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ISSN (Print) 1013-9052
EISSN 1658-3558
The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia
Tel.
 		966-1-467-7328
Fax.
 		933-1-467-7308 /
966-1-467-7534
Email
 		saudidj@ksu.edu.sa

SDJ

Comparison of caries In 6-7 year old Saudi girls
attending public and armed forces schools in
Riyadh, Saudi Arabia


Dr. Magda Mansour, BDS, MSc
Dr. Shahid Anwar, BDS, MSc, DDPH RCS, FRACDS
Dr. Cynthia Pine, BDS, PhD, FDSRCS

  Dentistry Department, Riyadh Armed Forces Hospital, P.O. Box 1394, Riyadh 1143, KSA

Abstract 

The purpose of this study was to determine and compare the prevalence of caries among 6-7 year old Saudi school girls attending the public and Armed Forces schools in Riyadh and to provide baseline data for future interventions in the development of oral health care. Three public and three Armed Forces schools were randomly selected and 100 children from each type of school were examined. Mean dmft for girls attending public schools was 6.0 (SD ±3.7) and was 8.1 (SD +4.1) for Armed Forces schools while caries-free dentitions were 7.1% and 3.0%, respectively. There was a statistically significant difference between the means for dmft (P<0.01) and those for caries-free children (P<0.05), among the two types of schools examined. Clearly, there is a real need for oral health promotion and care for the Saudi school girls 6-7 years of age.

Introduction
Socio-economic status has been associated with caries in numerous studies.1-2 Silverstone pointed out the effect of social status on the diet, oral hygiene practices, dental services uptake of both individuals and communities.3 These factors were found to have an effect on the dmft level. Various indices have been used in survey work to measure the effect of social class on caries. These indices seek to measure the socio-economic status of individuals. The most common one used are: occupation of father or head of the family,4-5 the Registrar General's Classification,6 and number of rooms and toilets in the house.7
In developing countries, it is very difficult to designate a particular social class to a house­hold. No single system for classification has yet been developed and tested, and which is also true for Saudi Arabia. However, many more have been devised and used according to the types of people and places being surveyed. Examples are ACORN (A Classification of Residential Neighborhood), a system based on census statistics.8 In Guatemala, the type of footwear used by subjects was the basis for classification.9 Anwar and Downer10 used different types of schools as a basis for differentiating between the children and comparing their oral health status. It has also been pointed out that the type of school has a direct effect on caries risk status.11 In Saudi Arabia, the schools for the Saudis are segregated by gender. This study only focused on Saudi girls studying in different types of schools. Earlier studies in the Kingdom have concentrated only on either pre­schoolers, 1, 2 or on the population of children 12 years and older.13 In both of these age groups, the prevalence of deciduous caries or the end result of the carious lesions in deciduous dentition cannot be evaluated.14 Such infor­mation is necessary to plan provision for dental care and the level of oral health education and promotion required.
Materials and Methods

Three public schools, out of 30, and 3 armed forces schools out of 9 were randomly selected from the list of schools provided by the con­cerned departments. The ages of the subjects ranged from 6-7.5 years. Because of constraints in time and logistics, the authors decided to examine 100 female children from each type of school. A list of students of Saudi descent was obtained from each selected school. The class teacher was asked to select every third girl on the list from each section, until 100 children were obtained from each type of school. The head mistresses of the schools were asked to ensure the presence of the selected child on the day of the examination. Written consent from the individual parent was not deemed necessary by the authorities as the clinical examination was only visual and no radiographs were conducted. The instrument used for examination included a sickle-shaped explorer and the data was recorded on examination forms. The clinical examination was carried out with the help of a scribe. Students were seated on a straight-backed chair facing sunlight in the school premises. Dental caries was assessed using the WHO methodology,15 under standardized condi­tions. Ten percent (10%) of the subjects were re­examined and an intra-examiner reproducibility of Kappa = 0.85 was achieved. Data was entered in a personal computer and the SPSS program was used for statistical analysis of the data. T-test was used to deter­mine the presence of any statistically significant difference between the two types of schools and a p-value of 0.05 or less was considered significant.

Results

Ninety-nine Saudi girls were examined in the public schools. Their mean dmft was 6.0 (SD ±3.7), the dt was the greatest component at 4.8 (SD±3.6) and 7.1% were caries-free. In com­parison, mean dmft and the dt factor of the girls from the Armed Forces schools were 8.1 (SD ±4.1) and 6.3 (SD ±4.2), respectively; 3.0% were caries-free (Table 1).
 

Discussion

Many epidemiological reports from the Riyadh region19 in Saudi Arabia show an increase in the prevalence of dental caries.16-17-18 Earlier studies compared the dmft between the Saudi boys and girls and no statistically significant difference in caries prevalence was reported. Others found a higher caries prevalence in boys.17 Al Sekait found more caries in girls in his study.16 The present study focused on the caries status in girls and compared the differences between the public and Armed Forces schools. Although the combined dmft of 7.08 is in line with the previous studies for Riyadh region19 and for Abu Dhabi,20 the present figures are definitely higher than those reported in other studies in Saudi Arabia.11-21 The percentage of caries-free chil­dren has declined in comparison with the pre­vious studies in Saudi Arabia21-22 and in the Middle East.14
The statistically significant difference between the caries levels in the public and Armed Forces schools is also noteworthy. Further studies are required to look into the causes for this difference. This study compared the Armed Forces schools with public schools. No such comparison has been reported in Saudi Arabia. A study to investigate the dmfts of the families of USAF was carried out, however.23 The statistical figures reported in the present study may be treated with caution as the number of subjects was not very high although the sample was representative and showed a trend. It also implied that Saudi girls at six years of age are far from the Oral Health goal of being 50% caries-free by the year 2000 as established by WHO and FDI.24
This high prevalence of caries has significant health care implications. Further and larger studies should be undertaken in order to look into the reasons for the gap between the target and the present state; estimate the future needs for dental health services and facilitate planning for distribution of resources for dental care. The present epidemiological study aimed at providing a baseline for future analysis of change in dental health and disease in Saudi school girls in general and Armed Forces schools in particular. It also showed the need for regular and coordinated surveys to assess changes in caries level and to take appropriate steps for prevention.


Acknowledgement

The authors extend their appreciation to Dr. Tahir Paul of the Riyadh Armed Forces Hospital for his help in the preparation of this paper. 

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Tables

 

34-1
 
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