Dental caries risk factors of childbearing-age mother in rural village: A cross-sectional study

Aulia Ramadhani; Adi Hapsoro; Roesanto Heroesoebekti; Nawira

doi:10.4103/jioh.jioh_260_18

ORIGINAL RESEARCH

Year : 2021 | Volume : 13 | Issue : 2 | Page : 151-155

Dental caries risk factors of childbearing-age mother in rural village: A cross-sectional study

Aulia Ramadhani¹, Adi Hapsoro², Roesanto Heroesoebekti², Nawira³
¹ Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
² Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
³ Resident of Conservative Dentistry Specialist Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Date of Submission	22-Oct-2018
Date of Decision	12-Sep-2020
Date of Acceptance	03-Mar-2021
Date of Web Publication	17-Apr-2021

Correspondence Address:
Ms. Aulia Ramadhani
Faculty of Dental Medicine, Universitas Airlangga, Jl. Prof Dr. Moestopo, no. 47, Surabaya.
Indonesia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jioh.jioh_260_18

Abstract

Aim: To evaluate the risk factors of dental caries in childbearing-age mother. Materials and Methods: This was a descriptive-observational study. The samples were selected by using the total sampling method in the population of childbearing-age mothers in Urung-urung Village, Indonesia, with a total sample of 85 respondents. This study used a questionnaire for risk factor assessment, as well as intra-oral examination using the DMF-T index (decay, missed, filled teeth index) and the OHI-S (Oral Hygiene Index Simplified). Data that had been obtained were processed to determine the caries level based on the DMF-T index. From the DMF-T index data, a cross-tabulation test was carried out between the DMF-T score and education level, age, daily expenditure, use of prostheses, toothbrush habits, knowledge of oral health, and status of oral hygiene presented in table form. Data analysis was conducted by using SPSS Ver 18 Software Program (IBM, New York). Results: Overall, 65% of the respondents have a high DMF-T score (>6). The results of the cross-tabulation test with the DMF-T score showed that age (OR = 1.151), educational background (OR = 2.625), access to health services (OR = 1.140), knowledge of dental caries (OR = 1.040), and the OHI-S score (OR = 3.087) were risk factors for the severity of dental caries. However, only the OHI-S score showed a significant Odds Ratio (OR) <0.05. Conclusions: The OHI-S score variable represented the risk factor of caries severity in the childbearing-age mother population in Urung-urung Village.

Keywords: Childbearing Age Mothers, Dental Caries, Risk Factors

How to cite this article:
Ramadhani A, Hapsoro A, Heroesoebekti R, Nawira. Dental caries risk factors of childbearing-age mother in rural village: A cross-sectional study. J Int Oral Health 2021;13:151-5

How to cite this URL:
Ramadhani A, Hapsoro A, Heroesoebekti R, Nawira. Dental caries risk factors of childbearing-age mother in rural village: A cross-sectional study. J Int Oral Health [serial online] 2021 [cited 2023 Oct 5];13:151-5. Available from: https://www.jioh.org/text.asp?2021/13/2/151/313841

Introduction

Dental and oral health problems currently remain a complaint from the Indonesian population. One of the dental and oral diseases that commonly occurs is caries. Dental caries is an important health problem, because this infection can affect anyone regardless of age; and if it is left unchecked, it will be a source of focal infection in the mouth, causing pain complaints.^[1] Dental caries are caused by a low degree of dental and oral hygiene. Dental and oral health efforts need to be reviewed from the point of view of environmental aspects and public awareness toward the degree of dental and oral hygiene.^[2] The results of the Indonesian Basic Health Survey in 2018 show that 45.3% of Indonesians suffered from dental caries. It is also reported that 54% of East Java populations suffered from dental problems, including dental caries.^[3]

Childbearing women are women between the ages of 15 and 49 years. Women experience several hormonal changes when they enter adolescence until they are older. At certain times, women need to pay extra attention to themselves because these hormonal changes have a significant effect on almost all aspects of their lives, including dental and oral health. Hormone fluctuations cause women to be in a situation that is more susceptible to dental and oral problems. This vulnerability can occur during puberty, when entering the monthly menstrual cycle, during pregnancy, and menopause. For women who experience dental and mouth problems during menstruation, the awareness of maintaining oral and dental hygiene is the main key to staying in top condition after completing menstruation.^[4]

Childbearing-age mothers tend to have a high prevalence rate of dental caries and periodontal disease, although these do not usually occur in the majority. Several studies have revealed that economic and ethnic factors are risk factors for increasing the prevalence of caries in childbearing-age mothers.^[5] In addition, the low number of dental care in childbearing-age mothers affects the high prevalence of dental caries.^[6] Dental caries is also a maternal–child health association, where the occurrence of dental caries in children is influenced by biological factors, behavior, and social relationships of the mother.^[5] Children of mothers who have high levels of untreated cavities or tooth loss are more than three times as likely to have cavities as a child.^[7]

Previous studies have suggested that ethnic minorities and low economic levels place childbearing-age mothers at risk of having a high prevalence of caries. Urung-urung Village is one of the villages with a low economy and has a large population of childbearing-age mothers. Based on the background, as mentioned earlier, the researchers wanted to evaluate the risk factors of dental caries in the low economic population of childbearing-age mothers in Urung-urung Village, Jatijejer.

Materials and Methods

Setting and design

This was an observational descriptive study with a cross-sectional research design. This study was carried out in Urung-urung Village for two months. The total sampling method was chosen for this descriptive study. The entire population consisting of 85 childbearing-age mothers in the village of Urung-urung comprised the research sample. The inclusion criteria of this study were all childbearing-age women who were registered as patients at the Urung-urung Public Health Center between 2016 and 2018. The data collection was carried out with a home visit or home-to-home visit, preceded by explaining the purpose of the study to the respondents. All respondents had filled in the written informed consent prepared by the researchers.

Data collection

Data collection on childbearing-age mothers in Urung-urung was performed by listing their names and ages and then having the respondents to fill out the questionnaire administered by the researchers. After the questionnaire was filled out, oral hygiene and dental caries of the respondents were examined.^[8] The respondents were asked to open their mouths, and the researchers examined the condition of the oral cavity by using a dental diagnostic mirror. When data collection was completed, data processing was then performed.

Statistical analysis

The data obtained were processed to determine the caries level based on the DMF-T index. The data obtained show the DMF-T index, which was categorized as unfavorable if the score reached >6 based on WHO. From the DMF-T index data, a cross-tabulation analysis was carried out to see the effect between the DMF-T number variables and independent variables such as education level, age, daily expenditure, use of prostheses, toothbrush habits, knowledge of oral health, and level of oral hygiene. Cross-tabulation with chi-square analysis (Sig of OR<0.05, CI 95%) to several risk factors was done and analyzed by using OR presented in a table. The cutoff point for DMF-T index is 6 (a score above 6 will be categorized as unfavorable). The category for OHI-S index is as follows: good—0 to 1.2, fair—1.3 to 3.0, and poor—3.1 to 6.0.^[7] Data analysis was conducted by using SPSS Ver 18 Software Program (IBM, New York).

Results

Data on the distribution of respondents can be seen in [Table 1]. It can be seen that the proportion of the age distribution of 85 respondents was almost the same: 49.4% were younger than 34 years old, and 50.6% were older than 34 years. The data obtained for the distribution of educational backgrounds were also the same. There was only a small difference between respondents who had completed junior high school and those who had not. Overall, 60% of respondents had a fairly low daily expenditure, which was less than IDR 16,000 per day or around USD 1.09 (per 2020); 54% of respondents had good access or came to the health care center quite often. However, despite not having a high enough educational background and a low economic situation, 75% of respondents could answer questions about dental caries well.

Table 1: Respondents’ distributions

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[Table 2] shows that 65% of respondents have a high DMF-T score (> 6). The results of the cross-tabulation test between the DMF-T score variable and other variables show that age (OR = 1.151, 95%, CI: 0.469–2.823), educational background (OR = 2.625, 95%, CI: 0.997–6.912), access to health services (OR = 1.140, 95%, CI: 0.455–2.861), knowledge of dental caries (OR = 1.040, 95%, CI: 0.240–4.499), and the OHI-S score (OR = 3.087, 95%, CI: 1.186–8.036) had an OR of more than 1 (OR> 1); this cutoff point was selected to compare the magnitude of risk factor assessed.^[9] However, only the OHI-S score variable (OR = 3.087) had a significance value of less than 0.05 (Sig. OR = 0.021).

Table 2: Chi-square (cross-tabulation) analysis of risk factor and DMF-T score

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Discussion

The results of the chi-square analysis between age and DMF-T index show OR = 1.151. These results indicate that age is a risk factor for dental caries. People who are older have a risk of having dental caries. The results are in accordance with the theory, which states that the caries prevalence increases with increasing age.^[5],[6] In education risk factors, the results of the chi-square analysis between education and DMF-T index show OR= 2.625. These results indicate that the lower educational background is a risk factor for dental caries with a risk of two times. The higher the level of education, the easier it will be to accept new things and easily adjust to new things. The higher the level of education, the more receptive the mothers will be. They have attitudes and behave according to what is recommended in dental and oral care. Similarly, on the contrary, the lower the level of education, the more difficult it will be for them to receive and absorb the information obtained.^[10]

The results show that the average expenditure for daily basic needs in a day was IDR 16,000. This expenditure represented the subject’s income each month. The results of the chi-square analysis between income and DMF-T index show OR= 0.738. This means that daily basic need expenditure did not affect the risk of getting dental caries among women of childbearing age in Urung-urung, but directly, the amount of income would have an effect on the medical treatment received.^[10] If their income increases, the cost of health care also increases. Families with high income tend to be more consumptive, and it is possible to consume a more varied diet, including consuming foods with high sugar levels.^[11] This consumption pattern results in children who come from high socioeconomic families having more caries than children who come from lower socioeconomic families.

Most childbearing-age mothers in Urung-urung did not use prostheses. The results of the chi-square analysis between the use of prostheses and DMF-T index show OR = 0.00. This means that the uses of prostheses did not affect the risk of getting dental caries. Probably, denture uses affect the other oral health issues, because the use of dentures can often cause dental and mouth problems if the users ignore cleanliness and maintenance.^[12] Denture users who ignore the instructions given by the dentist regarding oral and denture hygiene may have a problem involving the food residue accumulation, leading to the formation of plaque. The results of the study show that there was no correlation between the use of prostheses and the severity of caries, but all childbearing-age mothers who used prostheses had a DMF-T index of ≥3.^[12],[13] The results that differ from this theory can be due to good knowledge of dental caries and most of them do not use prostheses.

The results of the chi-square analysis between attempts to visit health-care facilities and services when experiencing dental complaints and DMF-T index scores show OR = 1.140. These results indicate that access to health services is a risk factor for dental caries. Respondents who are farther from the health-care facility are more likely to have dental caries. The realization of the dental health status of the community is inseparable from the efforts of dental health services providers.^[14] The consideration of the treatment selection for pain due to caries can be influenced by several factors, such as knowledge of dental and oral health, medical expenses, location of health services, and awareness of the importance of maintaining dental and oral health. This is the opposite of existing theories. In this study, it can be concluded that the mother’s experience with the dentist did not affect the severity of her dental caries. This can happen since she may not comply with the treatment plans, including several dental visits required to complete the treatment.^{[15],[16],[17]}

The results of the chi-square analysis of dental caries knowledge and DMF-T index scores show OR = 1.040. This means that knowledge of dental caries was a risk factor for dental caries. Respondents with limited knowledge of dental caries tend to suffer from dental caries. The results were contrary to the theory, which stated that the higher the knowledge, the lower the incidence of caries.^[18] Some of the factors that influence the incidence of dental caries in childbearing-age mothers are bad habits in maintaining dental health. Childbearing-age mothers in Urung-urung understood that one way of preventing dental caries was by brushing teeth. However, in general, mothers brushed their teeth while taking a bath, which was in the morning and evening; meanwhile, they did not brush their teeth after dinner and before going to bed. Another habit was the consumption of snacks, such as chips, crackers, and fried foods, outside the main meal hours. This routine caused dental caries to easily occur.^[8]

On oral hygiene risk factors, the results of the cross-tabulation analysis between oral hygiene and DMF-T index score show OR = 3.087. These results indicate that the respondents with low OHI-S scores were three times more likely to have dental caries. The results were in accordance with the theory, which stated that oral hygiene plays an important role in dental and oral health.^[19] Poor dental or oral hygiene leads to high risk of caries and vice versa.^[20] Of the 58 childbearing-age mothers who had poor oral hygiene, 56 respondents had a poor DMF-T score. This can be due to childbearing-age mothers in Urung-urung having poorly cleaned their teeth and mouth, which affect the occurrence of caries.

Of all the risk factors associated with the severity of dental caries among childbearing-age mothers, only the OHI-S score variable can be stated to represent the population (P < 0.05). Some other risk factors did not have a significant relationship or were contrary to the existing theories. This can be caused by other cofounding factors. Limitations of this study include the small number of respondents, limited time to conduct interviews and data collection, and access to medical records that are difficult to obtain.

Acknowledgment

Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.

Authors’ contribution

Roesanto Heroesoebekti: Concepts, research design, literature search, data collecting, manuscript review, guarantor. Adi Hapsoro: Concepts, research design, data collecting, data analysis, statistical analysis, manuscript review, guarantor. Aulia Ramadhani: Data collecting, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review. Nawira: Manuscript preparation, manuscript editing.

Ethical policy and institutional review board statement

Ethical approval for performing this study has been obtained from the Research Ethics Committee of Faculty of Dental Medicine Universitas Airlangga.

Patient declaration of consent

The respondents signed the written informed consent for participation in the study and publication of the data.

Data availability statement

Data is available for sharing. Corresponding author will provide it.

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