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UNIVERSITY OF HEALTH SCIENCE
FACULTY OF ODONTO-STOMATOLOGY
Thesis defended
by
Mr. Sim Samnang and Bun Chanrakmsey
Topic:An Investigation on the Impact of Dental
Caries on Quality of Life among 6 and 12
year-old Children in Phnom Penh, 2012
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Content
I. Introduction
II. Literature review
III. MethodologyIV. Result
V. Discussion
VI. Conclusion and recommendationVII. References
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I. Introduction
BackgroundOral health makes an individual be able to talk, eat andsocialize without any problems that associate withdisease, discomfort or embarrassment. Oral health is
fundamental to general health and well-being,significantly impacting on quality of life. It can affectgeneral health conditions.
Oral health means more than healthy teeth. The health ofthe gums, oral soft tissues, chewing muscles, the palate,tongue, lips and salivary glands are also significant. Poororal health can have a bad impact on childrensperformance both in school and their daily living as wellas their success in later life.
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I. Introduction
Dental caries in other countries
Worldwide, dental caries is the most prevalent ofthe oral diseases with considerable variations in its
occurrence between countries, regions withincountries, areas within regions and within socialand ethnic groups. During the past four decades, forexample, the prevalence of dental caries in the
general populations of Western industrializedcountries has decreased markedly. In children also,a reduction of dental caries experience has beenreported by many authors.
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I. Introduction
Dental caries in Cambodia
Based on the facts issued by the Ministry of Health in the
National Oral Health Master Plan report, in 1999, only
0.5% of the Gross Domestic Product (GDP) was spent onhealth, compared to around 2% in other developing
countries.
The caries experience (DMFT) of 6 years old children was
7.9+/- 5.6. The caries experience (DMFT) of 12 years old
children was 1.1+/-1.6 and all were untreated caries (DT).
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I. Introduction
Aim
The aim of this study is to investigateon the impact of dental caries on the
quality of life among 6 and 12-year-olds children in 7 Makara in Phnom Penh, 2012.
Objectives
General objective
To record the oral health status and quality of life of 6 and 12-year olds in 7
Makara in Phnom Penh, 2012.
Specific objective
To record the prevalence of dental caries in 6-and 12-year-olds
To assess the impacts of dental caries on the quality of life of 6-and 12- year-olds
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II. Literature review
Dental caries
Dental caries or tooth decay is a multifactorial disease
experienced by 90% of the worlds population. It is
therefore, a common chronic disease that causes painand disability across all age groups. If left untreated,
dental caries can lead to pain and infection, tooth
loss, and edentulism (total tooth loss). In astatistically very few cases, if left untreated, it can
lead to septicemia and death.
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II. Literature review
Etiology and pathology of dental caries
In general, tooth decay requires the simultaneous
presence of many factors such as bacteria (in the
plaque), sugar, and a vulnerable tooth surface.Although several micro-organisms found in the
mouth can cause tooth decay, the primary disease
agent appears to be Streptococcus mutans.Streptococcus mutans is the primary etiologic agent
of dental caries in humans, a common infectious
disease in the world.
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II. Literature review
Etiology and pathology of dental caries
The simple sugars used by the bacteria are glucose,sucrose, lactose. They are converted primarily into
lactic acid. When this acid builds up on the toothsurface, it dissolves the minerals in the enamel,creating micropores or spaces, which if notreversed may ultimately result in cavities. Dental
caries may develop on any tooth surface in the oralcavity where a microbial biofilm (dental plaque) isallowed to develop and remain for a period.
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II. Literature review
Etiology and pathology of dental caries
The presence of microbial biofilm (dental plaque) is aimportant factor for caries. Metabolic activity takes
place constantly within the biofilm resulting innumerous minute fluctuations in pH. These maycause loss of mineral from the tooth surface wherethe pH is dropping or a gain of mineral where the pH
is increasing. The cumulative result may be a net lossof mineral leading to dissolution of the dental hardtissues and a carious lesion.
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II. Literature review
Etiology and pathology of dental caries
There are four principal elements in this
multi-factorial disease:
1- Micro-organisms in the oral bio-film or dental
plaque
2- Substrate/diet (foods, sugars)
3- Host teeth
4- Time
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II. Literature review
Impact of dental disease on quality of life
Despite a low mortality rate associated with dentaldiseases, they have a considerable impact on self-
esteem, eating ability, nutrition and health both inchildhood and older age [31]. Teeth are important inenabling consumption of a varied diet and inpreparing the food for digestion. In modern society,
the most important role of teeth is to enhanceappearance; facial appearance is very important indetermining an individuals integration into society.
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II. Literature review
Impact of dental disease on quality of life
Teeth also play an important role in speech andcommunication. The second International CollaborativeStudy of Oral Health Systems (ICSII) revealed that in allcountries covered by the survey substantial numbers ofchildren and adults reported impaired social functioningdue to oral disease, such as avoiding laughing or smilingdue to poor perceived appearance of teeth.
Throughout the world, children frequently reportedapprehension about meeting others because of theappearance of their teeth or that others made jokesabout their teeth.
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III. Methodology
Data collection was performed in 2012. Four primaryschools were chosen in order to investigate dental cariesstatus.
A total sample of 600 students was selected for the
interview and the oral health examination. The protocoland detection criteria used in the clinical examinationwere those of the World Health Organization.
The clinical exanimations were carried out by twoexaminers throughout the survey in order to minimize
examiner error.The examinations and interviews were conducted out-door using daylight, but not direct sunlight as the lightsource.
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IV. Result
Age
Sex
TotalBoy Girl
Number Percentage Number Percentage Number Percentage
6 186 62% 114 38% 300 50%
12 132 44% 168 56% 300 50%
Total 318 53% 282 47% 600 100%
Percentage of sample size, by age and sex
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IV. Result
Sex
Tooth Brushing Total
Yes Percentage No Percentage Number Percentage
Male 292 92% 26 8% 318 53%
Female 259 92% 23 8% 282 47%
Total 551 92% 49 8% 600 100%
Frequency of teeth brushing
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IV. Result
Oral health problem Yes Percentage No Percentage Total
Toothache during last month 437 73% 163 27% 600
Go to school when toothache 373 63% 227 37% 600
Pain at night 221 37% 379 63% 600
Difficult in chewing 198 33% 402 67% 600
Self-report of oral health problems in selected schools
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IV. Result
Age
Time/day
Total
0 (%) 1 (%) 2 (%) 3 (%)
6 26 8.7% 108 36% 164 54.7% 2 0.6% 300
12 22 7.3% 92 30.7% 186 62% 0 0% 300
Total 48 8% 200 33.35% 350 58.35% 2 0.3% 600
Frequency of tooth brushing for selected school
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IV. Result
Problems Age Number Percentage Total
Eating6 155 25.8%
310 (51.6%)12 155 25.8%
Cleaning 6 149 24.8% 295 (49.2%)12 146 24.3%
Smiling
6 80 13.3%
165 (27.4%)12 85 14.1%
Sleeping
6 83 13.8%
164 (27.3%)12 81 13.5%
Speaking
6 87 14.5%
164 (27.3%)12 77 12.8%
Performing
6 41 6.8%
107 (17.9%)12 66 11%
Feeling6 33 5.5%
94 (15.6%)12 61 10.1%
Interacting
6 40 6.6%
86 (14.2%)12 46 7.6%
Total 1385
Oral impairments affect childrens daily living, by sex
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IV. Result
Age Sex
dt > 0 dmft > 0
Number Percentage Number Percentage
6
Boy 185 61.66% 185 61.66%
Girl 113 37.66% 113 37.66%
Total 298 99.32% 298 99.32%
12
Boy 67 22.33% 69 23%
Girl 75 25% 76 25.33%
Total 142 47.33% 145 48.33%
Prevalence of dental caries (Primary teeth)
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IV. Result
Age Sex
DT > 0 DMFT > 0
Number Percentage Number Percentage
6
Boy 125 41.66% 122 40.66%
Girl 77 25.66% 75 25%
Total 202 67.32% 197 65.66%
12
Boy 117 39% 117 39%
Girl 145 48.33% 147 49%
Total 262 87.33% 264 88%
Prevalence of dental caries (Permanent teeth)
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IV. Result
Age Sample size Mean (dmft) SD
6 300 12.20 4.17
12 300 1.58 2.26
Total 600 6.89 6.28
Mean of decayed, missing, and filling teeth (dmft)
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IV. Result
Age Sample size Mean (DMFT) SD
6 300 1.39 1.22
12 300 4.37 3.45
Total 600 2.88 2.33
Mean of Decayed, Missing, and Filling teeth (DMFT)
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V. Discussion
The results show the mean dmft of 12.20 4.17, DMFT of1.39 1.22 among six-year children, and the mean dmftof twelve-year children is 1.58 2.26, DMFT of 4.37 3.45 and overall mean dmft is 6.89 6.28, DMFT is 2.88
2.33 for 4 primary schools in 7 Makara District in PhnomPenh.
The value of six-year children (12.20 4.17) is the highestmean dmft among all the studies, including Vong Viengdistrict in Laos (9.60), Phnom Penh National Survey
(9.00), National Oral Health Survey Philippine (8.40 4.20), Suratthani province southern Thailand (8.10 0.10), Romania Constanta district (5.74 3.73), andKunming city in China (4.47 4.39).
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V. Discussion
For twelve-year children, the mean DMFT of (4.37 3.45)
is also the highest mean among other studies, including
Romania Constanta district (3.31 3.04), Phnom Penh
National Survey (3.20), National Oral Health SurveyPhilippine (2.90 2.90), Suratthani province southern
Thailand (2.40 0.10), Vong Vieng district in Laos (1.90
0.30), and Kunming city in China (1.42 1.83).
It is clear that all the studies cannot be compared directly
and properly due to the socio-demographic reasons
associated with living in different environments26
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V. DiscussionMean Decayed, missing and filled teeth dmft and (DMFT) among 6 year-old
children, reported in studies conducted in Cambodia and Thailand since 1991
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Country / Province Year Ndmft DMFT
Mean SD Mean SD
7 Makara district, Cambodia 2012 300 12.20 4.17 1.39 1.22
Kunming city, China 2011 212 4.47 4.39
National Oral Health Survey, Philippine 2010 2030 8.40 4.20 0.70 1.10
Constanta district, Romania 2009 163 5.74 3.73 0.91 1.30
Vong Vieng district, Laos 2006 47 9.60 0.7 0.70 0.1
Suratthani province, Thailand 2001 1156 8.10 0.10
Phnom Penh (National survey) 1991 288 9.00
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V. DiscussionMean Decayed, missing and filled teeth dmft and (DMFT) among 12-year-old
children, reported in studies conducted in Cambodia and Thailand since 1991
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Country / Province Year Ndmft DMFT
Mean SD Mean SD
7 Makara district, Cambodia 2012 300 1.58 2.26 4.37 3.45
Kunming city, China 2011 1149 1.42 1.83
National Oral Health Survey, Philippine 2010 2022 0.20 0.60 2.90 2.90
Constanta district, Romania 2009 259 3.31 3.04
Vong Vieng district, Laos 2006 59 1.60 0.30 1.90 0.30
Suratthani province, Thailand 2001 1116 2.40 0.10
Phnom Penh (National survey) 1991 288 3.20
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V. Discussion
Strengths and weaknesses of the study
This study is firstly conducted in 4 primary schools in
7 Makara district of Phnom Penh city which is never
done before.
There were 300 six-year and 300 twelve-year children
selected to be examined in this study. Some children
could not give 100% correct answer.During examination, there were some teeth need to
be treated, but due to the lack of instruments and
materials, no treatment was provided to the children.29
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VI. Conclusion and recommendation
This study showed an increase number in the DMFT of six-year and twelve-year school children in 7 Makara districtcompared to the 1991 National Survey. The prevalence ofdental caries (dt) among six-year was 99.33%. The boys(61.66%) tend to have higher caries than the girls (37.66%).
For twelve-year children, the prevalence of dental carries (DT)was 87.33%. The girls (48.33%) have higher caries than theboys (39%).
Most of the children had dental problem which caused manyproblems, such as difficult in eating, sleeping, speaking, and
so on. These problems reduce quality of their life and hindertheir growing and studying. Furthermore, if they do not growand study well, it can affect the development of the country,because there will be a reduction of high qualified humanresources.
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VI. Conclusion and recommendation
Therefore, it is recommended that there is a need forstrengthening of activities and cooperation of the OralHealth Preventive School Program among primaryschools in 7 Makara district of Phnom Penh City in order
to reduce the prevalence of dental caries.One more thing is that the cooperation of schools to thepreventive program being a key factor to reduce dentaldecay, new approaches should be developed and put into
action to improve the motivation and willingness ofschool directors to implement the program regularly andeffectively.
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VII. References
1. Kruger E, Whyman R, Tennant M. High-acuity GIS mapping of private
practice dental services in New Zealand: does service match need?
International dental journal. 2012;62(2):95-9
2. Oral health in America: a report of the Surgeon General. Journal of the
California Dental Association. 2000;28(9):685-95.
3. Nurelhuda NM, Trovik TA, Ali RW, Ahmed MF. Oral health status of 12-
year-old school children in Khartoum state, the Sudan; a school-based survey.
BMC oral health. 2009;9:15.
4. Horowitz HS. The 2001 CDC recommendations for using fluoride to
prevent and control dental caries in the United States. Journal of public health
dentistry. 2003;63(1):3-8; discussion 9-10.
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VII. References
5. Beltran-Aguilar ED, Barker LK, Canto MT, Dye BA, Gooch BF, Griffin
SO, et al. Surveillance for dental caries, dental sealants, tooth retention,
edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002.
Morbidity and mortality weekly report Surveillance summaries (Washington,
DC : 2002). 2005;54(3):1-43.
6. Vieira AR. New directions in cariology research. International journal of
dentistry. 2010;2010.
7. Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors for dental caries inyoung children: a systematic review of the literature. Community dental
health. 2004;21(1 Suppl):71-85.
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VII. References
8. Takahashi N, Nyvad B. Caries ecology revisited: microbial dynamics and
the caries process. Caries research. 2008;42(6):409-18.
9. Liljemark WF, Bloomquist C. Human oral microbial ecology and dental
caries and periodontal diseases. Critical reviews in oral biology and medicine :
an official publication of the American Association of Oral Biologists.
1996;7(2):180-98.
10. Agarwal S, Pandit IK, Srivastava N, Gugnani N. Genetic engineering and
dental caries. Indian journal of dental research : official publication of Indian
Society for Dental Research. 2003;14(4):284-8.
11. Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental
diseases. Public health nutrition. 2004;7(1A):201-26.
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