Integrated Medical Education Resources: 160102P - DENTAL EPIDEMIOLOGY IN SAUDI ARABIA: Prevalence And Risk Factor Of Dental Caries Among Children

Presentation at the workshop on ‘Facing the challenges of the ageing society’ held at the King Fahad Medical City Small Auditorium on February 2, 2016 by Prof Omar Hasan Kasule Sr. Chairman of the Human and Medical Ethics Committee

INTRO 1

This review focuses on dental caries in children as a representative of oral health
The presentation has 2 parts paralleling the definition of epidemiology as (a) study of the occurrence and distribution of disease (b) study of determinants (risk factors) of disease
2 statistics used: prevalence and DMFT (decayed, missing, filled teeth)
Prevalence is too high and is increasing.

INTRO 2

Caries like CHD are a window to socio-economic transitions in society
Complex relationship with socio-economic risk factors was not investigated.
I had expected a pattern similar to CHD: high in the high SES at first and reverses with time.
The prevalence of caries has not changed much in a period of 30 years despite tremendous social and economic change: ? diet ?dental services ?SES change

SUMMARY

Prevalence of dental caries in children has been uniformly high over the past 30 years
The associated risk factors/indicators: diet (beverages, sugar), SES indicators (parental education and income, type of school, family size), anthropometrics, poor oral hygiene, fluorine.
Need for more detailed studies for example brushing vs bruising teeth

SYSTEMATIC REVIEW ON DENTAL CARIES PREVALENCE-2013

Based on a thesis and 27 surveys identified from pubmed
The national prevalence of dental caries and its severity in children in Saudi Arabia was estimated to be approximately 80% for the primary dentition with a mean dmft of 5.0 and approximately 70% for children's permanent dentition with a mean DMFT score of 3.5.
Conclusion: Childhood dental caries is a serious dental public health problem that warrants the immediate attention of the government and the dental profession officials in Saudi Arabia

Source: Al Agili DE. A systematic review of population-based dental caries studies among children in Saudi Arabia. Saudi Dent J. 2013 Jan;25(1):3-11

Meta Analysis On Dental Caries Prevalence In Saudi Arabia-2013

Literature search was started and found all studies conducted in Saudi Arabiaon dental caries from 1999 to 2008.
60 articles were found on PubMed of which 16 passed through inclusion criteria and included in analysis.
Population covered 2 to 12-year-old Saudi (primary teeth) and 6-18 (permanent teeth)
Mean decayed, missing, and filled teeth (dmft) for primary teeth was 5.38 (95% CI: 4.314 - 6.436)
Mean decayed, missing, and filled teeth (dmft) for permanent teeth was 3.34 (95% CI: 1.97 - 4.75).
Authors called for more research because their results were susceptible to publication bias

Source: Khan SQ1, Khan NB, Arrejaie AS. Dental caries. A meta analysis on a Saudi population. Saudi Med J. 2013 Jul;34(7):744-9.

Prevalence Of Dental Caries In Children- Eastern Saudi Arabia 2015

This cross sectional study was conducted at Dammam, KSA. February to May 2014.
Sample size 711, 397 aged 6-9 years who were examined for primary teeth caries, and 314 aged 10-12 years were examined for permanent teeth caries.
The overall prevalence of dental caries in primary and permanent teeth was almost 73% (n=711), 78% for the 6-9-year-old and 68% for the 10-12-year-old children, it was approximately 68% (n=314).
Conclusion: prevalence below other saudi studies but high by international standards

Source: Farooqi FA1, Khabeer A, Moheet IA, Khan SQ, Farooq I, ArRejaie AS.Prevalence of dental caries in primary and permanent teeth and its relation with tooth brushing habits among schoolchildren in Eastern Saudi Arabia‬. Saudi Med J. 2015 Jun;36(6):737-42.

Prevalence Of Dental Caries In Children – Jazan 2015

Cross-sectional, descriptive study 853 children aged 6-15 years (520 boys and 333 girls) were assessed by questionnaire and clinical examinations.
Caries prevalence (≥ 1 dft/DMFT) was high (91.3%).

Source: Quadri FA1, Hendriyani H2, Pramono A3, Jafer M1Knowledge, attitudes and practices of sweet food and beverage consumption and its association with dental caries among schoolchildren in Jazan, Saudi Arabia. East Mediterr Health J. 2015 Sep 8;21(6):403-11.

Prevalence Of Dental Caries In Children – Madinah – 2014

Cross-sectional, analytical study 360 students participated from 4 boys' schools.
The mean dmft score was 1.53 (sd 1.88).
Caries prevalence was low (57.2%) but the mean sic index was relatively high [3.63 (sd 1.66)]. The prevalences of plaque and gingivitis were high (82.8% and 70.8% respectively). Lower molars had the highest rate of caries. No children presented with dental fluorosis and 82.5% had a class i jaw relationship.
Recommendation: oral hygiene awareness programmes at schools, together with brushing and flossing programmes, are recommended in order to maintain and improve the oral health of young children in Medina.

Source: Bhayat A1, Ahmad MS1.Oral health status of 12-year-old male schoolchildren in Medina, Saudi Arabia. East Mediterr Health J. 2014 Dec 17;20(11):732-7.

Prevalence Of Dental Caries In Children In Jeddah-2014

A random sample of 24 elementary and middle schools in Jeddah was selected. All 3rd and 8th graders aged 9-14 were screened (N = 1655) for caries.
The overall caries experience was 83.13%. Untreatedcaries prevalence in primary and permanent teeth of all students was 63.01% and 56.7%, respectively.

Source: Al Agili DE, Alaki SM. Can Socioeconomic status indicators predict caries risk in schoolchildren in SaudiArabia? a cross-sectional study. Oral Health Prev Dent. 2014;12(3):277-88.

Prevalence Of Dental Caries In Children In Jeddah-2012

The carious status of the first permanent molar (FPM) was studied in 432 school children (aged 9-12 years) from a randomly selected primary schools from Sharfia area of Jeddah
The prevalence of four sound FPMs varied according to age with the highest (33%) amongst the nine-year olds and the lowest (16.5%) in the oldest children (12 years).
Almost one-third (32.5%) of the children, who knew the age of eruption of the FPMs, had all of their molars sound. The children who had received advice regarding oral hygiene from a dentist or parent had more sound FPMs compared to the children who did not receive any advice.
Conclusion: The number of carious FPMs increased with age. The prevalence of caries of the FPM was high and increased with increasing age. The level of knowledge had a positive correlation with the caries levels amongst this cohort of scholars.

Source:. Al-Samadani KH1, Ahmad MS. Prevalence of first permanent molar caries in and its relationship to the dental knowledge of 9-12-year olds from jeddah, kingdom of Saudi Arabia. ISRN Dent. 2012;2012:391068.

Prevalence Of Dental Caries In children Attending A Tertiary Care Center - 2009

The medical records of 175 healthy and 211 medically compromised 5-year-old Saudi children were reviewed.
A total of 91.9% of medically compromised and 84.0% of healthy children had evidence of caries.

Source: Brown A1. Caries prevalence and treatment needs of healthy and medically compromised children at a tertiary care institution in Saudi Arabia. East Mediterr Health J. 2009 Mar-Apr;15(2):378-86.

Prevalence Of Dental Caries In Children In Riyadh-2008

A total of 789 randomly selected preschool children, 379 (48%) male and 410 (52%) female, with mean age of 4.7 (SD 0.5) years were examined for dental caries
The overall caries prevalence among the sample was 74.8%. The mean decayed, missing, and filled (dmft) score was 6.1 (SD 3.9) with a decay component of 4.66, a missing component of 0.54, and a filled component of 0.92.
CONCLUSION: Caries prevalence and severity are very high in the study population, and most children have posterior tooth caries.

Source: Wyne AH1. Caries prevalence, severity, and pattern in preschool children. J Contemp Dent Pract. 2008 Mar 1;9(3):24-31.

Prevalence Of Caries In Children In Jeddah – 2006

A random sample of 300 children (6 to 7-year-olds) was drawn from six schools of military dependents.
Caries were diagnosed in 288 (96%) of the children, and only 4% were clinically caries free.
Mean decayed, missing, and filled teeth (dmft) for the 300 children was 8.06 (+ 4.04) per child and mean decayed, missing, and filled surfaces (dmfs) was 23.18 (+ 15.64).
Conclusions: The level of caries was higher than seen in children of equivalent age in other studies. The level of caries is expected to increase in permanent dentition.

Source: Al-Malik MI1, Rehbini YA. Prevalence of dental caries, severity, and pattern in age 6 to 7-year-old children in a selected community in Saudi Arabia. J Contemp Dent Pract. 2006 May 1;7(2):46-54.

Prevalence Of Caries In Children In The Central Province – 2004

1,104 children; 431 (6-7-year-old) primary schoolchildren (249 in Riyadh and 182 in Qaseem) and 673 (12-13-year-old) intermediate schoolchildren (392 in Riyadh and 28
In primary schoolchildren the prevalence of caries was 91.2% both in Riyadh and Qaseem. The mean dmft scores were similar in Riyadh (6.53, SD 4.30) and Qaseem (6.35, SD 3.83).
Among the intermediate schoolchildren the prevalence of dental caries was slightly higher in Riyadh (92.3%) than Qaseem (87.9%). The mean DMFT score was higher in Riyadh (5.06, SD 3.65) as compared with Qaseem (4.53, SD 3.57)
Conclusion: The caries experience among the primary and intermediate schoolchildren in Riyadh and Qaseem was very high

Source: Al Dosari AM1, Wyne AH, Akpata ES, Khan NB. Caries prevalence and its relation to water fluoride levels among schoolchildren in Central Province of Saudi Arabia. Int Dent J. 2004 Dec;54(6):424-8.

Prevalence Of Dental Caries In Children In Jeddah -2003

A random sample of 987 children was drawn from 17 nursery schools.
Caries were diagnosed in 720 (73%) of the children:
Caries and rampant caries were related to social class.

Source: Al-Malik MI1, Holt RD, Bedi R. Prevalence and patterns of caries, rampant caries, and oral health in two- to five-year-old children in Saudi Arabia. J Dent Child (Chic). 2003 Sep-Dec;70(3):235-42.

PREVALENCE OF DENTAL CARIES IN CHILDREN – AL KHARJ 2003

One hundred and three, 5-year-old children, from preschool nurseries in Al-Kharj, Kingdom of Saudi Arabia were studied in 1994.
Only 16.5% were caries free.
The mean decayed missing filled teeth (dmft) was 7.1, and by excluding caries free children it was 8.5.
Conclusion: There was high prevalence of untreated caries and high dental needs with concomitant poordental health among these preschool children.

Source: Paul TR1. Dental health status and caries pattern of preschool children in Al-Kharj, SaudiArabia. Saudi Med J. 2003 Dec;24(12):1347-51.

PREVALENCE OF DENTAL CARIES IN CHILDREEN IN JEDDAH -2002

A sample of 987 children (2-5 years) was drawn from 17 kindergartens.
Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%).

Source: Al-Malik MI1, Holt RD, Bedi R. Erosion, caries and rampant caries in preschool children in Jeddah, Saudi Arabia. Community Dent Oral Epidemiol. 2002 Feb;30(1):16-23..

PREVALENCE OF DENTAL CARIES IN CHILDREN –ALAHSA-2002

Three hundred and twenty two randomly selected pre-school children were examined in kindergartens of Al-Ahsa,
Of the 322 children examined, 202 (62.7%) were caries positive.

Source: Wyne AH1, Al-Ghannam NA, Al-Shammery AR, Khan NB. Caries prevalence, severity and pattern in pre-school children. Saudi Med J. 2002 May;23(5):580-4.

PREVALENCE OF DENTAL CARIES IN RIYADH – 2002

A random sample of primary schoolchildren was examined for dental caries
The prevalence of caries among the sample was 94.4%.

Source: Wyne AH1, Al-Ghorabi BM, Al-Asiri YA, Khan NB. Caries prevalence in Saudi primary schoolchildren of Riyadh and their teachers' oral health knowledge, attitude and practices. Saudi Med J. 2002 Jan;23(1):77-81

PREVALENCE OF DENTAL CARIES IN CHILDREN IN JEDDAH - 2001

A sample of 987 children (2-5-year-olds) was drawn from 17 kindergartens.
Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%).

Source: Al-Malik MI1, Holt RD, Bedi R. The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia. Int J Paediatr Dent. 2001 Nov;11(6):430-9.

PREVALENCE OF DENTAL CARIES IN CHILDREN IN JEDDAH-2000

Over a 2-year period, all 296 public primary schools in Jeddah were visited by dentists conducting a health education campaign. A total of 82,250 children in the first and fourth grades were screened.
The rate of detected dental caries was 83%, with significantly higher rates detected among females and first-grade children.
Lower social class was significantly associated with higher rates of dental caries.

Source: Gandeh MB1, Milaat WA. Dental caries among schoolchildren: report of a health education campaign in Jeddah, Saudi Arabia. East Mediterr Health J. 2000 Mar-May;6(2-3):396-401.

PREVALENCE OF DENTAL CARIES IN CHILDREN IN ABHA -2000

A two-stage stratified random sample of 959 schoolboys representative of the 6 to 13 year-old school population in Abha were subjected to dental examination.
The total prevalence of caries-free children was 14.6%.
Conclusion: Comparisons with international goals for oral health by the year 2000 show that the goal for 12 year-olds with respect to the status of the permanent dentition has been attained, but not the goal for 5-6 year olds with respect to caries-free primary teeth. It is likely that nutritional status may have different effects on susceptibility to caries of deciduous and permanent teeth.

Source: Abolfotouh MA1, Hassan KH, Khattab MS, Youssef RM, Sadek A, El-Sebaiei M. . Dental caries: experience in relation to wasting and stunted growth among schoolboys in Abha, Saudi Arabia. Ann Saudi Med. 2000 Sep-Nov;20(5-6):360-3.

PREVALENCE OF DENTAL CARIES IN CHILDREN JEDDAH - 1996

1522 children aged 6-9 were examined from six primary schools located in different areas of the city.
The mean dmft and DFT were 4.23 and 1.85, respectively.
The mean dmft and DFT values excluding caries-free children, however, were 5.71 and 2.95, respectively.
Only 26.1% of the children were caries free.
There was a high proportion of untreated dental caries and most of the carious teeth were treated by extraction.
The need for effective preventive measures was stressed.

Source: Alamoudi N1, Salako NO, Massoud I. Caries experience of children aged 6-9 years in Jeddah, Saudi Arabia. Int J Paediatr Dent. 1996 Jun;6(2):101-5.

PREVALENCE OF DENTAL CARIES IN CHILDREN – RIYADH - 1992

A 3-day dietary history was obtained from 363 Riyadh schoolchildren aged 12-13 yr, after which their dentitions were examined for dental caries. About 16-31% of the children were caries-free and the mean DMFT varied between 1.67 and 2.43.
There was a statistically significant relationship between DFS and the frequency of sugar consumption on the first 2 days of the dietary diary.
It is suggested that the management of dental caries in the children must include the control of dietary sugar.

Source: Akpata ES1, al-Shammery AR, Saeed HI.. Dental caries, sugar consumption and restorative dental care in 12-13-year-old children in Riyadh, Saudi Arabia. Community Dent Oral Epidemiol. 1992 Dec;20(6):343-6.

PREVALENCE OF DENTAL CARIES IN GIZAN – 1985

296 preschoolchildren attending the pediatric clinic at Gizan Hospital were examined over a period of 3 months.
One third of the children had untreated caries and none of the children had received any restorative dental care. A strategy for development of preventive dental services for this age group is discussed.

Source: Community Dent Oral Epidemiol. 1985 Jun;13(3):176. Dental caries in preschoolchildren in Gizan, Saudi Arabia. Salem GM, Holm SA.

RISK FACTORS OF DENTAL CARIES AMONG CHILDREN- JAZAN - 2015

In a cross-sectional, descriptive study 853 children aged 6-15 years (520 boys and 333 girls) were assessed by questionnaire and clinical examinations.
While knowledge was generally good, 83.5% boys and 85.8% girls had poor attitudes to sweet foods and > 90% frequently consumed sweet foods/beverages.
Multiple regression analysis showed that children whose mothers were less educated (OR 2.46; 95% CI: 1.15-5.28) and children with poor dietary attitudes and practices (OR 4.05; 95% CI: 2.33-7.03 and OR 7.80; 95% CI: 4.50-13.52 respectively) were more likely to have dental caries.
Well-directed health promotion programmes are needed in Jazan.

Source: Quadri FA1, Hendriyani H2, Pramono A3, Jafer M1. Knowledge, attitudes and practices of sweet food and beverage consumption and its association with dental caries among schoolchildren in Jazan, Saudi Arabia. East Mediterr Health J. 2015 Sep 8;21(6):403-11.

RISK FACTORS OF DENTAL CARIES AMONG CHILDREN-JEDDAH-2014

A random sample of 24 elementary and middle schools in Jeddah was selected. All 3rd and 8th graders were screened (N = 1655) for caries. A parent questionnaire was administered to collect information on selected socioeconomic indicators. Untreated caries was the outcome of interest..
The most powerful individual SES predictors of caries were family monthly income and parents' education.
Until a more valid aggregate measure of SES is available, community wide approaches to caries prevention and risk reduction for all young children should be utilised to reduce SES-related caries risk.

Source: Al Agili DE, Alaki SM. Can Socioeconomic status indicators predict caries risk in schoolchildren in SaudiArabia? a cross-sectional study. Oral Health Prev Dent. 2014;12(3):277-88..

RISK FACTORS OF DENTAL CARIES AMONG CHILDREN-JEDDAH-2014

A cross-sectional survey in schoolchildren aged 6 to 8 years attending military primary schools in Jeddah, Saudi Arabia.
The inverse linear association between dental caries and all anthropometric outcomes suggests that higher levels of untreated caries are associated with poorer growth in Saudi schoolchildren.

Source: Alkarimi HA1, Watt RG, Pikhart H, Sheiham A, Tsakos G. Dental caries and growth in school-age children. Pediatrics. 2014 Mar;133(3):e616-23.

RISK FACTORS OF DENTAL CARIES AMONG CHILDREN-NATIONWIDE-2012

A questionnaire based national cross-sectional survey among 500 dentists was conducted under the auspices of Directorate of Dentistry, Ministry of Health.
83% of dentists identified poor oral hygiene as the major reason for high prevalence of caries.

Source: Togoo RA1, Al-Rafee MA, Kandyala R, Luqam M, Al-Bulowey MA.. Dentists' opinion and knowledge about preventive dental care in Saudi Arabia: a nationwide cross-sectional study. J Contemp Dent Pract. 2012 May 1;13(3):261-5.

RISK FACTORS OF DENTAL CARIES IN CHILDREN – NATIONWIDE - 2010

A total of 12,200 selected subjects were examined for dental caries
There was an inverse relationship between fluoride exposure and caries experience
There was no significant difference in caries experience or in the prevalence of dental fluorosis when fluoride levels increased from 0.3 ppm to 0.6 ppm.
In contrast, caries experience was lower, while severity of fluorosis was significantly higher at fluoride levels above 0.6 ppm.
Conclusions: a) Fluoride levels in drinking water sources in Saudi Arabia correlate significantly with caries experience and prevalence of dental fluorosis. b) Appropriate fluoride concentration for drinking water in SaudiArabia may be about 0.6 ppm.

Source: AlDosari AM1, Akpata ES, Khan N. Associations among dental caries experience, fluorosis, and fluoride exposure from drinking water sources in Saudi Arabia. J Public Health Dent. 2010 Summer;70(3):220-6.

RISK FACTORS OF DENTAL CARIES IN CHILDREN – AL AHSA – 2008

The cross-sectional descriptive study included 1115 Saudi male selected by multistage random sample from 18 public primary schools. Subjects were interviewed by closed ended questionnaire gathering data regarding frequency consumption of some cariogenic foods, oral hygiene practices and dental health knowledge. Students were submitted to dental screening to detect the clinically evident caries lesion.
Maternal working conditions, large family size and poor oral hygiene practices were the chief predictors for dental caries among the included school children.
Conclusion: The poor oral hygiene practices, lack of parental guidance and appropriate dental health knowledge with frequent exposure to cariogenic foods in addition to socio-demographics are the main risk factors for dental decay among the surveyed students.

Source: Amin TT1, Al-Abad BM. Oral hygiene practices, dental knowledge, dietary habits and their relation to cariesamong male primary school children in Al Hassa, Saudi Arabia. Int J Dent Hyg. 2008 Nov;6(4):361-70.

RISK FACTORS OF DENTAL CARIES IN CHILDREN – RIYADH - 2008

A total of 789 randomly selected preschool children, 379 (48%) male and 410 (52%) female, with mean age of 4.7 (SD 0.5) years were examined for dental
There was no significant difference (p>.05) in caries prevalence and severity in relation to gender of the children.
The caries prevalence and severity were significantly higher (p<.05) among children from government preschools as compared to those from private preschools.

Source: SWyne AH1. Caries prevalence, severity, and pattern in preschool children. J Contemp Dent Pract. 2008 Mar 1;9(3):24-31

RISK FACTORS OF DENTAL CARIES IN CHILDREN – ABHA - 2000

A two-stage stratified random sample of 959 schoolboys representative of the 6 to 13 year-old school population in Abha were subjected to dental examination.
The children were also subjected to weight and height measurements and their values were compared with the local growth standards.
wasted children were found to have a higher caries prevalence in the primary dentition than the well-nourished children (P<0.01), while children with stunted growth exhibited lower caries prevalence in the permanent teeth (P<0.05).
Conclusion: It is likely that nutritional status may have different effects on susceptibility to caries of deciduous and permanent teeth.

Source: Abolfotouh MA1, Hassan KH, Khattab MS, Youssef RM, Sadek A, El-Sebaiei M. Dental caries: experience in relation to wasting and stunted growth among schoolboys in Abha, Saudi Arabia. Ann Saudi Med. 2000 Sep-

RISK FACTORS OF DENTAL CARIES IN CHILDREN – JEDDAH – 2001

A sample of 987 children (2-5-year-olds) was drawn from 17 kindergartens.
Consumption of carbonated drinks and fruit syrups was also related to caries but they were part of a larger number of significant factors including socio-demographic measures and oral hygiene practices.
CONCLUSIONS: There was a relationship between caries and social class, or between caries and oral hygiene practices;
Dietary factors relating to caries and/or rampant caries were found in this sample of children.

Source: Al-Malik MI1, Holt RD, Bedi R. The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia. Int J Paediatr Dent. 2001 Nov;11(6):430-9.

RISK FACTORS OF DENTAL CARIES IN CHILDREN – RIYADH 1992

A 3-day dietary history was obtained from 363 Riyadh schoolchildren aged 12-13 yr, after which their dentitions were examined for dental caries.
There was a statistically significant relationship between DFS and the frequency of sugar consumption on the first 2 days of the dietary diary.
It is suggested that the management of dental caries in the children must include the control of dietary sugar.

Source: Akpata ES1, al-Shammery AR, Saeed HI Dental caries, sugar consumption and restorative dental care in 12-13-year-old children in Riyadh, Saudi Arabia. Community Dent Oral Epidemiol. 1992 Dec;20(6):343-6.

RISK FACTORS OF DENTAL CARIES IN CHILDREN – JEDDAH, MAKKAH, RABAGH - 1990

Children aged 6, 12 and 15 years were examined for dental caries in three cities in Saudi Arabia, with varying levels of naturally occurring fluoride in the drinking water; Jeddah (less than 0.3 ppm), Rabagh (0.8 ppm) and Mecca (2.5 ppm).
For each age group, caries levels were considerably higher in Jeddah than in Rabagh or Mecca. Occlusal surfaces were most frequently affected.
Children attending public schools experienced a considerably higher caries prevalence than those attending private schools. All age groups had high levels of untreated dental decay.
Preliminary results indicate that residents of Mecca exercise unacceptable levels of dental fluorosis.

Source: al-Khateeb TL1, Darwish SK, Bastawi AE, O'Mullane DM. Dental caries in children residing in communities in Saudi Arabia with differing levels of natural fluoride in the drinking water. Community Dent Health. 1990 Jun;7(2):165-71.