|Year : 2022 | Volume
| Issue : 1 | Page : 41-47
Effect of anterior dental caries on psychological behavior and quality of life of Saudi pediatric patients
Rafi Ahmad Togoo, Hanan Qasem Alfaifi, Fatimah Mohammed Algarny, Jamilah Dafer Alahmari, Raghad Ayed Ali AlQhtani, Hanin Ahmed Asiri
Departments of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
|Date of Submission||16-Aug-2021|
|Date of Decision||18-Nov-2021|
|Date of Acceptance||18-Nov-2021|
|Date of Web Publication||29-Apr-2022|
Dr. Hanan Qasem Alfaifi
Intern, Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha
Source of Support: None, Conflict of Interest: None
Introduction: Dental caries is the most common chronic infectious disease involving children and toddlers. Carious invasion of anterior teeth causes infection, pain, compromised speech, mastication, and impacts the esthetics and appearance of the child. Dental caries' immediate and long-term effects affect the child's quality of life and his family, leading to significant social, economic, and psychological consequences.
Aim: The present study was conducted to evaluate the effect of anterior dental caries on Saudi pediatric patients' psychological behavior and quality of life.
Materials and Methods: A self-administered, structured questionnaire was used to assess the demographic variables, the prevalence of dental caries (anterior teeth), and their psychological effects on children. The data obtained were subjected to statistical analysis using IBM SPSS version 20.0 software.
Results and Discussion: Five hundred and twenty-two children were included in the study, out of which 67.62% were affected with anterior carious lesions, with a mean age of 4.90 ± 1.981 years. Most parents reported that their child has anterior carious lesions, with 50% of children having toothache and 49% difficulty in eating food, especially sweets. Affected children showed psychological issues as they avoided playing, hesitated to smile, were introverted, and covered their faces while smiling.
Conclusion: A high anterior dental caries prevalence and the resultant effect on psychological behavior and quality of life were observed among young children in Saudi Arabia. Enhanced educational, counseling, and preventive programs among parents and children will reduce dental caries incidence and ensure young children have a good quality of life.
Keywords: Anterior dental caries, children, psychological behavior, quality of life, Saudi Arabia
|How to cite this article:|
Togoo RA, Alfaifi HQ, Algarny FM, Alahmari JD, AlQhtani RA, Asiri HA. Effect of anterior dental caries on psychological behavior and quality of life of Saudi pediatric patients. Saudi J Oral Sci 2022;9:41-7
|How to cite this URL:|
Togoo RA, Alfaifi HQ, Algarny FM, Alahmari JD, AlQhtani RA, Asiri HA. Effect of anterior dental caries on psychological behavior and quality of life of Saudi pediatric patients. Saudi J Oral Sci [serial online] 2022 [cited 2022 May 20];9:41-7. Available from: https://www.saudijos.org/text.asp?2022/9/1/41/344400
| Introduction|| |
Dental caries is a serious international public health challenge in both developed and developing nations. It is the most common chronic infectious disease involving children and toddlers, caused by the interaction of bacteria, mainly Streptococcus mutans, and sugary foods on tooth enamel. It is characterized by a distinctive pattern of involvement of teeth. The definitions used to describe this condition in children were related to its etiology, particularly concerning the inappropriate use of nursing practices. To date, various terms are being used interchangeably to name dental caries in young children, such as early childhood tooth decay, early childhood caries (ECC), or baby bottle-fed tooth decay. However, “early childhood caries” is the most recognized and popular among dentists and dental researchers.,
ECC (Early childhood Caries) is defined as “the presence of one or more decayed (non-cavitated or cavitated lesions), missing teeth (due to caries), or filled tooth surfaces in any primary tooth in a child aged 72 months or younger. In children younger than 3 years of age, any sign of smooth surface caries indicates severe ECC (S-ECC). From ages 3 through 5, one or more cavitated, missing teeth (due to caries), or filled smooth surfaces in primary maxillary anterior teeth or decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces constitutes S-ECC.
ECC is recognized as a dull, white demineralized initial carious lesion to evident cavitation along the gingival margin. It commonly involves labial or lingual surfaces of the teeth, especially primary maxillary incisors. The carious lesion is clinically evident as a yellow or brown hard cavitated area. In older children with fully erupted primary dentition, more advanced carious invasion can be seen. The severe form of ECC is termed rampant caries, which usually affect immune tooth surfaces. It is commonly present as severe involvement of smooth surfaces of maxillary anterior teeth in young children.
Carious invasion of anterior teeth causes infection, pain, compromised speech, and mastication and impacts the esthetics and appearance of the child. Dental caries' immediate and long-term effects affect the child's quality of life and his family, leading to significant social, economic, and psychological consequences. As being different from adult patients, children cannot self-regulate their behavior and experiences. Thus, children and toddlers deserve special attention and care concerning their oral health, which creates a profound impact on their psychological well-being and quality of life.
To date, no study has been conducted to evaluate the effect of anterior dental caries on children's psychological well-being and quality of life in the pediatric population of Saudi Arabia. Thus, the present study was conducted to evaluate the effect of anterior dental caries on Saudi pediatric patients' psychological behavior and quality of life.
| Materials and Methods|| |
The present cross-sectional study was an online questionnaire-based study conducted from March 2021 to June 2021. A self-administered structured questionnaire was used to assess the demographic variables, the prevalence of dental caries in anterior teeth, and its psychological effects on children. The validity and reliability of the questionnaire were established with a pilot study using Cronbach's alpha and was found to be satisfactory (with [coefficient of Cronbach's alpha] α = 0.84). The study was conducted following the Declaration of Helsinki and was approved by the local ethics committee of the institute (SRC/REG 2019–20/93). Informed written consent was obtained from the parents/guardians of the subjects before their enrollment in the study. A convenient sample of 700 was chosen, out of which 522 subjects responded duly to the questionnaire, with a response rate of 74.57%. Children falling in the age range of 2–5 years, both genders, and whose parents/guardians were fluent in the Arabic language and consented to participate were included in the study. All those who were undergoing orthodontic treatment or had any systemic disease were excluded from the study. Based on the response from parents/guardians regarding dental caries (in anterior teeth), the children were divided into caries-free and caries-affected groups.
Besides demographic parameters, the questionnaire included 16 well-structured items to be asked to parents/guardians of the children through online mode (WhatsApp). The questionnaire included demographic data such as age, education, marital status of parents (together/separated), and parents' financial status. Questions regarding the number of family members, child order, weight of the child, total number of decayed teeth of children, number of carious lesions in anterior teeth of their children, pain, and difficulty in eating. Various factors determining the psychological impact of anterior carious lesions were analyzed and compared among the caries and caries-free groups.
The data obtained were subjected to statistical analysis using IBM SPSS version 20.0 software. Descriptive statistics, i.e., frequencies and percentages, were computed. The comparative analysis was done using Chi-square statistical analysis.
| Results|| |
A total of 522 children were included in the study, out of which 67.62% were affected with anterior carious lesions and 32.38% were caries free, with 67.62% caries prevalence [Table 1]. Demographic data were recorded in terms of the age of participating children and maternal and father age [Table 2]. The mean age of participants ranged from 4.224 ± 2.06 to 4.90 ± 1.981 years of age.
Demographic characteristics such as gender distribution and weight of participants and education and marital and financial status of parents were evaluated [Table 3]. In both the groups, females were more than males. Most of the children were of perfect weight. The maximum answering guardians of children were their mothers. It was found that the maximum number of both mothers and fathers were baccalaureate in terms of education status and were married, with moderate income.
|Table 3: Distribution of study subjects in caries-affected and caries-free groups|
Click here to view
[Table 4] shows the responses to eight questions asked to access the details of affected children in the family and parents' knowledge regarding identifying dental caries in their child's mouth. Most children were born as the first child, and around 80.04% had less than five carious lesions. Most parents reported that their child has anterior carious lesions, with 50% of children having toothache and 49% difficulty in eating food, especially sweet.
|Table 4: Distribution of study subjects according to questionnaire in caries-affected and caries-free groups|
Click here to view
[Table 5] shows that questions were asked about the psychological effect on children in the caries-affected and caries-free groups. It was observed that around 48% of affected children ask about their teeth, whereas in the caries-free group, 65% of children do not ask. It was observed that affected children avoid playing compared to normal children, and their friends even harassed them. Few of them show hesitation in daily activities such as smiling while taking pictures, being introverts, or covering their face while smiling. However, when compared with unaffected children, more affected children showed a statistically significant difference in psychological impact.
|Table 5: Psychological effect on children in caries-affected and caries-free groups|
Click here to view
Statistically, the relation between answers to all questions was derived using Chi-square statistical analysis, and a significant relation was observed among all options for each question.
| Discussion|| |
Being a significant dental public health problem, dental caries is the most prevalent oral disease among children. Evaluating the prevalence of dental caries at various levels is of great interest to many epidemiological researchers worldwide. This disease leads to damage to the tooth and can cause morbid conditions of the oral cavity and other systems of the body.
Saudi Arabia is a large, multicultural country with varied caries prevalence in different cities and regions. Various studies revealed that the incidence of caries prevalence is relatively high in most of the areas and cities of Saudi Arabia.,, A study by Al-Meedani and Al-Dlaigan about 69% of children had dental caries with a dmft score of 3.4 (±3.6) and dmfs of 6.9 (±9.9). In a recent study by Farsi et al., preschool children showed a high caries prevalence of 89%. In another study by Wyne, caries prevalence was 74.8%, with a mean dmft score of 6.1 in preschool children. Similar to these studies, we also observed a prevalence rate of 67.62% among preschool children.
In the present study, we observed female predominance among caries-affected children. Results of our study were similar to the study by Wyne, which showed that 52% of females were affected. Over the past decades, various research reports have shown that the prevalence of dental caries is linked to different social factors., It has been advocated that dental caries among children are influenced by parents' education status, age, and socioeconomic condition. We observed that affected children were from moderate family income families with parents holding a bachelor's degree. A statistically significant relationship (P < 0.05) was observed regarding parents' education status and caries incidence among children.
Wigen and Wang revealed the associations between parental factors and caries development in early childhood. The present study showed an association between parents' educational level and the prevalence of caries. Similar to our study, they found that the children of highly educated parents had lower caries prevalence. Hallet and O'Rourke also showed a high incidence of caries in children of mothers with low educational levels. These results can be due to improved oral health awareness and better dental health practices in children among educated parents.
We observed that the incidence of caries was more in families where >5 family members reside. Similar findings were observed in a study by Wellappuli and Amarasena, who found a positive correlation of family size with dental caries. They found that in small families, children maintain good oral hygiene than children from large family sizes.
We observed that most affected children were firstborn to their parents, and a significant difference was observed statistically in terms of order of birth and caries incidence. Similar results were observed in a study by Folayan et al. However, in a study by Al-Meedani and Al-Dlaigan, no association was observed between child order of birth and caries prevalence.
Thus, the lower level of parent education, parents' income, socioeconomic status, increased number of children in the family, and effect of gender could be risk factors for increased caries levels. In the present study, we observed that parents have limited knowledge in identifying the anterior carious lesions. Nevertheless, the most common complaint they observed was toothache and difficulty in eating food among affected children. Similar findings were observed in various studies,,, who reported that parents noticed complaints from children such as toothache, problems in eating certain foods, and children's absence from school. They are ashamed to smile and stop playing with other children because of their teeth.
Acs et al. noticed that pain and infection are the most common effects of nursing caries. Pain may be associated with other factors depending on the severity of the disease, such as altered eating patterns, sleep, the behavior of the child, and absence from school. They reported that around 26.0% of the parents reported psychological effects on their children suffering from dental caries.
We observed that anterior dental caries create various impacts on the psychological well-being of children such as missing school, being reluctant to play, smiling, being introverted, and incidences of being bullied and harassed by other children. Chen and Hunter also observed similar problems and stated that oral health problems could affect the individual's quality of life by impairing social functioning and self-esteem. Reisine et al. also revealed that dental caries among children affect their quality of life. Matilla et al. stated that the incidence of dental caries directly impacts the mental well-being of children and is influenced by his family and peer groups.
The results of our study redefine the public health policy priorities regarding dental caries among young children. Children with severe caries usually complained of toothache and eating disturbance. When there is the involvement of anterior teeth, it leads to more impact on their psychological well-being, thus affecting their quality of life.
Different government policies have been proposed that directly impact providing adequate oral health care to children. These policies also control various structural risk factors associated with ECC. Different authors have investigated the efficacy of newer anticaries agents (like silver diamine fluoride solution) for controlling dentine caries and even proposed new intervention protocols for ECC. Various research findings have been applied to practice. Different policymakers and general dental practitioners have replied to new guidelines for managing ECC. For example, guidelines developed by the American Academy of Pediatric Dentistry in ECC have been successfully implemented and used. To manage ECC, every country has implemented its guidelines and strategies to manage ECC.
Based on these findings, we advocate that various preventive educational programs (oral hygiene practices and dietary advice) should be reinforced among parents, especially mothers of young children. Preventive therapies such as topical fluoride applications, fluoride supplements, and pit and fissure sealants should be implemented as early as possible, especially on the caries susceptible teeth. To maintain children's psychological health, they should be educated regarding the maintenance of their oral health.
Random sampling technique would have increased the representativeness of the sample. The present study was conducted on limited sample size and was restricted to the population of a particular region of Saudi Arabia. Hence, future studies should be done with more elaborated sample size, covering different regions of Saudi Arabia. The future study would also include the effect of traumatic dental injuries and malocclusion on the child's psychology.
| Conclusion|| |
A high anterior dental caries prevalence and the resultant effect on psychological behavior and quality of life were observed among young children in Saudi Arabia. Enhanced educational, counseling, and preventive programs among parents and children will reduce dental caries incidence and ensure young children have a good quality of life.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med 2013;4:29-38.
Inglehart MR, Filstrup SL, Wandera A. Oral health and quality of life in children. In: Inglehart M, Bagramian R, editors. Oral Health-related Quality of Life. Chicago: Quintessence Publishing Co.; 2002. p. 79-88.
Chen KJ, Gao SS, Duangthip D, Lo ECM, and Chu CH. Prevalence of early childhood caries among 5-year-old children: A systematic review. J Investig Clin Dent 2019;10:e12376.
El Tantawi M, Folayan MO, Mehaina M, Vukovic A, Castillo JL, Gaffar BO, et al
. Prevalence and data availability of early childhood caries in 193 United Nations Countries, 2007-2017. Am J Public Health 2018;108:1066-72.
Policy on early childhood caries (ECC): Classifications, consequences, and preventive strategies. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2020:79-81.
Kirthiga M, Murugan M, Saikia A, Kirubakaran R. Risk factors for early childhood caries: A systematic review and meta-analysis of case-control and cohort studies. Pediatr Dent 2019;41:95-112.
Abou El Fadl R, Abdel Fattah M, Ezz M. Assessing the prevalence of early childhood caries and the associated determinants in a group of pre-school children: Results from a national oral health survey in Egypt. Egypt Dent J 2019;65:31-9.
Duangthip D, Chen KJ, Gao SS, Lo ECM, Chu CH. Early childhood caries among 3- to 5-year-old children in Hong Kong. Int Dent J 2019;69:230-6.
Al-Meedani LA, Al-Dlaigan YH. Prevalence of dental caries and associated social risk factors among pre-school children in Riyadh, Saudi Arabia. Pak J Med Sci 2016;32:452-6.
Farsi N, Merdad L, Mirdad S. Caries risk assessment in pre-school children in Saudi Arabia. Oral Health Prev Dent 2013;11:271-80.
Wyne AH. Caries prevalence, severity, and pattern in pre-school children. J Contemp Dent Pract 2008;9:24-31.
Alshunaiber R, et al
. Early childhood caries and infant's oral health; pediatricians' and family physicians' practice, knowledge and attitude in Riyadh city, Saudi Arabia. Saudi Dent J 2019;31 Suppl: S96-105.
Wigen TI, Wang NJ. Parental influences on dental caries development in pre-school children. An overview with emphasis on recent Norwegian research. Norsk Epidemiol 2012;22:13-9.
Hallet KB, O'Rourke PK. Dental caries experience of pre-school children from north Brisbane region. Aust Dent J 2002;47:331-8.
Wellappuli N, Amarasena N. Influence of family structure on dental caries experience of pre-school children in Sri Lanka. Caries Res 2012;46:208-12.
Folayan M, Owotade F, Oziegbe E, Fadeyibi R. Effect of birth rank on the caries experience of children from a suburban population in Nigeria. Dent Oral Hyg 2010;2:27-30.
Paglia L, Friuli S, Colombo S, Paglia M. The effect of added sugars on children's health outcomes: Obesity, obstructive sleep apnea syndrome (OSAS), attention-deficit/hyperactivity disorder (ADHD) and chronic diseases. Eur J Paediatr Dent 2019;20:127-32.
Acs G, Lodolini G, Kaminsky S, Cisneros GJ. Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 1992;12:302-5.
Chen MS, Hunter P. Oral health and quality of life in New Zealand: A social perspective. Soc Sci Med 1996;43:1213-22.
Reisine S, Fertig J, Weber J, Leder S. Impact of dental conditions on patient's quality of life. Community Dent Oral Epidemiol 1989;17:7-10.
Matilla ML, Rautava P, Silanpaa M, Paunio P. Caries in five-year-old children and associations with family-related factors. J Dent Res 2000;79:875-81.
Chen J, Duangthip D, Gao SS, Huang F, Anthonappa R, Oliveira BH, et al
. Oral health policies to tackle the burden of early childhood caries: A review of 14 countries/regions. Front Oral Health 2021;2:670154.
Crystal YO, Marghalani AA, Ureles SD, Wright JT, Sulyanto R, Divaris K, et al
. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatr Dent 2017;39:135-45.
Duangthip D, Chu CH. Challenges in oral hygiene and oral health policy. Front Oral Health 2020;1:575428.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]