|Year : 2021 | Volume
| Issue : 1 | Page : 35-41
Dental caries prevalence, restorative needs and oral hygiene status in adult population: A cross-sectional study among nurses in Jos University Teaching Hospital, Jos, Nigeria
Abiodun Enoch Idowu1, Babatunde O Fakuade2, Olaniyan O Taiwo3, John O Majekodunmi3, Olohigbe O Alufohai4, Fatima K Sandabe4
1 Faculty of Dental Sciences, College of Health Sciences, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
2 Department of Dental and Maxillofacial, Federal Teaching Hospital, Gombe, Nigeria
3 Inter-Country Centre for Oral Health (ICOR) for Africa, Jos, Nigeria
4 Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, Bayero University, Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Submission||19-Oct-2020|
|Date of Decision||07-Jan-2021|
|Date of Acceptance||04-Feb-2021|
|Date of Web Publication||4-May-2021|
Dr. Abiodun Enoch Idowu
Faculty of Dental Science, College of Health Sciences, University of Jos, Jos
Source of Support: None, Conflict of Interest: None
Context: Dental caries affects the quality of life and it is the most common oral health challenges worldwide. While dental caries prevalence is well documented to be declining in many developed countries, the prevalence among adult population in Nigeria is yet to be fully documented. Aim: This study aimed to determine dental caries prevalence, restorative needs, and oral hygiene status among nurses. Materials and Methods: This was a descriptive cross-sectional study. The study participants were recruited by simple random sampling technique. The nurses' caries status was determined using the WHO-recommended D-decayed, M-missing, F-filled, T-teeth (DMFT) index. Restorative index was used to determine the restorative needs while simplified oral hygiene index (OHI-S) by Green and Vermilion was adopted for the assessment of oral hygiene status. Statistical Analysis Used: Descriptive statistics and Chi-squared tests were used for data analysis. This was done using SPSS version 23.0. Results: A total of 251 subjects participated in this study. The age range was 19–64 years, and the mean age was 38 ± 9.88. Among the participants, 60.6% have experienced dental caries inform of filled, decayed and missing teeth. Dental caries prevalence was 43.8% and the mean DMFT was 2.06 ± 2.46. Met need index and restorative index were 0.46 and 14.6% respectively. Using OHI-S, 22.7% had good, 66.1% fair, and 11.2% had poor oral hygiene status. Conclusion: The prevalence of dental caries among nurses 'the adults' study population was high with low secondary prevention and low Restorative index. Majority had 'fair' Oral hygiene status.
Keywords: Dental caries, d-decayed, m-missing, f-filled, t-teeth, met need index, oral hygiene, restorative index, simplified oral hygiene index
|How to cite this article:|
Idowu AE, Fakuade BO, Taiwo OO, Majekodunmi JO, Alufohai OO, Sandabe FK. Dental caries prevalence, restorative needs and oral hygiene status in adult population: A cross-sectional study among nurses in Jos University Teaching Hospital, Jos, Nigeria. Niger J Basic Clin Sci 2021;18:35-41
|How to cite this URL:|
Idowu AE, Fakuade BO, Taiwo OO, Majekodunmi JO, Alufohai OO, Sandabe FK. Dental caries prevalence, restorative needs and oral hygiene status in adult population: A cross-sectional study among nurses in Jos University Teaching Hospital, Jos, Nigeria. Niger J Basic Clin Sci [serial online] 2021 [cited 2021 Jun 23];18:35-41. Available from: https://www.njbcs.net/text.asp?2021/18/1/35/315410
| Introduction|| |
Dental caries is among the non-communicable diseases that affect the oral health and the general health of an individual. Dental caries is one of the most prevalent disease conditions that affect the human race of all ages, genders, and races, and it is one of the global health challenges.,, While the prevalence of dental caries has been declining in developed countries due to improved oral health awareness and preventive measures.,, cases of mortality and morbidity resulting from oro-facial infection of odontogenic origin secondary to dental caries are common in many dental facilities in Nigeria. Hence, the need for comprehensive national data on dental caries prevalence and its trend in a developing country like Nigeria. The majority of the available reports on dental caries in Nigeria are from the southern part of Nigeria, focusing on the young and adolescents.,,,
The primary prevention of dental caries is well documented to be closely related to oral hygiene practices, which involves the removal of debris, plaque and calculus, and the maintenance of continuous application of low fluoride.,,, There are many documented oral hygiene indices for assessing the effectiveness of oral hygiene practices, but the simplified oral hygiene index (OHI-S) by Green and Vermillion is widely accepted globally for epidemiological study.,,, The acceptability of OHI-S may be due to its simplicity and being easy to analyze. Hence, it was adopted for this study.
Secondary prevention of dental caries in a population can be assessed by evaluating the met need index ('MNI') and restorative index 'RI'., MNI is a proof of treatment received by an individual due to dental caries, and it is a ratio of the mean missing plus filled teeth to mean DMFT (M + F/DMF)., The RI is a reflection of restorative care received by an individual who suffered caries in the past, and it is a ratio of the filled to filled plus decayed teeth percent., Information on both RI and MNI in literature among adults living in the northern part of Nigeria is scanty, hence the present study.
Dental caries can be assessed quantitatively in an epidemiological study by many indices, including DMFT index. It is a measure of lifetime caries experience in permanent dentition, which was first introduced in 1938 and recommended worldwide for caries assessment.,,, While the DMFT among children and adolescents has been well documented in literature from many parts of the world,,,,,, it is not yet fully documented among the adult population especially in the Northern part of Nigeria. Therefore, this study's objective was to determine dental caries prevalence, the restorative index, MNI, and oral hygiene status among nurses in Jos University Teaching Hospital (JUTH).
| Materials and Methods|| |
This study was conducted among the Nurses at the JUTH Jos, Plateau State-North-Central, Nigeria. It is a descriptive cross-sectional study, and ethical approval was obtained from the institutional review board of JUTH. The participants were recruited by a simple random sampling technique to get the predetermined and calculated sample size of 227. The sample size was determined based on a formula, at caries prevalence of 17.8%, an estimated error of 0.05 and a confidence level of 95%.
All categories of nurses irrespective of age, gender and cadre, willing to participate, ready to fill and complete the informed consent form and undergo basic clinical oral examination participated in the study.
Data collection was done through the use of self-administered questionnaires and the result of the clinical oral examination. The participants were made to filled semi-structured, pretested and closed-ended questionnaires which contained the bio data and oral hygiene practices. The questionnaire's validity was done during the pilot study. The lead researcher conducted a simple clinical oral examination at a rate of 20 participants per day. The participants were made to sit on a straight-back chair. At the same time, the examiner stands in front to perform the clinical oral examination under natural light, and another dentist recorded the findings. 'OHI-S' by Green and Vermillion was adopted for assessing each participant's oral hygiene status. The scoring criteria were based on the level of debris and calculus accumulation on the index teeth. The OHI-S was calculated for each subject as OHI-S=DI-S+CI-S (DI-S=Debris Index and CI-S=Calculus Index). Detection of dental caries was done using caries probe, and the World Health Organization DMFT for assessing caries prevalence was adopted for this study. Data processing and analysis were done using the Statistical Package for IBM USA Social sciences version 23.0. All the subjects identified with oral health challenges were referred and managed at the JUTH dental outpatient clinic.
| Results|| |
Demographically, 77 (30.7%) of the participants were males, while 174 (69.3%) were females. Age distribution among the participants shows 57 (22.7%) <30 years, 96 (38.2%) 31–40 years, 62 (24.7%) 41–50 years and 36 (14.3%) were >50 years. The overall prevalence of dental caries was 43.8%. Higher dental caries prevalence was observed among the female (47.7%) compared to the male (35.1%) participants. Dental caries prevalence was also observed to be higher among the older age compared to the younger participants.
[Table 1] shows the caries experience and components of DMFT with gender among the participants. More females compared to the males, were observed to have experienced dental caries, which was statistically significant with P = 0.003. There was no gender bias in the decayed, missing, and filled component of DMFT. Among both males and females, the majority were observed to have an average of 2 decayed teeth, an average of one missing tooth, and an average of one filled tooth. While the mean DMFT among the participants was 2.06 ± 2.46, it was lesser among the male compared to the female participants. The overall restorative index 'RI' was 14.6% and it was higher among females than males. The MNI among the study population was 0.46 and it was observed to be higher among the female participants. Caries experience was found to increase with age. Compared to the younger participants, older aged participants were observed to have experienced more dental caries and this was statistically significant with P = 0.002. While only one participant within 41–50 years had up to seven decayed teeth, majority of the participants had between one and two DMFT. The mean DMFT was also observed to increase with age as shown in [Table 2].
|Table 1: Distribution of decayed, missing and filled teeth and met treatment need among the study population|
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|Table 2: Distribution of decayed, missing and filled teeth and met treatment need among study population|
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Majority of the participants presented with 'fair' oral hygiene status. Poor oral hygiene status was more noticed among the participants that were 40 years and above compared to the younger participants and this was statistically significant P = 0.009 As shown in [Table 3]. Although statistically, there were no significant findings in the association between dental caries and oral hygiene status among the participants, dental caries was observed more among the participants with poor oral hygiene, as depicted in [Table 4].
|Table 3: Oral hygiene score according to green and vermillion Index (Simplified oral hygiene index (OHI-S) among the study population|
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All participants were observed to be using fluoride-containing toothpaste as a cleaning agent but the different texture of toothbrush for regular teeth cleaning. The majority uses medium texture toothbrush, and this they do once a day. While many participants use toothpicks, only a few uses interdental floss for interdental space cleaning. Good oral hygiene was observed more among participants that cleanse their teeth after breakfast and after dinner and also among those that use a medium texture toothbrush and interdental floss as revealed in [Table 5].
| Discussion|| |
The prevalence of dental caries was higher in this study than two previous reports among adult Nigerians from the southern city of Port Harcourt-22.6%, and 35.1% and equally higher than 12.8% reported among female adults in the southwest region of Nigeria. While two of the previous reports were based on dental outreaches and the other among the hospital patients, the present study was purely a cross-sectional study, and this may be attributed to the higher prevalence of dental caries in this study. Although a lower prevalence of 30% was reported in another, but a higher prevalence of 78.2% and 92.0% have also been reported among adults in similar cross-sectional studies., The prevalence of dental caries was significantly higher among the female compared to the male participants, and this conforms to previous reports, although among children., Higher caries prevalence observed among females was found to be associated with no other reason apart from more female participation compared to males in this study. Caries prevalence in the present study was also observed to increase with age significantly, and this confirmed to a previous report. Generally, the higher prevalence of dental caries among participants in this study may be attributed to poor oral health and poor preventive measures which is more among the elderly. Majority among the participants have experienced dental caries and consequently, the mean DMFT was 2.06 ± 2.46. This was lower compared to report from a similar study, but higher than in another report from southern Nigeria. The mean DMFT, although higher but not statistically significant among the female compared to male participants and this conforms to previous reports.,, This is contrary to another report which indicated higher DMFT among adult males compared to females. The mean DMFT was also observed to increase with age in this study and it confirms reports from similar studies, although contrary to another report which indicated no specific trend in age. The DMFT, which revealed caries experience may increase as a result of advance in age, but the gender disparity in the DMFT may be as a result of more female participants. Lack of adequate attention paid to oral health care especially among the older age groups may be responsible for the findings in this study. While the majority of the participants were detected to have one or two teeth each with fresh or recurrent caries, only one female participant age 31–40 had seven decayed teeth. There was no specific trend in gender and age concerning the missing and filled component of DMFT in this study. While many participants had one or more missing teeth due to dental caries, just a tiny fraction had coronal restorations of their decayed teeth. The higher missing teeth and lower filled teeth observed among the study population were contrary to a report of lower missing teeth and higher filled teeth from a similar study. Many untreated carious teeth without restoration observed in this study may be a manifestation of oral health neglect among the participants. Since dental caries is preventable, knowledge of both the primary and secondary prevention with early restoration (fillings) of the affected tooth will hurt the progress of caries thereby preventing deterioration of conditions and tooth extraction. The observable low level of secondary prevention in the present study also justified similar reports of the lowered percentage of filled teeth and higher missing teeth components of DMFT from similar studies in Nigeria.,, Declining prevalence of dental caries characterized by Lower DMFT and reduced caries experience with improved filling and lowered missing teeth among adults in developed countries where reportedly due to improved oral health awareness and level of dental care. The level of dental care in a population can be assessed by determining the restorative index. The lower value of the restorative index 'RI' obtained from this study further revealed the reason for low filled teeth among the study participants. The RI among the study participants was lower in this study than in the reports from similar studies in Nigeria which was 25.3%, and 26.8%, but higher than in other studies still from Nigeria., The 'MNI' among the study population was low compared to a previous report from southwest Nigeria. There was no significant trend of MNI in gender and age among the participants. Although the MNI was low in this study it was higher than what was reported from a recent study conducted in northwest Nigeria. The low value of RI and MNI in this study may be attributed to low level of oral health awareness, poor access to dental care, ignorance of the few available dental services/facilities among the participants and relatively few dental surgeons in the north central region of Nigeria. Investigation on oral hygiene status shows that the majority of the participants had a 'fair' oral hygiene score, and this conforms to the previous report. Contrary to a similar report that more females had good oral hygiene score compared to males, there was no significant gender difference in oral hygiene status among the study participants. Poor oral hygiene status was observed to be significantly more among the participants above 40-year-old. This may be due to better oral hygiene practices among the younger age group compared to the old. Generally, poor oral hygiene status among a few participants may be a reflection of inappropriate oral hygiene practices. Although all the participants use fluoridated toothpaste and brush for regular teeth cleaning, majority of the participants cleanse their teeth once a day instead of an ideal practice of twice a day. Significantly, it was equally observed that instead of an ideal practice of brushing teeth after breakfast, the majority of the participants brushes their teeth before breakfast. This may be due to poor oral health knowledge and awareness among the study participants and it confirms a report of gaps in oral hygiene practices and knowledge among health professionals. Poor timing for teeth cleaning may be responsible for the fair and poor oral hygiene status among majority of the participants. Although not statistically significant, dental caries experience was observed to be higher among participants with poor oral hygiene compared to those with good oral hygiene score and this confirms the previous report. Dental calculus and debris on the teeth, which was used for the grading of the oral hygiene status is also implicated in the initiation and progression of dental caries.
| Conclusion|| |
The prevalence of dental caries among adults in this study was high, with many untreated new and recurrent caries and also many missing teeth. Very few participants had restoration of the decayed teeth and both the restorative index and MNI were observed to be very low. The majority of participants had 'fair' while few had 'good' oral hygiene status. Poor oral hygiene practices were observed among the majority of the participants and this might be responsible for the higher caries prevalence in this study.
Oral health awareness and information on appropriate oral hygiene practices and dental care must be targeted towards adults in Nigeria and more importantly the health workers.
I want to acknowledge Mr. Amanum Innocent for the Technical help he offered in the management of data.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]