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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 126-130

Age and reasons for first dental visit in a tertiary care hospital in South India


1 Department of Dental and Oral Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission24-Aug-2021
Date of Acceptance07-Sep-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Shini Susan Samuel
Department of Dental and Oral Surgery, Unit-2, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dmr.dmr_26_21

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  Abstract 


Background: Early visit to the dentist with an aim of prevention has been advocated universally, but the timing for seeking dental treatment differs among different countries. Aim: This study aimed to determine the timing and reasons for the first dental visit among children attending the dental clinic in a tertiary care hospital in Tamil Nadu, South India. Methods: This hospital-based study reviewed the dental records of children who had visited the dental clinic from January 1, 2019 to December 31, 2019. All those between 0 and 10 years of age and visiting a dentist for the first time were included in the study. The continuous variables were analyzed using mean and standard deviation. The categorical variables were calculated using Chi-square, Fisher's exact test, and two-proportion test. Results: We reviewed the dental records of 1005 children (60% boys and 40% girls). The most frequent age for the first dental visit was between 5 and 6 years. The most common reasons for visits to the dental clinic were pain (23.8%) and dental caries (16.6%). Only 3.8% of children had their first dental visit by 1 year of age and primarily for therapeutic purposes. Dental caries and traumatic injuries were more frequent in children below the age of 3 years. Conclusion: The present study found pain as the most frequent reason for the visit, but there was a delay in first dental visits among children. This study suggests effective oral health policies for children and a need to change the perception and practices among the dental professionals in the region. Timing of the first dental visit of a child can help us to determine the quality of dental care a child receives. Delayed dental visit among children in this study indicates the ineffective oral health policies and the gap that exists between the pediatric health-care providers in India.

Keywords: Age, first dental visit, reasons


How to cite this article:
Samuel SS, Rebekah G. Age and reasons for first dental visit in a tertiary care hospital in South India. Dent Med Res 2021;9:126-30

How to cite this URL:
Samuel SS, Rebekah G. Age and reasons for first dental visit in a tertiary care hospital in South India. Dent Med Res [serial online] 2021 [cited 2022 Jan 24];9:126-30. Available from: https://www.dmrjournal.org/text.asp?2021/9/2/126/331397




  Introduction Top


Dental caries continues to be the most common chronic disease of childhood and a public health challenge across the world.[1] It not only impacts the general well-being of the child but also has a significant economic burden on families. Health organizations have adopted various oral health policies, yet disparities exist among certain sections of the population. In India, dental caries affects more than half of the children and the prevalence of dental caries among children ranged from 51.9% to 63.1%.[2]

It is important to provide oral health care for children that will enable them to reach adulthood with healthy permanent dentitions.[3] Based on the current recommendation, parents should be encouraged to establish a dental home for their infants by 1 year of age.[4]

Studies report that children who had their preventive dental visit by 1 year were unlikely to have subsequent restorative or emergency visits.[5] Early dental visits have shown a significant reduction in the incidence of dental caries in children and the expenditure toward dental treatment.[5],[6]

Despite the recommendation, studies have shown that parents do not bring their child to the dentist at the recommended age.[7],[8],[9] There is a delay or nonutilization of dental services and parents seek treatment for their children only when symptoms occur. There are limited studies on the age at which parents bring their children's first dental visit in India.[10],[11]

Therefore, this study aimed to determine the timing and common reasons for the first dental visits among children attending the dental clinic in a tertiary care hospital in Tamil Nadu, South India.


  Methods Top


The present retrospective study was carried out in the dental department of a tertiary care hospital in Tamil Nadu, South India. The approval was obtained from the Institutional Review Board for Research and Ethics committee [IRB Min No 12730] before the study, and the patient confidentiality was maintained.

We reviewed the dental records of children between the age of 0 and 10 years and who visited the dental clinic from January 1, 2019 to December 31, 2019. The study included the data of all children who had their first dental visit and those with incomplete data were excluded.

Variables in the clinical data included: place and date of birth, gender, medical/dental history, age of the first dental visit, and the reason for the visit.

Based on age, we further divided the selected children into the following groups:

  • Group I: <1 year
  • Group II: 1–3 years
  • Group III: 4–5 years
  • Group IV: 6–7 years
  • Group V: 8–10 years


The reasons for dental visit were categorized into the following:

  1. Routine check-up
  2. Dental caries
  3. Pain
  4. Swelling/abscess
  5. Trauma
  6. Mobile teeth
  7. Bleeding gums/bad breath/deposit/stains
  8. Discolored teeth
  9. Retained/missing/dental anomaly
  10. Malocclusion
  11. Others, which included soft tissue lesion, cleft lip/palate, bone pathology
  12. Referred for dental diseases
  13. Referred for medical needs.


Statistical analysis

The clinical data of the study were entered into EpiData version 3.1 (EpiData Association, Odense, Denmark), and statistical analysis was performed using IBM® SPSS® Statistics, version 21 (Bengaluru, Karnataka, India). The continuous variables such as age were analyzed using mean and standard deviation (SD). The frequencies and percentages of the categorical variables were calculated using Chi-square, Fisher's exact test, and two-proportions test. The significance of associations between the categorical variables was also analyzed.


  Results Top


The present study included the dental records of 1005 children up to 10 years of age with 603 boys (60%) and 402 girls (40%). Among the study sample, only 38.6% were residents within the region.

We found the mean age of the children in this study to be 5.4 years with a SD of 2.5. The most frequent age for first dental visit was between 5 and 6 years [Figure 1]. There was a predominance of boys in each of the age groups, which was statistically significant [Table 1].
Figure 1: Frequency of the age of first dental visit

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Table 1: Association between gender and age at the first dental visit

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The most common reasons for the first dental visit were pain (23.8%) and dental caries (16.6%) [Figure 2]. Only 0.2% of the children came for a routine checkup and 40% were in the 6–7 years age group.
Figure 2: Frequency of reasons for first dental visits

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Of the total, only 3.8% of children had their first dental visit by 1 year of age, and the majority in this group had anomalies such as cleft lip/palate and natal/neonatal teeth. Dental caries and pain were the most common reasons for the first dental visit between 1 and 3 years of age. The pain was the most frequent reason for the first dental visit among the age groups of 4–5 years as well as 6–7 years. The main reason for the first dental visit among 8–10 years was malocclusion.

In the study, 33.2% of children had some underlying medical condition and the majority (67.4%) were boys. The study found a highly significant association between medical condition and gender but not with age groups. The association between gender and routine checkup was statistically significant, whereas that between gender and malocclusion was highly significant [Table 2].
Table 2: Association of gender between medical condition and reasons for first dental visit

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We compared the reasons for the first dental visit with the age groups in this study. Dental caries was a common reason among the age groups of 1–3 years and 4–5 years, but the pain was frequent among 4–5 years. Traumatic injuries were observed to be highest among 1–3-year olds, and mobility was the most common among 6–7-year olds. The association between different reasons among age groups and their significance is as shown in [Table 3].
Table 3: Association of age with medical condition and reasons for the first dental visit

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  Discussion Top


Establishment of a dental home at an early age will enable a child to receive appropriate preventive oral health care. This will help to improve oral health knowledge and practices among the families, especially those at risk.[12] The child's first dental visit based on the risk assessment should take place as early as 6 months of age and no later than 12 months.[13]

The present study reviewed dental records of 1005 children up to 10 years of age. The most frequent age for the first dental visit was between 5 and 6 years. Previous studies in India have shown that the majority of children had their first dental visit only after 6 years.[10],[11] Studies from countries such as Poland and Lebanon (4 years),[7],[8] Saudi Arabia (3–5 years),[9] and Bulgaria (3–6 years)[14] have reported a lower age group. A higher age group 7 years) has been reported in Nepal and Nigeria.[15],[16]

Of the total, our study found only 3.8% of children had their initial visit by the 1 year of life and is not according to the current recommendation. A higher percentage of children (25.2%) below 3 years of age had their first dental visit, although this was not in agreement with the findings of the previous Indian studies. Meera et al. have reported that 7.5% of children had their dental visit by 3 years of age.[10] A recent study by Dave et al. have reported that only 4.7% of children had their first dental visit by 3 years.[11] The disparities in the findings could be due to the different demographic locations and the time of the study.

In the present study, pain and dental caries were the most frequent reasons for dental visits. A majority of published studies reported pain as the primary reason for visiting a dentist[7],[9],[10],[11],[15],[16] although some studies have reported dental caries.[8],[14] This study found that the frequency of dental diseases increased with age. Dental caries (26%) and traumatic injuries (11.6%) were predominant among children of age 1–3 years. Pain and swelling peaked among 4–5 year-old children (33.8% and 11.7%, respectively). It is important to provide parents with adequate information regarding early childhood caries as well as the risk and emergency management of dental injuries at an early age of a child.

This study found that the majority of first dental visits were for therapeutic needs but not preventive. Only 0.2% of the children came for a routine checkup and 40% were in the 6–7-year age group. Volpato et al. found that although parents showed an early interest in a preventive/educational approach for their children, a large majority of parents only brought their children for curative treatment.[17] They suggested considering infant oral health care as the foundation on which dentists can build preventive dental care and assure optimal oral health into childhood.

A study conducted in North Carolina found that the pediatric primary care providers tended to under-refer children.[18] In the present study, although 33.2% of children had some underlying medical condition, referral by the medical specialists for dental diseases was at a much lower proportion (6.6%).

Limitations

The study utilized existing data and therefore depended on that data and was prone for bias. Our study population was not area specific or population based and included children from a diverse population who had visited the hospital. The racial and cultural differences along with the attitudes and availability of dental services may also have influenced the study findings. This was a hospital-based study, and the findings carefully interpreted.


  Conclusion Top


The average age for the first dental visit in this study shows the need to improve the current dental practices in children. The lack of awareness among parents concerning the ideal age for the first dental visit was clear. Dental professionals can improve the utilization of dental services with effective communication and collaboration with the primary health-care providers. Integration of oral health along with the general health in children needs to be considered, and the parents need to be informed about healthy diet, feeding, and oral hygiene practices, optimal exposure to fluoride. This will enable the dentists to establish a dental home in young children with an aim of prevention.

Ethical clearance

The study was approved by the institutional Review Board for Research and Ethics committee of Christian Medical College, Vellore [IRB Min No 12730].

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of untreated caries: A systematic review and metaregression. J Dent Res 2015;94:650-8.  Back to cited text no. 1
    
2.
Bali RK, Mathur VB, Talwar PP, Chanana HB. National Oral Health Survey & Fluoride Mapping, 2002-2003, India. Delhi: Dental Council of India; 2004. p. 26.  Back to cited text no. 2
    
3.
Drummond BK, Meldrum AM, Boyd D. Influence of dental care on children's oral health and wellbeing. Br Dent J 2013;214:E27.  Back to cited text no. 3
    
4.
American Academy of Pediatric Dentistry, Best Practices: Perinatal and Infant Oral Health Care. Reference Manual of Pediatric Dentistry. 2019–2020, p. 228-32.  Back to cited text no. 4
    
5.
Savage MF, Lee JY, Kotch JB, Vann WF Jr. Early preventive dental visits: Effects on subsequent utilization and costs. Pediatrics 2004;114:e418-23.  Back to cited text no. 5
    
6.
Nowak AJ, Casamassimo PS, Scott J, Moulton R. Do early dental visits reduce treatment and treatment costs for children? Pediatr Dent 2014;36:489-93.  Back to cited text no. 6
    
7.
Mika A, Mitus-Kenig M, Zeglen A, Drapella-Gasior D, Rutkowska K, Josko-Ochojska J. The child's first dental visit. Age, reasons, oral health status and dental treatment needs among children in Southern Poland. Eur J Paediatr Dent 2018;19:265-70.  Back to cited text no. 7
    
8.
Daou MH, Eden E, El Osta N. Age and reasons of the first dental visit of children in lebanon. J Med Liban 2016;64:18-22.  Back to cited text no. 8
    
9.
Murshid EZ. Children's ages and reasons for receiving their first dental visit in a Saudi community. Saudi Dent J 2016;28:142-7.  Back to cited text no. 9
    
10.
Meera R, Muthu MS, Phanibabu M, Rathnaprabhu V. First dental visit of a child. J Indian Soc Pedod Prev Dent 2008;26 Suppl 2:S68-71.  Back to cited text no. 10
    
11.
Dave B, Patel R, Bargale S, Deshpande A, Shah V, Chawda G. 1st dental visit: 'An ounce of prevention is worth a pound of cure'. Int J Oral Health Med Res 2018;5:4-7.  Back to cited text no. 11
    
12.
Nowak AJ, Casamassimo PS. The dental home: A primary care oral health concept. J Am Dent Assoc 2002;133:93-8.  Back to cited text no. 12
    
13.
Thompson CL, McCann AL, Schneiderman ED. Does the texas first dental home program improve parental oral care knowledge and practices? Pediatr Dent 2017;39:124-9.  Back to cited text no. 13
    
14.
Mileva SP, Kondeva VK. Age at and reasons for the first dental visit. Folia Med (Plovdiv) 2010;52:56-61.  Back to cited text no. 14
    
15.
Ghimire N, Kayastha B, Nepal P. The first dental visit. J Chitwan Med Coll 2014;3:30-3.  Back to cited text no. 15
    
16.
Olatosi OO, Onyejaka NK, Oyapero A, Ashaolu JF, Abe A. Age and reasons for first dental visit among children in Lagos, Nigeria. Niger Postgrad Med J 2019;26:158-63.  Back to cited text no. 16
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17.
Volpato LE, Palti DG, Lima JE, Machado MA, Aranha AM, Bandeca MC, et al. When and why parents seek dental care for children under 36 months. J Int Oral Health 2013;5:21-5.  Back to cited text no. 17
    
18.
Pierce KM, Rozier RG, Vann WF Jr. Accuracy of pediatric primary care providers' screening and referral for early childhood caries. Pediatrics 2002;109:E82-2.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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