Dental Caries, Gingivitis and Treatment Needs Among Children Residing in Four Charitable Institutions in Nairobi City County

Abstract

Background: Global epidemiological studies have reported that the oral health status of institutionalized children is worse than that of their counterparts in the general population. This has been attributed to poor oral hygiene and limited access to preventive or therapeutic dental services. Furthermore, there is inadequate information on the dental health of Kenyan children residing in Charitable Children Institutions (CCIs). Objectives: The main objective of the study was to determine the prevalence of dental caries, gingivitis and treatment needs of children residing in CCIs in Dagoretti and Westlands Sub-Counties of Nairobi City County in Kenya. Study design: This was a descriptive cross-sectional study. Material and methods: The study population comprised of 170 participants aged 6 to 15 years and who had continuously resided in the selected CCIs for a period of at least three months. Data was collected for the study using the WHO (2013) simplified oral health questionnaire for children, administered by the Principal Investigator (PI), who also carried out the clinical oral examinations of the participants. The questionnaire gathered information on the participants' socio-demographic profile, oral hygiene practices, and dietary practices. The oral hygiene status, including the presence of plaque, gingival health, dental caries status, and treatment needs, were recorded using a modified version of the WHO (2013) oral health assessment form for children. A trained and pre-tested assistant recorded the clinical findings. xviii Data analysis and presentation: The data was analyzed using SPSS version 25 for Microsoft Windows. The descriptive statistics applied to the continuous data were summarized as range, mean ± standard deviation while categorical data in percentage. The inferential statistics applied for comparison of the continuous variables were ttest and one-way analysis of variance (ANOVA). Categorical variables were compared by Chi-square (χ2) and Fishers exact test. All statistical tests and hypothesis testing were determined at 95% Confidence Interval (CI) and p < 0.05 was considered statistically significant. Data was presented in form of statements, tables, graphs and pie charts. Results: Among the 170 study participants, 86 (50.6%) were male and 84 (49.4%) were female. The mean age of the study participants was 10.7±2.9 SD. While all the participants reported using a conventional toothbrush and toothpaste, 140 (82.4%) reported to brushing their teeth once a day, 14 (8.2%) brushed twice daily, 15 (8.8%) brushed several times a week and one participant (0.6%) reported to brushing once a week. These findings indicated poor oral hygiene amongst the participants, as reflected by a mean plaque score of 2.1±0.4 SD. A high prevalence of gingivitis was also observed, affecting 99.4% of the participants, with a mean gingival index of 1.4±0.3 SD. The prevalence of dental caries was 75.9%, and the mean values for dmft/DMFT were 0.96 (±1.76 SD) and 1.15 (±1.49 SD) respectively. Based on the assessment of the periodontal treatment needs, majority of the study participants, 140 (82.4%), required scaling and oral prophylaxis and 30 (17.6%) required improvement of personal oral hygiene. Regarding dental caries, most of the participants, 99 (76.7%), xix required restorations as part of their treatment whilst 19 (14.7%) required pulp therapy, and 7 (5.65) required extractions. Conclusion: The study participants had poor oral hygiene status in spite of the majority of the study participants (82.4%) claiming to brush at least once daily using a conventional toothpaste and toothbrush. There was a high prevalence of gingivitis and dental caries in the study participants at 99.4% and 75.9% respectively. The children also had many unmet dental treatment needs with majority requiring scaling and polishing, and restorations. Recommendation: Treatment intervention programs, such as oral health education and outreach programmes with mobile dental clinics can be undertaken through the Health Department of the respective county governments, to address the treatment needs of institutionalized children. A wider multi-centre study is necessary to determine the burden of oral diseases in institutionalized children. The baseline data from the study may help in formulation of oral health care protocol in order to provide preventive and curative oral health services for institutionalized children