J Bagh College Dentistry Vol. 30(3), September 2018 Assessment of 28 Assessment of Dental Caries among Internally Displaced Children in Baghdad Athraa M. Alwaheb B.D.S., M.Sc. (1) Akram F. Alhuwaizi B.D.S., M.Sc., Ph.D. (1) ABSTRACT Background: The internally displaced children are vulnerable groups have less access to dental services, worse oral health, and bear a disproportionate burden of oral diseases. Aim of the study: This study was conducted on group of internally displaced children living in Baghdad governorate camps to measure their dental caries prevalence and experience and find out the association between dental caries and the duration of displacement in camps. Subjects and methods: A sample of 1393 children were selected, 567 internally displaced children from camps in Baghdad governorate and 826 school children as control matching in age and gender. The age of children ranged from 5-12 years old. Oral examination was performed using WHO 2013 criteria, to measure dental caries using CPI probe. Results: There were a significant difference of dmfs and dmft between Internally displaced children and Schoolchildren. Caries free Internally displaced children were 39.2% and 30% among school children. There was no statistically significant correlation between camp duration and dental caries experience in deciduous teeth while a significant relation was found in permanent teeth. Conclusion: This study revealed an increase in dental caries experience with increase in duration of displacement. Hence this survey highlighted the need of internally displaced children to dental health education programs and preventive measures and give information for monitoring the caries which is helpful for policy makers. Key words: Internally displaced children, Dental caries, CPI. (J Bagh Coll Dentistry 2018; 30(3): 28-31) INTRODUCTION Migration, both forced and voluntary. has long been. a major part. of Iraqis’ lives. Violence and wars which begun in December 2013, has displaced three million Iraqis, which had precipitated a complex and urgent humanitarian situation (1,2). Humanitarians estimated during 2017; a 1.1 million of displaced people were expected to be resident in emergency sites and camps (3) an estimation of 50,760 families, 304,560 internally displaced persons (IDPs) residing in Baghdad governorate came from Anbar Governorate, Ninewa and Salahaldin and other governorates (4). Internally displaced persons are considered as vulnerable groups have less access to dental services, poor oral health, and suffer from extreme burden of oral diseases (5). A study were done on Syrian(6) refugee found out dental caries 1.6 ± 2.6 teeth. and internally displaced children in Kosovo(7) and Pakistan(8). The internally displaced children with low socioeconomical level and low parents educational level experienced poor oral hygiene and increase in dental caries(9). Dental caries is a worldwide chronic disease affecting all age groups, both gender, races, and all geographic residency, causing pain, groups; caries free (0), 1-5 surfaces, 6-10 surfaces and more than 10 surfaces affected by dental local and systematic infection and progress into tooth pulp ending with dental abscess formation if (1) Professor, College of Dentistry, University of Baghdad, Baghdad, Iraq untreated. Also, it affects children’s general health, growth and development, nutrition and quality of life (10,11). Iraq is one of the developing countries that showed an increase in caries prevalence and severity. Many studies found that caries prevalence was low (12-16) while other studies showed high prevalence (17-22). This study was conducted on group of internally displaced children (IDC) living in Baghdad governorate camps to find out the association of dental caries with duration of displacement in comparison to schoolchildren living near camps. SUBJECTS AND METHODS A sample of 567 internally displaced children were selected from different camps in Baghdad governorate and 826 schoolchildren matching with age and gender as control aged 5-12 years old. The internally displaced children (IDC) were originated from Alanbar governorate Salahaldin and Ninewa. Intra oral examination of dental caries status was recorded according to WHO 2013(23) using CPI probe. Dental caries was measured by dmft/s for deciduous teeth and DMFT/S for permanent teeth. Dental caries indices: tooth (dmft, DMFT) and surface levels (dmfs, DMFS). The dmfs/DMFS percentage divided into four groups; caries free (0), 1-5 surfaces, 6-10 surfaces and more than 10 surfaces affected by dental caries. The duration of displacement was divided into 3 J Bagh College Dentistry Vol. 30(3), September 2018 Assessment of 29 groups 1-12, 13-24, more than 24 months. The data were grouped by statistical quartile. The statistical data analysis was approached by using statistical package (SPSS) ver. (23.0) in order to analyze and assess the results of this study through application of descriptive data analysis, by frequencies, and percentages. Inferential data analysis, these types of analysis were used to test hypotheses by accept or reject it, which included the following; Contingency Coefficients (C.C.) test: Estimating of the association table for finding cause's relationship- test and Spearman Rank Correlation test. RESULTS: The children age range from 5-12 years with mean age of 8.70±SD 2.01 for IDC and 8.72± SD1.95 with 278 (49%) boys IDC and SC=404 (48.9), girls 289 (51%) IDC and 422(51.1%)SC. The percentage of children who spend two years in camps was 81.1%, and 18.9% spent more than two years. Prevalence of children with caries free deciduous teeth were 39.2% among IDC and 30% among school children. Number and percentage of decayed surfaces were higher in IDC than SC. Missing surfaces (ms) which means extracted teeth due to caries; and filled teeth are higher among SC than IDC. There were highly significant association in caries prevalence between IDC and SC as shown in table 1 with comparison significant (C.S.). Table 2 demonstrates caries prevalence in permanent dentition, children with caries free permanent teeth were 74.8% among IDC and 77.4% among school children. All the components of DMFS showed no significant differences between IDC and school children. The percentage of children having 1-5 teeth affected with caries in IDC (22.6%) are more than that of school children (18.9%). IDC had significantly lower caries experience in the deciduous dentition (dmfs =6.16±0.32 and dmft=2.71±0.12) than school children (dmfs= 8.06±0.28 and dmft=3.22±0.10). However, in the permanent dentition caries experience showed no statistically significant differences between IDC (DMFS =0.86±0.07 and =0.60±0.05) and school children (DMFS=0.94±0.08 and DMFT= 0.64±0.04) (Table 3). No statistically significant differences between IDC (DMFS=0.86±0.07 and DMFT=0.60±0.05) and school children (DMFS =0.94±0.08 and DMFT=0.64±0.04) (Table 3). The caries severity (dmfs) for girls and boys showed no significant association for both IDC and school children (Table 4). Table 5 shows that there was no statically significant correlation between camp duration and caries experience dmfs and its components (Table 5). While for permanent teeth there was a significant difference between the groups with caries experience increasing with camp duration (F=4.957, df=2, p=0.007) as shown in figure 1. Table 1: Distribution of the children according to dmfs and its components. Dental caries IDC SC C.S. (*) p-value No. % No. % Ds 300 52.9 578 31.4 Ms 41 7.2 142 17.2 Fs 4 0.7 15 1.8 dmfs 0 222 39.1 248 30.0 C.C.=0.119 p=0.000 (HS) 1 – 5 137 24.2 189 22.9 6 – 10 101 17.8 158 19.1 > 10 107 18.9 231 28.0 Total 567 100 826 100 HS: Highly Significant at p<0.01; based on a contingency coefficient (C.C.) tests Table 2: Distribution of the children according to DMFS and its components. Dental caries IDC SC C.S. (*) p-value No. % No. % DS 132 23.2 159 19.2 MS 5 0.9 15 1.7 FS 6 1.1 13 1.6 DMFS 0 424 74.8 639 77.4 C.C.=0.054 p=0.259 (NS) 1 – 5 128 22.6 156 18.9 6 – 10 13 2.3 25 3 > 10 2 0.3 6 0.7 Total 567 100 826 100 NS=Not Significant p>0.05; based on a contingency coefficient (C.C.) tests. Table 3: The mean and the standard error of dental caries experience of the children. Variable Sample Mean Std. Error t C.S. (*) p-value dmfs IDC 6.16 0.32 4.326 p=0.000 HS* SC 8.06 0.28 dmft IDC 2.71 0.12 3.180 p=0.002 HS* SC 3.22 0.10 DMFS IDC 0.86 0.07 0.602 p=0.548 NS SC 0.94 0.08 DMFT IDC 0.60 0.05 0.578 p=0.564 NS SC 0.64 0.04 *HS: Highly Sig. at p<0.01; NS: Not sig.at p>0.05, based on t-test. J Bagh College Dentistry Vol. 30(3), September 2018 Assessment of 30 Table 4: Caries severity dmfs of children distributed according to gender. Dmfs Gender Total C.S. (*) p-value Boys Girls N % N % N % IDC 0 106 38.1 116 41.1 222 39.1 CC=0.081 p=0.293 NS 1–5 60 21.6 77 25.7 137 24.2 6–10 53 19.1 48 16.1 101 17.8 >10 59 21.2 48 16.1 107 18.9 Total 278 100 289 100 567 100 SC 0 99 24.5 149 35.3 248 30.0 CC=0.196 p=0. 862 S 1–5 98 24.3 91 21.6 189 22.9 6–10 81 20.0 77 18.2 158 19.1 >10 126 31.2 105 24.9 231 28.0 Total 404 100.0 422 100.0 826 100.0 S= Sig. at p<0.05; NS: Not sig.at p>0.05 based on a contingency coefficient (C.C.) tests. Table 5: Mean and standard error and the correlation of dental caries in deciduous teeth of internally displaced children according to duration of living in camps. Displacement Duration (months) N Mean SE C.S. (*) p-value ds 1 – 12 229 2.64 0.33 r=-0.082 p=0.051 13 -24 231 2.71 0.37 25+ 107 2.05 0.44 ms 1 – 12 229 0.63 0.14 r=-0.065 p=0.121 13 -24 231 0.54 0.15 25+ 107 0.37 0.18 fs 1 – 12 229 0.01 0.00 r=0.002 p=0.963 13 – 24 231 0.04 0.02 25+ 107 0.00 0.00 dmfs 1 – 12 229 5.46 0.44 r=-0.051 p=0.222 13 -24 231 5.94 0.49 25+ 107 4.30 0.61 NS: Non Sig. at p>0.05; Testing based on Spearman Rank Correlation test. Figure 1: Mean dental caries in permanent teeth of internally displaced children according to duration of living in camps. DISCUSSION The caries free IDC was 93% of children which more than SC 30% and more than study done in Jordan(24) and more than IDC in Kosovo (6).The dmft of IDC was found to 2.7 ± 0.12 and which considered moderate according to WHO 2013(20) (Moderate 2.7– 4.4) and less than school children dmft 3.23 ±0.10 and lower than (25),.The DMFT of IDC 0.60 ±0.05 which is very low in a accordance to WHO 2013 (Very low <1.2),also lower than other studies done on IDC in Iran, Kosovo and Pakistan and Syrian refugee teeth (6,7,9,26). This low caries experience is may be due to their displacement situation which made them far from cariogenic food like sweet candies and sugary drinks in addition to low socioeconomic in area of origin; most of children who lived in camps came from periurban areas(28) In this study girls had higher prevalence than boys but with no significant differences which is in disagree with previous studies (16,29) and agreement with others(13,14,17,30,31),this can be explained by earlier eruption of teeth in girls, hence longer exposure of girls' teeth to the cariogenic oral environment in addition to easier access to food supplies by women and frequent snacking during food preparation (31). The duration of living in camps had no significant association with dmfs and all its component, also mean DMFS increase with increasing duration (statistically significant p<0.05). 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Explaining sex differences in dental caries prevalence: saliva, hormones, and life-history etiologies. Am J Hum Biol. 2006;18(4):540-55. الخالصة األطفال النازحون هم من الفئات الضعيفة غير المحصنة الذين لديهم قدرة أقل على الحصول على خدمات العالجية االسنية : لخلفيةا : أجريت هذه الدراسة على مجموعة من األطفال الدراسةالهدف من صحة فموية سيئة ، ويتحملون عبئاً من االمراض الفموية النازحين داخلياً الذين يعيشون في مخيمات محافظة بغداد لقياس انتشار تسوس األسنان لديهم ومعرفة االرتباط بين تسوس األسنان لنازحين داخلياً من المخيمات في من األطفال ا 765, طفالً 3939: تم اختيار عينة من واألسصليب خشخص االومدة النزوح في المخيمات. سنة. تم 32-7في العمر والجنس. تراوحت أعمار األطفال بين متجانسة كعينة ضابطةمن أطفال المدارس 626محافظة بغداد و كان هناك النتصئج:.CPI، لقياس تسوس األسنان باستخدام مسبار 2139باستخدام معايير منظمة الصحة العالمية فمويإجراء فحص االطفال النازحين بدون تسوسداخلياً وبين تالميذ المدارس. بلغت نسبة النازحينبين األطفال dmftو dmfsبين ةق كبيروفر في األسنان التسوسالمخيم النزوح في بين أطفال المدارس.لم تكن هناك عالقة ارتباطية ذات داللة إحصائية بين مدة ٪91و 39.2٪ تسوس األسنان مع زيادة فيكشفت هذه الدراسة عن زيادة :االستنتصجاللبنية في حين تم العثور على عالقة كبيرة في األسنان الدائمة. داخلياً إلى برامج التثقيف في مجال صحة األسنان والتدابير النازحيناجة األطفال ت هذه الدراسة عن حمدة النزوح.ومن ثم أبرز ائية وإعطاء معلومات لرصد التسوس وهو أمر مفيد لصانعي السياسات.الوق https://www.ncbi.nlm.nih.gov/pubmed/?term=Lukacs%20JR%5BAuthor%5D&cauthor=true&cauthor_uid=16788889 https://www.ncbi.nlm.nih.gov/pubmed/?term=Largaespada%20LL%5BAuthor%5D&cauthor=true&cauthor_uid=16788889 https://www.ncbi.nlm.nih.gov/pubmed/16788889 https://www.ncbi.nlm.nih.gov/pubmed/16788889