Oral Hygiene Practices and Caries Prevalence among 9-15 Years Old Ghanaian School Children

Abstract

Introduction: Good oral hygiene protects against oral diseases such as caries and gum infections. Twice daily tooth brushing with fluoride pastes and flossing is recommended to keep the mouth clean and reduce plaque bacterial growth. Poor access to oral cleaning material and dental care services exposes children from poor backgrounds to oral diseases. Objectives: The study assessed oral hygiene practices and caries prevalence among school children. Dental caries and gum disease are the most common oral diseases in children [1] and may be associated with severe pain [2-4]. The pain may interfere with food intake and affect the normal growth of the child [1,5]. Globally prevalence of dental caries is declining but the factors that predispose children to caries persist [6]. These factors include high snacking habits and bad oral hygiene practices [7]. Studies have indicated that socio-economic factors are associated with caries prevalence in both adults and children [4,8,9]. Dental caries was shown to be most prevalent in school children from poorer families. These Children also had a greater number of untreated oral lesions [10,11]. Dental Caries is an infectious disease caused by the acid produced by the fermentation of simple sugars by oral bacteria, the chief of which are streptococcus mutans and lactobacillus species [12,13]. Although sugars are provided by the type of diet consumed especially in our snacks, its effect on caries shows only when it is accompanied by poor oral hygiene practices and resultant poor oral hygiene status [14,15]. Oral cleanliness is therefore a basic factor for good oral health, especially in children. Poor oral hygiene leads to dental plaque formation [16,17]. Dental plaque, the soft adherent materials deposited on the tooth surface may consist of bacteria, desquamated epithelial cells, and migrated polymorphonuclear leukocytes [18]. A study in suburban school children in Accra reported plaque accumulation of 90% in 5-6 year-olds but 54% in 9-year-olds. [19]. Poor oral hygiene therefore allows the bacteria in the plaque to thrive and then ferment sugars in foods to produce acid that leads to dental caries. Methods: A cross-section of 9-15-year-old school children (n=1,040) were randomly selected from private and public schools in Accra, Ghana. Oral hygiene and snacking habits were assessed by interview using a structured questionnaire. Oral cleanliness and dental caries were assessed by oral examination by two calibrated dental surgeons. Silness and LÖe Plaque Index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were used to determine oral hygiene and caries status respectively. Results: The mean age of the sample was 12.01±1.52 years. Overall caries prevalence was 17.4% but (19.9%) in the public and (15.1%) in the private schools. It was higher in the females (19.3%) than the males (15.1%) in both private and public schools. Almost all (96.6%) brushed once a day. About 60.0% had plaque and 64.4% had supra gingival calculus. The overall mean DMFT score was 1.138±0.476. Types of snacks taken in a day and weekly frequency of snacks were significantly higher in the private schools than in the public school children. Overall, oral hygiene status was acceptable in the children. Lack of good oral hygiene therefore becomes the single most important factor in determining the risk of caries, especially in children. Frequent snacking on sugar foods such as soft drinks, candies, fruit drinks, and high-sugar fruits may increase the risk of caries in children [20,21]. Simple mouth cleaning practices can easily clear this sugar substrate remove oral plaque, and reduce the incidence of dental caries. Caries will occur when plaque pH levels drop below 5.5 due to increased acid production in the dental plaque from the fermentation of sugars in the foods consumed [22]. Conclusion: Oral hygiene practices and status were comparable in the private and public schools. Snacking frequency was high in both groups but did not account for the differences in caries prevalence observed.