Pediatric Dentistry Epidemiology Multiple Chapters

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Cross-Sectional Study: To Assess the Prevalence of Dental Diseases and Treatment Needs of Pediatric Patients Attending Dental Clinics at Ajman University

The WHO Global Oral Health Program emphasizes that although countries have made substantial progress in their effort to improve community health in general, there is still a lot to be done in relation to oral health - particularly among minority and economically-disadvantaged groups1. Oral diseases such as orodental trauma, oropharyngeal cancers, oral lesions, tooth loss, periodontal disease, and dental caries continue to be a thorn in the flesh for governments in the world over even though reports have shown declines in their prevalence and severity. Despite their endemic nature, these diseases impact negatively on the health of the general population and put a strain on the global economy1. Having damaged, discolored or missing teeth affects patients' well-being and daily lives, just as the time taken to tend to the same restricts activities at home, school, and at the workplace; causing dozens of work and school hours to be lost annually. Anderson 2 points out that the reason why interceptive and preventive interventions have repeatedly failed is because policy-makers have focused on expending resources to the entire population rather than concentrating on the at-risk populations. He advises that in cases where disease is increasingly skewed, "and there are effective interventions, risk-assessment can play a significant role in the treatment of infectious diseases"2(p 377).

This study presents the researcher's current knowledge of the epidemiology and risk assessment elements of dental diseases with an increased focus on the adolescent and pediatrician population in the city of Ajman. Ajman was selected for this analysis, first because of its cosmopolitan nature, and secondly, because its average-income status makes it an attractive basis for studying the effect of risk factors other than socio-economic disadvantage. Not many studies have been initiated to assess the oral health status of school-going children in Ajman area, and even the few that have seem to concentrate more on the characteristics of the population as a whole, as opposed to specific demographic cohorts3, 4, 5. In light of this, the current analysis seeks to provide baseline data on the prevalence of dental diseases and treatment needs among 4 to 18-year-old school-going children attending dental clinics in Ajman University. It is based on Moses and his colleagues'6 four-step plan for improving oral health in the community, which involves i) collection of data on oral diseases; ii) evaluation of data to identify community needs; iii) identification of at-risk groups, and iv) formulation of informed treatment plans; and is geared towards guiding oral health planners in Ajman, and the greater Saudi towards developing effective preventive strategies and treatment plans for their communities

Background of the Study

Periodontal disease and dental caries are considered the most burdensome oral health conditions worldwide, alongside malocclusion and enamel fluorosis. Dental caries has persisted as a serious global health concern, with a prevalence rate seven times that of hay fever and five times that of asthma7. The disease currently affects between 60 and 90% of the school-going children population, and a significant proportion of the adult population8. The WHO, in its 2003 annual health report9, points out that although there are significant disparities in the severity and distribution of dental caries between continents and even regions within the same country, the overall prevalence rates of the disease among school-going children have fallen substantially from those reported in the closing decades of the 19th century. Fos and Hutchison 7 attribute this decline to higher levels of education among parents, increased dental insurance coverage, and increased procedure use by dental care providers.

The WHO report 9 shows dental caries prevalence rates, measured by the Decayed, Missing, and Filled Teeth index (DMFT), as being relatively high in the European region (DMFT=2.6) and the Americas (DMFT=3.0), and considerably low (DMFT =1.2-2.6) in Asia and the Middle East. The trend, however, appears to have changed over the last decade, at least for Saudi Arabia. A 2014 review by Al-Ansari 10of the University of Damman in Saudi Arabia, which brought together the findings of multiple cross-sectional studies conducted on the Saudi Arabian populace between 1981 and 2012, found the dental caries prevalence rate to have averaged 7.34 in DMFT for the population aged between 3 and 7; 7.35 for the population aged between 12 and 19; and 14.53 for the adult population between the ages of 30 and 45. This represented a 95% prevalence rate for children aged between 3 and 7; 91% for adolescents between ages 12 and 19; and a massive 98% for adults aged between 30 and 4510. The rising prevalence rates in recent years have been attributed to the rising consumption of sugary foods and increased non-exposure to fluorides8.

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It is estimated that approximately 84.37% of school-going children in Asia suffer from gingivitis, and that another 36.42% and 36.36% suffer from malocclusion and enamel fluorosis respectively11. Clinicians and health specialist further estimate that 62 million children in the Asian region are at risk of developing fluorosis, and that the risk is higher for females (DMFT=1.83) compared to males (DMFT=1.3)11. Children with special needs and those from low-income backgrounds have also been found to run higher risks of getting infected and a two times greater likelihood of having untreated tooth decay7. These are worrying statistics, especially because the effects of dental diseases spread far beyond the oral cavity and its supporting structures, and have a pronounced effect on the well-being of the entire body system7. Periodontal disease, for instance, has been found to be a risk factor for a number of serious health complications - including obesity, rheumatoid arthritis, insulin resistance, peripheral arterial diseases, and cardiovascular diseases 12, 7-8.

In light of all these factors, the Saudi Arabian economy is deemed to lose billions of shillings in treatment in coming years; and not only that, the general well-being of the population stands to be compromised. Arigbede and his colleagues 12 (p 487) caution against treating oral health as a "separate, distant, and less important area of health, which is totally unrelated to lifespan and its quality." Thus, in order for comprehensive healthcare to be achieved, oral health needs to be give the attention it deserves; and this requires clinicians and policy makers alike to first understand the epidemiology and risk assessment elements of dental diseases and other oral health conditions. This understanding provides a sound rationale for the current study.

Aim: To assess the prevalence of dental diseases and treatment needs among pediatric patients attending dental clinics in Ajman University

Study Design: Retrospective study using the records of pediatric patients of Ajman University

2.0 Literature Review

This review comprises of two sections. The first section covers literature on the pathobiology of four selected diseases that have been found to be most common among the population of interest -- dental caries, periodontal diseases, enamel fluorosis and malocclusion. It explores definitions, epidemiology, pathobiology, and infectious agents in relation to each of the select diseases. The second section covers literature on the impact of dental diseases on morbidity and general health. It assesses the health effect of dental diseases on various body systems.

Section One

i) Dental Caries

Definition and Etiology: Dental caries is tooth decay that causes enamel breakdown, often resulting in clinical damage to the overall structure of the tooth7, 12. Three different hypotheses have attempted to explain the etiology of dental caries13. The three agree on the physiological mechanisms involved, and only differ in regard to the etiological agent responsible. The specific plaque hypothesis postulates that caries results from the over-infestation of the Streptococcus mutans bacterium, often denoted as S. mutans, whose bacterial cells colonize the tooth structure, inhibiting glucan action, and creating a thick, sticky intraoral bacterial film referred to as dental plaque 2, 13. This plaque reacts with metallic substrates in food to produce organic acids that gradually dissolve the calcium component present in the tooth enamel, leading to cavitation2. The severity of the infection is determined by the degree of bacterial infestation. Smooth surface caries is associated with S. mutans infestation levels exceeding 500,000cfu/ml (colony-forming units per milliliter of saliva); whereas fissure caries is associated with lower infestation levels (Anderson, 2002).

The ecological hypothesis and the non-specific plaque hypothesis do not, however, seem to be in agreement with this view. The ecological plaque hypothesis postulates that caries develops when unexpected changes in the local environment of the oral cavity interfere with the bacterial balance therein, spurring an overgrowth of disease-causing microflora14. The non-specific plaque hypothesis, on the other hand, casts doubt on the implication of S. mutans as the primary etiological agent in caries development. It suggests that caries is not caused by the action one particular species, but rather is the product of the overall activity of multiple bacterial species found in the oral cavity, including Lactobacilli, Propionibacterium, and Atopobium14. Aas and his colleagues 14 sought to find out how true this claim is. They analyzed 243 samples of dental plaque obtained from primary and permanent teeth; and….....

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