|Year : 2017 | Volume
| Issue : 4 | Page : 146-150
Dental caries prevalence among primary male schoolchildren in Riyadh, Saudi Arabia: A cross-sectional survey
Abdullah A Alamri, Mohammed S Aldossary, Sattam A Alshiha, Hessa M Alwayli, Yazeed K Alfraih, Mohammed A Hattan
Department of Dentistry, Ministry of Health, Riyadh, Saudi Arabia
|Date of Web Publication||21-Aug-2017|
Mohammed S Aldossary
P. O. Box: 13743, Riyadh 11414
Source of Support: None, Conflict of Interest: None
Aims: The aim of the study was to assess caries prevalence among 6–9-year old children in Riyadh, Saudi Arabia and to compare between results based on nationality, grade levels, and location of residence. Materials and Methods: A total of 1844 male students from 17 public male primary schools in Riyadh city were examined according to the World Health Organization diagnostic criteria. The decayed-missing-filled teeth (dmft) index and its components were measured. One-way analysis of variance, Student's t-test, and Chi-square test were used to determine the significance differences, at α = 0.05. Results: The overall mean of the decayed teeth (dt) for all children was 3.15 (standard deviation [SD]: 3.36) which increased to 4.57 (SD: 3.14) when excluding children without active caries. The mean dmft score was 4.30 (SD: 3.87) which raised to 5.37 (SD: 3.60) following excluding caries-free children (dmft = 0). The caries prevalence was 80.15%. Although the non-Saudi children showed slightly fewer values compared to Saudi children, there were no statistically significant differences in all values (P > 0.05). The dmft index score was higher for second grade (4.42, SD: 3.78), followed by third grade (4.26, SD: 3.54) and first grade (4.24, SD: 4.19). However, there were no statistically significant differences (P > 0.05). The dmft values ranged between 2.69 (SD: 3.25) for Central and 5.0 (SD: 4.13) for West of Riyadh. The ascending order was Central < North < East < South < West. Conclusions: This study supports the high prevalence of caries among children of this age group necessitating the urgent need for effective community-based preventive programs.
Keywords: Caries prevalence, dental caries, oral health, school children
|How to cite this article:|
Alamri AA, Aldossary MS, Alshiha SA, Alwayli HM, Alfraih YK, Hattan MA. Dental caries prevalence among primary male schoolchildren in Riyadh, Saudi Arabia: A cross-sectional survey. J Int Oral Health 2017;9:146-50
|How to cite this URL:|
Alamri AA, Aldossary MS, Alshiha SA, Alwayli HM, Alfraih YK, Hattan MA. Dental caries prevalence among primary male schoolchildren in Riyadh, Saudi Arabia: A cross-sectional survey. J Int Oral Health [serial online] 2017 [cited 2019 Oct 21];9:146-50. Available from: http://www.jioh.org/text.asp?2017/9/4/146/213491
| Introduction|| |
Dental caries is a persistent public health problem among children in Saudi Arabia with a high prevalence reported in both preschool and schoolchildren.,, Epidemiological surveys are important to monitor the trends of dental caries, to assess dental needs, and to plan appropriate preventive programs.,,,
A number of epidemiological surveys in Saudi Arabia have been reported in the literature, both nationally and regionally, for different target groups. The surveys have been carried out as age-specific or for preschool children and schoolchildren, and some surveys were trying to determine caries risk/preventive factors and their association to the caries prevalence. All of which reported results of wide variations although presenting high caries prevalence.,
Riyadh city is the capital and the largest city of Saudi Arabia. Since 2000, five surveys for caries prevalence have been published specifically for primary schoolchildren in Riyadh,,,,, with low sample size, and the most recent two surveys were conducted in 2004., Therefore, there seemed to be a need to conduct another study as follow-up on the previous studies to observe the changes in caries prevalence in this specific age group; 6–9-year-old children.
Furthermore, different governmental and private organizations in Saudi Arabia provide independently preventive programs, and it is worth to follow up and monitor the efficiency of the applied dental health education and preventive programs and dental services in general.
The aim of this study was to assess dental caries prevalence in the primary dentition among 6–9-year old public male primary school children ( first, second, and third grades) in Riyadh city, Saudi Arabia and to compare dental caries by factors of nationality, age/grade, and location of residence.
| Materials and Methods|| |
This cross-sectional study was conducted during October 2015 to May 2016 at public male primary schools in Riyadh city, Saudi Arabia. It was carried out as a part of the annual dental preventive program targeting primary schoolchildren, organized by the Preventive Dentistry Department, Ministry of Health, Riyadh, Saudi Arabia. The program includes educational part on oral hygiene and topical fluoride application. Ethical approval was obtained from the Preventive Dentistry Committee, Ministry of Health, Riyadh, Saudi Arabia (H-01-R-009-1352).
In the 2015–2016 academic year, the total number of Riyadh public male primary schools was 512 schools, with a total number of 169,439 students. The Saudi children counted for 129,092 (76.2%) and the non-Saudi children were 40,347 (23.8%) students (Statistical and Information Technology Department, Ministry of Education, KSA, 1436-1437 H, Personal Communication). The non-Saudi children included other Arabic-speaking nationalities from Middle East such as Yemenis, Palestinians, Egyptians, Sudanese, and Syrians.
The list obtained from the Ministry of Education (Statistical and Information Technology Department, Ministry of Education, KSA, 1436-1437 H, Personal Communication) served as sampling frame for the study. A total of 17 public male primary schools were randomly selected using stratified random sampling from different five locations within Riyadh city (North, East, West, South, and Central).
The schools were officially informed, and visitation permissions and coordination with the schools were obtained from the Ministry of Education and school principals to arrange a day for data collection. Written consents were obtained from children's parents.
In this survey, 1844 male students were examined, which included all children with obtained consent form, in the first three grades within the selected school ( first, second, and third grades). The age of schoolchildren at first grade is 6–7, second grade is 7–8, and third grade is 8–9 years old.
Before commencing the examination, a brief orientation and oral hygiene instructions to the students were carried out. Topical fluoride varnish (Clinpro™ 5% Sodium Fluoride White Varnish, 3M ESPE, St. Paul, MN, USA) was applied following examination to the children with obtained informed consent.
Dental caries was assessed using the World Health Organization diagnostic criteria for oral health survey. The decayed teeth (dt), missing teeth (mt) due to caries, and filled teeth (ft) primary teeth; the (decayed-missing-filled teeth [dmft]) index (primary teeth only) was used to assess the caries prevalence.
Oral examination was conducted by ten examiners (trained and calibrated male hygienists) who were divided into five teams. In this way, each team included two examiners; one either conducted examination or assisted in data entry in a designed data collection form.
The children were examined in their classroom with the child sitting on a conventional, nondental classroom chair, with a disposable mouth mirror, tongue blade, and a probe, when needed, under adequate natural light and under all infection control measures. The probe was used sparingly on doubtful surfaces. In case of any doubt, the tooth was marked sound. Tooth was recorded as mt due to caries if the tooth was not present at an age when normal exfoliation would not be a sufficient explanation for its absence. No radiographs were taken.
Inter- and intra-examiner reproducibility was assessed using kappa statistics by re-examining a group of fifty children, 4 weeks after the start of the study. A very high degree of agreement was demonstrated (κ > 0.80).
All data were managed and edited using Microsoft ® Excel ® (Microsoft ® Office 2007, Microsoft ® Corp, Redmond, WA, USA). All statistical analyses were performed using Statistical Package for the Social Sciences (IBM SPSS Statistics 20.0 Armonk, NY, USA). Frequencies, means, and standard deviation (SD) were generated.
One-way analysis of variance and Student's t-test were used to determine statistical significance differences between means of results. Chi-square test was used to assess the significance of differences in proportions.
Comparisons were made based on factors of nationality (Saudi and non-Saudi), grades ( first, second, and third), and location of residence (North, East, West, South, and Central). The level of statistical significance was set at α = 0.05.
| Results|| |
This study consisted of 1,844 public male primary schoolchildren in the first three grades, who were examined for dental caries from 17 schools in Riyadh city. The detailed caries prevalence results for the whole participants are presented in [Table 1].
The overall mean of the dt for all children was 3.15 (SD: 3.36) which increased to 4.57 (SD: 3.14) when excluding children without active caries (dt = 0; n = 572). The active caries-free children accounted for 31.02% of the examined children, which indicated that 69.08% of children were with active, untreated caries.
The range of dt was 0–20. There were only two children with dt = 20, both children were in first grade; one child was Saudi in West of Riyadh and the other was non-Saudi child in the Central. The mean of the mt due to caries was 0.97 (SD: 1.55) and the mean of the ft was 0.18 (SD: 0.69). Children with at least one filling accounted for 9.44% (n = 174).
The dt component was the major constituent of the dmft index (73.3%). The mean dmft score was 4.30 (SD: 3.87). However, following excluding children with dmft = 0, (n = 366), the mean dmft score was raised to 5.37 (SD: 3.60). In other words, the children who had not experienced dental caries were 19.85%, and the caries prevalence was 80.15%, indicating the proportion of the children who had one or more dt, mt due to caries, or ft.
When comparing children based on nationality, [Table 2], there was no statistically significant differences in all values (P > 0.05) between Saudi (n = 1571, 85.2%) and non-Saudi (n = 273; 14.8%) children although the non-Saudi children showed slightly fewer values compared to Saudi children.
Comparing children based on grade levels is shown in [Table 3]. The mean (dt) for first, second, and third grades were decreasing, 3.36 (SD: 3.75), 3.09 (SD: 3.15), and 2.96 (SD: 3.04), respectively. However, this was not statistically significant (P > 0.05). The dmft index score was higher for second grade (4.42, SD: 3.78) followed by the dmft for third grade (4.26, SD: 3.54) and the dmft for first grade (4.24, SD: 4.19). However, there were no statistically significant differences (P > 0.05).
The detailed comparisons between children based on the location of residence are presented in [Table 4]. The (dt) values ranged between 2.20 (SD: 3.14) for Central and 3.83 (SD: 3.52) for West of Riyadh. The ascending order was Central <South <North <East <West.
The dmft values ranged between 2.69 (SD: 3.25) for Central and 5.0 (SD: 4.13) for West of Riyadh. The ascending order was Central <North <East <South <West.
| Discussion|| |
A number of caries prevalence surveys in Saudi Arabia have been conducted in different cities or regions. In Riyadh, the studies among primary schoolchildren showed a persistence high prevalence of caries.
A survey in Riyadh by Al-Banyan et al. showed a dmft value of 3.8 among 272 male and female children group aged 5–12 years old. The caries prevalence (%dmft >0) was very high reaching 99.3%.
In another study included 449 children of 8–9 years old, the caries prevalence was 94% with a dmft value of 6.3.
Al-Wazzan  conducted a study in 2004 included 602 male and female children in the first grade primary schools, aged 6–7 years old. The prevalence of caries was 94.4% and the dmft was 7.34 for both male and female children. However, the dmft index for male children only was higher; 8.13.
Al Dosari et al., investigated the caries prevalence for children of 6–7 years old, resulted in caries prevalence of 91.2% in both Riyadh and Qaseem cities, and the dmft was 6.53 for Riyadh children group. These reports were with quite low sample size and showed very high caries prevalence and dmft values. Since then, there were no recent or updated surveys. A literature review in 2013 by Al Agili  suggested the need for updating the baseline information regarding caries prevalence.
Comparison to previous studies would be difficult and challenging due to the variation in study design, populations examined, target groups, and sample size. However, as stated earlier, this survey was conducted to update the literature.
The present study showed a slight decrease in caries prevalence but still high. The mean dmft for the children was 4.30 and 5.37 following excluding the caries-free (dmft = 0) children. The caries prevalence (% dmft >0) was 80.15%. Many previous studies in Saudi among children have reported decay (dt) as the major component of dmft score.,,, This is a similar finding in the current study, which the dt accounted for 73.3% of the dmft score.
The proportion of children with active caries was 68.98%, and most of the dt were unrestored; children with at least one filling n = 174 (9.44%). The children who had at least one mt due to caries accounted for 40.4% of the examined children. This would highlight the high prevalence of active, untreated caries with extraction being more treatment choice over fillings. Our results showed that the treatment provided, as determined by the ft and mt due to caries, was low, accounting for only 26.7% of the dmft score. This is similar to the findings by Alamoudi et al., Farsi et al., and Marya et al.
This may be a reflection of poor dental awareness and lack of education in seeking treatment. In fact, our clinical experience shows that many patients seek treatment only when there are serious signs and symptoms.
In Saudi Arabia, male and female schools are separated, and it is not allowed for male investigators to access female students and schools according to Saudi community traditions. For this reason, this study involved only male students.
The public schools are usually attended by children of low to middle socioeconomic class. However, investigating its effect on caries prevalence was not a scope of the current study.
With the limitation of this study regarding the examination setting, especially with regard to using natural light and class room chair, there is always concern about detecting proximal caries and tooth-colored restoration and could be missed during our screening., This would result in underestimating the dmft values.
This study supports the high prevalence of caries among children of this age group; 6–9 for both Saudi and non-Saudi children in Riyadh. The variation between locations of residence would be beneficial to be investigated more in further studies. The investigation of underlying risk and preventive factors was not scope of the current study.
However, we noted that, from the Central (n = 174), there were 102 non-Saudi (58.6%) and 72 Saudi children. From the West (n = 593), there were 53 non-Saudi (8.9%) and 540 Saudi children. The difference in proportion could be the speculation that can be made, in view of that non-Saudi children showed less caries prevalence. Non-Saudis would be with different awareness about oral hygiene, life style, and cultural factors, giving greater attention to oral hygiene.
Although this study based on visual inspection only without radiographs examination, this is often the only choice for many epidemiologic studies with acceptable sensitivity and specificity of the visual inspection for caries diagnosis.,,
Surveys are used to monitor the trends in oral health and disease, to develop policy, to evaluate dental health programs, and to assess the dental needs.,
This study has provided useful baseline data for future comparisons. The caries prevalence information would assist in the determination of treatment needs and preventive efforts, planning programs, formulation of appropriate strategies, and to be used in the future for the design of oral health education programs for this specific age group. With these results, there is a need for immediate attention facilitating the dental access, making referrals to these students, and making their parents more aware of the existing problems.
| Conclusions|| |
- This study supports the high prevalence of caries among children of this age group; 6–9 for both Saudi and non-Saudi children in Riyadh
- High caries prevalence in schoolchildren necessitates effective prevention and management of dental caries in earlier stage
- More organized prevention, promotion, and education programs are needed in Saudi communities to increase awareness about the importance of oral health.
The authors express thanks to the teachers for their cooperation and for the field examiners for their appreciated efforts.
Financial support and sponsorship
The study was funded by Ministry of Health, Riyadh, Saudi Arabia.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Al-Meedani LA, Al-Dlaigan YH. Prevalence of dental caries and associated social risk factors among preschool children in Riyadh, Saudi Arabia. Pak J Med Sci 2016;32:452-6.
Al Agili DE. A systematic review of population-based dental caries studies among children in Saudi Arabia. Saudi Dent J 2013;25:3-11.
Al-Ansari AA. Prevalence, severity, and secular trends of dental caries among various Saudi populations: A literature review. Saudi J Med Med Sci 2014;2:142-50. [Full text]
Jain SK, Pushpanjali K, Reddy SK, Gaikwad R, Deolia S. Comparison of different caries diagnostic thresholds under epidemiological and clinical settings among 7-15 year old school children from Bangalore city. J Int Soc Prev Community Dent 2013;3:85-91.
Kassawara AB, Assaf AV, Meneghim Mde C, Pereira AC, Topping G, Levin K, et al.
Comparison of epidemiological evaluations under different caries diagnostic thresholds. Oral Health Prev Dent 2007;5:137-44.
Ahovuo-Saloranta A, Forss H, Hiiri A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev 2016;1:CD003067.
Frencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T, et al.
Global epidemiology of dental caries and severe periodontitis-A comprehensive review. J Clin Periodontol 2017;44 Suppl 18:S94-105.
Al-Banyan RA, Echeverri EA, Narendran S, Keene HJ. Oral health survey of 5-12-year-old children of National Guard employees in Riyadh, Saudi Arabia. Int J Paediatr Dent 2000;10:39-45.
Mansour M, Anwar S, Pine C. Comparison of caries in 6-7 year old Saudi girls attending public and armed forces schools in Riyadh, Saudi Arabia. Saudi Dent J 2000;12:33-6.
Al-Wazzan KA. Dental caries prevalence in 6-7 year-old school children in Riyadh Region: A comparative study with the 1987 Oral Health Survey of Saudi Arabia Phase I. Saudi Dent J 2004;16:54-60.
Wyne AH, Al-Ghorabi BM, Al-Asiri YA, Khan NB. Caries prevalence in Saudi primary schoolchildren of Riyadh and their teachers' oral health knowledge, attitude and practices. Saudi Med J 2002;23:77-81.
Al Dosari AM, Wyne AH, Akpata ES, Khan NB. Caries prevalence and its relation to water fluoride levels among schoolchildren in Central Province of Saudi Arabia. Int Dent J 2004;54:424-8.
World Health Organization. Oral Health Surveys: Basic Methods. 5th
ed. Geneva;Switzerland: WHO Publications; 2013.
Farooqi FA, Khabeer A, Moheet IA, Khan SQ, Farooq I, ArRejaie AS, et al.
Prevalence of dental caries in primary and permanent teeth and its relation with tooth brushing habits among schoolchildren in Eastern Saudi Arabia. Saudi Med J 2015;36:737-42.
Quadri MF, Hakami BM, Hezam AA, Hakami RY, Saadi FA, Ageeli LM, et al.
Relation between dental caries and body mass index-for-age among schoolchildren of Jazan city, Kingdom of Saudi Arabia. J Contemp Dent Pract 2017;18:277-82.
Al-Shammery AR, Guile EE, El-Backly M. Prevalence of caries in primary school children in Saudi Arabia. Community Dent Oral Epidemiol 1990;18:320-1.
Akpata ES, Al-Shammery AR, Saeed HI. Dental caries, sugar consumption and restorative dental care in 12-13-year-old children in Riyadh, Saudi Arabia. Community Dent Oral Epidemiol 1992;20:343-6.
Alamoudi N, Salako NO, Massoud I. Caries experience of children aged 6-9 years in Jeddah, Saudi Arabia. Int J Paediatr Dent 1996;6:101-5.
Farsi DJ, Elkhodary HM, Merdad LA, Farsi NM, Alaki SM, Alamoudi NM, et al.
Prevalence of obesity in elementary school children and its association with dental caries. Saudi Med J 2016;37:1387-94.
Marya C, Kataria S, Nagpal R, Oberoi SS, Dhingra C, Arora D, et al.
A cross-sectional study for assessment of untreated dental caries and its consequences among slum-dwelling children. Int J Clin Pediatr Dent 2017;10:29-33.
Wang SS, Zhang H, Si Y, Xu T. Analysis of forecasting indexes for dental caries in 3- to 6-year-old children. Chin J Dent Res 2016;19:153-8.
Beltrán ED, Malvitz DM, Eklund SA. Validity of two methods for assessing oral health status of populations. J Public Health Dent 1997;57:206-14.
Schwendicke F, Stolpe M, Meyer-Lueckel H, Paris S. Detecting and treating occlusal caries lesions: A cost-effectiveness analysis. J Dent Res 2015;94:272-80.
Schwendicke F, Brouwer F, Paris S, Stolpe M. Detecting proximal secondary caries lesions: A cost-effectiveness analysis. J Dent Res 2016;95:152-9.
[Table 1], [Table 2], [Table 3], [Table 4]