Dental caries, gingivitis and oral hygiene status among 3-18-year-old children with type 1 diabetes mellitus attending Kenyatta National Hospital.

Abstract

Background: Diabetes mellitus (DM), once considered a disease of the West and the affluent, is now rising at an alarming rate in all populations irrespective of the age. The reduced salivary secretions in children diagnosed with T1DM, tend to increase the likelihood of dental caries in these children. This associated risk, can be mitigated by the child adhering to a prescribed diabetic diet, enriched with fiber and low in simple carbohydrates. On the other hand, gingival bleeding has been shown to be strongly related to the amount of plaque deposits10. The prevention of periodontal breakdown associated with gingivitis in diabetic patients has largely been based on improving the oral health practices of the patients. Study Objective: The main objective of the present study was to determine the dental caries experience, occurrence of gingivitis and the oral hygiene practices of 3-18 year-old children diagnosed with T1DM. Setting: The Paediatric Outpatient Clinic at the Kenyatta National Hospital in Nairobi, Kenya. Materials and Methods: This was a descriptive cross-sectional study where a total of 82 children aged between 3 and 18 years diagnosed with T1DM participated. The participants’ hospital records were perused to obtain diagnostic tests, duration since diagnosis and the level of control of T1DM. A structured questionnaire was administered to obtain information on the socio-demographic characteristics of the children participating in the study and their caregivers. The children’s oral health practices and the frequency of consumption of cariogenic diet were also obtained. In addition, an oral examination of the participants was undertaken to determine their plaque score, gingivitis and dental caries experience. xiii Data analysis: The data gathered were entered into a computer, coded, cleaned and analyzed using SPSS 20.0 computer software. Fisher’s exact test and Pearson’s Chi Square were used to test significant associations between two categorical variables within the study population while bivariate analysis, regression models and Odd’s Ratios were used to test significant relationships between the dependent variables and the independent variables. The level of significance was pegged at p< 0.05, and the outcomes of the study were presented in the form of frequency diagrams, graphs and tables. Results: The 82 children who participated in this study had a mean age of 11.6 ±4.1 SD, with the duration of having the disease ranging from one month to six years (mean duration of 3.3 years). Seventy two percent (72%) of the children had poorly controlled T1DM, out of whom 52.4% had moderate plaque accumulation. The prevalence of gingivitis was 100%, with 63.4% having mild gingivitis and the remaining children having moderate gingivitis. The prevalence of dental caries among the children was 78%, with a mean DMFT/dmft of 3.23+2.86. overall, the results of the study showed significant relationships between T1DM (level of control and duration) and oral hygiene status (P<0.05). On the other hand, there was a significant relationship between the level of control of T1DM and gingivitis (P<0.05) while there was no significant relationship between T1DM (level of control and duration) and dental caries experience (P>0.05) in this study. Conclusions: There oral hygiene of the children who participated in this study was poor with a high dental caries experience (78%) and gingivitis (100%). Uncontrolled T1DM and an increase in duration of having T1DM was associated with significant increase in dental plaque scores, gingival scores among the children with poorly controlled T1DM while the disease duration did not show any significant change in the severity of gingivitis. On the other hand, level of control and the duration of T1DM did not have a significant relationship with the dental caries experience of the study participants. Recommendations: There is a need to achieve controlled T1DM in child sufferers as this is likely to assist in maintaining a better oral hygiene status as well as the prevention of gingivitis among the children. There is also a need to conduct a comparative study among children with and those without T1DM to assess differences in oral hygiene status, gingivitis and dental caries experience between the groups.