Dental caries, sugar consumption and restorative dental care in 12-13-year-old children in Riyadh, Saudi Arabia
E. S. Akpata, Abdullah R. Al-Shammery and Hassan \. Saeed Department of Restorative Dental Sciences. College of Dentistry. King Saud University. Riyadh. Saudi Arabia
A k p a t a ES. Al-Shammety AR, Saeed HI. Denial caries, sugar consumplion and restorative dental eare in 12- 13-yeai--old ehildten in Riyadh, Saudi Arabia. C o m m u n i t y Dent Oial Epidemiol 1992; 20; 343 6. Abstt-ael A ,3-day dietary histoty was obtained I'roni 363 Riyadh schoolchikitcti a g e d 12 13 yt-. afler which llicit- dentitions wct-c examined for denial caries. About 16- 3 \"A\ of llic chiklrcn wete caries-lt-ee and the mean DMET varied betweeti 1.67 a n d 2.43. However, in lho.se with at leasl one looth deeayed. missing or filled, lhe m e a n DMET remained constant at about 3, irrespective of age or gender; and mosl of t h e carious teeth wet-e utitestoi-cd. There was a statistieally signifieant relationship bet-ween DES atid the IVequcncy of sugar consumption on the first 2 days of the d i e t i u y diaty. It is suggested ihat lhe managemenl of denial caries in Ihc children m u s t include the conlrol ol dietary sugat-.
C a r i e s experietiee has been reported to be o n tiie inetease in tnany third world count r i e s (I) and this has genet-ally been a s c r i b e d to inereased sugar consumplioti. I n Saidi Arabia, lhe Iradilioiial diet cont a i n s considct-ablc amounts ol sugat-. Furtlict-inot-e. with lhe rapid economic developtiietil in lhe kingdom within ihc pasl few decades, the Western dicl licli iti tcf i n e d carbohydrates is now- comtnonp l a c e . Hence it is to be expeeted that caties experietiee in the country would be on the i n c r e a s e . Iti a iccent biief teporl ofa surv e y carried out iti Riyadh Central Provi n c e of Saudi Atabia (2), earies experience in t h e primary detitition was obsetved to b e higher in lhe urban than iti lhe rural a r e a s , ll is probable Ihal this difference a l s o exists iti lhe i->crmanetil denlilion. AltlHiitgh prcvetitive tiieasut-es, such as t o p i c a l atul systemic niH-itidation, would t-ediice lhe caries allack resulling from the b i g h sugar intake, most of the carious l e s i o n s which beeome manifest elinieally w o u l d t-equitc restorative tnatiagemenl. A s there is very lilllc detailed infortnatioti o n caries experienee and the level of testoriitive detilal cat-e iti Saudi Arabia, t h e r e is a need for oral heallh survey tep o r t s which tnay itiliuence the tnanagcm e n t ol\-iral cotiditiotis in tliecotntnunity. In this papet-, we shall deseribe, iti the
detail, the caries experienee in the ehildteti in Riyadh, the ft-equeney of sugar eonsumption and its relation to caries, as well as the level of testoralive denial eat-c. Materials and methods Ten out of the 125 intermediate schools in the urban atea of Riyadh (Ihe eapilal of Saudi Arabia) wet-e t-atidomly selected. Eive of lhe seleeted schools were attended by boys atul five by girls. Efforts wet-e tnade to include in the sample .sehools from the various income areas ol Riyadh. All the childt-en iti the satnple wete Saudis. The dentitions of all the ehildten aged 12 13 yr in the 10 selected schools vvci-e exatnitied for dental caries (Table 1) by the satne exatnitier iti 1989. The detital exatninatioti was carried oul on a tiiobile chair in a corridor, under nalural lighting eondilions. The diagnosis ofdental caries was predominantly by the visual method and this was augmented by the getitle use of Ash's tnimber 54 probe lo retnove detital plaque atul cotil'inn the softness ol" pit atid fissure carious Icsiotis. .\n approximal surface was tecotdcd as cat-ious wheti Ihete was a definite break iti enamel, i-ir Ash's number 54 probe caught oti a roughetied surface.
Key words: children; dentat caries; restorative index; sugar consumption E, S, Akpata. Department of Restorative Dental Sciences, Coilege of Dentistry, King Saud tJniversity. RO, Box 60169, Riyadh 11545. Saudi Arabia Accepted for publication 1 February 1992
Fifly-lhree (14.6"'(i) of the subjects were re-examined to as.sess lhe intraexaminer teproducibility. Prior lo the dental examttiatton. each of the subjects completed at home a 3day dietary diary. Everything eaten or drunk was reeorded on color-coded forms for each of the 3 days, one of whieh fell on a weekend in about 66"/(i of the subjeets. The forms were eoUeeted in the elassroom each morning and a dietary interview cat-ried out on the fourth day lo facilitate the clarification of uncertainties in the diary. Erom the data obtained, the childt-en were categorized according to their frequeney of sugar eonsumption viz; Ec-)w - sugar eonsumption not more than once a day; Medium sugar consumption 2-3 titnes a day; High sugar consutnptioti 4-5 times or more a day. The telalionship between sugar consumption and caries experienee was then detertiiined. using the chi-square test. Results Intt-a-cxaminer reproducibiiity of caries diagnosis expressed in terms of Cohen's (3) Kappa statistie was 0.83. Caries experience amongst lhe Riyadh children measut-ed as DMET was moderale (Table 1). The meati DME'T was high-
344
A K I ' A T A ET AL.
Table 1. Mean DMl-T (+slandarcl error) and the level of Restorative Index. Rl i(l-'/l-' t-D)l()()| I'or Riyadh children aged 12 13 yr Age (yr)
RI
No. of suhjeds
D
M
1.49 1.27
0.00 0.11
1.74
0.05 0.08
DMET
DES
{(E/E-l-D)100)
0.67 0.29
2.16-F 0.334 1.67 + 0.177
2.44 1.75
31.0 18.6
0.64 0.46
2.43 + 0.286 2.15 + 0.171
2.97 2.50
26.9
Boys 12 13
43 110
Girls 12 13
67 143
1.61
er in girls than boys, but this was not statistieally significant. Contrary to expectation, the mean DMET value was higher in the 12-yr-olds than in the childt-en aged 13 yr (Tables 1 and 2). In those with at least one tooth decayed, missing or filled, however, the mean DME'T was approximately 3, irrespective of age or gender (Table 2) and, as expeeted, there was an inverse relationship between mean DMET and the proportion of earies-free persons in the various sample groups (Table 3). The mean number of deeayed and filled surfaees (DFS) ranged between 1.75 and 2.97 (Table I). In addition, the ratio of the DES/DMET was 1.05 in the I 3-yr-old boys and 1.22 in the 12-yt--okl girls (Table 3), indicating that, on the average, there were fewer than two at-
Table 2. Caries experience in Riyadh children with at leasl one toolh decayed, missing or niled Age tyr)
No. of subjects
Mean DMIT
"/i Pit and fissure caries
27 61
3.4
3.0
93.4 8X.6
49 103
3.3 3.0
79.8 84.9
Boys
12 13 Girls 12
13
taeked surfaees in each carious t(-)oth. Deeayed pits and fissut-es eontributed a vast t-najority of the earious lesions; 93.4 and 79.8% in the 12-yt--okl boys atid girls, respectively (Table 2). Caries pt-evalenee varied belween about 74'Mi in the 12-yr-old girls and about 56'^ in the 13-yr-old boys (Tables 4 and 5). The t-estorative index, Rl, measttted by the ratio (E/E-|-D)IOO (4) was t-elatively low, varying between 31.0 and I8.6'^ in the 12- and 13-yr-okl boys, respectively (Table 1). The 3-day dietary survey showed that practically all the ehildt-en had their breakfast about 7;00 a.m. before school; ate a sugar-eontaining snack at .school about 9;00 a.m., and had lunch and dinner about 2;00 p.m. and 8;00 p.m.. t-espeetively. Thus, if the sehool snack was regarded as an in-between tneal, praetically all the ehildren eonsumed sugar inbetween meals. The sehool snaek usually ineluded sandwiches, soft drinks and sometimes cakes, ehocolates and other confectioneries. Etirthertnoi-e, sevetal of the food itetns eaten by the chiklreii at home also eontained sugar. Complete 3-day dietary diaries wet-e available for a total of 342 subjects, com-
prising 93 and 249 ehildren aged 12 at-id 13 yr, respectively. Tables 6-8 show cross tabulations of DES against the ftequeney of sugar consumption in the l2-l3-yi-. old ehildt-en. There was a slalislically significant relationship betweeti sugar eotisutnptioti atid DES (/'
E. S. Akpata, Abdullah R. Al-Shammery and Hassan \. Saeed Department of Restorative Dental Sciences. College of Dentistry. King Saud University. Riyadh. Saudi Arabia
A k p a t a ES. Al-Shammety AR, Saeed HI. Denial caries, sugar consumplion and restorative dental eare in 12- 13-yeai--old ehildten in Riyadh, Saudi Arabia. C o m m u n i t y Dent Oial Epidemiol 1992; 20; 343 6. Abstt-ael A ,3-day dietary histoty was obtained I'roni 363 Riyadh schoolchikitcti a g e d 12 13 yt-. afler which llicit- dentitions wct-c examined for denial caries. About 16- 3 \"A\ of llic chiklrcn wete caries-lt-ee and the mean DMET varied betweeti 1.67 a n d 2.43. However, in lho.se with at leasl one looth deeayed. missing or filled, lhe m e a n DMET remained constant at about 3, irrespective of age or gender; and mosl of t h e carious teeth wet-e utitestoi-cd. There was a statistieally signifieant relationship bet-ween DES atid the IVequcncy of sugar consumption on the first 2 days of the d i e t i u y diaty. It is suggested ihat lhe managemenl of denial caries in Ihc children m u s t include the conlrol ol dietary sugat-.
C a r i e s experietiee has been reported to be o n tiie inetease in tnany third world count r i e s (I) and this has genet-ally been a s c r i b e d to inereased sugar consumplioti. I n Saidi Arabia, lhe Iradilioiial diet cont a i n s considct-ablc amounts ol sugat-. Furtlict-inot-e. with lhe rapid economic developtiietil in lhe kingdom within ihc pasl few decades, the Western dicl licli iti tcf i n e d carbohydrates is now- comtnonp l a c e . Hence it is to be expeeted that caties experietiee in the country would be on the i n c r e a s e . Iti a iccent biief teporl ofa surv e y carried out iti Riyadh Central Provi n c e of Saudi Atabia (2), earies experience in t h e primary detitition was obsetved to b e higher in lhe urban than iti lhe rural a r e a s , ll is probable Ihal this difference a l s o exists iti lhe i->crmanetil denlilion. AltlHiitgh prcvetitive tiieasut-es, such as t o p i c a l atul systemic niH-itidation, would t-ediice lhe caries allack resulling from the b i g h sugar intake, most of the carious l e s i o n s which beeome manifest elinieally w o u l d t-equitc restorative tnatiagemenl. A s there is very lilllc detailed infortnatioti o n caries experienee and the level of testoriitive detilal cat-e iti Saudi Arabia, t h e r e is a need for oral heallh survey tep o r t s which tnay itiliuence the tnanagcm e n t ol\-iral cotiditiotis in tliecotntnunity. In this papet-, we shall deseribe, iti the
detail, the caries experienee in the ehildteti in Riyadh, the ft-equeney of sugar eonsumption and its relation to caries, as well as the level of testoralive denial eat-c. Materials and methods Ten out of the 125 intermediate schools in the urban atea of Riyadh (Ihe eapilal of Saudi Arabia) wet-e t-atidomly selected. Eive of lhe seleeted schools were attended by boys atul five by girls. Efforts wet-e tnade to include in the sample .sehools from the various income areas ol Riyadh. All the childt-en iti the satnple wete Saudis. The dentitions of all the ehildten aged 12 13 yr in the 10 selected schools vvci-e exatnitied for dental caries (Table 1) by the satne exatnitier iti 1989. The detital exatninatioti was carried oul on a tiiobile chair in a corridor, under nalural lighting eondilions. The diagnosis ofdental caries was predominantly by the visual method and this was augmented by the getitle use of Ash's tnimber 54 probe lo retnove detital plaque atul cotil'inn the softness ol" pit atid fissure carious Icsiotis. .\n approximal surface was tecotdcd as cat-ious wheti Ihete was a definite break iti enamel, i-ir Ash's number 54 probe caught oti a roughetied surface.
Key words: children; dentat caries; restorative index; sugar consumption E, S, Akpata. Department of Restorative Dental Sciences, Coilege of Dentistry, King Saud tJniversity. RO, Box 60169, Riyadh 11545. Saudi Arabia Accepted for publication 1 February 1992
Fifly-lhree (14.6"'(i) of the subjects were re-examined to as.sess lhe intraexaminer teproducibility. Prior lo the dental examttiatton. each of the subjects completed at home a 3day dietary diary. Everything eaten or drunk was reeorded on color-coded forms for each of the 3 days, one of whieh fell on a weekend in about 66"/(i of the subjeets. The forms were eoUeeted in the elassroom each morning and a dietary interview cat-ried out on the fourth day lo facilitate the clarification of uncertainties in the diary. Erom the data obtained, the childt-en were categorized according to their frequeney of sugar eonsumption viz; Ec-)w - sugar eonsumption not more than once a day; Medium sugar consumption 2-3 titnes a day; High sugar consutnptioti 4-5 times or more a day. The telalionship between sugar consumption and caries experienee was then detertiiined. using the chi-square test. Results Intt-a-cxaminer reproducibiiity of caries diagnosis expressed in terms of Cohen's (3) Kappa statistie was 0.83. Caries experience amongst lhe Riyadh children measut-ed as DMET was moderale (Table 1). The meati DME'T was high-
344
A K I ' A T A ET AL.
Table 1. Mean DMl-T (+slandarcl error) and the level of Restorative Index. Rl i(l-'/l-' t-D)l()()| I'or Riyadh children aged 12 13 yr Age (yr)
RI
No. of suhjeds
D
M
1.49 1.27
0.00 0.11
1.74
0.05 0.08
DMET
DES
{(E/E-l-D)100)
0.67 0.29
2.16-F 0.334 1.67 + 0.177
2.44 1.75
31.0 18.6
0.64 0.46
2.43 + 0.286 2.15 + 0.171
2.97 2.50
26.9
Boys 12 13
43 110
Girls 12 13
67 143
1.61
er in girls than boys, but this was not statistieally significant. Contrary to expectation, the mean DMET value was higher in the 12-yr-olds than in the childt-en aged 13 yr (Tables 1 and 2). In those with at least one tooth decayed, missing or filled, however, the mean DME'T was approximately 3, irrespective of age or gender (Table 2) and, as expeeted, there was an inverse relationship between mean DMET and the proportion of earies-free persons in the various sample groups (Table 3). The mean number of deeayed and filled surfaees (DFS) ranged between 1.75 and 2.97 (Table I). In addition, the ratio of the DES/DMET was 1.05 in the I 3-yr-old boys and 1.22 in the 12-yt--okl girls (Table 3), indicating that, on the average, there were fewer than two at-
Table 2. Caries experience in Riyadh children with at leasl one toolh decayed, missing or niled Age tyr)
No. of subjects
Mean DMIT
"/i Pit and fissure caries
27 61
3.4
3.0
93.4 8X.6
49 103
3.3 3.0
79.8 84.9
Boys
12 13 Girls 12
13
taeked surfaees in each carious t(-)oth. Deeayed pits and fissut-es eontributed a vast t-najority of the earious lesions; 93.4 and 79.8% in the 12-yt--okl boys atid girls, respectively (Table 2). Caries pt-evalenee varied belween about 74'Mi in the 12-yr-old girls and about 56'^ in the 13-yr-old boys (Tables 4 and 5). The t-estorative index, Rl, measttted by the ratio (E/E-|-D)IOO (4) was t-elatively low, varying between 31.0 and I8.6'^ in the 12- and 13-yr-okl boys, respectively (Table 1). The 3-day dietary survey showed that practically all the ehildt-en had their breakfast about 7;00 a.m. before school; ate a sugar-eontaining snack at .school about 9;00 a.m., and had lunch and dinner about 2;00 p.m. and 8;00 p.m.. t-espeetively. Thus, if the sehool snack was regarded as an in-between tneal, praetically all the ehildren eonsumed sugar inbetween meals. The sehool snaek usually ineluded sandwiches, soft drinks and sometimes cakes, ehocolates and other confectioneries. Etirthertnoi-e, sevetal of the food itetns eaten by the chiklreii at home also eontained sugar. Complete 3-day dietary diaries wet-e available for a total of 342 subjects, com-
prising 93 and 249 ehildren aged 12 at-id 13 yr, respectively. Tables 6-8 show cross tabulations of DES against the ftequeney of sugar consumption in the l2-l3-yi-. old ehildt-en. There was a slalislically significant relationship betweeti sugar eotisutnptioti atid DES (/'
