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Dental caries in early childhood children in the city of Cartagena.

Dental caries in children of early childhood in the city of Cartagena.

Shyrley Diaz Cardenas 1, Sthefanie del Carmen Perez Puello 2,Miguel Angel
Simancas-Pallares 3

SUMMARY
Received for publicationeithern:
Introduction: Presenting dental caries in the
November16 of 2018
primary dentition becomes a risk factor for
Accepted for publicationeithern:
developing caries lesions in the permanent
December 19, 2018
dentition. Therefore, dental care should start from
Published in: the first years of life in order to detect and control
December 2018 risk factors that prevent the appearance or
How to cite this artYoass: complication of oral diseases.
Diaz Cardenas, S., P.andrez Puello, Aim:describe
S., Simancas-Pallares, M. Dental Prevalence of dental caries in early childhood
caries in niños of early childhood in children (≤ 5 years) in the city of Cartagena and its
the city of Cartagena. Scienceand association with sociodemographic and family
Virtual Health. 2018; 10(2), 50-61. factors.Materials and methods:Descriptive cross-
DOI: sectional study in 630 children from 2 to 5 years
https://doi.org/https://doi.org/
old belonging to public and private children's
homes. Sociodemographic variables were
10.22519/21455333.1167 _
investigated: age and sex of the child, level of
education of the parents and income.
socioeconomic and family variables: family structure, presence of overcrowding and
number of siblings. The presence of dental caries was diagnosed using the ceo-d index.
Descriptive statistics and risk estimation were performed through OR with 95%
confidence intervals.Results:the prevalence of caries in children was 30.79 %. In the
multivariate analysis, the variables that best explain the presence of dental caries in early
childhood are: child's preschool age (OR: 3.65; 95% CI: 2.23-5.97; p=<0.001) and belonging
to needed to go to public children's homes (OR: 2.77: 95% CI: 1.92-3.99; p=<0.001).
Conclusion: belonging to preschool age (3 to 5 years of age) and studying in a public
children's home could behave as risk factors for developing dental caries lesions in early
childhood.

Keywords:Dental caries, preschool, oral health, child care.(DECS)

1Dentist, Health Management Specialist. Family Health Specialist. Master in Public Health. Professor Faculty of Dentistry, University of Cartagena. Resident Ia Pediatric
Dentistry Specialization with Emphasis in Babies APCD Sao Paulo-Brazil. E-mail:sdiazc@unicartagena.edu.co
2Dentist, Master in Dentistry with emphasis in Public Health. Specialist in Interdisciplinary Care for Early Childhood. Professor of Dentistry Program Rafael Núñez University

Corporation. Downtown, Calle de la Soledad #5-7o. Cartagena de Indias, Colombia. E-mail:sthefanie.perez@curnvirtual.edu.co

3Dentist,
Statistics Specialist. Master in Clinical Epidemiology. Professor, Faculty of Dentistry, University of Cartagena. E-mail:
msimancasp@unicartagena.edu.co

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ABSTRACT

Background.To present dental caries in primary dentition becomes a risk factor for developing caries in
permanent dentition. Therefore, dental care should start from the first years of life in order to detect and
control risk factors to avoid its appearance or complication of oral diseases.Objective. Describe the
prevalence of dental caries in children of early childhood (<5 years) of the city of Cartagena and its
association with sociodemographic and family factors.methods. Descriptive crosssectional study in 630
children aged 2 to 5 years belonging to public and private children's homes. We investigated
sociodemographic variables: age and sex of the child, level of education of parents and socioeconomic
income and family variables: family structure, the presence of overcrowding and number of siblings. The
presence of dental caries is diagnosed by thedmf-tcoefficient index. Descriptive statistics and risk
estimation were performed through OR with 95% confidence intervals. results. The prevalence of dental
caries in children was 30.79%. In the multivariate analysis, the variables that best explain the presence of
dental caries in early childhood are: preschool age of the child (OR: 3.65; 95% CI: 2 .23-5.97, p = <0.001)
and belong to public homes for children (OR: 2.77; 95% CI: 1.92-3.99, p = <0.001).conclusions.Belonging
to pre-school age (3 to 5 years old) and studying in a public child home could be a risk factor for
developing dental caries lesions in early childhood.

Keywords:Dental caries, preschool, oral health, child care.(MeSH)

INTRODUCTION

LDental caries (CD) continues to be one of the chronic oral disorders

more prevalent in early childhood (1). Taking into account its multifactoriality,
biological, behavioral and social factors have been related to the appearance of
the first clinical sign, the white spot (2). In addition, a systematic review has shown
the association between inadequate oral health behaviors of parents and the
development of caries lesions in children (3). Other family factors such as living
with more than 3 siblings, low socioeconomic status, parental occupation level,
even low education of the caregiver have also been associated with a higher
prevalence of CD(3).

Considering the vulnerability of preschool-age children, it is important to know

the social determinants involved in the health-disease process, in such a way as to
intervene to control them and prevent the appearance of new caries lesions in the
permanent dentition (4 ). The presence of CD in preschool age or in the primary
dentition becomes a predictive factor for CD in the permanent dentition (4); In
addition, delays in care generate
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complications such as the presence of alveolar abscesses and cellulitis that could
compromise the life of the child (5). In addition, in their daily routine it can lead to
absences from school, loss of sleep, decreased chewing and phonation functions,
increased costs of future dental treatments and expenses in the family economy
(5). In addition, CD could affect the psychological and emotional development of
the child (irritability, low self-esteem, negative appreciation) (6). In this sense, DC
is a dynamic process that not only alters oral health and the functionality of the
stomatognathic system; on the contrary, it can also affect the quality of life of the
individual and those around him (6).

Despite the promotion and prevention strategies developed to reduce DC in the

preschool and school population in Colombia, according to the National Oral
Health Study (ENSAB IV), the DC experience measured through the index of
decayed, filled and extracted teeth (ceo-d) at 3 and 5 years is 47.10% and 62.10%,
respectively (7). Likewise, some epidemiological studies that have been carried out
in Valle del Cauca and Medellín-Colombia reported an experience of CD in 5-year-
old children of 45.6% and 88.6% (children from low strata) and 50.7% (children of
medium and high strata) (8.9), respectively. Therefore, it is evident how the DC
experience continues to be high in this vulnerable group despite the oral health
promotion activities carried out,

In addition, considering the consequences of oral health problems in the minor,

their care must be prioritized by their primary care center. In light of the IMCI
Strategy, Comprehensive Care for Early Childhood Diseases, oral health should be
one of the components evaluated by health professionals such as doctors, nurses,
and dentists for timely care (10). Oral health care for children under 5 years of age
depends exclusively on their parents or caregivers (3), but currently in Colombia
there is a neglect of this population, taking into account the high CD observed,
which often denotes carelessness due to negligence, which could be considered a
form of child abuse and generate detriment to their oral, physical and mental
health and their quality of life (11).

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Taking into account that Cartagena de Indias-Colombia has an estimated

population of 100,758 children under 5 years of age (12) and that few studies
report prevalence of dental caries for this population group (13), the objective of
this study was to describe the Prevalence of dental caries in early childhood
children in the city of Cartagena and its association with sociodemographic and
family factors.

METHODS

SA descriptive cross-sectional study was carried out, with a total sample conforming
Made up of 630 children (female and male) between the ages of 2 and 5 selected
by convenience sampling and belonging to different public and private children's
homes dedicated to the care of early childhood children. The children were
selected taking into account the following criteria: age range between 2 and 5
years, belonging to public and private early childhood homes in the city of
Cartagena and accepting to participate in the study through consent. informed in
writing of the applicant. In turn, all those children who presented systemic
diseases such as: diabetes, arterial hypertension, Down syndrome or any motor or
sensory disability were excluded.

During oral health brigades carried out in these homes, the oral clinical
examination of the children was carried out in the presence of their parents to
receive the necessary oral orientations for each case. In addition, a structured
questionnaire self-filled by the parents was designed and applied to assess
sociodemographic variables such as age (infant <3 years, preschool 3 to 5 years)
and sex of the child, age of the mother, father or caregiver (≤44 years, > 44 years),
monthly economic income (≤ 1 Current Legal Monthly Minimum Wage (SMMLV),
>1 SMMLV) and parental education level (<10 years, ≥ 10 years). Next, we inquired
about family variables such as family structure (nuclear, non-nuclear), presence of
overcrowding (>2 members per room, ≤ 2 members per

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room) and number of siblings (>2 children, ≤ 2 children). When evaluating the reliability of
the instrument, a Cronbach's Alpha of 0.81 was obtained.

The presence of CD was evaluated according to the criteria of the World Health Organization (WHO) by visual method and taking into account the decayed

component according to the decayed teeth index, indicated for extraction or filling per tooth (ceo -d) (14). Before carrying out the clinical examination, a team

made up of two examiners participated in training activities for the purposes of standardization in caries diagnosis, which included analysis of lesions by

images, differential diagnoses, and clinical examination of patients with sociodemographic characteristics similar to those of the present. study. In addition,

intra-examiner and inter-examiner tests were performed and compared to a ''gold standard'' where maximum kappa values (0.81 and 0.86, respectively)

were established between examiners. Also, A pilot test was carried out with 20 children to determine the applicability. The clinical examination was carried

out by visual method, after brushing the teeth directed by the examiner using: mouth mirror, WHO probe and a portable light and air device. Regarding the

analysis and interpretation of the data, descriptive statistical tests were used; the prevalence of dental caries in children was estimated through frequencies.

Risk estimates were made through OR (Odds Ratio) with 95% confidence intervals. The estimators generated in consideration of the objectives proposed in

this study were calculated using the Stata version 11.0® program. previous dental brushing directed by the examiner using: mouth mirror, WHO probe and a

portable light and air device. Regarding the analysis and interpretation of the data, descriptive statistical tests were used; the prevalence of dental caries in

children was estimated through frequencies. Risk estimates were made through OR (Odds Ratio) with 95% confidence intervals. The estimators generated in

consideration of the objectives proposed in this study were calculated using the Stata version 11.0® program. previous dental brushing directed by the

examiner using: mouth mirror, WHO probe and a portable light and air device. Regarding the analysis and interpretation of the data, descriptive statistical

tests were used; the prevalence of dental caries in children was estimated through frequencies. Risk estimates were made through OR (Odds Ratio) with 95%

confidence intervals. The estimators generated in consideration of the objectives proposed in this study were calculated using the Stata version 11.0®

program. Risk estimates were made through OR (Odds Ratio) with 95% confidence intervals. The estimators generated in consideration of the objectives

proposed in this study were calculated using the Stata version 11.0® program. Risk estimates were made through OR (Odds Ratio) with 95% confidence

intervals. The estimators generated in consideration of the objectives proposed in this study were calculated using the Stata version 11.0® program.

RESULTS

C.Regarding the sociodemographic variables, the preschool group located between

3 to 5 years was the most frequent age group with 76.19%. With respect to sex,
the frequencies behaved in an almost similar way, as well as the type of children's
home to which they belonged. Regarding the family variables, the vast majority of
their parents have ≥ 10 years of study, economic income
> 1 SMMLV and live in Nuclear family (Table No. 1). The prevalence of dental caries in
children was 30.79%, this being higher in preschoolers (3 to 5 years).

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Table 1. Sociodemographic Characteristics and Presence of Dental Caries in Children of

children's homes in the city of Cartagena-Colombia. 2016-2017

variables Frequency (%)

Age of children
Infant (<3 years) 150(23.81)
Preschool (3 to 5 years) 480(76.19)
Sex
Male 302(47.94)
Female 328(52.06)
Children's home
Public 318(50.48)
Private 312(49.52)
Parents age
≤ 44 years 312(49.52)
> 44 years 318(50.48)
Father Education Level
≥ 10 years of study 512(81.27)
< 10 years of study 118(18.73)
Mother Education Level
≥ 10 years of study 539(85.56)
< 10 years of study 91(14.44)
socioeconomic income
≤1 SMMLV 272(43.17)
> 1 SMMLV 358(56.83)
Number of brothers
≤ 2 children 500(79.37)
> 2 children 130(20.63)
overcrowding
≤ 2 members per room 468(74.29)
> 2 members per room 162(25.71)
Familiar structure
Nuclear family 406(64.44)
224(35.56)
Presence of dental caries
Absence 436(69.21)
Presence 194(30.79)
Presence of dental caries by age
group
Infant (<3 years) 24(16)
Preschool (3-5 years) 170(35.4)

When associating the presence of CD with sociodemographic and family variables, it

was found that all of them showed associations with statistical significance, except for
the sex of the children and the age of the parents (Table No. 2). In the analysis

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multivariate, the variables that best explain the presence of dental caries in early
childhood are: preschool age and belonging to public children's homes (Table No.
2).

Table No. 2. Association between Sociodemographic and Family Variables with the
Presence of Dental Caries in children from children's homes in the city of Cartagena-
Colombia. 2016-2017

variables Univariate Analysis Multivariate analysis*

OR (95% CI) P OR (95% CI) P

Age of children
Infant (<3 years)
Preschool (3 to 5 years) 2.87(1.79-4.6) <0.001 3.65(2.23-5.97) <0.001
Sex
Male
Female 0.94(0.67-1.32) 0.729 †
Children's home

Public 2.41(1.71-3.41) <0.001 2.77(1.92-3.99) <0.001

Private
Parents age

≤44 years
> 44 years 0.80(0.57-1.13) 0.212 †
Father Education Level

≥ 10 years of study
< 10 years of study 1.64(1.08-2.48) 0.019 †
Mother Education Level

≥ 10 years of study
< 10 years of study 1.76(1.11-2.77) 0.015 †
Income
≤ 1 SMMLV 1.68(1.19-2.36) 0.003 †
> 1 SMMLV
Number of brothers
≤ 2 children 1.54(1.03-2.31) 0.034 †
> 2 children

overcrowding

≤ 2 members per room

> 2 members per room 1.69(1.16-2.46) 0.006 †
Familiar structure
Nuclear family
Non Nuclear Family 1.51(1.07-2.14) 0.019 †
* Value of the Model: X2= 53.61, p= <0.001

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DISCUSSION

ANDThis study corresponds to the few studies carried out in the city of Cartagena.
gena that report the state of oral health in early childhood, taking into account
that it constitutes one of the priority groups for health care. Among the main
limitations of the present study are reported the difficulty in accessing the
population because they are children's homes and obtaining informed consent,
taking into account that they were under 5 years of age and the parents required
further explanations about the oral exams that were performed. made to minors.
However, the clinical data and other study variables were collected, which allowed
the objectives set to be achieved.

Regarding the presence of dental caries, prevalences of 30.79% are reported in children under 5 years of age, being higher in the 3 to 5-year-old group with 35.4%, lower than that reported

at the national level in the ENSAB. IV, in which a prevalence of 62.10% was evidenced at the age of 5 years (7). This could be related to the index used for the evaluation of dental caries in the

present study, ceo-d index, which considers the presence of caries from the appearance of cavities (14), while they are currently being used. Indices such as the International Caries

Detection and Assessment Systems (ICDAS II) have been used, which are more preventive and identify the development of lesions from the appearance of the first clinical sign, the white

spot visible after drying for 5 seconds, which always generates higher prevalences than those reported by ceo-d (15). Likewise, it should be taken into account that the age group where

dental caries is most reported in this study (children from 3 to 5 years old) corresponds to the group with the largest number of children who attend children's homes in Colombia, while the

modality pregnant and lactating women have recently been incorporated for care in these homes, which could also explain the low prevalence in this last group; The prevalence of caries

reported for infants could also vary if an epidemiological study were carried out with a representative sample and using, as previously mentioned, other diagnostic indices. It should be

taken into account that the age group where dental caries is most reported in this study (children 3 to 5 years old) corresponds to the group with the largest number of children who attend

children's homes in Colombia, while the pregnant and infant is recently being incorporated for care in these homes, which could also explain the low prevalence in this last group; The

prevalence of caries reported for infants could also vary if an epidemiological study were carried out with a representative sample and using, as previously mentioned, other diagnostic

indices. It should be taken into account that the age group where dental caries is most reported in this study (children 3 to 5 years old) corresponds to the group with the largest number of

children who attend children's homes in Colombia, while the pregnant and infant is recently being incorporated for care in these homes, which could also explain the low prevalence in this

last group; The prevalence of caries reported for infants could also vary if an epidemiological study were carried out with a representative sample and using, as previously mentioned, other

diagnostic indices. while the pregnant and lactating modality is recently being incorporated for care in these homes, which could also explain the low prevalence in this last group; The

prevalence of caries reported for infants could also vary if an epidemiological study were carried out with a representative sample and using, as previously mentioned, other diagnostic

indices. while the pregnant and lactating modality is recently being incorporated for care in these homes, which could also explain the low prevalence in this last group; The prevalence of

caries reported for infants could also vary if an epidemiological study were carried out with a representative sample and using, as previously mentioned, other diagnostic indices.

In addition, in Colombia, current legislation (Resolution 412 of 2000) allows

children over 2 years of age to be treated for the first time in the dental office and
not the group of children under 2 years of age or infants, which also could

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generate the absence of reports of dental caries or underestimations that do not

reflect the true clinical reality observed in these children in which many of their
mothers during the development of community work report absence of oral
brushing from the eruption of the first teeth (11 ,16).

The evidenced results contribute to the studies on oral health carried out in this
population group of children between 0 and 5 years of age in the city of
Cartagena (16). Previously, studies had been carried out in the child population,
but the age group included was between 4 and 5 years (13). Therefore, there was
a gap in knowledge regarding the prevalence of caries at younger ages.

The presence of dental caries in early childhood was associated with different
social determinants such as low educational level in parents, low socioeconomic
income, belonging to a non-nuclear family, living with more than 2 siblings, and
living in overcrowded conditions. All this indicates that to prevent dental caries,
dental care provided from community activities or within dental offices where
traditionally teaching oral brushing and curative treatments is not enough. Some
studies, like this one, report the association of different social determinants with
the appearance of dental caries and force us to investigate them, parallel to the
investigation of oral hygiene and diet habits, thus intervening in a comprehensive
manner (17-19).

Likewise, during early childhood, the acquisition of the first habits in general and
oral health occurs, therefore, it is necessary to encourage good practices in
children and carry out interventions that allow modifying knowledge and attitudes
in oral health in the parent-child pairing. child, resulting in better care habits and
a decrease in dental caries (20). A systematic review showed that the relationships
in the caregiver/father-child pair intervene in the acquisition of healthy or
inappropriate behaviors in oral health, that is, the family is related to the bond
and the influence of caregivers on emotions, good practices and the discipline of
children to carry them out (21).

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The model that best explained the presence of dental caries in early childhood
was the one in which only the age of the child between 3-5 years and the type of
children's homes to which they belong were reported. In the age range of 3 to 5
years, there is a variation in food consumption and an alteration in the diet,
preferring some food groups, especially carbohydrates and sweets. Some studies
have reported that delaying the consumption of sweets in children reduces the
risk of developing dental caries lesions (22-23). For this reason, it is recommended
that during the first 1000 days of the child's life the consumption of sugars be
avoided (24),

From another perspective, belonging to a public children's home and its

association with the development of dental caries exposes the high vulnerability
of the population and the difficulty they could present in accessing oral hygiene
implements and dental consultations in the health regime. public (25). In this
sense, it is recommended to continue studying other sociodemographic,
socioeconomic and behavioral variables that act as determinants of health and
that could be considered risk factors for the development of dental caries lesions
in early childhood.

CONCLUSIONS

LThe prevalence of dental caries in early childhood children was 30.79%.

In addition, belonging to the preschool population group (3 to 5 years of age) and
studying in a public children's home could behave as risk factors for the presence
of dental caries in early childhood. Therefore, it is recommended to start
preventive dental care from the first years of life, with an individual risk approach
based on social determinants such as sociodemographic and family factors that
prevent the appearance of dental caries and improve the health conditions of the
patient. child.

CONFLICT OF INTERESTS
The authors declare no conflict of interest.

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