|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2022 | Volume
: 10
| Issue : 1 | Page : 29-34 |
|
Oral health status of middle school students in Jeddah: A learning experience outside the classroom
Mohamed R Abdelrasoul1, Ahmed Fouad Hassan1, Fawaz Pullishery2
1 Division of Periodontology, Batterjee Medical College, Batterjee Medical College, Jeddah, Saudi Arabia
2 Department of Community Dental Practice and Research, Batterjee Medical College, Jeddah, Saudi Arabia
| Date of Submission | 31-Jan-2022 |
| Date of Decision | 06-Mar-2022 |
| Date of Acceptance | 20-Mar-2022 |
| Date of Web Publication | 31-Dec-2022 |
Correspondence Address:
Fawaz Pullishery
Department of Community Dental Practice and Research, Batterjee Medical College, Jeddah-21442
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/dmr.dmr_8_22
Objective: Outreach activities are one of the essential components of dental education that would help the students understand the community's oral health needs. The study aimed to engage dental undergraduate students in measuring their oral health status using four dental indices among middle school students. Subjects and Methods: The study was conducted as a part of an oral health education program in two public schools in Jeddah. Consent was obtained from both school students and parents. Two calibrated examiners measured the dental status using Ramfjord's calculus index, decayed, missing, and filled teeth (DMFT) index, simplified debris index, and modified gingival index. An independent statistician did data analysis using SPSS ver 23. Results: Male students showed statistically significant higher scores for debris index, calculus index, and gingival index compared to female students (P < 0.001). The mean D and M component DMFT indices were significantly higher in female students (P < 0.001). Conclusions: The variations in oral health status between students can be attributed to differences in oral hygiene practices and other sociodemographic factors, including ethnicity and socioeconomic status. This study showed a positive learning experience for dental students in assessing the oral health status of schoolchildren.
Keywords: Dental caries, dental education, dental health survey, health promotion, preventive dentistry
How to cite this article:
Abdelrasoul MR, Hassan AF, Pullishery F. Oral health status of middle school students in Jeddah: A learning experience outside the classroom. Dent Med Res 2022;10:29-34 |
How to cite this URL:
Abdelrasoul MR, Hassan AF, Pullishery F. Oral health status of middle school students in Jeddah: A learning experience outside the classroom. Dent Med Res [serial online] 2022 [cited 2023 Mar 21];10:29-34. Available from: https://www.dmrjournal.org/text.asp?2022/10/1/29/366446 |
| Introduction | |  |
Community service as an educational tool is not a new phenomenon in the field of higher education.[1] The first step in adult education for community development is to gain an understanding of exactly what are the needs of the community.[2] However, there is still a lack of continuity between classrooms and residential communities.[3] Community participation is based on the belief that health development can best be achieved through combining the efforts of both the government and all concerned parties. As the community's demand for health continues to grow and change, this cooperation is essential.[3],[4] The term need can also be defined as the service that is required to effect change. It is important to recognize what the needs are in order to address the problem and find a solution.[3] Community service is an important component of educational process and is also being encouraged as of the goals of the participating authors' institution.
The most common oral disease is dental caries, and the diseases that affect the periodontium. The treatment of dental diseases and problems poses a significant economic problem in many high-income countries, as it accounts for 5%–10% of the overall health expenditures.[5] Dental caries is a major oral health problem affecting 2.43 billion people (35.3% of the population) worldwide in the year 2010.[6] A high burden of dental caries was evident among children in Saudi Arabia with an estimated prevalence of approximately 80%.[5] The burden of dental caries is high in Saudi Arabia, with eight out of ten primary schoolchildren aged 6–8 years suffering from this preventable condition.[7]
Children are predominantly susceptible to dental caries and gingival diseases due to changing dietary habits with increased consumption of refined carbohydrates and less focus on oral hygiene maintenance.[8]
Saudi Arabia is a country with a serious early childhood oral health problem. While research on this problem has focused mainly on the issue of dental caries, there have been a few studies that have looked at the problem from the perspective of oral hygiene.[9] Gingival inflammation is a reversible condition that mostly in childhood and adolescence,[10],[11] with the prevalence decreasing as adulthood is reached.[12] Gingivitis is a risk factor for periodontitis,[13],[14] which, in turn, is associated with several systemic disorders of public health importance including coronary heart diseases,[15] atherosclerosis, and diabetes.[16] Adolescence is an age where individuals adopt habits that may be carried forward well into adulthood including toothbrushing,[12] smoking,[17] and dietary habits.[18] Diseases that begin at this stage in life and continue uncontrolled may start cumulative destruction that becomes difficult to tackle later.[19] In Saudi Arabia, marked changes in lifestyle are taking place, and they have public health implications because of their association with several diseases including those of the oral cavity. For example, reports indicate an increase in the consumption of sweetened beverages such as soft drinks and fruit juices, in addition to a low prevalence of regular toothbrushing and increased prevalence of smoking among young Saudi Arabians.[20]
Previous research on the effects of service programs generally supports the presumption that community service is beneficial for adolescents. In particular, evidence has been provided regarding students' personality (e.g., self-concept, self-efficacy, and self-esteem), social attitudes (e.g., social responsibility, civic engagement, reducing stereotypes), and learning (e.g., outcomes, course grades, and attitudes).[2] The aim of our study was to engage our students in a learning experience outside the classroom with a hands-on practice about dealing with the two most common oral diseases and to assess and compare the community indices of these diseases among middle school males and females.
| Subjects and Methods | | |
This study was conducted during an oral health education program for middle schoolchildren in Jeddah. The study was conducted during January–March 2019. The study population included 11–16 year of schoolchildren of both genders. Parents were informed about the study's purpose and benefits, and those who gave consent for participation were only included. The oral health assessment was done using Ramfjord's calculus index,[21] decayed, missing, and filled teeth (DMFT) index,[22] simplified-debris index,[23] and modified gingival index.[24] Two calibrated examiners (dentists) were in charge of recording the oral health status [Figure 1]. The interexaminer and intraexaminer reliability was assessed before examining the children that showed a very good intraclass correlation for Ramfjord's calculus index (ICC = 0.879), DMFT index (ICC = 0.913), debris index (ICC = 0.861), and modified gingival index (ICC = 0.798).
Each student was allotted a separate sheet that recorded the sociodemographic details and indices' score. All the data obtained were tabulated accordingly subjected to statistical analysis. Frequencies and percentages were used to represent categorical variables. The data normality check showed that some continuous variables did not follow a normal distribution (Shapiro–Wilk test, P < 0.05). Comparison of continuous variables was performed using Student's t-test and Mann–Whitney U test. A significance value (P value) less than 0.05 was considered statistically significant.
| Results | | |
The study included 410 schoolchildren that had 62.9% (n = 258) of male and female 37.1% (n = 152) students. The comparison of gingival status showed that male students had comparatively more scores for debris index, calculus index, and gingival index than female students, which showed a statistically significant difference (P < 0.001). Similarly, each component of DMFT index except “missed” component showed statistically significant difference between male and female students (P < 0.001) [Table 1]. The correlation of the scores of all applied dental indices based on the gender of the schoolchildren is given in [Figure 2] and [Figure 3]. | Figure 3: Correlation of scores of all dental indices without D component of decayed, missing, and filled teeth index
Click here to view |
| Discussion | | |
Dental decay is the most common oral disease in childhood from the first through the 12th year of life. In this crucial period, the primary teeth are exfoliated, and the permanent teeth, exclusive of third molars, are formed and erupt into a functional pattern.[25] A considerable number of surveys have been done on dental caries' experience in permanent dentition. These studies are in general agreement with the fact that approximately 20% of the children at the age of 6 years have experienced tooth decay in their permanent teeth. From there, a rapid increase follows, and at the age of 8 years and 10 years, 60% and 85% of the children are affected by dental caries, respectively. At the age of 12 years, when most of the permanent dentition has erupted, over 90% of the schoolchildren have experienced dental caries.[8] In the present study, the point prevalence of dental caries was 75.6%, where male students showed a prevalence of 72.1%, and for female students, it was 78.5%. The prevalence of dental caries was higher when compared with the other survey findings that had reported prevalence of 53%,[26] 65.88%,[27] 68.8%,[28] and 65.3%,[29] respectively. Furthermore, our results matched with the findings of the study conducted in the Hail region (78.9%),[30] Al-Khobar,[31] and Makkah,[32] but were in contrast with the findings from the central province of KSA.[33] This collective evidence signifies the endemic nature of dental caries and the economic burden on the country.
Our results were consistent with the study results conducted in Riyadh[7] with caries prevalence among 8-year-old schoolchildren of 83% and a recent meta-analysis of various dental caries studies in different regions of Saudi Arabia that determined the prevalence to be 80%.[5] Furthermore, our findings were similar to previous studies conducted in Dammam, Tabuk, Riyadh, and Jeddah, with a caries prevalence of 73%, 77%, 80%, and 78%, respectively.[34]
The results of our study showed that the mean DMFT index value was 1.07 ± 1.5 for 13–15-year-old school students male and females, which is lesser than with AlDosari et al., 2010,[35] who have shown that the mean DMFT index value was 3.12 (2.24–7.35) for 15–18-year-old adolescents in a study of 11 regions in KSA. A higher mean DMFT value of 4.66 for 16-year-old adolescents was reported by Outub in the Makkah region.[9] Likewise, Hassan et al., 2005,[36] reported that the DMFT was 4.31 for 16–18-year-old adolescents in Jeddah city. In addition, Magbool, 1992,[31] reported that the DMFT was 4.59 for 16–17-year-old adolescents in Al-Khobar. This might be attributed to the use of desalinated water for domestic purposes in Jeddah, Makkah, and Al-Khobar, KSA, which may affect mineral levels in the water.
The lesser value of the DMFT mean in our study was reported to the small sample size of our study and the difference in the age groups between our study and the previous studies mentioned. The value of the mean DMFT index was in accordance with the WHO report in 2003[37] for the Eastern Mediterranean Region DMFT index mean, which is 2 ± 1.3.[38]
Analysis of the DMFT components in this study shows that the decayed teeth index mean value was 2.4, while the DM and DF index mean values were 0.2 and 0.6, respectively, comprising a much lesser of the total DMFT mean value. This might be related to the lack of oral hygiene knowledge and practices or difficulties in accessing dental services.
The results of this study indicated that females showed a significantly higher DMFT mean value than males. The observation of higher caries risk among females might conjointly be connected to fluctuating hormonal levels during puberty.[39] This result is consistent with a study in Jeddah KSA.[36] Moreover, the foreign direct investment previously reported higher caries experience in females due to earlier permanent teeth eruption than in males.[40]
In the present study, the prevalence of gingivitis among school students was 66.8%, which is consistent with the study done by Tantawi and AlAgl 2018[20] in Dammam and Khobar on a sample on Saudi Arabian males aged 13–15 years old that showed a gingivitis prevalence of 73.9% and also was similar to that among Nigerian schoolchildren (71%). Moreover, the prevalence of gingivitis in our study was similar to that reported among 12-year-old males in Medina, Saudi Arabia (71%).[41]
A study done in Jazan measured the plaque index score for 500 adolescents where the mean plaque index value for male and female school students was 0.69 and. 0.66, respectively, which is not too far from our study results that showed plaque index for male and female studied group 1.1 and 0.9, respectively.[34] Another study done by El-Angbawi and Younes, 1982,[42] showed that males had significantly higher debris, calculus deposits, and intense gingivitis counts than females, which is similar to our study findings. We assume that there may be variances in the practices of oral hygiene among the population residing in different sectors of the world and even in the same country, especially attributed to their culture, lifestyles, and last but not least socioeconomic status which affects the outcome and the prevalence of the two most common oral diseases in the world.
| Conclusions | | |
The comparison of these community indices leads to our assumption that there may be variances in the practices of oral hygiene among the population residing in different sectors of the world and even in the same country, especially attributed to their culture, lifestyles, and last but not least socioeconomic status which affects the outcome and the prevalence of the two most common oral diseases in the world. We successfully engaged our students in a learning experience outside the classroom and opened to them hands-on practice about most two common oral diseases. Nevertheless, by the positive feedback we received, we concluded that these dental community services have significantly outreached to our targeted age group, and it was beneficial to them in terms of a better understanding and knowledge about oral diseases and applied oral hygiene practice.
Ethical clearance
The study was approved by the Research and Ethics Committee of the authors' institution. Reference No: RES-2021-0017).
Acknowledgements
All the authors would like to express their deep gratitude toward all the parents, the teachers, and administrative staff of the two participating schools.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Astin AW, Vogelgesang LJ, Ikeda EK, Yee JA. How Service Learning Affects Students; Higher Education Research Institute, University of California: Los Angeles, CA, January 2000; Executive Summary; 2000.  |
| 2. | Meyer M, Neumayr M, Rameder P. Students' community service: Self-selection and the effects of participation. Nonprofit Volunt Sect Q 2019;48:1162-85. |
| 3. | VanRyn VS, Wehrwein EA. Building community by serving the community. Adv Physiol Educ 2018;42:247-50. |
| 4. | Kozlowski SW, Ilgen DR. Enhancing the effectiveness of work groups and teams. Psychol Sci Public Interest 2006;7:77-124. |
| 5. | Al Agili DE. A systematic review of population-based dental caries studies among children in Saudi Arabia. Saudi Dent J 2013;25:3-11. |
| 6. | Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2163-96. |
| 7. | Alhabdan YA, Albeshr AG, Yenugadhati N, Jradi H. Prevalence of dental caries and associated factors among primary school children: A population-based cross-sectional study in Riyadh, Saudi Arabia. Environ Health Prev Med 2018;23:60. |
| 8. | Naidoo S, Myburgh N. Nutrition, oral health and the young child. Matern Child Nutr 2007;3:312-21. |
| 9. | Alwayli H, Mosadomi HA, Alhaidri E. The impact of a school based oral hygiene instruction program on the gingival health of middle school children in Riyadh: Saudi Arabia. Saudi J Oral Sci 2015;2:99-102. [Full text] |
| 10. | López R, Fernández O, Baelum V. Social gradients in periodontal diseases among adolescents. Community Dent Oral Epidemiol 2006;34:184-96. |
| 11. | Chiapinotto FA, Vargas-Ferreira F, Demarco FF, Corrêa FO, Masotti AS. Risk factors for gingivitis in a group of Brazilian schoolchildren. J Public Health Dent 2013;73:9-17. |
| 12. | Hunter ML, Newcombe R, Richmond S, Owens J, Addy M. The Cardiff dental survey: Oral hygiene and gingival health between the ages of 11-12 and 30-31 years. Br Dent J 2007;203:E23. |
| 13. | Lang NP, Schätzle MA, Löe H. Gingivitis as a risk factor in periodontal disease. J Clin Periodontol 2009;36 Suppl 10:3-8. |
| 14. | Ebersole JL, Nagarajan R, Akers D, Miller CS. Targeted salivary biomarkers for discrimination of periodontal health and disease (s). Front Cell Infect Microbiol 2015;5:62. |
| 15. | Mustapha IZ, Debrey S, Oladubu M, Ugarte R. Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: A systematic review and meta-analysis. J Periodontol 2007;78:2289-302. |
| 16. | Corbella S, Francetti L, Taschieri S, De Siena F, Fabbro MD. Effect of periodontal treatment on glycemic control of patients with diabetes: A systematic review and meta-analysis. J Diabetes Investig 2013;4:502-9. |
| 17. | |
| 18. | Collison KS, Zaidi MZ, Subhani SN, Al-Rubeaan K, Shoukri M, Al-Mohanna FA. Sugar-sweetened carbonated beverage consumption correlates with BMI, waist circumference, and poor dietary choices in school children. BMC Public Health 2010;10:234. |
| 19. | Sheiham A, Alexander D, Cohen L, Marinho V, Moysés S, Petersen PE, et al. Global oral health inequalities: Task group-implementation and delivery of oral health strategies. Adv Dent Res 2011;23:259-67. |
| 20. | El Tantawi M, AlAgl A. Association between gingivitis severity and lifestyle habits in young Saudi Arabian males. East Mediterr Health J 2018;24:504-11. |
| 21. | Ramfjord SP. Indices for prevalence and incidence of periodontal disease. J Periodontol 1959;30:51-9. |
| 22. | Klein H, Palmer C. Studies on dental caries vs. familial resemblance in the caries experience of siblings. Public Health Rep 1938;53:1353-64. |
| 23. | Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13. |
| 24. | Lobene RR, Weatherford T, Ross NM, Lamm RA, Menaker L. A modified gingival index for use in clinical trials. Clin Prev Dent 1986;8:3-6. |
| 25. | Harikiran AG, Pallavi SK, Hariprakash S, Ashutosh, Nagesh KS. Oral health-related KAP among 11- to 12-year-old school children in a government-aided missionary school of Bangalore city. Indian J Dent Res 2008;19:236-42. [ PUBMED] [Full text] |
| 26. | Ingle NA, Dubey HV, Kaur N, Gupta R. Prevalence of dental caries among school children of Bharatpur city, India. J Int Soc Prev Community Dent 2014;4:52-5. |
| 27. | Karunakaran R, Somasundaram S, Gawthaman M, Vinodh S, Manikandan S, Gokulnathan S. Prevalence of dental caries among school-going children in Namakkal district: A cross-sectional study. J Pharm Bioallied Sci 2014;6:S160-1. |
| 28. | Arangannal P, Mahadev SK, Jayaprakash J. Prevalence of dental caries among school children in Chennai, Based on ICDAS II. J Clin Diagn Res 2016;10:ZC09-12. |
| 29. | Soumya SG, Shashibhushan KK, Pradeep MC, Babaji P, Reddy VR. Evaluation of oral health status among 5-15-year-old school children in Shimoga City, Karnataka, India: A cross-sectional Study. J Clin Diagn Res 2017;11:ZC42-7. |
| 30. | Aljanakh M. Prevalence and severity of dental caries among public school students aged 16-l8 in Hai'l, Kingdom of Saudi Arabia. Int J Health Sci (Qassim) 2017;11:50-3. |
| 31. | Magbool G. Prevalence of dental caries in school children in Al-Khobar, Saudi Arabia. ASDC J Dent Child 1992;59:384-6. |
| 32. | Qutob A. A Needs-Based Approach for Health Human Resources Planning for Dentistry in Jeddah, Saudi Arabia. University of Toronto; 2009. |
| 33. | Wyne AH. The bilateral occurrence of dental caries among 12-13 and 15-19 year old school children. J Contemp Dent Pract 2004;5:42-52. |
| 34. | Alzahrani AA, Alhassan EM, Albanghali MA. The oral health status and attitudes of Saudi adolescent male students in Albaha Province. Adv Dent Oral Health 2018;10:555779. |
| 35. | AlDosari AM, Akpata ES, Khan N. Associations among dental caries experience, fluorosis, and fluoride exposure from drinking water sources in Saudi Arabia. J Public Health Dent 2010;70:220-6. |
| 36. | Hassan A, Amer H, Mousa A, Gaznawi H. Prevalence and intensity of dental caries among school students in Jeddah City. Egypt Dent J 2005;51:1427-32. |
| 37. | Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21 st century-the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23. |
| 38. | Abdel-Rasoul GM, Mahrous OA, El-Shazly HM, Gabr HM, Alghalban YA. Epidemiology of dental caries among preparatory school children (12-15 years old) in Shebin El-Kom District, Menoufia Governorate. Menoufia Med J 2019;32:120-6. [Full text] |
| 39. | Lukacs JR, Largaespada LL. Explaining sex differences in dental caries prevalence: Saliva, hormones, and “life-history” etiologies. Am J Hum Biol 2006;18:540-55. |
| 40. | Review of methods of identification of high caries risk groups and individuals. Fédération Dentaire Internationale Technical Report No. 31. Int Dent J 1988;38:177-89. |
| 41. | Bhayat A, Ahmad MS. Oral health status of 12-year-old male schoolchildren in Medina, Saudi Arabia. East Mediterr Health J 2014;20:732-7. |
| 42. | El-Angbawi MF, Younes SA. Periodontal disease prevalence and dental needs among schoolchildren in Saudi Arabia. Community Dent Oral Epidemiol 1982;10:98-9. |
[Figure 1], [Figure 2], [Figure 3]
[Table 1]
|
Search Pubmed for