged 3, 4, and 5 years old respectively. They included 230 (53.2%) male and 202 (46.8%) female participants. All the children (100%) who participated in the study had plaque deposits. The mean total plaque score was 12.83, SD=4.30), the male participants having a higher plaque score (13.33, SD=4.46) when related to the female participants (12.25, SD=4.05). The difference in the plaque scores between males and females was statistically significant (p= 0.008). The severity of the plaque deposits in these children varied from mild [164 (38.0%)], to moderate [266 (61.5%)] and severe [2 (0.5%)]. The mean total gingival Index of the study participants was 6.36, (SD=4.14). The males had a higher gingival index (6.77, SD=4.15) than their female counterparts (5.90, SD=4.50). The difference in the gingival index between males and females was also statistically significant (p=0.03). Further, a statistically significant association was also noted between plaque score and gingival index (p < 0.001). In addition, all the children (100%) had gingivitis with 378 (87.5%) having mild gingivitis, 53 (12.3%), moderate gingivitis and only one (0.2%) had severe gingivitis. The majority of the children 338 (78.3%) needed oral hygiene instructions, 33 (7.6%) had no need for periodontal treatment and 61 (14.1%) needed oral prophylaxis in addition to being given oral hygiene instructions. The overall dental caries prevalence was 48.6% and was 11.6%, 18.5%% and 18.5% for the 3-, 4-, and 5-year olds respectively. The male participants were more affected with dental caries (26.1%) than the female participants (22.5%). The mean dmft for the participants was 2.33 (SD=3.20), the decayed component (dt) being the highest (M=2.04, SD=3.01). Some of the children (8.1%) had undergone the practice of Ebiino or Infant Oral Mutilation (IOM). Tooth filling was the most needed dental treatment for dental caries followed by pulp therapy. Conclusion: The dental caries prevalence among the participants was 48.6% with decay contributing the most (88.65%) to the dental caries experience. Most of the affected children needed fillings as their dental treatment need. Further, the majority of the participants in the study had mild-to-moderate plaque deposits and mild gingivitis, indicating greater need for oral hygiene measures to be instituted among the participants. The practice of Ebiino, a form of oral infant mutilation (IOM) appeared to be endemic in this community. Recommendations: The government of Uganda could use this data in the planning for oral health care and provision of oral health related services geared towards the improvement of the oral health and prevention of oral diseases of the children in Nyakagyeme sub-county and possibly other regions. Oral health education campaigns need to be organised in this region to help inform the parents and their children about the effects of oral diseases and how to prevent such diseases, including campaigns geared towards addressing the practice of Ebiino.