122

Dental Journal
(Majalah Kedokteran Gigi)
2020 September; 53(3): 122–125

Research Report

The correlation analysis of dental caries, general health conditions 
and daily performance in children aged 2–5 years

Darmawan Setijanto,1 Taufan Bramantoro,1 Nanissa Dyah Anggraini,2 Ardhyana Dea Maharani,2 Dwita Angesti,2 Dani Susanto Hidayat3 and Aulia 
Ramadhani1
1 Department of Dental Public Health,
2 Dental Profession Program,
3 Postgraduate Program,
Faculty of Dental Medicine, Universitas Airlangga,
Surabaya – Indonesia

ABSTRACT
Background: Oral health is important for general health and quality of life. One of the oral diseases with a high prevalence in Indonesia 
is dental caries. Dental caries can cause limiting disturbances of daily activities such as biting, chewing, smiling and talking, and of 
psychosocial well-being, including development and general health of children. Purpose: This study aims to analyse the correlation 
of dental caries incidence rate with general health conditions and daily performance of children aged 2–5 years. Methods: This was 
an analytical observational cross-sectional study. The study sample was 103 pairs of children and their mothers, selected using cluster 
random sampling technique. Intra-oral examination was conducted on the children to obtain decay, missing, filled-teeth (DMF-T) index 
score. Information about oral impacts on daily performance (OIDP) of the children was collected through a questionnaire distributed 
to the mothers. The data obtained were statistically analysed with a regression test (p < 0.05). Results: It was found that dental caries 
had a significant correlation with general health (p = 0.00) and daily performance, including chewing function disorder (p = 0.00), 
difficulties in maintaining oral health (p = 0.039), sleep disorders (p = 0.00), and emotional instability (p = 0.00). Conclusion: The 
incidence rate of dental caries has a significant effect on the general health conditions and daily performance of children aged 2–5 
years.

Keywords: child health; daily performance; dental caries; oral impact on daily performance

Correspondence: Taufan Bramantoro, Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga,                      
Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya 60132, Indonesia. Email: taufan-b@fkg.unair.ac.id

INTRODUCTION

Oral and dental health is important for general health. 
Unfortunately, children seem to be vulnerable to oral and 
dental diseases because they generally have poor oral and 
dental care habits. Eating sweet food and drinking sweet 
drinks are some examples of their bad habits.1 Based on the 
2018 Basic Health Research data, dental caries prevalence 
in Indonesia was 81.5% in children aged 3–4 years and as 
high as 92.6% in those aged 5–9 years. Indonesia’s decay, 
missing, filled-teeth (DMF-T) index in 2018 was 7.1, an 
increase of 54% from RISKESDAS 2018.2

Oral health is also considered fundamental to public 
health since a healthy mouth allows individuals to talk, 

eat, and socialise without experiencing pain, discomfort, 
or embarrassment.3 However, without adequate care, 
dental caries may occur and eventually lead to tooth decay. 
Dental caries is the main cause of toothache and tooth 
loss. Everyone is susceptible to dental caries throughout 
their lives.4 Nonetheless, dental caries is one of the many 
childhood diseases that can be prevented.

Dental caries can also interfere with the chewing system 
in general or become a focal infection, thus affecting the 
health and development of children.5 For instance, dental 
caries greatly affects the quality of life of children in 
America, Canada and England. In Aboriginal children in 
Western Australia, dental caries is the fifth most common 
disease causing preschool children to be hospitalised (ages 

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017. 
Open access under CC-BY-SA license. Available at http://e-journal.unair.ac.id/index.php/MKG
DOI: 10.20473/j.djmkg.v53.i3.p122–125

mailto:taufan-b@fkg.unair.ac.id
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123Setijanto et al./Dent. J. (Majalah Kedokteran Gigi) 2020 September; 53(3): 122–125

1–4 years).6 Toothache caused by dental caries causes a 
loss of 50 million school hours per year, affecting school 
attendance and future adult life.

In Indonesia, toothache has caused 62.4% of the 
population to experience discomfort at work/in school 
for an average of 3.86 days per year. This condition 
indicates that dental disease, although not fatal, reduces 
work productivity. A research in Medan even reveals 
the impact of dental caries on four dimensions of quality 
of life, namely, limited function, pain, psychological 
discomfort and physical disability. In addition, Sheiham7 
highlights three effects of untreated dental caries on the 
growth and development of preschool children. First, 
pain caused by dental caries can interfere with children’s 
food intake. Second, pain caused by dental caries can 
trigger sleep disturbances and subsequently leads to 
glucocorticoid production and growth disturbances. Third, 
chronic inflammation caused by dental caries can suppress 
haemoglobin and lead to anaemia, since the production 
of erythrocytes in the bone marrow is reduced. Thus, it 
is essential to treat dental caries in preschool children to 
improve not only their growth and development but also 
their quality of life.8–10

A preliminary survey of 30 respondents conducted in 
pre-kindegarten schools in Kenjeran Health Center working 
area found a 50% incidence rate of caries severity. For the 
problems outlined earlier, this study is focused on the dental 
caries incidence rate and the general health conditions of 
children aged 2–5 years in some pre-kindergarten and 
kindergarten schools around the Kenjeran Health Center, 
Surabaya City. This study aims to analyse the correlation 
of the dental caries incidence rate with the general health 
conditions and the daily performance of children aged 
2–5 years.

MATERIALS AND METHODS

This was an analytical observational cross-sectional study. 
The DMF-T index of children aged 2–5 years was collected 
along with questionnaire results distributed to their mothers. 
The study sample was 103 pairs of pre-kindergarten and 
kindergarten school children and their mothers, around 
Kenjeran Health Center, Surabaya, selected using the 
cluster random sampling method. This research has received 
a certificate (628/HRECC.FODM/X/2019) from the Ethics 
Commission of the Faculty of Dental Medicine, Universitas 
Airlangga. Each respondent’s parent was asked to provide 
informed consent before participating in this study.

The severity of children’s caries was observed through 
direct primary tooth examination (intra oral). Next, DMF-T 
index measurement was conducted to observe the dental 
health conditions of children by observing cavities (decay), 
teeth lost due to caries (missed), and teeth that had been 
filled. Based on the data collected, the DMF-T score was 
obtained and analysed statistically to find any correlation 
with the general health conditions and the daily performance 

of the children collected through questionnaires distributed 
to their mothers.

The questionnaire used in this study was concerned 
with oral impact on daily performance (OIDP) of the 
children involving a) eating and enjoying food, b) talking 
and pronouncing clearly, c) cleaning teeth, d) sleeping 
and relaxing, e) smiling, laughing and showing teeth 
without embarrassment, f) keeping emotions so as not 
to be easily offended, g) performing main work or social 
roles, and h) being able to understand conversations with 
people around them. In addition, a question instrument 
was added to analyse the general health conditions of the 
participants. The data obtained were statistically analysed 
using a regression test with the Statistical Package for Social 
Science (SPSS, IBM corporation, Illinois, US) software 
version 22, with a p-value of 0.05%.

RESULTS

This research was conducted in pre-kindergarten and 
kindergarten schools in Surabaya on 103 pairs of children 
aged 2–5 years and their mothers. The dependent variable 
in this study is caries, while the independent variable is 
the general health conditions of children aged 2–5 years. 
The data were statistically analysed with a regression test 
to find correlation between these variables. The regression 
test results showed a significant correlation between the 
incidence rate of dental caries and the general health 
conditions of those children. The distribution of respondents 
in this study can be seen in Table 1.

Based on Table 1, the results show that 53.4% of the 
respondents had a high caries index of >6.6. Similarly, the 
data of the children’s general health conditions indicate that 
72.8% of the respondents had experienced illness in the 
last two months. The correlation of dental caries incidence 
rate with the children’s daily performance was statistically 
analysed using the results of the OIDP questionnaire. The 
results of this analysis can be seen in Table 2. Table 2 
also shows the correlation of the incidence rate of dental 
caries with OIDP of each respondent. The table also 
illustrates that there was a significant correlation between 
the incidence rate of dental caries and chewing function 
disorders, with a p-value of 0.000 (p < 0.05). However, 
there was no significant correlation between the incidence 
rate of dental caries and speech difficulties, with a p-value 
of 0.195 (p > 0.05).

The OIDP index scores indicate a significant correlation 
between the incidence rate of dental caries and difficulties 
in maintaining oral hygiene, with a p-value of 0.039 (p < 
0.05). There was also a significant correlation between the 
incidence rate of dental caries and sleep disorders due to 
oral and dental health problems, with a p-value of 0.000(p 
< 0.05). There was a significant correlation between the 
incidence rate of dental caries and emotional instability, 
with a p-value of 0.000 (p < 0.05). There was no significant 
correlation between the incidence rate of dental caries and 

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017. 
Open access under CC-BY-SA license. Available at http://e-journal.unair.ac.id/index.php/MKG
DOI: 10.20473/j.djmkg.v53.i3.p122–125

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124 Setijanto et al./Dent. J. (Majalah Kedokteran Gigi) 2020 September; 53(3): 122–125

difficulties in smiling due to oral health problems, with a 
p-value of 0.078 (p > 0.05).

In other words, the incidence rate of dental caries had 
a significant correlation with the general health conditions 
of children aged 2–5 years, related to chewing function 
disorders, difficulties in maintaining oral hygiene, sleep 
disorders due to oral and dental health problems, and 
emotional instability due to oral and dental health problems. 
However, the incidence rate of dental caries had no 
significant correlation with speech difficulties, avoiding 
meeting people, and difficulties in smiling. However, 
the statistical test using a regression test shows that the 
incidence rate of dental caries has a significant effect on 
the general health conditions of children aged <5 years, 
with a p-value of 0.000 (p < 0.05).

DISCUSSION

This study shows a significant correlation between the 
incidence rate of dental caries and the general health 
conditions of children aged 2–5 years. This may be due to 
several factors that can increase the severity of dental caries, 
such as education level; thus, the higher the education 
level, the higher the awareness of maintaining one’s own 
general health.5 In addition, it can also be assessed from 
how dental and oral health is maintained, such as not 
eating carcinogenic foods, use of toothbrushes, brushing 
teeth frequently, and using proper brushing technique.11 
Similarly, Wening et al.8 argue that although there is no 
significant correlation between the severity of dental caries 
and the nutritional status of children, a decrease in desire 

Table 1. Distribution of respondents

Variables N* Percentage (%)

Sex
Male 49 47.6%
Female 54 52.4%

Age
2–3 years old 18 17.5%
4–5 years old 85 82.5 %

Caries severity
Low (0-6.6) 48 46.6%
High (>6.6) 55 53.4%

Toothache
Never experienced 53 51.5%
Had experience 50 48.5%

Daily brushing habit
1x a day 17 16.5%
2x a day 79 76.7%
3x a day 7 68%

General health conditions in the last two months
Never sick 28 27.2%
Ever sick 75 72.8%

Having toothache
Often 62 60.2%
Never 41 39.8%

Chewing function disorders
No 38 36.9%
Yes 65 63.1%

Sleep disorders
No 71 68.9%
Yes 32 31.1%

Difficulties in maintaining oral hygiene
No 71 68.9%
Yes 32 31.1%

Avoid meeting people due to oral and dental health problems
No 93 90.3%
Yes 10 9.7%

Emotional instability due to oral and dental health problems
No 80 77.7%
Yes 23 22.3%

Difficulties in smiling due to oral and dental health problems
No 93 90.3%
Yes 10 9.7%

* number of respondents

Table 2.  Regression test results on the correlation of the dental caries incidence rate with the children’s daily performance using the 
oral impact on daily performance (OIDP) questionnaire

Risk Factor N Sig.

Chewing function disorders 103 *0.000
Speech difficulties 103 0.195
Difficulties in maintaining of oral hygiene 103 *0.039
Avoiding meeting people due to oral and dental health problems 103 0.077
Sleep disorders due to oral and dental health problems 103 *0.000
Difficulties in smiling due to oral and dental health problems 103 0.078
Emotional instability due to oral and dental health problems 103 *0.000

* significant at p-value <0.05

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017. 
Open access under CC-BY-SA license. Available at http://e-journal.unair.ac.id/index.php/MKG
DOI: 10.20473/j.djmkg.v53.i3.p122–125

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http://dx.doi.org/10.20473/j.djmkg.v53.i3.p122-125


125Setijanto et al./Dent. J. (Majalah Kedokteran Gigi) 2020 September; 53(3): 122–125

to eat still can be triggered by discomfort felt when eating 
when having a toothache. Decreased appetite can also have 
an impact on children’s general health as nutrient intake 
decreases and causes decreased endurance. Ramayani et al.9 
state that children suffering from dental caries are lighter in 
weight than those without dental caries. The findings of the 
previous studies strengthen the results of this study, which 
revealed a significant correlation between dental caries and 
children’s general health.

This study also evaluates the severity of dental caries 
in children aged <5 years, using the DMF-T index and 
OIDP. It is known that severe dental caries can affect 
quality of life intrinsically and extrinsically. Intrinsically, 
a severe dental cavity can penetrate the pulp chamber 
and cause inflammation of the pulp tissue, causing pain 
and discomfort leading to sleep disorders, which can also 
reduce immune function. Extrinsically, dental caries can 
cause poor oral hygiene (OH) and tooth morphology, which 
can interfere with chewing function, leading to reduced 
nutrient intake, which can also reduce immune function. 
The decline in immune function can cause general health 
problems in toddlers. Dental health is one of several oral 
health factors that are important for child development 
especially. Dental caries is the most common dental health 
problem found in children, which is caused by food residue 
that sticks to the teeth. Calcification of teeth causes teeth 
to become porous, hollow, and even fractured (broken). 
Dental caries can also cause children to experience loss of 
chewing power and disruption of digestion, which results 
in less optimal growth.12,13

This study found that age and gender of children aged 
<5 years had no significant effect on the incidence rate 
of dental caries. The OIDP questionnaire results consists 
of eight items evaluating the impacts of oral health on 
children’s ability to perform their daily activities, including 
the measurement of physical, psychological and social 
dimensions. This questionnaire instrument focuses on ten 
basic daily activities, namely, eating, talking, cleaning 
the mouth, performing light physical activities, sleeping, 
relaxing, smiling, having emotional states, going out, and 
enjoying interacting with others.14–16

In addition, the influence of daily life performance 
on oral caries aims to provide alternative sociodental 
indicators, focusing on measuring a person’s ability to carry 
out the indicated daily activities with the condition of the 
oral caries. The results of the OIDP questions concerned 
with the general health conditions of children aged <5 years 
who often have toothache and dental caries indicated a 
significant correlation between the incidence rate of dental 
caries and the frequency of having toothache. There was a 
significant correlation between the incidence rate of dental 
caries and the behaviour of avoiding meeting people due to 
oral and dental health problems. There was also a significant 
correlation between the incidence rate of dental caries and 
emotional instability due to oral and dental health problems. 
In other words, the incidence rate of dental caries had a 
significant effect on the emotions of children.

While the OIDP focuses on ten basic daily activities, 
it does not mean that all of those ten basic daily activities 
necessarily affect dental caries in children.17–19 Finally, it 
can be concluded that the incidence rate of dental caries has 
a significant effect on the general health conditions and the 
daily performance of children aged 2–5 years.

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Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017. 
Open access under CC-BY-SA license. Available at http://e-journal.unair.ac.id/index.php/MKG
DOI: 10.20473/j.djmkg.v53.i3.p122–125

http://e-journal.unair.ac.id/index.php/MKG
http://dx.doi.org/10.20473/j.djmkg.v53.i3.p122-125