September 1986, Volume 36, Issue 9

Original Article

DENTAL HEALTH OF PRESCHOOL CHILDREN IN PESHAWAR IN RELATION TO THEIR DIETARY AND ORAL HYGIENIC HABITS

Dilshad  ( College of Home Economics, University of Peshawar, Peshawar. )
Naila Kail  ( College of Home Economics, University of Peshawar, Peshawar. )

Abstract

A survey of dental health, hygiene and dietary habits in children was done in Peshawar.
Dental ailments observed in pre-school children were due to lack of regular dental check ups, intake of refined sugary foods and wrong application of brushes. Thorough cleansing of teeth after meals particularly after dinner with good quality clean brushes, consumption of coarse fibrous foods, milk and raw vegetables and regular dental check ups are recommended to improve dental health in children (JPMA 36: 225, 1986).

INTRODUCTION

It has been observed and generalized that dental health of even small children in Pakistan is deteriorating which is assumed to be due to excessive intake of sugar, sweetened and sugar concentrated foods, deficient intake of nutritionally rich foods due to ignorance and poverty, poor practices in oral hygiene and no concept of regular dental check-up. It has also been noted that increased prosperity is coupled with increased use of commercialised refined foods and confectionaries.
In Pakistan, especially in N.W.F.P. no reliable data is available about the dental health of pre-school children. The present study therefore, is a pilot investigation of the state of dental health of pre-school children in Peshawar in relation to their dietary and oral hygienic habits.

MATERIAL AND METHODS

One hundred 3-6 years old children belonging to different areas of Peshawar were randomly selected from four schools situated in the university campus and university town. A questionnaire and a dietary schedule was designed and a structured interview technique was used to collect the following information:
1. Age of the child
2. Monthly income of the family
3. State of dental health of the child
4. Oral hygiene and dietary habits of the child
5. Practices in dental check-up of the child by the dentists
The teeth of the children were checked personally by the investigators. They also interviewed the child’s mother and filled in the questionnaires. Dietary schedules were distributed among the mothers to record daily dietary intake of their children for one week. The family’s income was grouped in three categories i.e. lower middle income group (LMIG) Rs. 1000-3000, middle income group (MIG) Rs. 3000-5000 and high income group (BIG) Rs. 5000 and above. The investigation was completed during the months of January to March 1984.

RESULTS

Of 52% children with poor dental health 55.56% belonged to LMIG, 52.17% to MIG and 44.44% to BIG (Table I).


Dental maladies afflicting children were dental caries (92 3%), Tartar deposits (48%), bleeding gums (30.77%),

infection, hypoplasia and Various dental problems can occur alone or in combination of two or three at a time or as separate illness. Their frequency in various groups in shown in Table III.


Oral hygiene is practiced by 70% of the selected children (Table IV).

Sixty seven percent cleaned their teeth before breakfast, 4.29% after breakfast and 28.57% after dinner. Majority of children used brushes to clean their teeth.
Only 12% children had a regular dental check-up (Table V).

The reason for no dental check-ups offered by 90.9% of mothers was their ignorance about its importance.
Refined foods, sweets and conlectionaries were consumed 5.94 times/week/child by LMIG, 11.78 times/week/child by MIG and 15.5 times/ week/child by HIG (Table VI).

Intake of meat, eggs, fruits and coarse fibrous food was inadequate particularly in LMIG.

DISCUSSION

Dental ailments are common in pre-school children in Peshawar and their frequency is inversely proportional to the financial stitus of the family1
Dental caries, which afflicted most of the children with poor dental health in this study is much less than what has been reported from European countries and Canada.2,6
A strong correlation (r=O.93) was observed between tartar deposits and lack of coarse fibrous food intake (Table VII).

This emphasized the importance of these foods in prevention c?f tartar deposits and dental caries7.
Bleeding gums were more frequently obser­ved in MIG than in LMIG. Inadequate intake of fruits had no effect on gum bleeding health.8,9 Tartar deposits had no effect but a significant correlation (r0.997) was observed between brushing and bleeding gums. This might be due to wrong method of brushing teeth, use of poor quality brushes with hard bristles or keeping the brushes in unhygienic condition.
Oral hygienic measures were practiced by majority of the selected children but how regularly they clean their teeth, the method of cleaning and the time at which they clean vary from one income group to another and hence influence their dental health. The highest percentage of children from MIG clean their teeth regularly and use tooth-brushes mostly as a cleansing agent as compared to children from LMIG and HIG, although highest percentage of children of HIG enjoy better dental health than that of MIG. This might have been because of an inefficient application of tooth brushes by the children of the latter income group.10There was a significant correlation (r = ‘0.72) between poor teeth cleaning habits, tartar deposits and overall dental ailments (r = 0.77) and a weak correlation (r=0.5) with dental caries. The habit of cleaning teeth after dinner is commendable as the lack of it adversely (r =0.997) affect the dental health.
Among the selected group, very few children go through regular dental check-up by the dentists. Majority of these belong to the HIG followed by MIG and LMIG11 .This observation may be considered as one of the reasons for fewer dental illnesses of severe nature like dental caries and tooth extraction among children from MIG and HIG as compared to children from LMIG. A significant relationship (r0.789) was observed between dental ailments and lack of dental check-ups. Ignorance about their importance and lack of time were the main reasons given by mothers for no dental check-ups in children.
Socio-economic status of the family affects the nutritional status and thus the dental health of the children. A very strong correlation (r0.88) was found between dental ailments and deficient intake of milk12,13  and an insignificant correlation (r=0.35) between dental ailments and deficient intake of meat as the meat deficiency is probably met by legumes in the affected children.
Majority of children even from MIG and HIG inspite of taking nutritionally adequate diet have poor dental health because the frequency of their consumption of sugary foods in between meals daily is even higher than the nutritionally required foods. On the whole a considerably strong correlation of r0.99 is observed between dental ailments and sugary foods and a correlation of a remarkable significance of rl .028 is also found between dental caries and sweets intake.14,16

ACKNOWLEDGEMENT

The authors are thankful to the school’s administrators for allowing them to select their pre-school children for the study.
The help of Dr. Tasleem Akhtar Research Director and Mr. Iqbal Statistician of PMRC Research Centre, Khyber Medical College, Pesha­war in the statistical analysis, typing of manuscript and presentation of this paper in the sym­posium on health problems of school children is gratefully acknowledged.

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