A CASE CONTROL STUDY ON DENTAL CARIES AND...

A CASE CONTROL STUDY ON DENTAL CARIES AND

ORAL HEALTH PRACTICES AMONG SCHOOL

CHILDREN IN A SELECTED SCHOOL

IN PALAKKAD DIST, KERALA.

BY

30083613

A DISSERTATION SUBMITTED TO THE TAMILNADU Dr.M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF

THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF SCIENCE IN NURSING

MARCH – 2010

A CASE CONTROL STUDY ON DENTAL CARIES AND

ORAL HEALTH PRACTICES AMONG SCHOOL

CHILDREN IN A SELECTED SCHOOL

IN PALAKKAD DIST, KERALA.

BY

30083613

Research Advisor: _____________________________________________________ Prof. Dr. JEYASEELAN MANICKAM DEVADASON, R.N., R.P.N., M.N., D.Lit., Ph.D.,

Clinical Speciality Advisor: ______________________________________________ Dr. Mrs. TAMILMANI, R.N., R.M., M.N., D.Lit., Ph.D.,

SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF SCIENCE IN NURSING

FROM THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI.

MARCH – 2010

CERTIFIED THAT THIS IS THE BONAFIDE WORK OF

30083613

AT THE ANNAI J.K.K. SAMPOORANI AMMAL COLLEGE OF NURSING

SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF NURSING FROM THE TAMILNADU DR. M.G.R.

MEDICAL UNIVERSITY, CHENNAI.

Examiners:

1. _______________________

2. _______________________

_________________________________________ Dr. JEYASEELAN MANICKAM DEVADASON,

R.N., R.P.N., M.N., D.Lit., Ph.D., DEAN, H.O.D., Nursing Research,

Annai J.K.K. Sampoorani Ammal College of Nursing, Komarapalayam.

CERTIFIED THAT THIS IS THE BONAFIDE WORK OF

30083613

AT THE ANNAI J.K.K. SAMPOORANI AMMAL COLLEGE OF NURSING

SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF NURSING FROM THE TAMILNADU DR. M.G.R.

MEDICAL UNIVERSITY, CHENNAI.

_________________________________________ Dr. JEYASEELAN MANICKAM DEVADASON,

R.N., R.P.N., M.N., D.Lit., Ph.D., DEAN, H.O.D., Nursing Research,

Annai J.K.K. Sampoorani Ammal College of Nursing, Komarapalayam.

ACKNOWLEDGEMENT

“Fear thou not ; for I am with thee: be not dismayed ; for I am thy God; I will strengthen thee; Yea, I will help thee; yea, I will uphold thee with the

right hand of my righteousness.” Isaiah 41:10

First and foremost I render praise and thanksgiving to the LORD ALMIGHTY for his blessings and abundant grace that enriched me throughout this study.

I express my thanks to Dr. JKK. MUNIRAJAHH, Founder and Managing Trustee, Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam for all the facilities he has provided for the betterment of many aspiring students of this institution.

This study has been undertaken and completed under the able supervision and expert guidance of Prof. Dr. JAYASEELAN MANICKAM DEVADASON, Dean and Research guide, Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam. I express my sincere gratitude for the support, timely and most useful suggestions to lay a strong foundation for this study. I extend my gratitude and thanks to Dr. Mrs. TAMILMANI, Principal, Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam for her encouragement, excellent guidance and constant support and valuable suggestions rendered during the study.

I express my heart felt and sincere thanks to Ms. SHEELA DEVI and Ms.ALLWIN, faculty of pediatric department, Annai J.K.K. Sampoorani Ammal College of Nursing, Komarapalayam for their efforts, valuable suggestions, timely guidance and personal interest. I express my sincere gratitude to Mr. JOY. T. GEORGE, Principal, S.D.A Higher Secondary School, Ottapalam, Palakkad District for granting permission to conduct my study.

Special thanks to Mr. STANLEY JOSE, Headmaster of the school and Mrs. SHEEBA

STANLEY for all the support and timely help during the data collection. I would like to extend my grateful thanks to the panel of dental experts namely Dr.ANURADHA SUNIL (M.D.S, Oral Pathology), Dr. ELAVARASU (B.D.S) Sambu Dental

Clinic , Komarapalayam, Dr. SUKUMARI ELAVARASU, (M.D.S, Peridontia), vice principal, JKK Natarajah Dental College, Dr. Mrs. TAMILMANI, Principal, Annai JKK Sampoorani Ammal College of Nursing, Mrs. KAVIMANI, M.Sc., (N), Mrs. THANGAMANI, M.Sc., (N), experts from the field of Nursing, for validating the tool amidst their busy schedule and giving valuable suggestions for the study.

I extend my sincere thanks to Dr. JAYASEELAN MANICKAM DEVADASON, Dean and Prof. DHANAPAL, statistician, Annai JKK Sampoorani Ammal College of Nursing for their guidance in the statistical analysis and interpretation of data.

I extend my thanks to the LIBRARY STAFF of Dr. M.G.R Medical University, Chennai; CMCH College of Nursing, Vellore and Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam for helping me to build a sound knowledge basis for the study.

I wish to express my heartfelt thanks to Mr. V.MOHANRAJ, Mr. M.SETHURAMAN and Mr.S.MANIKANDAN, who spent their valuable hours of work to shape this thesis neatly.

I also express my thanks for the assistance and support given by the faculty of Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam and my beloved classmates for all the help rendered to me in my most needful times. I am greatly indebted to my beloved husband, Mr. SAM WILSON for having nurtured his cherished dream into reality through his constant support, wholehearted encouragement and special prayers during this study. I also express my heartfelt thanks to my loving son RICHARD SAM and my daughter LINITA SAM and my dear friend’s daughter SMITHA SAJJAN for their constant help and support for getting this thesis ready. I dedicate this dissertation to my beloved mother, Mrs. CHINAMMA THOMAS who always supported me, constantly prayed for me and wanted her daughter to scale high ranks academically. I also extend my sincere thanks to all my kith and kin and friends for their encouragement, support and prayers during the period of study.

30083613

TABLE OF CONTENTS

CHAPTER

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PAGE

NO

I

II

III

INTRODUCTION

- Back ground of study

- Need for the study

- Statement of problem

- Objectives

- Hypothesis

- Operational definitions

- Assumption

- Delimitation

- Conceptual Framework

REVIEW OF LITERATURE

1. Studies related to dental caries

2. Studies related to oral health practices

3. Studies related to dental caries and oral health

practices.

METHODOLOGY

- Research approach

- Research design

- Variables

- Setting

- Population

1-10

1

3

6

6

7

7

8

8

8

11-25

11

16

21

26-35

26

27

29

29

29

CHAPTER

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PAGE

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IV

V

- Sample

- Sample Size

- Sampling technique

- Sample selection criteria

- Data Collection instruments

- Training of the investigator

- Description of the Tool

- Content validity

- Reliability of the tool

- Pilot Study

- Data Collection procedure

- Plan for Data Analysis

- Ethical consideration

DATA ANALYSIS AND INTERPRETATION

- Data on demographic variables and dental caries among

cases and controls

- Data on association between dental caries and oral

health practices among cases and controls

- Data on association between dental caries and selected

factors.

SUMMARY, FINDINGS, DISCUSSION, IMPLICATIONS,

LIMITATIONS, RECOMMENDATIONS AND CONCLUSION

- Summary

- Characteristics of the study sample

30

30

30

30

31

31

32

33

33

33

33

34

35

36-61

37

56

61

62-70

62

63

CHAPTER

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- Findings

- Discussion

- Implications

- Limitations

- Personal experience

- Recommendations

- Conclusion

REFERENCES

- Text books

- Journals

- Unpublished thesis

- Secondary sources

APPENDICES

ABSTRACT

64

66

68

69

70

70

70

71-75

71

72

75

75

LIST OF TABLES

TABLE NO TITLE PAGE

NO

1.

2.

3.

Frequency, percentage, chi-square value and odd’s ratio among

cases and controls regarding dental caries and oral health

practices.

Logistic regression on determinants related to oral health practices

and dental caries.

Logistic regression regarding association of demographic variables

and dental caries.

56

60

61

LIST OF FIGURES

FIGURE

NO. TITLE

PAGE

NO.

1.

2.

3.

4.

5.

6.

7.

8.

Conceptual framework

Research Design

Schematic research design

Frequency and percentage distribution of cases and controls based on

their age.


sex of the students.


religion.


type of family.


education of mother.

10

27

28

38

39

41

43

45

FIGURE

NO. TITLE

PAGE

NO.

9.

10

11

12

13


occupation of father.


occupation of mother.


family income.


incidence of dental caries among family members.


initiation of brushing.

47

49

51

53

55

LIST OF APPENDICES

NO APPENDIX

1.

2.

3.

4.

5.

6.

7.

Certificate of training

Content validity permission letter

Content validity certificate

List of experts

Permission letter to conduct research

Certificate of completion of research

Tool developed for data collection in English

CHAPTER – I

INTRODUCTION

“Beloved, I wish above all things that thou mayest prosper

and be in health, even as thy soul prospereth.”

- III John: 2

BACKGROUND OF THE STUDY

A smile is often the mark of the beginning of a great relationship. A smile looks better

if it is revealed through a neat, gleaming white set of teeth and healthy gums. Maintaining good

oral health is absolutely essential. Healthy teeth are important to child's overall health.

Oral health is concerned with functional efficiency of not only the teeth and its

supporting structure but also the surrounding parts of the oral cavity and of the various

structures related to mastication and the maxillo facial complex. The mouth is considered as

the most essential and versatile one of the human organs. The food needed by the body for life

processes enters through it and the first stage of digestion takes place in the oral cavity.

Dental caries is an irreversible microbial disease of the calcified tissues of the teeth

characterized by demineralization of the inorganic portion and destruction of the organic

substance of the tooth which often leads to cavitation. It is a complex and dynamic process

where a multitude of factors influence and initiate the progression of the disease. Although

effective methods are known for prevention and management of dental caries, it is a major

health problem affecting mankind, in that its manifestations persist throughout life despite

treatment.

1

Worldwide most children and an estimated 90% of adults have experienced caries with

the disease most prevalent in Asian and Latin American countries and least prevalent in African

countries. In the United States, dental caries is the most common, chronic childhood disease

being atleast 5 times more common than asthma, despite a decline in prevalence (Office of

Disease Prevention and Health Promotion, 2001). Approximately 5% of children in the U.S.A.

have tooth decay by 9 months of age, 15% by 12 months and 17% by age 4. By the time they

reach adulthood, 94% of Americans have had tooth decay. While there has been a significant

decrease in dental carries in recent years, millions of children in the United States continued to

live with painful, untreated oral disease. Dental carries is especially prominent in children from

low socio-economic backgrounds who are unable to receive treatment for the disease. Half of

the tooth decay in children from low income families goes untreated.

Dental caries and periodontal diseases are the most important oral disease prevalent

in Asian and Latin American countries. In developing countries, the availability of oral health

service is limited, with little or no access to preventive or restorative dental care; thus

periodontal disease and tooth loss are common. In addition to poor living conditions, the major

risk factors for poor oral health relate to unhealthy lifestyles (poor diet, nutrition, and oral

hygiene and use of tobacco and alcohol) (Pihlstrom, Michalowicz, and Johnson, 2005). Soft-

drinks are a significant factor, and controlling the intake of sugars is important for caries

prevention. Following global recommendations, encouraging a diet high in starchy staple foods,

fruits, vegetables and low in free sugars and fat would go a long way toward protecting both

oral and general health.

Oral health is an essential component of total health and well-being, and it affects

numerous aspects of a person’s health status. From the ability to eat and speak, to quality of

life, including self-esteem, learning, employment and levels of usual activity (Drum, Chen and

Duffy, 1988).

2

NEED OF THE STUDY

WHO (2008) recently published a global review of oral health which emphasized that

despite great improvements in the oral health of populations in several countries, global

problems still persist. This is particularly so among underprivileged groups in both developing

and developed countries. The experience of pain, problems with eating, chewing, smiling and

communication due to missing, discolored or damaged teeth have a major impact on people's

daily lives and well-being. Furthermore, oral diseases restrict activities at school, at work and at

home causing millions of school and work hours to be lost each year throughout the world.

Dental caries also known as tooth decay or cavity is a disease where bacterial process

damage hard tooth structure (enamel, dentine and cementum). These tissues progressively

break down, producing dental cavities or holes in the teeth. Two groups of bacteria are

responsible for initiating caries, Streptococcus mutants and Lactobacilli. If left untreated, the

disease can lead to pain, tooth loss, infection and in severe cases death.

Dental caries is caused mainly by bacterial deposits (known as plaque) on the tooth

surface. Bacteria uses food especially fermented carbohydrates trapped in-between teeth as

an energy source fermenting it to acids which lower the pH of the plaque. If the pH drops below

5.5, the acid reacts with the enamel dissolving sugars and starches and both are fermented by

the bacteria. All cavities occur when carbohydrates like sugar or starch in the food left on teeth

after every meal or snack and changed to acid demineralization of tooth by plaque bacteria.

Though more than 95% of trapped food is left packed between teeth after every meal or snack,

over 80% of cavities develop inside pits and fissures in grooves on chewing surfaces where the

brush cannot reach and there is no access for saliva and fluoride to neutralize acid and re-

mineralize demineralized tooth. Few cavities occur where saliva has easy access.

3

Dental caries and periodontal disease have historically been considered the most

important global oral health burdens. Dental caries is still a major health problem in most

industrialized countries as it affects 60–90% of school-aged children and the vast majority of

adults. In 2004, WHO updated the epidemiological information available in the databanks. At

present, the distribution and severity of dental caries vary in different parts of the world and

within the same region or country. Dental caries experience in children is relatively high in the

Americas Decayed Missing Filled Teeth (DMFT) = 3.0 and in the European Region DMFT = 2.6

whereas the index is lower in most African countries DMFT = 1.7

According to the Dental Council of India (DCI) report (2004) the prevalence of dental

caries among 12-15 year olds varied between 40-80% and was reported to be very high in

Northern States 85-90%. The prevalence of dental caries in 12 year olds was around 48.6%.

The DMFT score in the same age group was 1.15.

Recent studies by the dental council of India have revealed a bleak picture. Decayed

teeth are common and increase with age. Nearly 30% of rural people do not have any dental

treatment facilities. Leave alone the recommended twice-a-year dental check-up. 50% of urban

India do not use tooth brushes. On an average, only about 20 teeth are present in the elderly.

43% of India adults have aesthetically unacceptable teeth. 80% of the people have bleeding

gums and tartar. Although 65% of the elderly need some dental prosthesis or other, only a

pitiable low percent i.e., 11% have them. Only a tiny number of the population has ever visited

a dentist. A large number of adolescence and adults chew tobacco and the incidence of oral

sub mucus fibrosis and subsequent cancer is alarmingly high. All these could be prevented by

aggressive health education and primary prevention.

Dental health is also depended on eating habits. Earlier people used to eat 2 meals per

day and in between tea and coffee were less preferred. Children prefer eating processed food

and that too very frequently i.e., with very little gap in between food intake. After eating food

4

children are expected to brush the teeth or at least rinse the mouth. When children eat

chocolates and biscuits, they do not brush their teeth. This leads to tooth decay. Further, most

children have the habit of drinking sweetened milk before sleeping .This also further contributes

to tooth decay.

Jose et al., (2008) did a study on prevalence of dental health problems on 1068 school

children of the age group of 12-15 years in rural Kerala. The findings were 54.3% showed

evidence of dental caries and that dental caries was the most prevalent condition affecting the

children.

Chatufele et al., (2002) conducted a cross sectional study about oral health in rural

area of Loni, western Maharashtra in order to find out the relation between various oral

hygienic practices and oral health. It was found that oral health varies significantly with the

practices related to cleaning mouth and that oral diseases are strongly related with the

frequency of mouth washing, type of cleaning and rinsing of mouth.

Dental caries is expected to increase in many developing countries as a result of the

growing consumption of sugars and inadequate exposure to fluorides. WHO’s global oral health

program is set out to addressing oral hygiene practices, sugar consumption, lack of calcium

and micro-nutrients, and tobacco use. The key elements include addressing poor living

condition and low education levels as well as lack of traditions supporting oral health.

Dental health organizations advocate prevention and prophylactic measures such as

regular oral hygiene and dietary modifications to avoid dental caries.

Hygiene is embedded in Indian culture and is the way of life. In the indigenous time

tested practices of rinsing mouth with plain water after each meal, massaging gums, and teeth,

5

cleaning mouth with finger after each meal, promoting traditional diets, brushing of teeth,

avoiding smoking, chewing pan and tobacco in various forms.

Dental health directly influences the general health of an individual. Inadequate

knowledge and ignorance of oral health practices lead to a lot of oral health problems. The

most commonly occurring problems are dental carries, root abscess, gingivitis, pyorrhea, mal-

occlusion and halitosis. It is well recognized fact that the children of today are the citizens of

tomorrow. The prosperity of the nation depends on the health of the future citizens. Dental

health should be made priority in children who comprises 40% of our population.

In the process of review of literature, the investigator came across various studies

related to factors like nutritional status and dental caries, prevalence of dental caries,

association of sociodemographics and dental caries, oral health and knowledge and practice of

mothers. The investigator could not find any studies directly related with oral health practices

and dental caries. Considering the incidence and prevalence of dental caries, the investigator

proposed to conduct a case control study on dental caries and oral health practices among

school children.

STATEMENT OF THE PROBLEM

A case control study on Dental caries (DC) and Oral health practices (OHP) among

school children in a selected school in Palakkad Dist, Kerala.

OBJECTIVES

1. To describe the association between oral health practices and dental caries among

cases and controls.

2. To test the association between dental caries and selected factors among cases

and controls.

6

HYPOTHESES

H1 : There will be a significant association between dental caries and oral health

practices among cases and control group.

H2 : There will be a significant relationship between dental caries and selected

factors among cases and control group.

OPERATIONAL DEFINITIONS

1) Dental caries: It refers to the presence of any one of the signs and symptoms

mentioned in the screening form i.e., brownish grey or black discoloration of the tooth, food

impaction, sensitivity to hot/cold and pain among school children.

2) Oral health practices: Oral health practice refers to the responses of the

individuals to the items in the self-administered questionnaire that is regarding care of the oral

cavity. Oral health practices will be measured in terms of oral health practice scores. The

higher the score, the better is the oral health.

3) Cases: Refers to school children both males and females aged between 13-15

years with dental caries in one or more teeth, filled tooth, root canal treatment done or tooth

extraction done for dental caries, as identified using the dental caries observation checklist.

4) Controls: It refers to school children similar to cases except the dental caries as

measured by the observation checklist.

5) Selected factors: These were the factors thought to influence the oral health status

of the child. The selected factors included factors such as age, sex, religion, type of family

educational status of mother, occupation of father and mother, economic status, family history

of dental caries and the age of initiation of brushing.

7

ASSUMPTIONS

1) Dental caries is prevalent among school children.

2) The children will have some oral health practices.

3) The participants will be willing to participate and give reliable information.

4) The tools used will be sufficient to measure dental caries and oral health practices.

5) The response of school children to the items in the questionnaire will be the true

measure of their OHP.

DELIMITATIONS

The study was delimited to:

1) Children studying in a selected school in Palakkad Dist.

2) Dental screening done using mouth mirror and probe in day light

3) Data collected by self-administered questionnaire method.

4) Cases and control selected by purposive sampling technique.

CONCEPTUAL FRAMEWORK

A conceptual framework is made up of concepts, which are mental images of a

phenomenon. These concepts are linked together to express the relationship between them.

In the present study, the conceptual framework is based on knowledge, attitude and

practice model. When adequate knowledge combines with positive attitude it results in

adequate practices and health of an individual.

Knowledge refers to the awareness of an object or procedure. In this study it refers to

awareness of good oral hygiene practices and causes of dental caries. However this was not

included in the study.

8

9

Attitude refers to the opinion, ideas and feeling towards an object or procedure. In

thisvstudy, it refers to attitude to good oral hygiene practices and prevention of dental caries.

However this was not included in the study

Oral health practices refer to the activity, behavior of a person resulted from the

combination of knowledge and attitude. In this study it refers to the dental cleaning practices,

brushing technique, oral hygiene practices, care against detrimental habits and caries

preventive practices. Dental clinic practices refers to number of times of brushing teeth, article

used for brushing, type of brush, dentifrice used and brushing duration. Brushing technique

refers to brushing the front, inner and chewing surface of the teeth. Oral hygiene practices

refers to washing and gargling of mouth after meals and snacks, massaging gums and teeth,

changing of brush and the method of removing food particles from in between teeth. Care

against detrimental habits refers to avoiding sweets in between meals and avoiding bed coffee

before brushing teeth. Caries preventive practices refers to eating fruits, raw vegetables,

drinking milk and adequate amount of water and using sugar free chewing gum containing

xylitol ( e.g. Orbit).

Health =

* Adkno

regarhy

de *Kn + Practice +

* Inakno

regarhy

*N ed in the study

owledge

Fig.1. CON

equate wledge ding oral giene

+

+

dequate wledge ding oral giene

*Attitu

10

Poor Dental Health and

presence of dental caries

Optimum Dental Health and

absence of dental caries

+

Inadequate oral Health practices

* Negative attitude towards dental hygiene and aesthetics

CEPTUAL FRAMEWORK BASED ON KAP MODEL

+

Adequate oral

Health practices

* Positive attitude towards dental hygiene and aesthetics

ot includ

CHAPTER – II

REVIEW OF LITERATURE

Review of literature is an important step in the development of a research project. It

will help the researcher to develop a deeper insight into the problems and gain information on

what has been done before. It serves as a frame work of reference for studies. It focuses on

the feasibility of study related findings from one study to another with the hope of establishing a

scientific knowledge.

According to Polit and Hungler (2008), review of literature is a critical summary of

research on a topic of interest generally prepared to put a research problem in context or to

identify gaps and weakness in prior studies so as to justify a new investigation.

The review of literature is organized as follows:-

I. Studies on dental caries

II. Studies on oral health practices

III. Studies on dental caries and oral health practices.

I. STUDIES ON DENTAL CARIES

Narksawat K. et.al., (2009) conducted a cross sectional study on association between

nutritional status and dental caries in permanent dentition among 862 primary school children

in Thailand. Dental hygiene status was evaluated by observation check list and hygiene

practices by interview method. Spearman’s correlation and multiple logistic regression analysis

11

was used for statistical analysis and the result showed a negative relationship between

nutritional status and the DMFT index, which increased when the nutritional status decreased.

The normal weight and thin children were more likely to have a DMFT of at least one by 1.94

times (OR=1.94; 95% CI=1.25-3.00, p=0.004) and 2.22. 95% CI=1.20-4.09, p=0.001)

respectively compared to overweight and obese children, normal and thin school children had

a higher risk for dental caries.

Auad S.M. et al., (2009) conducted a study on 458, 13-14 year old school children on

dental caries and its association with socio demographics, erosion and diet from south Brazil.

The schoolchildren completed a questionnaire to provide dietary information and underwent

dental examination. Sociodemographic characteristics were collected using a questionnaire

completed by parents/guardians. Caries was assessed using decayed, missing, filled teeth/

surfaces (DMFT/DMFS) indices. Erosion was assessed using a previously validated index. The

result revealed that of 458 schoolchildren, 78% had caries experience. A statistically

significantly lower prevalence of caries was observed in children from a higher economic class

and whose parents had higher educational levels. Thirty-five percent of children with caries

also had erosion, while 32% with a DMFT of 0 had erosion (P = .72). The frequency of

consumption of drinks and foods was not statistically significantly associated with caries. The

intake of sugared carbonated drinks was statistically significantly associated with erosion (P =

.01). The mothers' educational level was the only variable independently associated with caries

experience (P=.04).

Thomson R.K. et al., (2008) did a study on risk indicators for dental caries on 644

young adults from South Australian Electoral roll of the age of 20-24 years. The study showed

that the mean number of affected surfaces was 6.05(SD8.44), the median 3.0 surfaces and

20.6% had no cavitated caries experience. The prevalence of untreated cavitated caries was

28.6%. Three quarters of the disease burden was found in 30% of the subjects. Precavitated

lesions were observed in 51.4% of subjects. The mean number of affected surfaces was

12

2.43(SD 5.93) of those who had a DMFS score of zero, 45.1% had at least one surface

affected by precavitated decay. As a result only 11.3% of young adults showed no signs of

carious experience. 75% of the precavitated surfaces were found in 18.3% of young adults.

The mean number of decayed surfaces (cavitated) was higher among those in receipt of

government benefits, persons who were not employed, those whose usual reason for visiting is

for a problem, those who last had care at a public clinic, those who brush their teeth less than

twice a day, those who reported 5 or more acidic drinks per day and current smokers.

Patro B.K. et al., (2008) did a cross sectional community based study on prevalence

of dental caries among 452 adults and elderly in an urban resettlement colony of New Delhi.

Local adaptation of the WHO questionnaire was filled by the respondents and oral examination

and dentition status recorded by trained investigators. The result showed the prevalence of

dental caries in the 35-44 years group as 82.4% and 91.9% in those >60 years. The decayed

missing filled teeth (DMFT) index was 5.7+4.7 in the 35-44 year age group and 13.8+9.6 in >60

years age group. 27.9% were currently using tobacco. A statistically significant association was

found between tobacco consumption and dental caries (p=0.026) 1/5th of the individuals with

dental problems relied on home remedies.

Jose et al., (2008) did a study on prevalence of dental health problems on 1068

school children of the age group of 12-15 years in Vadavucode block, in rural Kerala. Dental

examination was done by dental surgeons on 50-100 children per day; a small brochure on

dental hygiene was given to all. The children were examined for dental caries, gingivitis,

retained deciduous teeth, fractured teeth and orthodontic problems. The findings were 54.3%

showed evidence of dental caries, 3.18% received treatment, 21% showed evidence of

orthodontic problems, 15% had gingivitis, 7% had over retained deciduous teeth and 4% had

evidence of trauma to the anterior teeth. It was observed that dental caries was the most

prevalent condition affecting the children.

13

Ahmed N.A. et al., (2007) did a cross sectional study on dental caries prevalence and

risk factors among 392 school children of the age group of 12 years in Baghdad, Iraq. Dental

examination based on WHO criteria and questionnaire surveys were used for data collection.

Water samples were collected and fluoride concentration assessed. The findings revealed that

the mean DMFT and DF were 1.7 and 1.3. The rate of caries experience (DMFT>0) was 62%.

DMFT decreased significantly with higher education of mother, not being embarrassed to smile

and between meals mode of drinking. Increased sugar consumption was associated with being

a boy, having mothers with low education, living in low socio-economic area and brushing only

once a day. Positive oral hygiene practices were higher for girls. Western sweet snacks were

preferred and sweet tea was frequently consumed. The fluoride content in drinking water was

too low for caries prevention.

Gustavo et al., (2003) conducted a study in New York, USA on factors contributing to

oral health problems. The various factors found were financial barriers, language, literacy,

culture, acculturation, dietary pattern, substantial effect, cultural belief, values and the

individual’s attitudes and experience with the dental care system.

Al-Malik et al., (2001) conducted a cross sectional study on 987 2-5 year old children

on the relationship between erosion, caries and rampant caries and dietary habits in Soudi

Arabia. The cross sectional study including dental examination and questionnaire survey was

carried out at 17 kindergartens. Clinical examinations were carried out under standardized

conditions by a trained and calibrated examiner. Information regarding diet and socio-

economic factors was drawn from questionnaires distributed to the parents through the

schools. These were completed before the dental examination. The results revealed, of the

987 children, 309 (31%) showed signs of erosion. Caries were diagnosed in 720 (73%) of the

children and rampant caries in 336 (34%). Vitamin C supplements, frequent consumption of

carbonated drinks and the drinking of fruit syrup from a feeding bottle at bed- or nap-time when

the child was a baby, were all related to erosion. Consumption of carbonated drinks and fruit

14

syrups was also related to caries but they were part of a larger number of significant factors

including socio-demographic measures and oral hygiene practices.

Shekhar et al., (2001) An oral epidemiological survey done on the prevalence of

dental caries in Sansary District of Nepal. The survey was done in private and government

schools in a rural town. The result showed dental caries prevalence and decayed missing filled

teeth (DMFT) score of 5-6 year old children was 52% caries prevalence and the mean DMFT

score of 12-13 year old was 24%, caries prevalence and mean DMFT score of 15 years old

was 26%. In the 5-6 years old age group 36% of the treatment required could be met through

one surface restorations and 33% through 2 or more surface restorations and 18% through

extractions for the 12-13 years old and 15 years old, the major treatment need was for single

surface fillings (47% and 48% respectively) followed by the need for extractions (13% for both)

of two or more surface fillings (9% and8% respectively).

Selvarani R., (2001) did an experimental study to evaluate a structured teaching

programme on dental health in terms of knowledge and practice among school children of

selected schools in Madurai. The study concluded that in the experimental group 45%of

primary school children had poor cleanliness of the oral cavity, 85%had bad breath, 57.5% had

dental caries, 55% of children were suffering from bleeding gums, 72.5% had tartar

accumulation. In the control group55%of the children had poor cleanliness of oral cavity, 45%

of the children had bad breath and 65% of the children had dental caries. Among whom

38.46% of children had more than 2 caries teeth and 52.5% had bleeding gums and 80% of

the subjects had tartar accumulation. Majority of school children had poor knowledge regarding

dental health in both experimental and control group. Majority of the students in both group had

unsatisfactory practice towards dental health and that the structured teaching programme is an

effective means to increase the knowledge and to promote satisfactory practice towards dental

health. There was a positive correlation between the knowledge and practice of school children

towards dental health.

15

Sebastian D., (2001) conducted a case control study on oral health problems of

school children and the knowledge and practice of their mothers regarding oral health and oral

health problems in a school at Trichy. She used random sampling to select 50 cases and 50

controls. A structured interview schedule was used to collect data. Data collected was

analyzed using description and inferential statistics and multivariate analysis. The findings

revealed that the prevalence of oral health problems is high (70%) among school children.

There was significant association between mother’s knowledge and education among control

group. (p<0.001 level).

II. STUDIES ON ORAL HEALTH PRACTICES

Garbin C. et al., (2009) conducted a study to verify the influence of preschool children

participating in an oral health education program on daily health practices of their families,

through parent’s perception. A sample of 119 parents of 5-6 year old preschoolers was

selected. Data was collected using a structured self administered open-ended questionnaire.

The findings revealed that 98% knew about educative and preventive activities developed at

school and all of them affirmed that these activities were important. 90.5% of parents reported

that they learned something about oral health from their children and among them 47.8% cited

tooth brushing as the indicator for better learning. Besides this 87.3% of participants revealed

the change in oral health habits of their family members.

Shanthi S. et al., (2009) conducted a study to evaluate the effectiveness of structured

teaching programme on oral hygiene in terms of knowledge, attitude and practice among 90

students of 6th standard of Ramasamy Chettiar Higher Secondary School at Chidambaram. An

evaluative research approach with pre-experimental one group pre-test and post-test design

was used. Subjects were selected through cluster random sampling technique. The

investigator used a self-administered questionnaire and the data collection tools were validated

and the reliability determined by pilot study. After the pre-test structured teaching programme

16

(STP), a booklet on oral hygiene was distributed. Two post-tests were conducted with the

same tool. First post-test after one week and second post-test after 15 days after STP. The

collected data was tabulated and analyzed by using descriptive statistics such as percentage,

mean, SD, paired t-test, one way Anova and two way Anova. The major findings revealed an

overall prevalence of oral problems as 77.5% among school children. There was significant

increase in the level of knowledge, attitude and practice of school children between pre-test

and post-test at p<0.001 level. The girls knowledge score was slightly higher than the boys

which was significant at p<0.05 level. There was no significant relationship between

knowledge, attitude and practice level of the subjects and demographic variables.

Gussy M.G. et al., (2008) did a descriptive study on 294 parent child dyad to examine

the oral health related knowledge, attitude and reported behaviors of parents of children 12-24

months living in rural areas of Victoria, Australia. The child’s mother was the most common

respondent. The most important cause for tooth decay was identified as not cleaning teeth

everyday (40%) or sweet snacks and drinks between meals (39%). 10% thought that infection

with bacteria was the primary cause and less believed that the use of bottle at night time was

the most important factor (5.5%). 95% of parents believed that they should begin cleaning their

child’s teeth when or soon after the teeth appeared. Reported confidence cleaning their child’s

teeth was significantly associated with the items regarding parental self sufficiency in

managing their child’s oral health(x2=57.500.df=4. P=<0.001) and locus of control with relative

to the child’s health(x2=16.064. df =4. P<0.01).

Hilton I.V. et al., (2007) did a qualitative study to identify cultural beliefs, practices and

experiences that influence access to preventive oral health care for young children from 6

focused groups in each of the African-American, Chinese, Latino and Filipino communities in

San Francisco, California. Participants were carers of children aged between 1 and 5 years.

The sample size was 22 groups (n=177 participants). The findings of the study revealed lack of

knowledge and beliefs about primary teeth, created barriers to early preventive care in all

17

groups. In Chinese groups more than others, health beliefs regarding disease groups, multiple

family carers, especially elders influenced access to preventive care. Dental fear, greatly

influenced attitudes regarding accessing preventive care.

Poutanen R. et al., (2006), conducted a study on parental influence on children’s’ oral

health related behavior. The data were gathered by means of questionnaires from 11-12 year

old school children and their parents. Differences between sub groups of children were

analyzed by cross-tabulations and the factors related to children’s good or poor oral health-

related behavior by logistic regression analysis. The findings were that parents of children who

reported good oral health related behavior had better knowledge and more favorable behaviors

than those of other parents. Predictors for a child’s poor oral health-related behavior were the

child’s poor knowledge, male gender, and the parent’s frequent consumption of sweets and the

infrequent use of xylitol gum. The parents of children whose oral health behavior was favorable

was more likely to have a high level of occupation and favorable oral health related behaviors.

Kahabuka F. K. et.al (2006) conducted a study to assess the level of knowledge on

causes and prevention of dental caries and bleeding gums, oral hygiene and eating practices

among institutionalized former street children in Dar-es-Salaam. Structured standardized

questionnaire was used to collect data. The findings of the study were that 88% and 83% of

children showed the cause of tooth decay and bleeding gums respectively and 17-68% were

aware of preventive measures. 92% of the children said they brushed their teeth but 74%

brushed when living on the streets, this difference was significant (χ2 =4.40, p=0.05). About half

did not use toothpaste whilst 8% did not use toothpaste at institutions. That difference was

significant. (χ2 =5.081, p=0.02). Almost 22% use sweets and biscuits at institutions. About 44%

used the snacks while living on the streets, the difference was significant. (χ2 =3.798, p=0.04

and χ2=3.893, p=0.04). Only 6% use sodas and sweetened juices at institutions while 32-36%

used the drinks during street life, the difference was significant. (χ2=4.38, p=0.05 and

χ2=12.87, p=0.01)

18

Mumghamba E. G. et.al., (2006) conducted a cross sectional descriptive study to

determine the oral hygiene practices, periodontal conditions, dentition status and self-reported

bad mouth breath (S-BMB) among 302 postpartum mothers of the age group of 14-44 years in

Dar-Es-Salaam, Tanzania. The mothers were interviewed using structured questionnaire. Oral

hygiene, dentition and periodontal status were assessed using the community periodontal

index probe and gingival recession (GR) using William’s periodontal probe. The findings

revealed that total toothbrushing practice was 99%, tongue brushing (95%), plastic toothbrush

users (96%), chewing stick (1%), wooden toothpicks (76%), dental floss (<1%) and toothpaste

(93%). The prevalence of plaque and gingival bleeding on probing was 100%, gum bleeding

during tooth brushing (33%), calculus (90%), probing periodontal pocket depth (PPD) 4-5mm

(27%), PPD 6+mm (3%), GR 1+mm (27%)and tooth decay (55%). The prevalence of S-BMB

was 14%. The S-BMB had higher mean number of sites with plaque compared to the no S-

BMB group (p=0.04). factors associated with S-BMB were gum bleeding on tooth brushing

(OR=2.4) and PPD 6+mm (OR=5.4).

Mahesh K. P. et.al., (2005) conducted a study to assess the oral health status of 1200

students of the age group of 5-12 years in Chennai city. The sample consisted of 600 private

and 600 corporation school children from 30 schools, which had been selected randomly. The

survey was based on WHO, 1999 oral health assessment which had been modified by

including gingival assessment, enamel opacities, hypoplasia for 5 years. Evaluation of the oral

health status of these children revealed dental caries as the most prevalent disease affecting

permanent teeth more than primary teeth and more in corporation than in private schools,

thereby correlating with the socio economic status. The greatest need of dental health

education is at an early age including proper instruction of oral hygiene practices and school

based preventive programs which would help in improving preventive dental behavior and

attitude.

19

Knishkowy B., Sgan-Cohen H.D., (2005) did a study on oral health practices among

184, 7th-10th graders who attended preventive health visits in Israel. Structured questionnaires

were used to collect data on tooth brushing, flossing, visit to dentist and hygienist. Structured

counseling by the family nurse was provided following completion of the questionnaire. The

findings of the study were 97% of the teenagers brushed their teeth atleast once a day but only

7% used dental floss daily, 44.5% never flossed and another 10% didn’t know what dental

floss was. 83% had visited a dentist but only 33% had been to a dental hygienist in the past 2

years.

Zhu L. et.al., (2003) did a national representative study to describe oral health

behavior, illness behavior, oral health knowledge and attitudes among 4400 twelve year old

and 18 year old Chinese to analyze the oral health behavior profile of the 2 age groups in

relation to province and urbanization and to assess the relative effect of socio behavioral risk

factors on dental caries experience. The data was collected by clinical examinations (WHO

criteria) and self-administered structured questionnaires. The findings revealed that 44.4% of

the respondents brushed their teeth at least twice a day but only 17% used fluoridated

toothpaste. Subjects who saw a dentist during the previous 12 months or 2 years were 31.3%

and 35.3% for 12 year olds and 22.5% and 20.2% for 18-year-olds respectively. Nearly 1/3rd

(29%) of 12-year-olds and 40.5% of 18 year olds visited a dentist in case of signs of caries but

only when in pain. The risk of dental caries was high in the case of frequent consumption of

sweets and dental caries risk was low for participants with use of fluoridated toothpaste.

Marinho V. C. et al., (2003) conducted a study to determine the effectiveness of

fluoride toothpastes for preventing dental caries in children and adolescents. Randomized or

quasi randomized controlled trials with blind outcome assessment, comparing fluoride

toothpaste with placebo in children up to 16 years for one year. The main outcome was caries

increment measured by a change in DMFS. The main outcome was caries increment

measured by the change in decayed, missing and filled tooth surfaces D (M) FS. The primary

measure of effect was that prevented fraction (PF) that is the difference in caries increments

20

between the treatment and control group. The results were 74 studies were included. for the 70

that contributed data for meta-analysis (involving 42,300 children) the D(M)FS pooled PF was

24% (95% confidence interval (CI), 21-28%, P<0.0001).this means that 1.6 children need to

brush with a fluoride toothpaste over 3 years to prevent one D(m)FS in population with caries

increment of 2.6 D(M)FS per year. In populations with caries increment of 1.1 D (M)FS per

year, 3.7 children will need to use a fluoride toothpaste for 3 years to avoid one D(M)FS. There

was clear heterogeneity, confirmed statistically (p<0.0001). The effect of fluoride toothpaste

increased with higher baseline levels of D (M) FS, higher fluoride concentration, higher

frequency of use and supervised brushing but was not influenced by exposure.

Rajab L.D.,(2002) did a cross sectional study to assess the level of dental knowledge

and attitude towards childcare among 1556 parents of children of the age group of 6-16years

in Jordan. Self administered questionnaire was used for data collection. The findings showed

80% of the parents knew about the harmful effects of sugar and 79% thought that poor oral

hygiene may induce dental caries. In addition to proper oral hygiene (79%) and restriction of

sugar/sweets (42%), 36% of the parents emphasized regular dental visits. However, most

children saw a dentist for symptomatic reasons only(86%), while 11% attended for dental

checkups. Tooth brushing at least twice a day was reported for 31% of children. 14% of

children aged 6-9 years had association from adolescent brushing.

III. STUDIES DONE ON DENTAL CARIES AND ORAL HEALTH PRACTICES

Rehmanet U.R. et al., (2008) conducted a correlational study on dental caries, oral

hygiene status and risk factors among 242 adolescents between 11 and 14 years in selected

schools in UAE. Oral examination was performed to check for decayed, missing and filled teeth

(DMFT) index and simple oral hygiene (OHI-S) score. A questionnaire was used to gather data

concerning external modifiable risk factors such as socioeconomic status, oral hygiene

practices and snacking habits. The results showed that the DMFT index in 67.77% of students

21

fell between 0 and 3. The average DMFT was 3.27 and oral hygiene score (OHI-S) was fair.

The major component of the DMFT was the untreated decay (D). Half of the students claimed

to be familiar with the benefits of fluoride and toothbrush before bedtime. 16% of the subjects

were aware of a bad breath problem.

Amin T.T. et al., (2008) did a cross sectional descriptive study to assess the oral

hygiene practices, dental knowledge, dietary habits and their relationship to caries among

1115 Saudi male school students selected by multistage random sample from 18 public

primary schools. Subjects were interviewed by closed ended questionnaire gathering data

regarding frequency of consumption of cariogenic foods, oral hygiene practices and dental

health knowledge. The results showed clinically decayed tooth in 68.9% of the children. Caries

incidence was higher in children who consumed cariogenic foods. Only 24.5% of students

brushed their teeth twice or more per day and 29% of them never received instructions

regarding oral hygiene practices. Step wise logistic regression analysis revealed that maternal

working conditions, large family size and poor oral hygiene practices were the chief predictors

for dental caries.

Prusty M. (2008) conducted a correlative study on oral health status and oral health

practice among tobacco consumers in selected villages in Orissa on 100 samples. Mouth

mirror and probe were used to detect dental problems. Interview schedule was used to collect

the data. There was significant correlation between oral health practice and oral health status

among tobacco smokers r=0.048 (p<0.05) also no correlation between oral health practice and

oral health status among tobacco chewers. r= 0.437 (p<0.05)

Gagliarali D.I. et al., (2008) performed a study on impact of dental care on oral health

related quality of life and treatment goals among elderly adults receiving care through the

south Australian Dental Service (SADS) .The study revealed improvements in oral health

related quality of life(OHRQOL) were observed(p<0.05) mean OHIP-14 scores did not change.

22

Mean goal attainment ratings improved significantly (p<0.05) regardless of treatment goal

categories.

Santos N. D. et al., (2007) conducted a cross sectional study to assess the personal

hygiene and dental cavities and periodontal disease among 40 adolescents between 10 and

18 years in the cities of Recife and Santana, Brazil. The sample size was 1011 adolescents

and 971 12-year-olds in Feira De Santana. Assessment of cavity status through no. of cavitied,

missing and filled teeth, visible dental plaque, bleeding gums and periodontal status. The study

revealed that most of adolescents followed oral hygiene practices 3 times a day. The DMFT

values presented a median of 1.5 in Recife and averages of 1.89 in state schools, 2.17 in

municipal schools and 2.39 in private schools in Feira De Santana. The bleeding gum in Recife

presented a median of 27% and in Feira De Santana the healthy sextant averages of 4.36,

4.08 and 5.16 in state, municipal and private schools respectively.

Gordon N. (2007) conducted a descriptive study to determine the oral status of 60

children attending a facility based nutrition program and oral health knowledge, attitude and

practice of their parents/caregivers and to develop a framework for an oral health component.

The structured administered questionnaire for caregivers and an oral examination for the

children was used for data collection. The findings revealed that most parents started cleaning

their children’s mouth between 12 and 24 months (64%) add sugar to food and feeding bottles

and visit a dentist only when the child is symptomatic. These factors clearly place this group at

risk for developing caries and gingivitis. The oral examination revealed plaque deposits,

gingivitis, caries and white spots.

Nogueira dos Santor et al., (2002) did a cross sectional exploratory study on oral

health and hygiene, dental cavities and periodontal diseases among 971adolescents in the

cities of Brazil. The tools used were self administered questionnaire and dental examinations

were done to assess the number of cavitated teeth, missing and filled teeth, visible dental

23

plaque, bleeding gums and periodontal status. The analysis was based on chi-square,

Kruskall-Wallis and Fisher tests, with a confidence interval of 95%. The result of the study

showed that most of the adolescents followed oral hygiene practices three times a day. The

DMFT values presented a median of 1.89 in state schools and 2.17 in municipal schools. The

bleeding gums presented a median of 27%. The frequency of the dental cavities were low with

most of the adolescents reporting good oral hygiene and favorable periodontal conditions. .

Wierzbuka.M. et al., (2002) conducted a cross sectional study to assess the

occurrence of dental caries over time in Polish school children, to analyze the oral health

behavior of children and mothers and to compare the levels of dental knowledge and attitudes

of mothers and school teachers. The surveys were conducted in children aged 6 and 12 years

in 1995, 1997, 1999 & 2000. Questionnaire surveys of a sample of mothers & school teachers

were conducted in 1999. Children aged 6 years comprised 1998 (n=1860); 1997 (n=922); 1999

(n=2290); 2000 (n=3391). The surveys of 124 subjects covered 1995 (n=1859); 1997

(n=2743); 1999 (n=3060); 2000 (n=3391), mothers (n=1040) of a randomized sub sample of

children and 471 school teachers were identified for the questionnaire surveys in 1999. The

findings of the study were the proportion of 6 year old children being caries-free was 13% in

1995, 17% in 1997, 18% in 1999 and 12% in 2000. The mean DMFT of children aged 12 years

was 4.2 in 1995, 4.0 in 1997, 4.0 in 1999 and 3.8 in 2000; The decay component was

particularly high for rural children. In 1999, tooth brushing at least twice a day was reported for

64% of children and this practice was relatively frequent in urban areas. Dental visits were

made by 71% of children and 56% of mothers. Knowledge and attitudes were low particularly

in rural areas. Dental care habits of children were highly influenced by dental attendance and

level of education of mothers. Knowledge and attitudes were higher for teachers than mothers.

The teachers knew about the poor dental condition in children and wanted to become involved

in oral health education.

24

Petersen P. E. et al., (2001) conducted a cross sectional study to describe the level of

oral diseases and to analyze self- care practices and dental visiting habits of 2200, 6-12 year

old school children in urban and rural school children in southern Thailand. Clinical recordings

of dental caries and periodontal CPI scores 0,1 or 2 according to WHO and a structured

interview schedule were used as tool to measure oral health behavior and attitudes. It was

found that at age 6, 96.3% of children had caries and mean dmft was 8.1. In experience of pain

during the previous 12 months was reported by 53% of 12 year olds, 66% saw a dentist within

the previous year 24 % reported that visits were due to troubles in the teeth. Tooth brushing of

at least once a day was claimed by 88%, significant numbers of children reported having

hidden sugar every day: soft drinks (24%), milk with sugar (34%), and tea with sugar (26%),

important predictors of high caries experience were dental visits, consumption of sweets,

ethnic group (Muslim) and sex (girls). Whereas lower risk was observed in children with

positive oral health attitudes.

Jagadeesan et.al., (2000) did a cross sectional study on oral health status and the

risk factors for dental and periodontal diseases among rural women in Pondicherry. The study

found that the prevalence of dental caries was 40.55%,missing teeth due to caries was 27.3%,

periodontal diseases was 0.8% and 20.1%, 20.6%, and 25.6% for bleeding, calculus, shallow

pockets and deep pockets respectively.

25

CHAPTER - III

METHODOLOGY

Research methodology is a way to systematically solve the research problem.

Methodology for the study is defined as the way pertinent information is gathered in order to

answer the research question or analyze the research problem.

The study conducted was a case control study on dental caries and oral health

practices among school children at a selected school in Kerala.

This chapter deals with description of the different steps which were undertaken by the

researcher for the study. It includes the research approach, research design, variables, setting,

population, sample size, sampling technique, sampling criteria, development of tool,

description of the tool, content validity, reliability, pilot study, data collection procedure and plan

for data analysis and ethical issues.

RESEARCH APPROACH

When the association between two factors is strong and consistent a case control

study can be used. If the association is biological in nature and specific in the available time, a

retrospective study can be done.

Hence the research approach chosen for the study was a retrospective case control

study. Case control study is a design that moves in a reverse direction from known outcome to

the exposure factors which are thought to be the cause. Two groups were studied: the case

26

group is one who had dental caries or tooth extraction or filling or root canal treatment done for

dental caries. The control group is one in which the children were free from dental caries, tooth

extraction, tooth filling or root canal treatment done for dental caries. The oral health practices

of both groups were assessed retrospectively.

RESEARCH DESIGN

Polit and Hungler (2008) state that a research design incorporates the most important

methodological decisions that a researcher makes in conducting a research study. It depicts

the overall plan for organization of scientific investigation. It helps the researcher in the

selection of the subject, manipulation of independent variables and observation of type of

statistical method to be used to interpret the data. The selection of design depends on the

purposes of the study, research approach and variables to be studied.

The research design selected for the present study was case control design. The

school children were screened for dental caries (cases) and two groups were formed. One with

presence of dental caries and the other group without dental caries (controls). Oral Health

Practice was assessed retrospectively.

Good Oral

Health Practice Cases

Children with dental carries

Poor Oral Health Practice

Good Oral Health Practice

Poor Oral Health Practice

Time

Control

Children without dental

carries
Time Fig.2.CASE CONTROL DESIGN
27

TARGET POPULATION School children between the age of

12 – 15 years

Background factors Age, sex, Religion Type of family Education of Mother Occupation of Father Occupation of Mother Family income Family history of dental caries Age of initiation of brushing.

Assessable population School children between the ages of

12 – 15 years in selected school in Palakkad district

Screening for dental Caries (Mouth mirror and probe)

Sampling technique purposive Sampling

Cases 40 Children with dental caries

Cases 80 Children without

dental caries

Data collection procedure Dental caries

checklist and self administered questionnaire

Analysis and interpretation Description and inferential statistics

Findings

Reporting Thesis

Fig.3. SCHEMATIC RESEARCH DESIGN

28

VARIABLES

S P Gupta (2004) states that a variable is a characteristic that may take on different

values at different times, places or situations. The variables in the study were:

Associate variable : Dental caries (presence or absence)

Dependent variable : Oral health practices

Attribute variable : Age, gender, religion, education of mother, socio economic

status, type of family, occupation of father, occupation of

mother, and incidence of dental caries in family and initiation

of brushing.

SETTING

C R Kothari (2004) refers setting as the physical location and condition in which data

collection takes place for the study. The setting was selected based on acquaintance of the

investigator with the institution, feasibility of conducting the study, availability of subjects and

permission and cooperation from authorities. The setting for the study was S.D.A Higher

secondary School, Ottapalam, Palakkad Dist.

POPULATION

Population may be of two types, target population and accessible population. Target

population is the aggregate of cases on which the investigator would like to make

generalizations. Accessible population is the aggregate of cases that conform to the specific

criteria and which is accessible to the researcher as a pool of subjects for conducting the study.

The accessible population was school children of the age group of 12-15 years studying in

S.D.A Higher secondary School, Palakkad Dist.

29

SAMPLE

The male and female school children studying in standards 7th to 10th std. in the age

group of 12-15 years in S.D.A Higher Secondary School who fulfilled the inclusion criteria were

selected for the study.

SAMPLE SIZE

The sample size is determined based on the type of study variables being studied, the

statistical significance, required availability of samples, feasibility of conducting the study and

level of exposure among the controls. The sample size included 40 cases and 80 controls.

SAMPLING TECHNIQUE

In the present study the children were screened for dental caries and purposive

sampling technique was used for selecting the cases and control groups among those who met

the criteria of the study.

SAMPLE SELECTION CRITERIA

Eligibility criteria: Specified to school children

1. Who had dental caries, tooth extraction, tooth filling and root canal treatment done

for dental caries (cases).

2. Who did not have dental caries (controls).

Inclusion Criteria

Specified school students

• Children who are of the age group of 12- 15 years.

• Both male and female school children.

30

• Children who can read and write English.

• Children who are willing to participate in the study.

• Children who had tooth extraction for reasons other than dental caries were

included in control group.

Exclusion Criteria

• Children with any other oral pathological conditions like dental plaque,

periodontal disease and halitosis.

• Children who are absent during data collection.

DATA COLLECTION INSTRUMENTS

Data collection tools are the procedures or instruments used by the researchers to observe

or measure the key variable in research problem. A semi structured questionnaire was used to

collect the details on background variables and oral health practices. The cases in the present

study were identified using the screening form for dental caries and observation using mouth mirror

and dental probe in daylight.

.

TRAINING OF THE INVESTIGATOR

After obtaining the permission from the concerned authorities, the investigator underwent a

short training program of one week at one of the renowned dental clinic in Komarapalayam for

assessing dental caries. She was trained, guided and supervised by Dr. Elavarasu, an experienced

dental surgeon. On completion of the training, she was given a certificate on proficiency

(Appendix - I).

31

DESCRIPTION OF THE TOOL

The self administered questionnaire consisted of three parts:

Part 1 - Back ground data: This section sought background information such as age,

sex, religion, types of family, education of mother, occupation of father, occupation of mother,

family income, incidence of dental caries in family and initiation of brushing.

Part II: Questionnaire on oral health practices: This section sought information

regarding oral health practices such as,

1. Dental cleaning practices: 6 items (1,2,3,4,5,6)

2. Brushing technique: 3 items (7,8,9)

3. Oral hygiene practices: 5 items (10,11,12,13,14)

4. Care against detrimental habits: 2 items (15,16)

5. Preventive practices: 6 items (17,18,19,20,21,22)

Totally there were 22 items. This section was administered as a self administered

questionnaire. The average time taken to complete the questionnaire was 20 minutes.

Part III: Screening form for dental caries: This form was used to differentiate cases

and control group.

SCORING

Oral health practice was measured in terms of oral health practice scores. The

maximum oral health practice score was 68. The higher the score, the better the oral health

practices. For the purpose of the study, the oral health practice was classified as follows:

Adequate practice - A score 70% and above was considered adequate practice.

Inadequate practice - A score below 70% was considered inadequate practice.

32

CONTENT VALIDITY

To ensure content validity, the tool was submitted to six experts in the field of dentistry

and nursing. Based on suggestions and opinions of the experts, the tool was restructured.

RELIABILITY OF THE TOOL

The tool reliability of an instrument is the degree of consistency with which it measures

the attributes it is supposed to measure. The self administered questionnaire was administered

to 10 school children (5 cases and 5 controls) and the reliability coefficient was computed

using test retest method. The reliability coefficient, r=0.88 was high.

PILOT STUDY

Pilot study is a small scale version of trial run for the major study. Pilot study was done

among 10 children in which 5 were cases and 5 were controls, before doing the main study.

Formal permission was obtained from concerned authorities before conducting the study. The

tool was administered to10 school children. The self administered questionnaire and screening

form was found to be appropriate for the study.

DATA COLLECTION PROCEDURE

The present study was conducted in SDA Higher Secondary School, Ottapalam,

Palakkad Dist. The data were collected for 3 weeks in the month of October, 2009. Formal

approval was obtained from the school Principal after explaining the objectives and purpose of

the study. The investigator familiarized with the subjects and explained the purpose of the

study, the method of data collection, the use of mouth mirror and dental probe and the time

33

duration required. The participants were requested for their cooperation and assured about the

confidentiality of their response. Informed consent was obtained orally.

The children were made to sit on a chair comfortably with neck tilted back. They were

observed under natural light. Sets of mouth mirrors and probes were used to assess for dental

caries and observation check list was completed. The investigator took approximately 10

minutes per subject. After each use, the instruments were washed with tap water, and

disinfected in 1:20 Savlon solution for 30 minutes. After identification of dental caries, 40

children with dental caries or tooth extraction or root canal treatment for dental caries and 80

children without dental caries were selected using purposive sampling technique. The children

were given the self-administered questionnaire on oral health practices. The tool was checked

for completion at the end. The children were thanked for their cooperation. On an average 10-

12 school children were examined per day.

PLAN FOR DATA ANALYSIS

Data analysis enables the investigator to reduce, summarize, organize, evaluate,

interpret and communicate numerical information. The data collected from subjects were

edited, compared and analyzed by using both descriptive and inferential statistical analysis.

The data was analyzed as follows:

Part 1 : Data on background factors will be analyzed using frequency, percentage and

Chi-square distribution

Part 2 : Data on oral health practices and dental caries will be analyzed using Chi-

square, Odds ratio and linear regression.

34

ETHICAL CONSIDERATION

The pilot and the main study were conducted after approval from the principal of SDA

Higher Secondary School, Ottapalam, Palakkad Dist. The research problem and objectives

were approved by the research committee. The purpose and the other details of the study

were explained to the study participants and verbal consent was obtained. Assurance was

given to the study subjects of their anonymity and the confidentiality of the data collected from

them. No physical or psychological pain was caused.

35

CHAPTER – IV

DATA ANALYSIS AND INTERPRETATION

Polit and Hunglar (2004) define analysis as the method of organizing data in such a

way that the research question can be answered. Interpretation is the process of making sense

of the result and of examining the simplifications of the findings within a broader context.

The analysis and interpretation of the study was based on the data collected from

students regarding oral health practices and dental caries in cases and control groups. The

results were computed using descriptive and inferential statistics. Analysis was done using

SPSS version 10 package. A probability of less than 0.05 level was considered to be

significant.

Objective of the study were to describe the association between dental caries and oral

health practices among cases and controls and to test the association between dental caries

and selected factors among cases and control.

The collected data were edited, tabulated, analyzed and the findings were presented in

the form of tables and diagrams under the following sections:

Section 1 : Data on demographic variables among cases and controls.

Section 2 : Data on association between dental caries and oral health practices

among cases and controls.

Section 3 : Data on association between dental caries and selected factors.

36

SECTION – I: DATA ON DEMOGRAPHIC VARIABLES AMONG CASES AND CONTROLS.

Figure 4 shows frequency and percentage distribution of school children in regard to

their age. Majority of cases 16 (40%) were in the age group of 15 years and least were 13

years old 6 (15%). Among the controls, majority 22 (27%) were 15 years old and least 18

(22.5%) were 13 years.

The obtained chi-square value of 0.95 (p>0.05) was not significant. It was inferred that

majority of cases and controls were 15 years old. Also cases and controls were comparable

with regard to age of school children.

37

Cases

15%(6)

17.5%(7)

27.5%(11)

40%(16)

12 yrs13 yrs14 yrs15 yrs

Controls

27%

25%(20)

22.5%(18)

25%(20)

Fig. 4: Frequency and percentage distribution of cases and cont

based on their age

χ2 = 2.797 p > 0.05

(22)

rols

38

Figure 5 shows frequency and percentage distribution of children regarding sex. Majority of the

cases 22 (55%) were males and least were females 18 (45%). Among the controls, majority 47

(59%) were males and least 33 (41%) were females.

The obtained chi-square value of 2.797 (p>0.05) was not significant. It was inferred

that majority of cases and controls were males. Also cases and controls were comparable with

regard to sex of school children.

55%(22)59%(47)

45%(18)41%(33)

0%

10%

20%

30%

40%

50%

60%

Male Female

CasesControl

Fig. 5: Frequency and percentage distribution base

Sex of the students

χ2 = 0.153 p > 0.05

d on

39

Figure 6 shows frequency and percentage distribution of children regarding religion. Majority of

the cases 20 (50%) belonged to Hindu religion and least were Muslims 8 (20%). Among the

controls, majority 60 (75%) were of Hindu religion and least 9 (11%) were Muslims.

The obtained chi-square value of 7.61 (p<0.05) was significant. It was inferred that

majority of cases and controls were of Hindu religion. But cases and controls were not

comparable regarding religion.

40

Cases50%(20)

20%(8)

30%(12)

Hindu

Christian

Muslim

Controls

11%(9

14%(11)

75%(60)

Fig. 6: Frequency and percentage distribution of cases and con

based on religion.

χ2 = 7.61p < 0.05

)

trols

41

Figure 7 shows frequency and percentage distribution of children regarding type of family.

Majority of the cases 28 (70%) were from nuclear family and least 5 (12.5%) were from

extended families. Among the controls, majority 53 (66%) were from nuclear family and least

12 (15%) were from joint family.

The obtained chi-square value of 0.78 (p<0.05) was not significant. It was inferred that

majority of cases and controls were from nuclear families. Also cases and controls were

comparable with regard to type of family of school children

.

42

Cases

12.5%(5)

17.5%(7)

70%(28)

NuclearJointExtended

Controls

15%(12)

66%(53)

Fig. 7: Frequency and percentage distribution cases and

based on type of family.

χ2 = 0.78p > 0.05

19%(15)

controls

43

Figure 8 shows frequency and percentage distribution of children regarding education of

mothers and dental caries. Majority of the mothers of cases 39(97.5%) were literate and least 1

(2.5%) was illiterate. Among the mothers of controls, majority 76 (95%) were literate and least 4

(5%) were illiterate.


majority of mothers of cases and controls were literate. Also cases and controls were

comparable with regard to education of mother.

44

Cases

2.5%(1)

97.5%(39)

LiterateIlliterate

Controls

95%(76)

5%(4)

Fig. 8: Frequency and percentage distribution of cases and controls

based on education of mother.

χ2 = 0.42p > 0.05

45

Figure 9 shows frequency and percentage distribution of children regarding occupation of

father. Majority of the fathers of cases 21(52.5%) were skilled workers and least 2 (5%) were

unskilled workers. Among the fathers of controls, majority 31 (38.6%) were business men and

least 3 (3.8%) were unskilled.

The obtained chi-square value of 8.65 (p<0.05) was significant. It was inferred that

majority of fathers of cases were skilled workers and majority of fathers of controls were

business men. Cases and controls were not comparable with regard to occupation of fathers.

46

Cases

32.5%(13)

10%(4)5%(2)

52.5%(21)

SkilledUnskilledProfessionalBusiness

Controls

3.8%(3)28.8%(23)

28.8%(23)

Fig. 9: Frequency and percentage distribution of cases and

based on occupation of father.

χ2 = 8.65p < 0.05

38.6%(31)

controls

47

Figure 10 shows frequency and percentage distribution of children regarding occupation of

mother. Majority of the mothers of cases 28(70%) were house wives and least 1 (2.5%) was

unskilled worker. Among the mothers of controls, majority 52 (65%) were house wives and

least 1 (1.3%) was unskilled worker.


majority of mothers of cases and controls were house wives. Also cases and controls were

comparable with regard to occupation of mothers.

48

Cases

22.5%(9)

2.5%(1)

70%(28)

5%(2)

HousewifeUnskilledSkilledProfessional

Controls

27.5%(

6.3%(5)1.2%(1)

65%(52)


based on occupation of mother.

χ2 = 0.68p > 0.05

22)

controls

49

Figure 11 shows frequency and percentage distribution of children regarding family income.

Majority of the cases 38(95%) were from families above the poverty line and least 2 (5%) from

families below poverty line. Among the controls, majority 77 (96.3%) were from families above

the poverty line and least 3 (3.8%) were from families below the poverty line.


majority of cases and controls were from families above the poverty line. Also cases and

controls were comparable with regard to family income of school children.

50

Cases

5%(2)

95%(38)

Above PovertylineBeow Poverty Line

Controls

3

96.3%(77)

Fig. 11: Frequency and percentage distribution of cases an

based on family income.

χ2 = 0.10p > 0.05

.7%(3)

d controls

51

Figure 12 shows frequency and percentage distribution of children regarding incidence of

dental caries among family members. Majority of cases 11 (27.5%) of mothers have dental

caries and least 4 (10%) of grandparents have dental caries. Among the controls, majority 27

(33.8%) has no dental caries among family members and least 4 (5%) of grandparents have

dental caries.


majority of mothers among cases had dental caries and majority among controls had none in

the family with incidence of dental caries. Also cases and controls were comparable with regard

incidence of dental caries among family members.

52

Cases

22.5%(9)

10%(4)20%(8)

27.5%(11)

20%(8)

FatherMotherSiblingsGrandparentsNone

Controls

33.8%

5%(4)17.5%(14)

27.5%(22)

16.3%(13)

Fig. 12: Frequency and percentage distribution of cases and co

based on incidence of dental caries among family members

χ2 = 2.43 p > 0.05

(27)

ntrols

.

53

Figure 13 shows frequency and percentage distribution of children regarding initiation of

brushing. Majority of the cases 22(55%) initiated brushing between the ages 2-3 years and

least 1 (2.5%) initiated brushing between 4-5 years. Among the controls, majority 41 (51.3%)

initiated brushing between the ages 2-3 years and least 4 (5%) initiated brushing between 4-5

years.


majority of cases and controls initiated brushing between the ages 2-3 years. Also cases and

controls were comparable with regard to initiation of brushing in school children.

54

Cases20%(8)

22.5%(9)

2.5%(1)

55%(22)

Less than 2 yrs2-3 yrs4-5 yrsDo not know

Controls

16.3%(1

27.5%(2

5%(4)

51.3%(41)


based on initiation of brushing.

χ2 = 0.94 p > 0.05

3)

2)

controls

55

SECTION II : DATA ON ASSOCIATION BETWEEN DENTAL CARIES AND

ORAL HEALTH PRACTICES AMONG CASES AND CONTROLS.

For the purpose of the studies, the following null hypothesis was stated.

H01 – There will be no association between dental caries and oral health practices


TABLE – 1

Frequency, percentage, chi-square value and odd’s ratio among cases and

controls regarding dental caries and oral health practices.

Cases n=40 Control n=80

Oral Health Practices No. % No. %

Chi-square

df = 1

(p)

Odds ratio

(CI=95%)

Dental Cleaning

Practices

Inadequate

Adequate

10

30

25

75

7

73

9

91

5.79

p=0.016

S

2.02

(1.226-

3.326)

Brushing Techniques

Inadequate

Adequate

17

23

42.5

57.5

31

49

39

61

0.156

p=0.69

NS

1.109

(0.666-

1.845)

Oral Hygiene Practices

Inadequate

Adequate

9

31

22.5

77.5

18

62

22.5

77.5

0.000

p=1.000

NS

1.000

(0.546-

1.833)

56

Cases n=40 Control n=80

Oral Health Practices No. % No. %

Chi-square

df = 1

(p)

Odds ratio

(CI=95%)

Care Against

Detrimental Habits

Inadequate

Adequate

12

28

30

70

17

63

21

79

1.114

p=0.291

NS

1.345

(0.79-

2.289)

Caries Preventive

Practices

Inadequate

Adequate

40

0

100

0

70

10

87.5

12.5

5.455

p=0.020

S

NA

Total Oral Health

Practices

Inadequate

Adequate

30

10

75

25

22

58

27.5

72.5

24.502

p=0.001

S

3.923

(2.115-

7.278)

NA=Not Applicable S=Significant NS=Non Significant

Table-1 describes frequency, percentage and chi-square values and odd’s ratio in

cases and controls regarding oral health practices and dental caries.

Regarding dental cleaning practices, more number of cases 10 (25%) than controls 7

(9%) had inadequate dental cleaning practices. Also more number of controls 73 (91%) than

the cases 30 (75%) had adequate dental cleaning practices. There was significant association

between dental cleaning practices and dental caries. χ2=5.79(p<0.05) among cases. Further

57

the obtained odds ration OR=2.02[CI95%=1.226-3.3] suggests that children with inadequate

dental cleaning practices had 2 times higher risk of getting dental caries.

Regarding brushing technique, more number of cases 17 (42.5%) than controls 31

(39%) had inadequate brushing technique. Also more number of controls 49 (61%) than cases

23 (57.5%) had adequate brushing technique. However there was no significant association

between brushing technique and dental caries χ2=0.156 (p>0.05) among cases.

Regarding oral hygiene practices, the number of cases 9 (22.5%) and controls 18

(22.5%) with inadequate oral hygiene practices were equal. Also the number of controls 62

(77.5%) and number of cases 31 (77.5%) with adequate oral hygiene practices were equal.

There was no significant association between oral hygiene practices and dental caries.

χ2=000(p>0.05) among cases.

Regarding care against detrimental habits, more number of cases 12 (30%) than

controls 17 (21%) had inadequate practice of care against detrimental habits. Also more

number of controls 63 (79%) than cases 28 (70%) had adequate practices of care against

detrimental habits. There was no significant association between oral hygiene practices and

dental caries. χ²=1.114(p>0.05) among cases.

Regarding caries preventive practices, all the cases 40(100%) had inadequate

caries preventive practices and controls 70 (87.5%) had inadequate caries preventive

practices. Also among the controls 10 (12.5%) had adequate caries preventive practices

whereas none among cases had adequate caries preventive practices. There was significant

association between caries preventive practices and dental caries χ²=5.455(p<0.05) among

cases.

58

Regarding total oral health practices, more number of cases 30 (75%) than controls

22 (27.5%) had inadequate oral hygiene practices. Also more number of controls 58 (72.5%)

than cases 10 (25%) had adequate oral health practices. There was significant association

between oral health practices and dental caries. χ²=24.502 (p<0.05) among cases. Further the

obtained odds ratio OR=3.923[CI 2.115-7.278] suggests that children with inadequate oral

hygiene practices had 4 times higher risk of getting dental caries.

59

TABLE – 2

Logistic regression on determinants related to oral health practices and

dental caries

Oral health practices SE AOR signific

ance CI=95%

Dental cleaning practices

Brushing technique

Oral hygiene practices

Care against detrimental habits

Total oral health practices

.898

.771

.946

.800

1.100

.355

2.720

5.293

.001

18.977

.551

.099

.021

.978

.001

-2.294 to 1.225

-0.239 to 2.781

0.322 to 4.031

-1.545 to 1.591

-6.945 to -2.635

Table 2 describes the SE, AOR, significance and CI in cases and controls regarding

oral health practices and dental caries

The obtained adjusted odd’s ratio regarding dental cleaning practices AOR=0.355

(p=0.551), Brushing technique AOR=2.720 (p=0.099) and Care against detrimental habits

AOR=0.001 (p=0.978) were not significant, therefore the null hypothesis H01 was accepted.

Oral hygiene practices AOR=5.293 (p=0.021) and total oral health practices AOR=18.977

(p=0.001) were independently associated with dental caries.

It was inferred that oral hygiene practices and total oral health practices were

independently associated with dental caries. However the oral hygiene practices and total oral

health practices AOR=5.293 (p<0.05) and AOR=18.977 (p<0.001) were significantly associated

with dental caries.

60

SECTION - III: DATA ON ASSOCIATION BETWEEN DENTAL CARIES AND

SELECTED FACTORS AMONG CASES AND CONTROLS.

For the purpose of the study, the following null hypothesis was stated:

H02 : There will be no significant association between dental caries and selected

factors among cases and controls.

TABLE – 3

Logistic regression regarding association of demographic variables and dental caries

Demographic factors SE AOR significance

Age Sex Education of mother Occupation of father Occupation of mother Family income Decayed tooth in family members Initiation of brushing

1.026 0.726 2.916 1.222 1.614 2.669 1.209 1.184

3.556 1.645 2.525 4.802 0.061 0.589 0.412 6.061

0.059 0.200 0.112 0.028 0.805 0.443 0.521 0.014

The obtained adjusted odd’s ratio regarding age AOR=3.556(p=0.059), sex

AOR=1.645 (p=0.200), education of mother AOR=2.525 (p=0.112), Occupation of mother

AOR=0.061 (p=0.805); Family income AOR=0.589 (p=0.443); Decayed tooth in family

members AOR=0.412 (p=0.521) were not significant, therefore the null hypothesis H02 was

accepted. Occupation of father AOR=4.802 (p=0.028) and initiation of brushing AOR=6.061

(p=0.014) were independently associated with dental caries.

It was inferred that occupation of father and initiation of brushing were independently

associated with dental caries. However, the occupation of father AOR=4.802 (p<0.05) and

initiation of brushing AOR=6.061 (p<0.05) were significantly associated with dental caries.

61

CHAPTER – V

SUMMARY, FINDINGS, DISCUSSION, IMPLICATIONS,

RECOMMENDATIONS AND CONCLUSION

This chapter gives a brief account of the present study including conclusions drawn from

the findings, recommendations, limitations and suggestions for further studies and nursing

implications.

SUMMARY

The primary aim of this study was to find out the association between Oral health practices

and Dental caries among cases and controls.

The objectives of the study were,

• To describe the association between Oral health practices and Dental caries among

cases and controls.

• To test the association between Dental caries and selected factors among cases and

controls.

The study attempted to prove the following hypothesis

H1 : There will be a significant association between dental caries and oral health

practices among cases and control group.

H2 : There will be a significant relationship between dental caries and selected

factors among cases and control group.

62

The review of related literature enabled the investigator to develop the conceptual

framework, tools and methodology, which is the corner stone of this study. Literature review

done for the present study was organized under the following headings: studies on dental

caries, studies on oral health practices and studies on dental caries and oral health practices.

The conceptual framework was developed by the investigator, based on KAP model.

The research approach used was a case control design. A semi structured

questionnaire was used to collect the data. The content validity was done by six experts

including three dentists and three nursing personnel. The tool was found to be reliable and

feasible by test retest method. The reliability co-efficient r=0.88, was high.

The pilot study was conducted among 10 students in which 5 were cases and 5 were

controls and the tool was found to be feasible.

The main study was done at a selected school in Palakkad district, among 120 school

children (40 cases, 80 controls) who were selected by purposive sampling. The data gathered

were analyzed by using descriptive and inferential statistical methods . SPSS version 10 was

used for data analysis. The findings were presented on the basis of objectives of the study.

CHARACTERISTICS OF STUDY SAMPLES

Majority of school children among cases were 15 year olds 16 (40%), were males 22

(55%), were of Hindu religion 20 (50%), were from nuclear families 28 (70%), mothers were

literate 39 (97.5%), fathers were skilled workers 21 (52.5%), mothers were house wives 28

(70%), were from families above poverty line 38 (95%), had highest incidence of dental caries

among mothers 11 (27.3%) and initiated brushing between the ages of 2-3 years 22 (55%).

63

Majority of school children among controls were 15 year olds 22 (27%), were males 47

(59%), belonged to Hindu religion 60 (75%), were from nuclear family 53 (66%), mothers were

literate 76 (95%), fathers were business men 31 (38.6%), mothers were house wives 52 (65%)

were from families above poverty line 77 (96.3%), reported none in the family had dental caries

27 (33.8%) and initiated brushing between the ages of 2-3 years 41 (51.3%).

FINDINGS

Major findings of the study were presented under the following headings based on the

study objectives.

Objective 1- To describe the association between Oral health practices and

Dental caries among cases and controls.

• The Oral Hygiene Practices was independently associated with dental caries.

AOR=5.293 (p<0.05). [CI 95% = 0.322 - 4.031]

• Total Oral Health Practices were independently associated with dental caries.

AOR=18.977 (p<0.001). [CI 95% = -6.945 - -2.635]

• There was significant association between Total Oral Health Practices.

χ2 =24.502(p<0.05). The OR =3.9 suggests 3.9 times higher risk of dental caries in

cases.

• There was significant association between Dental Cleaning Practices and Dental

Caries among cases and controls. χ2 =5.79(p<0.05). The OR=2.02 suggests 2.02

times higher risk of dental caries among cases.

• There was significant association between caries preventive practices and dental

caries. χ2 =5.455(P<0.05).

64

• There was no significant association between brushing technique and dental caries

among cases and controls. χ2 =.156(p-..05), OR=1.109.

• There was no significant association between oral hygiene practices and dental

caries among cases and controls. χ2 =.000(p>.05), OR=1.0.

• There was no significant association between care against detrimental habits and

dental caries. χ2 =1.114(p>.05) OR=1.345.

Objective 2: To test the association between dental caries and selected factors


• There was significant association between occupation of father and dental caries

among cases and controls. AOR=4.802 (p<0.05)

• There was significant association on initiation of brushing and dental caries.

AOR=6.061 (p<0.05).

• There was no significant association between age and dental caries among cases

and controls. AOR=3.556 (p>0.05).

• There was no significant association between sex of the students and dental caries.

AOR=1.645 (p>0.05)

• There was no significant association between education of mother and dental caries.

AOR=2.525 (p>0.05).

• There was no significant association between occupation of mother and dental

caries. AOR=0.061 (p>0.05).

• There was no significant association between family income and dental caries.

AOR=0.589 (p>0.05).

• There was no significant association between decayed tooth in family members and

dental caries. AOR=0.412 (p>0.05).

65

DISCUSSION

Results of the study have been discussed based on the findings of the study.

Findings-1: Findings on the association between oral health practices and dental

caries among cases and controls.

• The Oral Hygiene Practices was independently associated with dental caries.

AOR=5.293 (p<0.05). [CI 95% = 0.322 - 4.031]

• Total Oral Health Practices were independently associated with dental caries.

AOR=18.977 (p<0.001). [CI 95% = -6.945 - -2.635]

• There was significant association between Total Oral Health Practices.

χ2 =24.502(p<0.05). The OR =3.9 suggests 3.9 times higher risk of dental caries in

cases.

• There was significant association between Dental Cleaning Practices and Dental

Caries among cases and controls. χ2 =5.79(p<0.05). The OR=2.02 suggests 2.02

times higher risk of dental caries among cases.

• There was significant association between caries preventive practices and dental

caries. χ2 =5.455(P<0.05).

• There was no significant association between brushing technique and dental caries

among cases and controls. χ2 =.156(p-..05), OR=1.109.

• There was no significant association between oral hygiene practices and dental

caries among cases and controls. χ2 =.000(p>.05), OR=1.0.

• There was no significant association between care against detrimental habits and

dental caries. χ2 =1.114(p>.05) OR=1.345.

66

The above findings were supported by Zhu L. et.al (2003) in a study to describe oral

health behavior, illness behavior, oral health knowledge and attitudes among children reported

that 44.4% of the respondents brushed their teeth twice a day but only 17% used fluoridated

toothpaste. 40.5% visited a dentist and the risk of dental caries was high in the case of

frequent consumption of sweets and dental caries risk was low for participants with use of

fluoridated toothpaste. Sebastian D (2001) in a study on Oral Health Problems of school

children and the knowledge and practice of their mother regarding oral health and oral health

problems, reported that the prevalence of oral health problems was high (70%) among school

children. Clark P. et al., (2001) in a study to identify toddlers who had an increased risk of

developing dental decay at school age reported that good oral hygiene practices can have an

impact on future dental health and care givers should be encouraged to brush young children’s

teeth regularly.

Finding-2: Dental caries and findings on association between dental caries and selected

factors among cases and controls.

• There was significant association between occupation of father and dental caries

among cases and controls. AOR=4.802 (p<0.05)

• There was significant association on initiation of brushing and dental caries.

AOR=6.061 (p<0.05).

• There was no significant association between age and dental caries among cases

and controls. AOR=3.556 (p>0.05).

• There was no significant association between sex of the students and dental caries.

AOR=1.645 (p>0.05)

• There was no significant association between education of mother and dental caries.

AOR=2.525 (p>0.05).

• There was no significant association between occupation of mother and dental

caries. AOR=0.061 (p>0.05).

67

• There was no significant association between family income and dental caries.

AOR=0.589 (p>0.05).

• There was no significant association between decayed tooth in family members and

dental caries. AOR=0.412 (p>0.05).

The above findings were supported by Amin T.T. et. al (2008) assessed oral hygiene

practices, dental knowledge, dietary habits, and their relationship to caries among Saudi male

students reported clinically decayed tooth in 68.9% of children. Only 24.5% students brushed

their teeth twice or more per day. Step wise logistic regression analysis revealed that maternal

working conditions, large family size and poor oral hygiene practices were the chief predictors

for dental caries. Al Malik (2001) in a study on relationship between erosion and caries

reported that there was significant relationship on dietary habits, socio-demographic measures

and oral hygiene practices.

However, the above results were not supported by Shanthi S et al (2009) who

evaluated the effectiveness of structured teaching program on oral hygiene in terms of

knowledge attitude and practice among school children which revealed that there was no

significant relationship between knowledge, attitude and practice levels of the subjects and

demographic variables and the overall prevalence of oral problems was 77.5%.

IMPLICATIONS

The findings of the study have implications in nursing service, in the hospital and

community and nursing research.

In Nursing Service

• The nursing personnel should provide special attention to the oral health of

children.

• The nurses should promote oral health practices such as brushing twice a day

using dentifrice with fluoride, avoiding sweets in between and using proper

brushing technique.

68

• The nurses should promote good oral hygiene practices such as washing and

gargling of mouth after food and change of brush every 3 months.

• The nurse should promote caries preventive practices such as eating balanced

diet which includes fruits and vegetables, drinking adequate water and regular

dental visits.

In Community

• The nurse should promote good oral health practices among children.

• The nurse can conduct programmes to promote oral health practices and

awareness of dental problems such as dental caries.

• The nurse can teach the children proper brushing technique and oral hygiene

practices.

In School

• The school teachers can be trained for imparting oral health education.

• The school curriculum should include topics on oral health practices.

Nursing Research

• Interventional studies can be under taken to test the effectiveness caries

preventive practices such as use of denitrifies with fluoride, sugar free chewing

gum which contains xylitol. (eg. Orbit)

LIMITATIONS

• Samples were selected using non-random method i.e., purposive sampling.

• The data was collected using self-administered questionnaire

• The data was collected from only one institution.

69

PERSONAL EXPERIENCE

• The investigator has gained a lot of new information and experience in many ways

starting from the searching of research problem till the submission of the report.

• The investigator did not have any problem in selecting the samples.

• All the participants who participated in the study understood the purpose of the

study and were very co-operative.

• Apart from the struggle and tension, doing research was quite interesting and

helpful.

RECOMMENDATIONS

The following recommendations are offered by the researcher.

• Longitudinal study can be done to assess the occurrence of dental caries.

• Studies can be done to assess the knowledge and attitude on prevention of dental

caries.

• Cross sectional study can be done on a large population to study the prevalence of

dental caries.

CONCLUSION

There was significant association between oral health practice and dental caries

among cases and there was significant association between occupation of father and initiation

of brushing among selected factors. The children need to start their oral hygiene practices in

their tender ages and parents need to be role models.

70

REFERENCES

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Bangalore.

3. Behrman R E, Nelson (1990) “Text book of pediatrics”, 13th edition. W B Saunders

Publications, Philadelphia.

4. Bonnie Bullough, Vern Bullough (1990) “Nursing in the community”, 1st edition, C.V

Mosby company, Missouri.

5. Carol Jean W. S, Merrily Forbes Crowley (1980) “Nutrition, Principles and

Application in health promotion”, 2nd edition, J.B Lippincott Company,

Philadelphia.

6. Dorothy R Marlow, Barbara A Redding, (1998), “Text Book of Pediatric Nursing”, 6th

edition, Harcourt Brace Publications, Philadelphia.

7. George WS, William G.C (1994) “Statistical methods”, 8th edition, Affiliated East

West Press pvt Ltd.

8. Gupta and Mahajan (2003) “Text book of preventive and social medicine”, 3rd

edition., Jaypee Brothers publications, New Delhi.

9. Kothari CR, “Research methodology”, New Age International (P) Ltd. Publishers,

New Delhi.

10. Marcia Stanhope, Jeanette Laneaster (2004) “Community and public health

Nursing”, 6th edition, Mosby, USA.

11. Polit and Hunger (2004) “Nursing Research principles and methods”, Lipincott

publications, Philadelphia.

71

12. Rajendran R, Sivapatha Sundaram B (2009) “Shafer’s Textbook of Oral Pathology”,

6th edition, Elsevier, Noida.

13. Satya Gupta(1996) “Pediatrics”, 3rd edition, New age International Ltd. New Delhi.

14. Susan Clement Stone, “Comprehensive family and community health Nursing”,

Mosby.

15. Wagle C.S (1993) “A short text book of pediatrics”, Bombay, vora medical

publications

16. Wong L. Donna (2006) “Nursing care of infants and children”, 5th edition., Mosby

publications, USA.

JOURNALS

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Australian dental journal, 54(1) pp 66-69.

2. Slade G.D (2008) “Impact of dental care in oral health related quality of life and

treatment goals among elderly adults”, Australian dental journal, 53(1) pp 65-68.

3. Roberts K, Thomson, Stewart JF (2008) “Risk indicators of caries experience among

young adults”, Australian dental journal, 53(2) pp 122-127.

4. Armfield JM, Spencer AJ (2008) “Quarter of a century of change: caries experience in

Australian children”, Australian dental journal, 53(2) pp 110-113.

5. Aiuch H, Kitasako Y et al (2008) “Remineralization of white spot lesions scientific

evidence”, Australian dental journal, 53(3) pp 167-171.

6. Patro B.K et al (2008) “Prevalence of dental caries among adults and elderly”, Indian

journal of dental research, March, pp 95-98.

7. (2009)-“Healthy teeth”, Nurses of India, Feb, pp 6-8

8. Salma (2000) “Dentition and dental health”. The Nursing journal of India, Vol LXXXX

(5) pp 102-104.

72

9. Doofode V.V, Ambedkhar N.N (2000) “Assessment of oral health status and its

association”, Indian journal of medical sciences, 154(7) pp 261-268.

10. Craig (2000) “Fluorides and the prevention of dental decay”, British dental Journal,

188(12) p 654.

11. Alonge O.K, Varendran S (1999) “Dental caries experience among school children”,

Community dental health 16(1) pp 45-49.

12. Zero Dt et al (2009) “The biology, prevention, diagnosis and treatment of dental caries:

scientific advances in the US” Journal of American Dental Association, Sept.

140, Suppl.1:255-345.

13. Amin T.T, Al-Abad B M (2008) “ oral hygiene practices, dental knowledge, dietary

habits and their relation to caries among male primary school children.

International Journal of Dental hygiene, Nov; 6(4): 361-370.

14. Rehman M M, Mahmood N, Rehman B (2008) “The relationship of caries with oral

hygiene status and extra oral risk factors” Journal Ayub Medical College,

Abbottabad. Jan-March; 20(1): 103-108.

15. Roberts M W (2008) “Dental health of children; where we are today and remaining

challenges” Journal of clinical pediatric Dentistry. Spring; 32(3): 231-234.

16. Du M, Luo Y, et al (2007) “caries in preschool children and its risk factors;

Quintessence International, Feb; 38(2): 143-151.

17. Santos N D et al (2007) “oral health among adolescents; aspects relating to hygiene,

dental cavities and periodontal disease”. Cien Saude Colet, Sept-oct; 12 (5);

1155-1166.

18. Hilton J V, et.al (2007) “cultural factors and children’s oral health care”, Community

Dental oral Epidemiology, Dec; 35(6): 429-438.

19. Gordon N (2007) “oral health care for children attending a malnutrition clinic in South

Africa”. International Journal on Dental Hygiene. Aug; 5(3): 180-186.

20. Ahmed N A et.al (2007) “Dental caries prevalence and risk factors, International Dental

Journal. Feb; 57(1): 36-44.

73

21. Kahabuka F K (2006) “Oral health knowledge and practices”. International Journal of

Dental Hygiene. Nov; 4 (4): 174-178.

22. Mumghamba E G, et.al (2006) “Oral hygiene practices, periodontal conditions,

dentition status and self reported bad mouth breath International Journal of

Dental Hygiene. Nov; 4(4): 166-173.

23. Knoshkowy B, Sgan Cohen H D (2005) “Oral health practices among adolescents.

International Journal on Adolescent medical Health. April-June; 17(2): 99-104.

24. Mahesh K P, et.al (2003) “Oral health status of 5 year olds and 12 years school

children”, Journal of Indian social pedod preventive dentistry. March; 23(1): 17-

22.

25. Simon C et al (2003) “Assessment of the oral health status of school children in Addis

Ababa”, Ethiopia medical journal, July; 41(3):245-256.

26. Ogawa H et al (2003) “A pilot study on dental caries status in relation to knowledge,

attitudes and practices in oral health. Asia pacific journal of public health.

15(2):117-119.

27. Dye B.A et al (2004) “The relationship between healthful eating practices and dental

caries ”, journal of American Dental Association. Jan; 135(1): 55-66.

28. Jose B.A, King N.M (2003) “Early childhood carious lesions in preschool children”,

pediatric dentistry. Nov-Dec; 25(6):594-600.

29. Zhu L et al (2003) “Oral health knowledge, attitudes and behavior of children and

adolescents”, International dental journal. Oct; 53(5); 289-298.

30. Christensen L.B et al (2003) “Oral health and oral health behavior”, community dental

health. Sep;20(3):153-158.

31. Rajab L.D (2002) “Oral health behavior of school children and parents”, International

journal of pediatric dentistry. May; 12(3): 168-176.

74

UNPUBLISHED THESIS

1. Prusty M (2008), “A correlative study on oral health status and oral health practice

among tobacco consumers in selected villages in Orissa” . A dissertation

submitted for M Sc Nursing at Dr M G R Medical University, Chennai.

2. Sebastian D (2001), “ A case control study on oral health problems of school children

and the knowledge and practice of their mothers’ regarding oral health and oral

health problems in a selected school at Trichy in Tamil Nadu”. A dissertation

submitted for M.Sc Nursing at Dr M G R Medical University, Chennai.

3. Sheela Devi (2009), “A case control study on stressors and nail biting among students

in selected schools at Dindigul District”. A dissertation submitted for M.Sc

Nursing at Dr M G R Medical University, Chennai.

4. Titu S K (2005), “A case control study on low visual acuity and watching television

among school children in a selected school at Komarapalayam, Namakkal

District, Tamil Nadu”. A dissertation submitted for M Sc Nursing at Dr M G R

Medical University, Chennai.

INTERNET SOURCES

1. www.google.com

2. www.medline.com

3. www.pubmed.com

4. www.yahoo.com

75

http://www.google.com/

http://www.medline.com/

http://www.pubmed.com/

http://www.yahoo.com/

APPENDIX – I

APPENDIX – II

LETTER SEEKING PERMISSION FOR CONTENT VALIDITY

From 30083613, 2nd Year M.Sc., Nursing, Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam, 638183 Namakkal Dist. To Respected Sir/Madam

Subject: Letter requesting opinion and suggestions for establishing content validity of the tool.

I am a post graduate student at Annai JKK Sampoorani Ammal College of Nursing. As per the partial fulfillment of the nursing degree under the Dr MGR Medical University, Chennai, I have selected the following topic for my dissertation. Topic: “A case control study on dental caries and oral health practices among school children in a selected school in palakkad Dist”. In connection with my dissertation I have developed a questionnaire on oral health practices and a screening form for dental caries. Tool consists of Part-I: Back ground factors Part-II: Questionnaire on oral health practices Part-III: Screening form for dental caries. Here with I enclose: Tool, Validation criteria, Dental Caries screening form.

I kindly request you to go through the items and give your valuable suggestions and opinions to develop the content validity of the tool. Thanking you, Yours sincerely, Place: Date: (30083613)

APPENDIX – III

CONTENT VALIDITY CERTIFICATE

Name :

Designation :

Name of the college :

I hereby certify that I have validated the tool of ___________, M.Sc., Nursing II Year

student, who is undertaking “A case control study on dental caries and oral health practices on

school children in a selected school in Palakkad District”.

Signature of the expert.

Place:

Date:

APPENDIX – IV

LIST OF EXPERTS

1. Dr. SUKUMARI ELAVARSU MDS HOD, Periodontia,

JKKNDC Komarapalayam.

2. Dr. ELAVARSU BDS

Sambu Dental Clinic Komarapalayam

3. Dr. ANURADHA SUNIL MDS

HOD, Oral Pathology Royal Dental College, Chalissery, Thrissur District

4. Dr. Mrs. TAMILMANI, M.Sc., (N), Ph.D.,

Principal Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam

5. Mrs. KAVIMANI MSc (N)

Principal SPM College of Nursing, Erode.

6. Mrs. THANGAMANI MSc (N)

HOD, OBG Dept. Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam.

APPENDIX – V

LETTER SEEKING PERMISSION TO CONDUCT RESEARCH STUDY

From 30083613 M.Sc., Nursing II year Annai JKK Sampoorani Ammal College of Nursing Komarapalayam-638183, Namakkal Dist To The principal SDA H igher secondary school, Kanniampuram (po) Ottapalam, palakkad Dist. Through The Dean, Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam-638183 Respected Sir,

Sub: Requesting permission to conduct research study in your school regarding- I am 30083613 2nd Year M.Sc., Nursing student of Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam, Under the Tamil Nadu Dr MGR. Medical University. I am conducting “A case control study on dental caries and oral health practices among school children”. I request your permission to conduct the study in your school. I promise you that all matters concerned with the research study will be kept confidential and it will not bring any inconvenience to your institution or to the students. Thanking you,

Yours sincerely, Place: Date: (30083613)

APPENDIX – VI

CERTIFICATE OF COMPLETION OF RESEARCH STUDY

APPENDIX – VII

QUESTIONNAIRE ON ORAL HEALTH PRACTICES

PART – I

BACKGROUND DATA

Instructions:

The following questions seek information about you and your background. Please

respond by placing a tick mark ( ) in the place given. Do answer all the questions.

1) Age of the student

a) 12

b) 13

c) 14

d) 15

2) Sex of the student

a) Male

b) Female

3) Religion

a) Hindu

b) Christian

c) Muslim

d) Any other, specify _______________

4) Type of family

a) Nuclear (Only parents and children)

b) Joint family (Parents, Grand parents, uncles, and Aunties)

c) Extended family (Parents and Grand parents)

5) State the educational status of your mother

a) Illiterate (Can not read or write)

b) Literate (Can read and write)

6) State the occupation of your father

a) Unemployed

b) Unskilled (coolie worker)

c) Skilled (mechanic, electrician etc.)

d) Professional (doctor, teacher etc.)

e) Others---------------

7) State the Occupation of your mother

a) House wife

b) Unskilled (coolie)

c) Skilled (tailoring etc.)

e) Professional (doctor, teacher etc.)

8) State the income of your family (per month) Rs._______________

a) Below poverty line (< Rs. 24, 000)

b) Above Poverty line (> Rs. 24, 000)

9) Which of the following family members suffer from tooth decay?

a) Father

b) Mother

c) Brothers/Sisters

d) Any other __________ (Specify)

10) At what age did you start brushing your teeth?

a) Less than 2 years

b) 2-3 years

c) 4-5 years

d) Do not know

e) Any other--------------

ORAL HEALTH PRACTICES

PART –II

Instruction:

This section seeks information regarding your activities related to oral health. There is

right or wrong response. Therefore, choose that response which best suits you by placing a

( ) mark in the given box against the chosen response.

1) When do you brush your teeth?

a) Morning only

b) Morning and bed time

c) Morning afternoon and bed time

d) Any other-----------

2) What do you use for brushing your teeth?

a) Tooth brush

b) Finger

c) Neem stick

d) Any other---------

3) What type of tooth brush do you use?

a) Soft bristled

b) Medium

c) Hard

d) Not applicable

4) What material do you use for brushing your teeth?

a) Tooth paste with fluoride

b) Tooth paste without fluoride

c) Tooth powder

d) Charcoal

e) Any other----------------

5) How much tooth paste do you use for each brushing?

a) Pea sized

b) 1/2 of the brush

c) 3/4 of the brush

d) Any other----

e) Not applicable

6) How long do you brush your teeth?

a) 4-5 minutes

b) 1-3 minutes

c) Less than one minute

d) Any other------------

(If you use tooth brush, answer the questions from 7-9)

7) How do you brush the front part of your teeth?

a.

b. c.

8) How do you brush the chewing surface of the teeth?

a. b. c.

9) How do you brush the inner part of the teeth?

a. b. c.

10) Do you wash and gargle your mouth after meals?

a) Every time

b) Some times

c) Rarely

d) Never

11) Do you wash and gargle mouth after eating snacks or sweet sticky food?

a) Every time

b) Some times

c) Rarely

d) Never

12) Do you massage your gums daily following brushing?

a) Every time

b) Some time

c) Rarely

d) Never

13) How often do you change your tooth brush?

a) Once in three months

b) Once in six months

c) Yearly

d) Any other

e) Not applicable

14) How do you remove food particles from between teeth?

a) Dental floss

b) Tooth picks

c) Pin/needle

d) Neem stick

e) Broom stick

f) Any other, specify------------

15) How often do you eat sweets/chocolates in between meals?

a) Often

b) Sometimes

c) Rarely

d) Never

16. Do you take bed coffee/Tea before brushing in the morning?.

a) Always

b) Sometimes

c) Rarely

d) Never

17) How often do you eat variety of fruits daily?

a) Always

b) Sometimes

c) Rarely

d) Never

18) How often do you have milk in your diet?

a) Always

b) Sometimes

c) Rarely

d) Never

19) How often do you eat raw vegetables with food?

a) Always

b) Sometimes

c) Rarely

d) Never

20) How often do you eat sugar free chewing gum (eg. Orbit) after meals?

a) Always

b) Sometimes

c) Rarely

d) Never

21) How many glasses of water do you drink per day?

a) 4 -6 Glass

b) 6- 8 Glass

c) Less than 4 Glasses

d) More than 8 Glass

22) How often do you visit the dentist?

a) Once in 6 months

b) Once in a year

c) Whenever there is a problem

d) Never

e) Any other-----------------

APPENDIX - VIII SCORING KEY

PART – II

7 a) 3

b) 2

c) 1

d) 0

8 a) 1

b) 2

c) 3

d) 0

9 a) 3

b) 2

c) 1

d) 0

10 a) 3 b) 2

c) 1

d) 0

11 a) 3 b) 2

c) 1

d) 0

18 a) 3

b) 2

c) 1

d) 0

19 a) 3

b) 2

c) 1

d) 0

20 a) 3

b) 2

c) 1

d) 0

21 a) 1

b) 2

c) 0

d) 3

22 a) 3

b) 2

c) 1

d) 0

12 a) 3 b) 2

c) 1

d) 0

13 a) 2 b) 1

c) 0

14 a) 3 b) 2

c) 0

d) 1

e) 1

15 a) 1

b) 2

c) 3

d) 0

16 a) 1

b) 2

c) 3

d) 0

17 a) 3

b) 2

c) 1

d) 0

1. a) 1

b) 2

c) 3

2. a) 3

b) 2

c) 1

3 a) 1

b) 3

c) 2

4 a) 3

b) 2

c) 1

d) 0

5. a) 1

b) 3

c) 2

6. a) 3

b) 2

c) 1

SCREENING FORM FOR DENTAL CARIES

To be filled by the investigator

IDENTIFICATION DETAILS

Name of the student _______________________

Class _______________________

SCREENING CRITERIA

DENTITION

8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8

8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8

I. DENTAL CARIES OBSERVATION

S.no Observation Present Absent

1 Brownish gray or black discoloration on the tooth.

2. Food impaction

3 Sensitivity to hot/cold

5 Pain

5. Swelling

6. Catch on teeth due to undermined enamel.

II. Number of filled teeth __________________

III. Number of root canal treatment done_________________

IV. Did you ever have tooth extractions Yes/No

1. If Yes state the reason for the extractions.

a. Dental Caries

b. Other reasons

V. Other pathologic conditions Gingivits/ Abscess/Periodontal Disease

Impression: Case / Control

Signature

ABSTRACT

A case control study on dental caries and oral health practices among students in a

selected school in Palakkad District was undertaken by 30083613 as a partial fulfillment of the

requirement for the award of the degree of Master of Science in Nursing, at Annai J.K.K

Sampoorani Ammal College of Nursing, Komarapalayam, under the Tamil Nadu Dr M.G.R.

Medical University, Chennai during the year 2008-2010.

The objectives of the study were to describe the association between oral health

practices and dental caries among cases and controls and to test the association between

dental caries and selected factors among cases and controls.

The research hypotheses formulated was that there will be significant association

between dental caries and oral health practices among cases and controls and that there will

be significant relationship between dental caries and selected factors in cases and control

group.

The review of literature was done under the following headings, studies on dental

caries studies on oral health practices and studies on dental caries and oral health practices.

Conceptual framework was based on knowledge, attitude and practice model. Only

practice was included in the study.

The research design used was case control design. The sample size was 120 (40

cases and 80 controls) in a selected school in Palakkad District. The study samples were

selected by purposive sampling technique after the screening procedure. The data was

collected by using a structured questionnaire developed by the investigator. The data obtained

were edited, organized, analyzed and interpreted by using SPSS package (version 10).

The findings of the study revealed that there was significant association between oral

health practices and dental caries. Occupation of father and initiation of brushing were

independently associated with dental caries among selected factors.

Findings, implications and recommendations were clearly stated in the study.

A CASE CONTROL STUDY ON DENTAL CARIES AND...

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