The Deciduous Caries Status And Impact Factors In A 5 Year Old Guangzhou Cohort

Deciduous caries is considered an early-onset, quick and wild spread infectious disease, with a relatively high prevalence but usually little symptoms, which commonly leads to malfunction of occlusion, inflammation and pain both in hard and soft tissues, as well as exhibits a great effect on the development of permanent teeth, oramaxillofacial region, even of the other system of the body. A healthy and intact primary dentition plays a direct and important role in the establishment of a normal permanent dentition. In lights of the epidemiological data from World Health Organization (WHO) in 2004, an inequality remains world wildly both in the incidence and severity of caries, which depends on the disequilibrium and imbalance of economy status, and culture etc. In China there are piles of surveys on the epidemiological tendency of primary caries. According to the data of the third nationwide sampled epidemiological survey on oral health status in 2005, the caries rate of deciduous caries in 5-year-old preschool children was 66.0%, with an urban area and countryside difference of 62.0% vs 70.2%, and 96.7% of the involved teeth remained untreated. In another small sample investigation in Guangzhou, the results demonstrated a high prevalence of caries and periodontal diseases, and a poor knowledge on the oral care of population. A better understanding of the current status of oral health in population and subsequent rearrangement of the available sources are in crucial need. Thus, in the current study, a national criterion was applied, for the first time in Guangzhou, to investigate the epidemiological status of oral health in Children.In previous studies a diversity of impact factors were noted to be related with the deciduous caries including oral health behaviors of children, food, social demography of the parents, knowledge and attitude towards oral health, parents'evaluation and intervention of oral care for children and so on. However, most of the data, if not all, were limited to the questionnaires and lack of a systematic analysis. For instance, the data from the third nationwide sampled epidemiological survey on oral health status in 2005 showed that in the population of 5-year-old preschool children only 13% started bushing before 3 years old, while the corresponding percentages starting at 3 or 4-5 years old were 26% and 40%, respectively, and 21% never brush before 5 years old. But the subsequent analysis of the relation of these data with caries rates was absent. Thereafter, a comprehensive equal-sized stratified multi-stage randomly sampling design based on the WHO criterion for oral health investigation (4th edition) and the methodology of the third nationwide sampled epidemiological survey on oral health status in 2005 was utilized in the current survey. The caries incidence was obtained by a caries screening while questionnaires were given to the parents of 5-year-old children to accumulate the related information including basic family statue, daily diet habit, oral health behavior, parents'knowledge and attitude towards oral health, parents'evaluation and intervention of oral care for children and parents' education background etc. Then the correlation of the captioned factors and caries prevalence was evaluated by a single variable analysis. The significant positive factors were combined into a multivariate unconditional logistic regression model by Enter method to analyze systematically the possible factors related with the occurrence of deciduous caries, thus to provide baseline information to promote the knowledge about oral health and caries, as well as the effectiveness of oral health intervention approaches.1 ObjectiveTo investigate the current status of deciduous caries in population at the age of 5 years in Guangzhou, and the relation with some possible impact factors, thus to provide scientific basis for the establishment of oral health care policies in Guangzhou.2 MethodsBased on the principle of efficacy and cost-effectiveness, an equal-sized stratified multi-stage randomly sampling design was applied to obtain a representative sample group consisted of 720 (540 from urban area and 180 from countryside) Guangzhou residents aged at 5 years old, with a gender ratio of half to half. The caries on the crowns of deciduous teeth were assessed; thereafter the data including their oral health habits, diet condition, and family related agents etc were obtained through questionnaires from children's parents. Both the caries screening and the questionnaires are based on the corresponding methodology and criterion of the third nationwide sampled epidemiological survey on oral health status in 2005. An additional 10% of samples were investigated to guarantee the enough samples in need. A double check system and a logistic data verify mechanism were applied in data collecting and inputting to ensure the accuracy of the data. A soft package for social statistics version 13.0 (SPSS 13.0) was used in which t-test was utilized for analysis of dmft (decayed, missed and filled teeth) while chi-square test was used for caries rates and single variable analysis, respectively. The significant positive factors in single variable analysis were further processed as independent variables when the presence of caries set as dependant variable, in a multivariate unconditional logistic regression model.3 Results3.1 The current status of deciduous caries in 5-year-old Guangzhou cohort3.1.1 Deciduous caries incidence in Guangzhou population aged at 5 years oldA total of 720 children aged at 5 were screened, and the caries rate was 57.5%. The corresponding figures for the population from urban area, countryside were 49.8% and 80.6%, with a significant difference (P＜0.01), while no difference was noted between male and female (57.8% vs 57.2%,P＞0.05).The index of dmft (decayed, missed and filled teeth) for the whole observed population was 2.90, while a significant geographic divergences between urban area and countryside were noted (2.20 vs 4.98,P＜0.01).3.1.2 The filling rate of deciduous caries in 5-year-old Guangzhou cohortAmongst the 720 children investigated, the total filling rate of deciduous caries was 3.26%, while a higher filling rate was noted in urban area (5.14%) than in countryside (0.78%), P<0.01. But a similar number was observed when the gender groups were compared (3.40% vs 3.14%, P>0.05). 3.1.3 The distribution of caries frequency in 5-year-old Guangzhou cohortA total of 306 caries-free objected were recorded, making a proportion of 42.50%; The number of population bearing 1-5 decayed teeth was 277, making 38.47% of the population, or 66.91% of caries involved population, while the figure for population with 6 or above decayed teeth was 137, constituting of 19.03% of whole population and 33.09% caries involved one. No gender differences was present in all frequency groups, but a demographic divergence was noted between urban area and countryside when the population with 6 or above decayed teeth was compared (12.96% vs 37.23% of the designed demographic population respectively, P<0.01)。3.1.4 Caries involvement of tooth position in dentition Amongst the total of 2084 decayed teeth from 720 investigated objectives, the susceptible tooth position was as followed in a descending sequence:maxilla deciduous middle incisors, mandibular deciduous molars, maxilla deciduous molars, maxilla deciduous lateral incisors, maxilla deciduous canines, mandibular deciduous canines, mandibular deciduous lateral incisors, and mandibular deciduous middle incisors.3.2 Single variable analysis3.2.1 Basic family statusIt was demonstrated that the number of children in the family was associated with caries rates (P<0.01) and a lower caries rate was noted in the group with only one child in the individual family. The annual income of the family was shown to be another related factor with caries rate (P＜0.05), while a lowest caries rate was noted in children from the family with middle ranked income.However, no relation of caries and the other family factors was found, including the weight when borne, the patterns of feeding, or whether the child or children were taken cared by parents,(P>0.05).3.2.2 Daily diet habitsThe frequency of intaking of fresh fruits, orange juice or apple juice (excluding fresh-made juice) was shown to be irrelevant factor with caries rate(P>0.05). But the frequency of eating sweat food was a relevant one, including biscuit, cake, bread, sugar, chocolate, sugar water, cola and spring soda, while the lower frequency of sweat foods intaking, the lower caries rate(P＜0.05).Caries rate was found to be dependant on whether taking sweat food or drinks before sleeping, and the children who never taking sweat food or drinks before sleeping exhibited the lowest caries rate (P<0.01).Sweat milk, yogurt or milk powder were not related with caries rate of children(P>0.05).3.2.3 The habits of oral health in childrenThe age of the children starting brushing and the daily frequency of brushing were both relevant factors with caries rates (P＜0.01). The lowest caries rate was noticed in the children who started brushing before 3 years old(47.5%) and who brush twice or above daily(47.4%).3.2.4 Parents'knowledge and attitude towards oral health, parents'evaluation and intervention of oral care for children and parents'education backgroundCaries rate was irrelevant with whether parents help children to brush or not(P>0.05),but dependent on whether checking the brushing effectiveness of their children(P<0.01). The caries rate reached the lowest 47.0%, providing the brushing effectiveness of children was checked every week or every day.When the parents had a good knowledge on the fluoride toothpaste, their children exhibited 1 lower caries rate, which implied the positive relation between such kind of knowledge caries incidence of their children, P＜0.01. However, application of fluoride toothpaste was a insufficient related factor with caries(P>0.05).Parents evaluation about the health of whole body of children was not relevant with caries rate (P＞0.05)but did the evaluation about the oral health, while in the children whose parents gave high evaluation about the oral health status the caries rate was at the bottom of 37.3%.The caries rate was also dependant on the parents' attitude towards the statements'the health of teeth is born to be, and irrelevant with self care'. The parents holding strong negative opinions had the lest-decayed children (49.6%).Controversially, the attitudes towards a few of other statements seems not related the caries occurrence, such as'oral health is important for life','prevention of caries dependants on self caring','it is important to protect the first molar of children',and 'unhealthy teeth of mother will influent their children'teeth', etc(P>0.05).If the parents regarded the statement'there is no need to treat deciduous caries'as false, their children showed a lower tendency to catch caries (P＜0.01);But the judgment about'fissure sealing can prevent caries in children' is nor related with caries rate (P>0.05).The educational background of parents was proved to be positively related with caries rate in their children, since the children had the lowest caries rate of 44.8% when their parents had an college degree or above.3.3 Multivariate logistic regression analysis for deciduous caries in 5-year-old populationWhen the caries taken as the dependant variable and the total of 15 positive factors in single variable analysis taken as independent variables, the results from a multivariate logistic regression model showed that three key factors were closed related with caries rates, including the frequency of drinking sugar water, the parents evaluation of oral health, and the educational background of parents.4. Conclusion4.1. A high caries prevalence and a poor filling rate for deciduous caries were noted in the children from countryside in Guangzhou. Effective measures are in need to control the caries status in this population.4.2. A total of 15 caries-related factors was revealed by single variable analysis, including the number of children and annual income in individual family, the frequency of intaking biscuit, cake, bread, sugar, chocolate, sugar water, cola and spring soda, whether taking desert or sweat drinks before sleeping, the age of starting brushing, the frequency of tooth brushing, whether the parents checking the effectiveness of tooth brushing of children, knowledge on fluoride toothpaste, parents'evaluation of oral health of their children, and, the educational background of parents. In a multivariate unconditional logistic regression model, three key factors were closed related with caries rates, including the frequency of drinking sugar water, the parents'evaluation of oral health, and the educational background of parents, which lead to the conclusion that the more efforts are in crucial need to promote the awareness and take necessary steps to enhance oral health measures, thus to establish a favorable oral health behavior among children.