oral health behavior and school health

Oral Health Status and Oral Health Behavior ofSchool Children in Central Nepal

Kakuhiro Fukai1，2），Hiroko Yano2），Seishiro Kamachi2），Shuich Nakamura2）
Fukai Institute of Health Science, 3-86 Hikonari, Misato-shi, Saitama, 341-003, Japan
Association of Dental cooperation in Nepal

1）
2）

Abstract： Objectives: To describe the oral health status and oral health behavior of school children in aregion of central Nepal.
Design: Cross-sectional study of four age groups (3-5 yrs, 6-10 yrs, 11-13 yrs, and 14-16 yrs). The
study consisted of clinical examinations based on WHO methodology as well as questionnaires.
Participants: The study took place in 4 village schools in a district in central Nepal. The number ofparticipants was 829 children ages 3-16 yrs (411 males and 418 females, 3-5 yrs: 95, 6-10 yrs: 298,
11-13 yrs: 347, 14-16 yrs: 89).
Results: At age 3-5 yrs, 45.3% were affected by dental caries and mean deft was 1.68. Mean
DMFT varied from 0.32 for 6-10 yrs and 0.56 for 11-13 yrs to 0.80 for 14-16 yrs. The prevalence
proportion of dental caries was 18.8% for 6-10 yrs, 30.5% for 11-13 yrs, and 34.8% for 14-16 yrs.
The proportion of participants who felt tooth pain during the previous year was 43.2% for 3-5 yrs,
52.0% for 6-10 yrs, 42.1% for 11-13 yrs, and 32.6 % for 14-16 yrs. The majority of children in all age
groups brush their teeth using toothpaste at least once a day. The proportion of children consuming sweets daily ranged from 13.5% to 45.3% depending on the age group. More than 80% of 6-13year-olds were aware of the effectiveness of tooth cleaning as well as the harmful effect sweets
have on dental health. Major oral health information sources were parents, teachers, and TV.
Conclusion: Systematic health education results in improvement the oral health of Nepali children,and primary schools provide the most effective setting for such oral health programs.
Key words : oral health behavior, oral health status, school children, Nepal

Introduction
In most industrial countries, prevalence rates
and mean dental caries in children have dramati【correspondence】
Kakuhiro Fukai
Fukai Institute of Health Science3-86 Hikonari, Misato-shi, Saitama, 341-003, Japan
Tel：+81-48-957-3315 Fax：+81-48-957-3315
E-mail：fukaik@fihs.org
Accepted for publication：1 October 2012

cally declined1，2）． However, data from several
studies supports the finding that dental caries areincreasing in urban areas of developing countries
where people have greater access to products containing sugar. In addition, community-based oral
health programs have for the most part not been̶ 146 ̶ヘルスサイエンス・ヘルスケア

established in those countries3−11）．

Volume 12，No.2（2012）

DMFT varied from 0.32 for 6-10 yrs and 0.56 for

The primary school years represent an impor-11-13 yrs to 0.80 for 14-16 yrs. Mean FT for thesetant target age when it comes to promoting life-age groups was 0, 0.01, and 0.02 respectively.

long health. WHO’s Global School Health Initiative,

These results indicate that the participants havelaunched in 1995, seeks to mobilize and strengthenvery low access to dental treatment. The preva-

health promotion and education activities at thelence proportion of dental caries was 18.8% for 6-local, national, regional and global level12）．In 2003,

10 yrs, 30.5% for 11-13 yrs, and 34.8% for 14-16 yrs

the World Health Organization stated that oral

(Table 2).

health promotion is an essential element of ahealth-promoting school, and published a document
about oral health promotion through schools ．
13）

Table 1 Prevalence proportion (PP) of dental caries
and deft index of children

In Nepal, the community-based health promotion approach is a way to address problems suchas poor oral health and untreated dental caries
where human and financial resources are limited.
The Nepal National Oral Health‘Pathfinder’survey 2004 was undertaken in order to improveoral health. However, little data is available on dental caries prevalence and oral health behavior of

Table 2 Prevalence proportion (PP) of dental caries
and DMFT index of children

schoolchildren14）．
The objectives of this study are to describe theoral health status and oral health behavior ofschoolchildren in a region of central Nepal.
Methods
This study was designed as a cross-sectional
study of four age groups (3-5 yrs, 6-10 yrs, 11-13yrs, and 14-16 yrs). The study consisted of clinical

Table 3 Percentage of children who responded invarious ways to oral health related QOL questions

examinations based on WHO methodology as wellas questionnaires. The questionnaires were undertaken by interview for 3-5 year-olds and selfrecording for 6-16 year-olds. The study took placein 4 village schools in a district in central Nepal in
2004. The number of participants was 829 children
ages 3-16 years (411 males and 418 females, 3-5
yrs: 95, 6-10 yrs: 298, 11-13 yrs: 347, 14-16 yrs: 89).
Results
At age 3-5 yrs, 45.3% were affected by dental
caries and mean deft was 1.68 (Table 1). Mean
̶ 147 ̶oral health behavior and school health

Table 3 shows the percentage of children giving

never visited a dentist.

various responses to oral health related QOL ques-

Table 5 shows the frequency of consumption oftions, by age group. The proportion of participantsvarious sugary items, by age group. The most

who felt tooth pain during the previous year wasprevalent sugar intake behavior is taking tea with43.2% for 3-5 yrs, 52.0% for 6-10 yrs, 42.1% for 11-sugar; the proportion of children drinking it at

13 yrs, and 32.6% for 14-16 yrs. When asked

least once a day was approximately 80% in all age

whether they had poor chewing function, 3.2% togroups. The percentage of children eating biscuits

15.0% of participants answered“yes”, depending

daily was around 50% for the 3-5 yrs, 6-10 yrs, andon age group. 1.1% to 12.1% of children indicated

14-16 yrs age groups. The proportion of childrenthat they felt uncomfortable about the appearance

consuming sweets daily ranged from 13.5% toof their teeth or mouth.

45.3% depending on the age group. The lower age

Table 4 shows the frequency of different types

groups had markedly higher sweets intake.

of oral health behavior, by age group. The majori-Table 6 highlights the dental attitude andty of children in all age groups brush their teeth

knowledge of children. In general, children of ages

using toothpaste at least once a day. But the pro-

6-16 years had a positive attitude toward oral

portion of children brushing their teeth more thanhealth and caries prevention. More than 80% of 6-twice a day ranged from 16.9% to 30.5%. 21.0%-

13 year-old children were aware of the effective-

35.8% of children reported brushing their teeth

ness of tooth cleaning as well as the harmful effectevery night. Approximately 30% of children had

sweets have on dental health. With respect to theTable 4 Percentage of children with different types of oral health behavior, by frequency

̶ 148 ̶ヘルスサイエンス・ヘルスケア

Volume 12，No.2（2012）questions on the relationship between gum bleed-mation from the media increased with age. 23.6%

ing and tooth brushing, 66.3% to 82.4% of childrenof 14-16 yrs children answered positively aboutanswered correctly. From 56.4% to 73.8% of chil-

getting information via TV.

dren knew the effect of fluoride on dental caries.
Discussion

At age 3-5 yrs, approximately 60% of children

The study provides information about dental

agreed that tooth brushing prevents decay andcaries and oral health behavior of primary school

sweets cause decay.
Table 7 shows the health information sources ofchildren in Nepal. The survey was confined toeach age group. Most children had been informedschools under oral health education programs inabout oral health by parents and schoolteachers.

the Kathmandu valley and therefore the data are

However, only 40% of children ages 3-5 yrs and 6-

not representative in pure statistical terms. How-

10 yrs and less than 30% of children ages 11-13 yrs

ever, the sampling of central Nepal may be indica-and 14-16 yrs got oral health information fromtive of the oral health situation and oral healththeir parents. Getting this information from par-behavior of children of different age groups.

ents tended to decrease with age. With regard toThe clinical examination procedure and diagnos-

the influence of teachers, more than 70% of chil-tic criteria were carried out according to thedren were getting oral health knowledge from

WHO methods, and some items of this question-

their teachers. The likelihood of getting this infor-

naire about oral health behavior were based on

Table 5 Percentage of children consuming sweet snacks, by frequency

̶ 149 ̶oral health behavior and school healththe published reports on the situation in China andeating sweets every day. This study demonstrates

Thailand4，5）． Therefore comparisons with these

the need for oral health education of mothers andother studies are possible. These findings are incommunity people. In addition, one of the major

agreement with another survey of DMFT in chil-oral health information sources of children was

dren of ages 12-13 years ．

TV; therefore, a health literacy program promot-14）

This survey’s findings show that most children

ing health information choice and understanding

are practicing oral hygiene behavior and arewould need to be included in any school oralaware of the preventive effects of tooth brushinghealth approach15）．

and the harmful effects sweets intake on oral

In conclusion, systematic health education

health. However, more than 30% of children are

improves the oral health of Nepali children, andTable 6 Percentage of children who responded in various ways to statements about the prevention of dental disease

Table 7 Percentage of children who get oral health information from various sources̶ 150 ̶ヘルスサイエンス・ヘルスケア

primary schools provide the effective setting forsuch oral health programs.
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