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 Table of Contents  
ORIGINAL RESEARCH
Year : 2020  |  Volume : 12  |  Issue : 3  |  Page : 231-235

Carbohydrate intake and dental caries status in preschool children in Bantul District, Yogyakarta, Indonesia: A cross-sectional study


Dental Hygiene Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia

Date of Submission29-Mar-2019
Date of Decision28-Nov-2019
Date of Acceptance29-Nov-2019
Date of Web Publication02-Jun-2020

Correspondence Address:
Miss. Leny P Arie Sandy
Dental Hygiene Program, Faculty of Dentistry, Universitas Gadjah Mada Yogyakarta, Denta Sekip Utara 1 Sleman Yogyakarta, 55281.
Indonesia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JIOH.JIOH_67_19

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  Abstract 

Aim: The aim of this study was to estimate the risk of carbohydrate intake habits for the incidence of dental caries in preschool children at the Aisyiyah Bustanul Athfal Kindergarten in Bantul District, Yogyakarta, Indonesia. Materials and Methods: This presented analytic study comprised 74 children and their mothers. Samples were obtained by purposive sampling in preschool students aged 3–6 years. Dental caries assessed using the Decay, Missing, Filling Teeth (DMF-T) index and the food diet assessed using a diet recall questionnaire with data analysis using the NutriSurvey 2007 software. Data were analyzed with the Statistical Package for the Social Sciences (SPSS) software using a chi-square test and logistic regression. Results: The result of this study showed a relationship between carbohydrate consumption and dental caries status, P = 0.01 (P ≤ 0.05). The results showed high rates of caries of children teeth 96%, of 74 students found 71 students had caries and had a history of consuming carbohydrate intake > 10% in 1 day 89% (65 student). Conclusion: Carbohydrate intake caused risk in dental caries in preschool children (P = 0.01). The majority of subjects (92%) were found to have experienced dental caries and had a habit of consuming carbohydrates >10% of total energy in 1 day. The subjects (67%) who were found to be caries free had a habit of consuming carbohydrates <10% of total energy in 1 day.

Keywords: Carbohydrates, Diet, Early Childhood Caries, Preschool Children


How to cite this article:
Arie Sandy LP, Setiawan PB. Carbohydrate intake and dental caries status in preschool children in Bantul District, Yogyakarta, Indonesia: A cross-sectional study. J Int Oral Health 2020;12:231-5

How to cite this URL:
Arie Sandy LP, Setiawan PB. Carbohydrate intake and dental caries status in preschool children in Bantul District, Yogyakarta, Indonesia: A cross-sectional study. J Int Oral Health [serial online] 2020 [cited 2020 Aug 4];12:231-5. Available from: http://www.jioh.org/text.asp?2020/12/3/231/285578




  Introduction Top


Dental caries in early childhood known as early childhood caries (ECC) is found in high percentage in developing countries such as Indonesia. The prevalence of ECC or commonly called rampant caries is high in various countries, and its severity increases with increasing age of children.[1] In developing countries, the prevalence of dental caries in this group is still high.[2] Different conditions occur in developed countries, in recent years the prevalence of dental caries in early childhood in developed countries has decreased.[3] ECC can be aggressive since the tooth eruption begins. Dental caries has a very rapid severity, attacks the smooth surface of the teeth, and has a detrimental effect on tooth development. This condition causes wider oral and dental health problems in the groups of children. In addition, the morphological factors of deciduous teeth that are different from permanent teeth further increase the susceptibility of deciduous teeth to dental caries.[4]

Preschool children are a group of children aged 3–6 years.[5] At this age, the child is still in its infancy and development. Dental and oral health problems are one of the factors that influence children’s growth and development.[6] Teething begins at the age of 3 months after birth until the age of 21–25 years. The age of deciduous tooth eruption starts from the age of 6 months to 7 years (deciduous dentition).[7]

As per data, the number of children aged 1–4 years in Indonesia is 19,388,791 and the number of children aged 5–6 years is 9,679,481 of the total population. In this group, the percentage of those who have dental health problems in children <1 year of age, children aged 1–4 years, and children aged 5–9 years is 1.1%, 6.9%, and 21.6%, respectively. The data show that as the age increases the dental and mouth problems also increase. This is still far from the World Health Organization (WHO) target, which states that 90% of 5-year-old children are caries free.[8]

Dental caries is a multifactorial disease caused by several factors, both direct factors, environmental factors, and personal factors. Dietary carbohydrates is one of the most important etiological factors as they are processed by bacteria in the dental plaque via the glycolytic pathway producing acids, mainly lactate.[9] Food diet or food intake is one factor that has a large role in the incidence of dental caries in preschool children. Carbohydrate consumption is a cause of dental caries in children.[10] Carbohydrates are the most important nutrients needed by the human body. They consist of monosaccharides, disaccharides, oligosaccharides, and polysaccharides. Carbohydrates play a role in the life of microorganisms in the formation of dental plaques.[11] Etiologically, carbohydrates are processed by bacteria through the glycolysis pathway that will produce lactic acid. This lactic acid can cause dental caries.[10] The type of carbohydrate most often consumed by the community is sucrose. Sucrose is a type of carbohydrate favored by cariogenic bacteria such as Streptococcus mutans. Streptococcus mutans is able to produce glucosil transferase (GTF) which can convert sucrose into glucan and subsequently form dental plaque.[12] Preschool children are among those who are vulnerable to dental and oral diseases, this is because behavior and self-care habits are still less supportive of dental and oral health.[13] Some previous studies suggest that frequent consumption of cariogenic foods can cause dental caries in individuals.

This study was carried out at Aisyiyah Bustanul Athfal Kindergarten in Bantul District, Yogyakarta, Indonesia. This area is the border of Yogyakarta and Bantul regions. The parents of students have diverse socioeconomic conditions. This study aimed to estimate the prevalence of the habits of carbohydrate intake and the incidence of dental caries in preschool children at Aisyiyah Bustanul Athfal Kindergarten in Bantul District, Yogyakarta, Indonesia.


  Materials and Methods Top


Study design

This was a descriptive analytical study conducted in 2016 on preschool children in Bantul District, Yogyakarta, Indonesia. The total sample consisted of 100 children of 3–6 years and their mothers, obtained by purposive sampling method at Aisyiyah Bustanul Athfal Kindergarten in Bantul District, Yogyakarta. Aisyiyah Bustanul Athfal Kindergarten was randomly selected as the sample population.

Sampling criteria

Inclusion criteria consisted of children aged 3–6 years, attending Aisyiyah Bustanul Athfal Kindergarten, and whose mothers signed informed consent. The parents of the participants were informed about the study, and written consents were obtained. Of 100 samples, 74 were obtained from total sampling that meets the inclusion criteria, and the location of this population was randomly generated.

Study method

The research instrument used DMF-T index to examine dental caries. DMF-T index is the sum of the D (decay) + M (missing) + F (filling) scores. Subjects with free caries were not identified as decay (score 0) and subjects with caries were identified as decay (score 1). Food diets were measured using a recall diet questionnaire, given to subjects for 24h. This recall diet questionnaire asked subjects to write down what they have eaten in a day. Carbohydrate intake was measured by entering the amount of content of each food eaten by the subject in the nutrient survey software.

Observational parameters

This software analyzed the amount of each ingredient from these foods. The end result was the total carbohydrate content from each type of food. Furthermore, the data obtained were analyzed for a detailed energy requirement calculation in each subject in 1 day using the NutriSurvey 2007 software. German [Figure 1]. Data is used to get the results of carbohydrate intake in each subject in 1 day [Figure 2].
Figure 1: The software contains a function for a detailed energy requirement calculation

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Figure 2: Diagram nutrient intake totally in 1 day/person

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No bias or withdrawal or dropout was noted in the studied participants. The index used was guided by the WHO dental caries index (DMF-T), whereas for the food recall questionnaire, it was in the form of an open question sheet, where subjects had to mention what foods have been consumed by them within 1 day/24h.

Statistical analysis

Chi-square test was used for testing the relationship between carbohydrate intake and dental caries, and logistic regression analysis was used to investigate the relationship between carbohydrate intake and dental caries. P values ≤0.05 were considered statistically significant. Statistical analyses (95% confidence interval) were carried out using the statistical software, the Statistical Package for the Social Sciences (version 19.0) (IBM, USA).


  Results Top


This study involved 74 children aged 3–6 years. The characteristics of the subjects obtained by the data are 58% female and 42% male gender. The mean age of children was 4.13 years (±0.77) and the mean age of their mothers was 34.5 years (±1.07). [Table 1] showed that the majority of subjects (89%) consumed carbohydrate >10% of total energy in 1 day and the subjects who consumed carbohydrate <10% of total energy in 1 day were 11%. [Table 2] showed that the majority of the subjects (96%) were found to have dental caries and only 4% students were caries-free. The result of the cross tabulation showed that the subject group with carbohydrate intake >10% of total energy in 1 day found 92% of the subjects with dental caries and the subject group with carbohydrate intake <10% of total energy in 1 day found 67% of the subjects to be caries free [Table 3]. The result of this study showed a relationship between carbohydrate consumption and dental caries status, P = 0.01 (P ≤ 0.05), whereas the age factor (P = 1.33/≥0.05) and also the sex had no relationship with dental caries (P = 0.46/≥0.05) [Table 4]. The result of logistic regression analysis found that the risk of consuming carbohydrates has a 62 times more chance of causing dental caries compared to gender and age [Table 5].
Table 1: Carbohydrate intake in 1 day in preschool children

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Table 2: Caries status in preschool children

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Table 3: Distribution carbohydrate intake and caries status in preschool children

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Table 4: Analysis: chi-square test

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Table 5: Analysis: logistic regression

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  Discussion Top


Dental caries in the group of preschool children or referred to as ECC has a high percentage in the community. Dietary carbohydrates is one of the most important factors in the occurrence of dental caries in preschool children.[9] Food diet is food consumed by individuals in a day. The pattern of food consumption for Indonesians according to the 2015 Central Bureau of Statistics data shows that Indonesians (89.2%) consume carbohydrates such as rice, corn, and wheat. Carbohydrates are the main food source consumed by the people of Indonesia.[14] Carbohydrates are food substances that have cariogenic potential or cause dental caries. Monosaccharides and disaccharides are more cariogenic than polysaccharides.[15][Table 1] showed that most subjects (89%) consumed carbohydrates >10% of total energy in 1 day. From the observations obtained, students after breakfast at school still buy high-sucrose snacks such as biscuits, candy, chocolate. This causes a higher amount of carbohydrate intake obtained in 1 day for each child.

The results of this study showed that there is a relationship between carbohydrate intake and dental caries in the group of children in Aisyiyah Bustanul Athfal Kindergarten in Bantul District, Yogyakarta (P = 0.01), these results showed that carbohydrate intake is a risk factor that causes dental caries, whereas age and sex factor do not cause dental caries [Table 4]. [Table 2] shows that majority of subjects (96%) were found to have dental caries and only 4% of students were caries free. The results of the cross tabulation found that most subjects (92%) experienced dental caries and had the habit of consuming carbohydrates >10% of total energy in 1 day and 67% subject were caries free and had the habit of consuming carbohydrates <10% of total energy in 1 day [Table 3]. This shows that most subjects experience dental caries and have a habit of consuming carbohydrates >10% of total energy in 1 day. According to WHO in 2015, individuals who consume carbohydrates >10% of total energy in 1 day are at a risk of developing dental caries. Carbohydrates play a role in the process of glycolysis, where the results of these processes produce lactic acid, which can cause dental caries.[16] Excessive consumption of carbohydrates will cause acid production by bacteria more often. This condition causes high acidity level in the oral cavity, and it has an impact on tooth enamel, which is easily dissolved. This causes teeth to be more susceptible to dental caries. The group of preschoolers is a group of children in the age range of 3–6 years, and the teeth that grow in them include those in the deciduous tooth phase.[17] The morphology of deciduous teeth was different from that of permanent teeth; deciduous teeth were more vulnerable than and not as strong as permanent teeth. This condition causes deciduous teeth to be more susceptible to dental caries. Dental caries attacks the smooth surface of the teeth and has a detrimental effect on tooth development. If a child has dental caries, it is very easy for caries to spread to other teeth.[5] The results of this study can confirm the recommendations given by WHO to limit the provision or intake of carbohydrates or sugar below <10% of total energy in 1 day. Research conducted by Palacios et al.[18] states that children who consume carbohydrates >10% of total energy in 1 day have the possibility to experience four times more dental caries, whereas this research showed that the risk of consuming carbohydrates to cause dental caries was found to be 62 times higher compared to gender and age as per the result of logistic regression analysis [Table 5].

The intake of sugar consumed by the subjects in this study is total sugar instead of free sugar. Sucrose is more cariogenic than glucose and fructose. It is can served as a substrate for synthesis of extracellular (EPS) and intracellular (IPS) polysaccharides by oral bacteria, which plays a role to increase biofilm accumulation and to prolong acidification.[18] Intake of sucrose and fructose was significantly higher in children with caries. The results of this study reinforce the suggestion to limit consumed carbohydrate <10% of total energy in 1 day as an effort to prevent dental caries. There is a significant relationship between the frequency of consumption of snacks and foods high in sugar.[19] The amount of carbohydrate intake increases the risk of dental caries.[20] The physical form of food, frequency of eating, time, and order of eating are also factors that influence the occurrence of dental caries.[15]

Carbohydrate intake causes dental caries in preschool children, P = 0.01 (P ≤ 0.05). The majority of subjects (92%) who experienced dental caries had a habit of consuming carbohydrates >10% of total energy in 1 day. A total of 67% subjects found to be caries free had a habit of consuming carbohydrates <10% of total energy in 1 day.

Ethical approval statement

This research has received approval from the institutional ethics committee at FKG UGM Yogyakarta, Indonesia. The protocol was approved by the ethics committee from the Faculty of Dentistry (No. 00737/KKEP/FKG-UGM/EC/2016).

Financial support and sponsorship

This research was supported by research grants from Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jean MB, Chantal G. The high incidence of early childhood caries in kindergarten age children. JODQ 2006:4:1-5.  Back to cited text no. 1
    
2.
Wyne AH. Caries prevalence, severity, and pattern in preschool children. J Contemp Dent Pract 2008;3:024-31.  Back to cited text no. 2
    
3.
Pitts NB, Chestnutt IG, Evans D, White D, Chadwick B, Steele JG. The dentinal caries experience of children in the United Kingdom, 2003. Br Dent J 2006;200:313-20.  Back to cited text no. 3
    
4.
American Academy of Pediatric Dentistry. Guideline on infant oral health care pediatric dentistry. 2012;34:132-6. Available from: http://www.aapd.org/media/policies_guidelines/g_infantoralhealthcare.pdf. [Last accessed on 2018 Dec 25].  Back to cited text no. 4
    
5.
Supartini. Textbook Basic Concept Pediatric Nursing. Jakarta, Indonesia: EGC; 2004. p. 12-6.  Back to cited text no. 5
    
6.
Ministry of Health. National Primary Health Research Report (RISKESDAS). Jakarta, Indonesia: Agency for Health Research and Development; 2007.  Back to cited text no. 6
    
7.
Pine CM, McGoldrick PM, Burnside G, Curnow MM, Chesters RK, Nicholson J, et al. An intervention programme to establish regular toothbrushing: Understanding parents’ beliefs and motivating children. Int Dent J 2000;20:312-23.  Back to cited text no. 7
    
8.
Indonesian Ministry of Health. Indonesia Health Profile 2014. Jakarta, Indonesia: Indonesia Ministry of Health; 2015.  Back to cited text no. 8
    
9.
Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet 2007;369: 51-9.  Back to cited text no. 9
    
10.
König KG, Navia JM. Nutritional role of sugars in oral health. Am J Clin Nutr 1995;62:275S-82S; discussion 282S-3S.  Back to cited text no. 10
    
11.
Kidd EAM, Bechal SJ. Essentials of Dental Caries: The Disease and its Management (translation). Jakarta, Indonesia: EGC; 1995.  Back to cited text no. 11
    
12.
Randolph PM, Dennison CI. Diet, Nutrition and Dentistry. St. Louis, MO: Mosby; 1981.  Back to cited text no. 12
    
13.
Haryani W, Hadi H, Hendrartini Y. The relationship between carbohydrate consumption and severity of dental caries of preschool children in Depok Sleman Yogyakarta. Berita Kedokteran Masyarakat 2002;XVIII:3.  Back to cited text no. 13
    
14.
Central Bureau of Statistics. Data of Rice, Corn, Soybean Production in Lampung 2014, Statistic Data Based. Lampung, Indonesia: Central Bureau of Statistics; 2015.  Back to cited text no. 14
    
15.
Stegeman CA, Davis JR. The Dental Hygienist’s Guide to Nutritional Care. 2nd ed. St. Louis, MO: Saunders; 2004.  Back to cited text no. 15
    
16.
WHO. Guideline: Sugar Intake for Adults and Children. Geneva, Switzerland: WHO; 2015.  Back to cited text no. 16
    
17.
Nursayanto. Ilmu Gizi dan Zat Gizi Utama. Jakarta, Indonesia: Golden Terayon Press; 1992.  Back to cited text no. 17
    
18.
Palacios C, Tumanyan SR, Bermúdez EM, Colón AM, Torres RY, Boneta ARE. Association between type, amount and pattern of carbohydrate consumption with dental caries in 12-year-olds in Puerto Rico. Caries Res 2016;50:560-70.  Back to cited text no. 18
    
19.
Chankanka O, Marshall TA, Levy SM, Cavanaugh JE, Warren JJ, Broffitt B, et al. Mixed dentition cavitated caries incidence and dietary intake frequencies. Pediatr Dent 2011;33:233-40.  Back to cited text no. 19
    
20.
Gustafson B, Uensel CE, Swenandelra L, Lundqvistm C. The effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontol Scandinav 1952;11:231-63.  Back to cited text no. 20
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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