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Oral Hygiene Status of 7-12 year old School Children in Rural and Urban
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Article · December 2011

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 JOURNAL OF THE INDIAN ASSOCIATION OF
PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III

Oral Hygiene Status of 7-12 year old School Children in

Rural and Urban population of Nellore District
1
Dr M.S.Minor Babu, 2Dr SVSG Nirmala, 3Dr N.Sivakumar

ABSTRACT
Introduction: Dental caries is a significant health problem among the people of all ages but the
magnitude of the problem is greatest among young children. As far as the population of Nellore district
is concerned, data is not available regarding dental caries and oral hygiene status of both rural as well as
urban population.
Objectives: The present study aims at assessing the prevalence of dental caries and oral hygiene
status in school children aged 7-12 years so as to provide information to health authorities to plan
appropriate preventive and curative oral health programs for school children.
Materials and Methods: The survey was carried out in 1590 children of 20 schools in both rural
and urban areas. Out of this 796 were male and 794 were female children. The DMFT and deft indices
were used to assess the number of decayed, missing, and filled teeth (DMFT) and surfaces (DMFS) for
the permanent dentition as well as the primary dentition (dft,dfs). Oral hygiene status was assessed by
using Oral Hygiene Index simplified.
Results: The overall prevalence of dental caries was 65.6%. High prevalence of dental caries was
seen urban school children of 7-9 & 10-12 year school children. Among them oral hygiene status was
observed to be poor in rural school children. Dental caries prevalence was higher in female children even
with good oral hygiene.
Conclusion: Prevalence of dental caries was higher in urban school children even with good oral
hygiene
Key words: Dental caries Prevalence, Oral Hygiene status, School children

INTRODUCTION child. Early recognition of this disease is of vital

Good oral health is essential for improving
overall health and well being. Dental caries is a
multifactorial disease and preventable public health
problem which interferes with normal nutrition,
speech, self esteem and daily routine activities.
Early detection of this & prompt intervention will
certainly prevent disease progression1. In India,
dental caries has been consistently increasing in
prevalence and severity over the last two decades,
about 80% of children and 60% of adults suffer
from dental caries2.
The overall impression is that dental caries has
increased in prevalence and severity in the urban
and cosmopolitan population over the last couple
of decades. However, there is no definite picture
as yet regarding the dental caries status in the rural
areas of our country, where 72.2 % of the
population live3. Healthy dentition is a primary
prerequisite for physical, social, emotional and
psychological development and well being of a
importance to preserve oral health.
Since the majority of children are living in
rural areas and their living standards are in general
inferior to those in urban areas, it is likely that
they have a different oral health profile. There are
no epidemiological studies done to evaluate the
prevalence of dental caries and oral hygiene status
in children of Nellore District, Andhra Pradesh.
Hence, this study was undertaken to evaluate and
compare the prevalence of dental caries and oral
hygiene status in 7-12 year old children in both
rural and urban children of Nellore district.
MATERIALS AND METHODS
The present study was undertaken by the
Department of Pedodontics and Preventive
Dentistry, Narayana Dental College and Hospital,
Nellore (Andhra Pradesh) to evaluate prevalence
of dental caries and oral hygiene status in school
going children aged 7-12 years of rural and urban

1 2
Assistant Professor, Dept. of Pedodontics and Preventive Dentistry, Vishnu Dental College, Bhimavaram. Professor,
3
Professor and Head, Dept. of Pedodontics and Preventive Dentistry, Narayana Dental College, Nellore.

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PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
areas of Nellore district. The survey was carried
out in 20 schools, of which 11 schools were
located in rural and 9 schools were in urban areas.
A total of 1590 children in the age groups of
7-9(group I) and 10-12(group II) years were
examined from both the genders. Out of this 796
were male and 794 were female children. Prior
consent was taken from respective school
authorities and parents of all participants. Children
were examined in upright chairs or stools in
adequate natural light during day time outside the
classrooms or in corridor of the schools using
WHO criteria. The subjects were examined using
plain mouth mirror and shepherd’s crook explorer
(NO.5). Single examiner interviewed and examined
all the subjects.
This group wise category was based on the
development of dentition. Henceforth 7-9 year age
children usually comes under early mixed dentition
period and 10-12 year age children comes under
late mixed dentition period.
The DMFT and deft indices were used to
assess the number of decayed, missing, and filled
teeth (DMFT) and surfaces (DMFS) for the
permanent dentition as well as the number of
decayed and filled teeth (dft) and surfaces (dfs) for
the primary dentition4. Oral hygiene status was
analyzed by using oral hygiene index simplified
by Greene and Vermillion (1964)5.Any oral
diseases or pathological conditions observed during
the examination was informed to the subjects and
they were referred to Narayana dental college &
Hospital, Nellore.
The data from the completed forms were
entered into Microsoft Excel –XP software
program. The data gathered was analyzed by using
chi-square test. The level of significance was set
at P = 0.05 and the statistical analysis was done
Table 1: Prevalence of dental caries in rural and urban school children
Rural school children
Age Group Total No of Total no of
children children affected
examined by caries
Group I 460 321
(7-9 years )
Group II 340 167
(10-12 years)
JOURNAL OF THE INDIAN ASSOCIATION OF
using 14th version of SPSS software (Statistical
Package for Social Sciences).
RESULTS
Group I included 460 children from rural and
490 children from urban schools. Group II
included 340 children from rural; 300 children
from urban schools.
In Group I, 321(69.9%) of 460 rural children
and 348 (71%) of 490 urban school children
showed caries. In Group II, 167 (49.1%) of 340
rural school children and 165 (55.7%) of 300
urban school children showed caries. (Table 1)
Table 2 represents the mean and standard
deviation of dft scores for rural and urban school
children
Table 3 represents the mean and standard
deviation of DMFT scores for rural and urban
school children
Table 4 represents the mean and standard
deviation of OHI-S scores for rural and urban
school children
Table 5 represents the mean and standard
deviation of dft, dfs, DMFT, DMFS and OHI(S)
of male and female children of group I
Table 6 represents the mean and standard
deviation of dft, dfs, DMFT, DMFS and OHI(S)
of male and female children of group II
Group I overall caries prevalence was 69.9%
in rural school children, whereas 71.1% was
observed in urban school children.
In Group II the prevalence was 49.1% in rural
where 55.7% was seen in urban school children.
It was also observed that caries prevalence slowly
increased with increase in age at both the places.
The mean dft(s), DMFT(S) scores were higher in
urban places of Nellore district than rural areas
Urban school children
Total No of Total no of
Prevalence children children affected Prevalence
examined by caries
69.9% 490 348 71%
49.1% 300 165 55.7%
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 JOURNAL OF THE INDIAN ASSOCIATION OF
PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III

Table 2. Comparison of dft between rural and urban school children

Groups Rural Urban Chi square P value Significance

Group I (7 – 9years ) 1.41 ± 1.48 2.55 ± 2.37 106.58 0.01 S
Group II (10-12 years ) 1.12 ± 1.46 1.44 ± 1.75 33.64 0.954 NS

Table 3. Comparison of DMFT between Rural and Urban School Children

Groups Rural Urban Chi square P value Significance

Group I (7 – 9 years ) 0.11 ± 0.44 1.01 ± 1.90 46.32 0.049 S
Group II (10-12 Years ) 0.59 ± 1.01 1.65 ± 2.05 29.33 0.893 NS

Table 4.Comparison of OHI-S between Rural and Urban School Children

Groups Rural Urban Chi square P value Significance

Group I (7 – 9 years) 1.27 ± 0.71 0.94 ± 0.50 1660.54 0.001 S
Group II (10-12 years ) 1.78 ± 0.74 1.18 ± 0.57 891.58 0.999 NS

Table 5. Comparison of mean and standard deviation between male and female (group I)

Mean ± SD
Chi-square P value Significance
Male Female
dft 1.88 ± 2.01 2.12 ± 2.11 99.40 0.75 NS
dfs 3.54 ± 4.13 3.74 ± 4.10 382.23 0.907 NS
DMFT 0.34 ± 1.09 0.81 ± 1.74 246.95 0.001 S
DMFS 0.52 ± 1.67 1.25 ± 2.71 229.09 0.001 S
OHI-S 1.11 ± 0.64 1.09 ± 0.63 1541.96 0.001 S

Table 6. Comparison of mean and standard deviation between male and female (group II)

Mean ± SD
Chi-square P value Significance
Male Female
dft 1.21 ± 1.54 1.33 ± 1.68 64.987 0.442 NS
dfs 2.09 ± 2.82 2.28 ± 2.97 229.208 0.010 S
DMFT 0.71 ± 1.23 1.48 ± 1.95 53.785 0.559 NS
DMFS 1.10 ± 2.03 2.21 ± 3.10 156.747 0.008 S
OHI-S 1.43 ± 0.85 1.41 ± 0.73 1318.366 0.584 NS

(Table 2 & 3). But OHI(S) scores were lower in
urban school children (Table 4)
DISCUSSION
Maintenance of oral health is a prerequisite for
general well being of an individual. But this oral
health is affected by a multitude of pathological
conditions, one of the most common conditions
being dental caries, a multifactorial disease. Major
factor known to be concerned with its initiation
and progress are the nature and the availability of
suitable nutrients for the oral microorganisms. A
number of factors have been put forward to
explain the variation in prevalence and severity of
dental caries and periodontal diseases, not only
between developing and developed countries, but
also between rural and urban populations. In
general, these factors can be divided into local
intraoral factors associated with plaque
accumulation, metabolism and fluoride exposure or
general factors such as age, sex and socio-cultural
variables.

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 JOURNAL OF THE INDIAN ASSOCIATION OF
PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
In present study, the overall caries prevalence
was 65.6 %.In developing countries like India
there has been marked increase in the incidence of
dental caries3, 6. The high caries prevalence in the
Nellore school children indicates the immensity of
oral health problems.
Prevalence of dental caries was low in group
I rural school children. These children belongs to
the lower strata of society, their access to refined
sweets and candies are less and their snacks would
be mostly restricted to locally made low sugar
unrefined sweets. They would also be taking
harder and fibrous food stuffs, which may explain
the low caries prevalence. Our results were similar
with the results obtained by Frencken7, who
carried out in 7-9 years old children in Tanzania
and found that dental caries was more prevalent
and severe in urban school children than rural
school children. These findings were similar with
study conducted by Saha and Sarkar in 19963.
Reasons for these differences was attributed to the
higher intake of candy, meals and sweetened
beverages in urban areas and the fluoride content
of drinking water in rural areas.
Group II rural school children showed 49.1%
prevalence, closely corresponded with study
conducted by Dhar et al8 whereas urban school
children showed high prevalence and this was
attributed to higher intake of candy, sweetened
beverages in urban areas and increased availability
of refined sugar in the form of sweets, biscuits and
chocolates sold at canteens located in school
premises. The findings of the present study are
closely related to the study conducted by Chironga
and Manji9, who observed higher mean DMFT
(0.57) in urban school children than rural school
children (0.49) in Zimbabwe. The raising levels of
caries which are said to be associated with changes
in standards of living, dietary habits, and increases
in sugar consumption.
ORAL HYGIENE STATUS:
Oral hygiene status was poor among rural
school children than urban school children for
above age groups which were correlating with the
study done by Saha and Sarkar3. Good oral
hygiene status depends on frequency, type of tooth
brushing, and mode of cleaning. Poor oral hygiene
status among rural school children could be
attributed to poor oral hygiene practices, use of
finger instead of tooth brush and tooth paste being
substituted with charcoal, whereas availability and
1078
affordability of tooth brushes and fluoridated tooth
pastes were high in urban population.
Comparison of Dental Caries and Oral
Hygiene Between Male & Female Children
In Group I:
In present study, the dft scores of female
children (2.12) were higher than male children
(1.88). This was explained by the fact that females
had higher dft values initially, though males had
slightly higher dft values after the age of 7,
peaking at age 9. The dft for females peaked at
age 5 to 6. This may have been indicative of males
maturing later than females and keeping their
primary teeth longer. The retention of those
primary teeth for an additional one or two year
may have played a large role in the disparity of
dft values between males and females. These
findings were contradictory with other studies
conducted by Mahesh kumar10, Rao1, who
observed higher dft scores in male children.
Whereas female children showed high DMFT
scores than male children, this could be attributed
to the fact that the permanent teeth erupts at an
earlier age and there will be prolonged exposure
to the oral environment in females. This finding is
closely corresponding with the study conducted by
Mahesh kumar et al10 who observed mean DMFT
was higher in girls (0.50) than boys (0.35). Oral
hygiene status was poor among male children than
female school children which is statistically
significant (P=0.001).This could be due to varied
habits, shedding of primary teeth, improper and
unsupervised oral hygiene practices in male
children whereas female children had lower scores
perhaps due to the increased grooming habits. This
finding was closely allied with other studies of
Saha and Sarkar 3, Mahesh kumar10, Omar and
Pitts11.
In Group II:
Mean dft scores were similar between male
and female children, could be due to the fact that
only few primary teeth were present with
remaining teeth exfoliated. Mean DMFT scores
were higher in female children (1.48) than male
children (0.71). One may speculate that the dietary
habits in males and females in the younger age
group differed little, while females in this age
group probably indulged in cariogenic items more
frequently than males. Another reason for the
higher caries prevalence in females may be the
earlier median age of eruption of permanent teeth
compared to males, which may be 6-10 months.
 JOURNAL OF THE INDIAN ASSOCIATION OF
PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
These results were closely corresponding with the
studies conducted by, Saravanan12,Chaffin13, Rao1,
Chironga and Manji9 and Joshi14. The findings in
their studies were attributed to the fact that females
mature earlier, thus permanent teeth had increased
opportunity for exposure in female children.
Oral hygiene status was poor in male children
as compared to female children, but these
differences were not statistically significant (P =
0.58). Female children have better oral hygiene
and the variation between sexes may be attributed
to behavioral differences.
These findings suggest that the oral hygiene
status was high in urban children could be due to
parent’s dental awareness which is reflected in the
child’s oral hygiene maintenance and the
educational level of the family members. Rural
children do not have access to restorative (or) any
other dental treatment due to the non-existence of
professional dental care in rural India and no
access to government dental services in the
surrounding region.
The school population of today is the adult of
tomorrow; they should be educated, so that a sense
of responsibility would develop in them about oral
health. Exploring the links among clinical
conditions, their personal and social outcomes not
only promote a more complex appreciation of oral
health, it also provides the opportunity to identify
interventions to curtail the consequences of oral
diseases by conducting school dental health
programs.
Based on our study, oral health assessment and
dental health education of children at an early age
helps in improving preventive dental behavior and
attitudes, which is beneficial for a
lifetime. This can be achieved by educating
the uneducated parents about dental health through
school dental health programs. Parents should be
made aware of proper brushing method, usage of
pit and fissure sealants and importance of other
preventive measures for children. The rationale of
school dental health program is to improve and
motivate the teachers, parents and children
regarding their dental health and treatment needs.
15
The school age is regarded as the most
important phase of child’s life as it plays an vital
role in the education and development at the
crucial stage of childhood and adolescence.
Parents, teachers, administrators, students and
1079
health professionals must be informed and
motivated to develop core values, visions, goals
and activities, and to provide new direction for
health education and promotion of optimal school
learning and health. If the child doesn’t maintain
adequate health, the benefits of education will be
lost because of absenteeism or lack of attention
due to ill health. 16
CONCLUSION
The overall prevalence of dental caries in the
study population was 65.6%. Prevalence of dental
caries was higher in urban than rural school
children. Among all the age groups, oral hygiene
status was observed to be poor in rural school
children compared to urban school children. Dental
caries prevalence was higher in female children in
all the age groups. But female children had good
oral hygiene than male in above age groups.
The results of our study point out that dental
caries is a major public health problem and an
active and effective preventive program for dental
care is needed for child population. Knowledge
imparted through these programs would go a long
way in maintenance of oral health in these
children. This study can help to the oral health
professionals not only to plan and implement
treatment procedures but also to design and carry
out appropriate preventive measures for dental
caries.
From this study we can suggest that, provision
of oral health education in the schools with proper
instructions on oral hygiene practices and School
based preventive programs will probably be
important for the maintenance and further
improvement of oral health in rural as well as
urban school children.
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