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Chapter I
THE PROBLEM AND ITS BACKGROUND
Introduction
The oral-health status of children in the Philippines is in an
alarming state, and this is true for other countries in Asia as well.
The latest National Oral Health Survey has revealed that 97 per
cent of first-graders in public schools in the Philippines suffer from
tooth decay. Dental caries amongst public school children remains
completely untreated, leading to unnecessary pain and intra-oral
infections. The National Oral Health Survey last 2009 revealed that
six-year-old children had on average nine decayed teeth in their mouth
with 40 percent of these teeth presenting caries with pulp
involvement. Twenty percent of six-year-old children also reported
toothache during the time of the survey and the condition is the main
reason for school absenteeism in the Philippines.
According to Zimmerman 2009, the main reasons for the
neglect of oral health care are an unhealthy diet and lack of access to
appropriate levels of fluoride. Daily tooth-brushing with fluoride
toothpaste is not yet a habit for the majority of Filipino children in their
family life. The National Oral Health Survey found the highest caries
levels in highly urbanized areas and easily accessible areas (near
highways), where money for soft drinks and junk food is available,
while caries levels in remote areas are lower, most probably owing to
traditional nutritional habits (Zimmermann 2009).
The researchers, being nursing students, opted to conduct this
study on the incidence of dental-related diseases in Pakil, Laguna, in
order to gain an insight into the actual situation prevailing in the field
of oral health and dental care which according to the latest National
Oral Health Survey is in an alarming state. The researchers would like
to find out whether such alarming situation also exists in the five
barangays of Pakil. This study is relevant to Nursing Care Management,
NCM 101 and 102; the researchers believe that the theories learned in
nursing care and management could be applied in this particular
situation- oral health being a part of nursing care.
Background Information
Dental diseases have a considerable impact on self-esteem,
eating ability, nutrition and health both in childhood and older age.
Teeth are important in enabling consumption of a varied diet and in
preparing the food for digestion. In modern society, the most important
role of teeth is to enhance appearance; facial appearance is very
important in determining an individual’s integration into society. Teeth
also play an important role in speech and communication. The second
International Collaborative Study of Oral Health Systems revealed that
in all countries covered by the survey substantial numbers of children
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and adults reported impaired social functioning due to oral disease,
such as avoiding laughing or smiling due to poor perceived appearance
of teeth. Throughout the world, children frequently reported
apprehension about meeting others because of the appearance of their
teeth or that others made jokes about their teeth. In addition, dental
diseases cause considerable pain and anxiety. These factors are likely
to be exacerbated in less developed societies where pain control and
treatment are not readily available.
Dental decay also results in tooth loss, which reduces the ability
to eat a varied diet. It is, in particular, associated with a diet low in
fruits, vegetables and non-starch polysaccharides, and with a low
plasma vitamin C level. Non-starch polysaccharides intakes of less than
10 grams per day fruits and vegetable intakes of less than 160 grams
per day have been reported in edentulous subjects. Tooth loss may,
therefore, impede the achievement of dietary goals related to the
consumption of fruits, vegetables and Non-starch polysaccharides.
Tooth loss has also been associated with loss of enjoyment of food and
confidence to socialize. It is, therefore, clear that dental diseases have
a detrimental effect on quality of life both in childhood and older age.
Dental caries. The deciduous teeth erupt from 6 months and
two years of age and are lost by the early teens. The permanent
dentition replaces the deciduous dentition from the age of 6 years and
is complete by age 21. Teeth are most susceptible to dental caries
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soon after they erupt; therefore, the peak ages for dental caries are 2–
5 years for the deciduous dentition and early adolescence for the
permanent dentition.
Nutritional status affects the teeth during the pre-eruptive stage,
however, this nutritional influence is much less important than the
post-eruptive local effect of dietary practices on caries formation.
Deficiencies of vitamin D, vitamin A and protein energy malnutrition
(PEM) have been associated with enamel hypoplasia. PEM and vitamin
A deficiency are also associated with salivary gland atrophy which
subsequently reduces the mouth’s defense against infection and its
ability to buffer plaque acids.
Dental caries occurs due to demineralization of enamel and
dentine (the hard tissues of the teeth) by organic acids formed by
bacteria in dental plaque through the anaerobic metabolism of sugars
derived from the diet. Caries occurs when demineralization exceeds re-
mineralization. The development of caries requires sugars and bacteria
to occur but is influenced by the susceptibility of the tooth, the
bacterial profile, quantity and quality of the saliva, and the time for
which fermentable dietary carbohydrates are available for bacterial
fermentation.
Dental erosion. Dental erosion is the progressive irreversible
loss of dental hard tissue that is chemically etched away from the
tooth surface by extrinsic and/or intrinsic acids and/or chelation by a
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process that does not involve bacteria. Erosion is often associated with
other forms of tooth wear such as abrasion and attrition (from over
zealous oral hygiene and grinding of teeth, for example). Poor salivary
flow or salivary deficiencies are thought to make some individuals
more susceptible to acid challenges. Low salivary flow rate or
inadequate buffering capacity are factors that exacerbates erosion.
Intrinsic acids are from vomiting and regurgitation. The extrinsic acids
are from the diet, e.g. citric acid, phosphoric acid, ascorbic acid, malic
acid, tartaric acid and carbonic acids found in fruits and fruit juices,
soft drinks—both carbonated and still, some herbal teas, dry wines and
vinegar-containing foods. The critical pH of enamel is 5.5 and therefore
any drink or food with a lower pH may cause erosion. Erosion reduces
the size of the teeth and in severe cases leads to total tooth
destruction. Extensive dental erosion requires expensive restorative
treatment. (Moynihan and Petersen 2000)
In this study, the researchers will evaluate the incidence of
dental diseases among school-age children, 6 to 8 years old, in terms
of the number of decayed, missing and filled teeth.
Conceptual Framework
Figure 1 below depicts the conceptual framework of this study
using the Input-Process-Output model. The Input frame houses the
profile of the children of the parent-respondents in terms of age,
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gender, grade level, The common factors that contribute to
development of dental problems among the children, The common
dental diseases observed among the children of the parent-
respondent, The common dental practices done by the children as
observed by the respondent-parents, The strategies or
recommendations to improve dental health. The Process frame
includes the interview and documentation of results. The Output frame
includes the implication based on the findings obtained in the
Incidence of Dental related Diseases Among School-Age children in
Pakil, Laguna.
INPUT PROCESS OUTPUT
1. Profile of the Children of Parent-respondents:
Age
Gender
Grade level
2. What are the
common factors that
contribute to
InterviewSurvey
Questionnaire-checklist
Documentation
Analysis
This implication is
based on the findings
obtained in the
Incidence of Dental
related Diseases
Among School-Age
children in Pakil,
Laguna
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development of
dental problems
among the children?
3. What are the
common dental
diseases observed
among the
children of the
parent-
respondents?
4. What are the
common dental
practices done by
the children as
observed by the
respondent-
parents?
5. What are the
strategies or
recommendations
to improve dental
health?
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Figure 1. Conceptual Model Showing the Input, Process and Output of the Study.
Statement of the Problem
The study aims to find out the incidence of dental-related
diseases in the five barangays of Pakil, Laguna.
Specifically, it sought to answer the following questions:
1. What is the profile of the children of the parent-respondents in
terms of
a. 1.1 age;
b. 1.2 gender; and
c. 1.3 grade level?
2. What are the common factors that contribute to development of
dental problems among the children?
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3. What are the common dental diseases observed among the
children of the parent-respondents?
4. What are the common dental practices done by the children as
observed by the respondent-parents?
5. What are the strategies or recommendations to improve dental
health?
Significance of the Study
The result of this study may benefit the following:
The school age children may benefit from the study through
institution of a dental care program initiated by the local Department
of Health. The data gathered on the level of DMFT if found alarming
may trigger local officials to find ways to improve the dental health
concerns of their constituents.
The parents may become aware of the importance of dental
care and nutrition of their children. Thus, they may help in developing
good dental care and habit among their children.
The findings of this study can help triangulate the previous
findings of health organizations like the World Health Organization
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on the standard level of Decayed Missing Filled Teeth for the country
as compared to other countries. The findings may also affirm or negate
the result of the latest National Oral Health Survey which found that
the Philippines Oral Health for children is in alarming state.
The result of this study may serve as a springboard for future
researchers to conduct parallel studies with a wider scope and more
variables to consider.
Scope and Delimitation
Subject Delimitation. In this investigation, the population or
respondents covered are the 102 randomly selected children and their
parents from barangays Baño, Burgos, Gonzales, Rizal and Tavera of
Pakil, Laguna, belonging to the age group of 6 to 8 years old..
Time Delimitation. The time coverage of the study falls on the
second semester of the school year 2009 – 2010.
Definition of Terms
For clarity of understanding, the following terms are
operationally defined.
Dental diseases include dental caries, developmental defects
of enamel, dental erosion and periodontal disease (gum disease). In
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this study, dental decay, missing, filled teeth, gingivitis and bad breath
were observed and recorded.
Dental caries is synonymous to tooth decay due to action of
bacteria and sugars.
Dental erosion is the progressive irreversible loss of dental
hard tissue that is chemically etched away from the tooth surface by
extrinsic and/or intrinsic acids and/or chelation by a process that does
not involve bacteria.
Decayed Missing Filled Teeth (DMFT) is the index of
incidence of dental diseases especially among school age (6 – 12 years
old) children used by the World Health Organization (WHO) in
monitoring and evaluating dental health among countries which should
not be more than the mean DMFT of 3.0.
Dental practices of respondent-children include number of
times of daily brushing, use of toothpaste, rinsing agent and salt and
water solutions.
Factors contributing to dental problems include number of
times the respondent-children visit the dentist in a year and their
weekly diet.
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Chapter II
REVIEW OF RELATED LITERATURE AND STUDIES
This chapter presents a review of local and foreign related
literature and studies obtained from local libraries and surfed from the
Internet.
Local Literature
The Philippines Comprehensive Dental Health Program aims to
improve the quality of life of the people through the attainment of the
highest possible oral health. Its objective is to prevent and control
dental diseases and conditions like dental caries and periodontal
diseases thus reducing their prevalence.
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Targeted priorities are vulnerable groups such as the 5-12 year
old children and pregnant women. Strategies of the program include
social mobilization through advocacy meetings, partnership with
government organizations and non-government organizations,
orientation/updates and monitoring adherence to standards.
To attain orally fit children, the program focuses on the following
package of activities: oral examination and prophylaxis; sodium
fluoride mouth rinsing; supervised tooth brushing drill; pit and fissure
sealant application; a-traumatic restorative treatment and IEC. The
Program also integrates its activities with the Maternal and Child
Health Program, the Nutrition Program and the Garantisadong
Pambata activities of the Women’s Health and Safe Motherhood Project
(WHSMP). (Jerome, 2006)
The Department of Education of the Philippines is planning to
expand its hygiene program in a bid to improve public school health
care.
According to Education Secretary Jesli Lapus, the new
Essential Health Care Package is expected to be endorsed by public
elementary schools across the country in the next school year.
The Essential Health Care Package will include hand soap,
toothbrushes, toothpaste, and deworming tablets, he told reporters at
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a press conference. “Our goal is to reduce dental caries up to 50 per
cent and cut down on parasitic infection by another 50 per cent,”
Lapus stated. “We want our students to be in their best physical form
to perform better in school.” (Salwiczek, 2009)
Foreign Literature
Dental health refers to all aspects of the health and functioning
of our mouth especially the teeth and gums. Apart from working
properly to enable us to eat, speak, laugh (look nice), teeth and gums
should be free from infection, which can cause dental caries,
inflammation of gums, tooth loss and bad breath.
Dental caries, also known as tooth decay or cavities, is the most
common disorder affecting the teeth. The main factors controlling the
risk of dental caries are oral hygiene, exposure to fluoride and a
moderate frequency of consumption of cariogenic foods.
Teeth are also affected by “tooth wear” or erosion. This condition
is a normal part of aging where tooth enamel is lost due to exposure
from acids other than those produced by plaque.
Attrition and abrasion are other forms of tooth wear. Attrition
occurs when teeth are eroded by tooth-to-tooth contact such as teeth
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grinding. Abrasion is caused by external mechanical factors such as
incorrect tooth brushing.
Periodontal disease, also known as gum disease, is caused by
infection and inflammation of the gingiva (gum), the periodontal
connective tissues and the alveolar bone. Periodontal disease can lead
to tooth loss.
The health of our teeth and mouth are linked to overall health
and well-being in a number of ways. The ability to chew and swallow
our food is essential for obtaining the nutrients we need for good
health. Apart from the impact on nutritional status, poor dental health
can also adversely affect speech and self-esteem. Dental diseases
impose both financial and social burdens as treatment is costly and
both children and adults may miss time from school or work because of
dental pain.
Dental caries, the most common disorder affecting the teeth, is
an infectious transmissible disease where acids produced by bacteria
dissolve the teeth.
Certain bacteria such as Streptococci mutans and Lactobacilli,
can be transmitted for example from parents to children. These
bacteria are cariogenic, which means decay-causing. They initiate a
sticky film, known as dental plaque, on the surface of the tooth.
Bacteria in dental plaque use fermentable carbohydrates to form acids.
Fermentable carbohydrates are sugars and other carbohydrates from
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food and drink that can be fermented by bacteria. The acids formed
dissolve minerals such as calcium and phosphate from the tooth. This
is called demineralisation.
But tooth decay is not inevitable. Saliva clears food debris from
the mouth, neutralises acids produced from plaque bacteria and
provides calcium and phosphate to the teeth in a process called
remineralisation. Saliva also acts as a reservoir for fluorides from
toothpaste or from fluoridated water. Fluoride helps control dental
caries by remineralising the teeth and inhibiting bacterial acid
production, which reduces or slows the decay process.
Tooth decay only occurs when the process of demineralisation
exceeds re-mineralisation over a period of time.
The following factors have an important impact on dental health:
Susceptibility to dental caries varies between individuals and between
different teeth within one person’s mouth. The shape of the jaw and
oral cavity, tooth structure and the quantity and quality of saliva are all
important in determining why some teeth are simply more susceptible
to decay than others. For example, some teeth may have pits, small
cracks or fissures that allow bacteria and acids to infiltrate more easily.
In some cases, the structure of the jaw/dentition renders teeth more
difficult to clean or floss.
The quantity and quality of saliva determines the extent to which
teeth remineralise. For example relatively fewer caries are generally
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found in the lower front part of the mouth where teeth are more
exposed to saliva.
The type and number of caries-causing bacteria present in the
mouth is also relevant. All bacteria can turn carbohydrates into acids
but certain families of bacteria such as Streptococci and Lactobacilli
are more powerful acid producers. The presence of this type of
bacteria in plaque increases the risk of decay. Some people have
higher levels of decay-causing bacteria than others due to neglected or
inappropriate oral hygiene.
In recent years there has been a reduction in the incidence of
dental caries in most European countries. An increase in oral hygiene
including regular brushing and flossing to remove plaque and the use
of fluoridated toothpaste, combined with regular dental check-ups, is
thought to be responsible for the improvement.
Fluoride inhibits demineralisation, encourages remineralisation
and increases the hardness of the tooth enamel making it less acid
soluble. The proper amount of fluoride helps prevent and control
caries. Fluoride can be supplied systemically through fluoridated
community drinking water, other fluoridated beverages or by
supplementation. Alternatively it can be provided topically direct to the
tooth surface via toothpaste, mouth rinses, gels and varnishes.
In some countries, salt, milk or other beverages have fluoride
added and supplements in the form of tablets or liquid are also
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available. The level of fluoride in drinking water and food needs to be
taken into account when assessing the need for fluoride
supplementation. This is especially important in young children under
the age of 6 whose teeth are still developing. Excessive intakes of
fluoride may eventually cause a mottling of the teeth known as
"fluorosis".
Tooth brushing with fluoridated toothpaste is thought to be the
most important factor in the observed decline in dental caries in many
countries. Brushing and flossing helps concomitantly to the fluoride
application to remove bacteria from the mouth and reduce the risk of
both caries and periodontal disease.
The regular application of fluoride varnishes by dental
practitioners is an established caries preventive measure in many
countries. This practice is especially suitable for children at high risk of
dental caries.
Regular dental check-ups can help detect and monitor potential
problems. Regular plaque control and removal can help diminish the
incidence of dental caries. If very little plaque is present, the amount of
acid formed is insignificant and decay cannot occur.
Although the decline in tooth decay in many countries has been
largely linked to fluoride exposure and improved dental hygiene,
eating habits still affect the risk of tooth decay.
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For many years the simplified message to prevent tooth decay
was ‘don’t eat too much sugar and sugary foods’. Over the last few
decades sugar intake in many countries has remained constant whilst
caries levels have declined. This suggests that where appropriate oral
hygiene is practiced (i.e. regular tooth brushing using fluoride
toothpaste) the role of sugars in tooth decay is less manifest.
Advice to replace sugar with starchy foods to avoid tooth decay
is of questionable value. It is now known that any food containing
fermentable carbohydrates can contribute to tooth decay. This means
that as well as sweets and confectionery, pasta, rice, potato crisps,
fruits, and even bread can set the scene for demineralisation. For
example, a study testing the acid-producing potential of various
starchy foods including pasta, rice and bread, found that these foods
produced the same amount of acid as a 10% sucrose (table sugar)
solution. Another study found that acid formation in plaque after eating
soft bread or potato chips was greater and lasted longer than after
eating sucrose.
The physical characteristics of a food, particularly how much it
clings to the teeth also influence the tooth decay equation. Foods that
adhere to the teeth increase the risk of tooth decay compared to foods
that clear from the mouth quickly. For example crisps and biscuits stick
to teeth for longer periods than foods such as caramels and jelly
beans. This may be because caramels and jellybeans contain soluble
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sugars that are washed away more quickly by saliva. The longer
carbohydrate-containing foods are around the teeth, the more time
bacteria have to produce acid and the greater the chance of
demineralisation.
There is some debate over the relative importance of the
frequency of consuming carbohydrate foods and its link with dental
caries. As with the relationship between diet and caries, the link
appears to have been weakened with the adoption of good oral
hygiene and fluoride.
Each time we nibble a food or sip a drink containing
carbohydrates, any decay-causing bacteria present on the teeth start
to produce acid and demineralisation commences. This continues for
20 to 30 minutes after eating or drinking, longer if food debris is locally
entrapped or remains in the mouth. In between periods of eating and
drinking saliva works to neutralise the acids and assist in the process
of remineralisation. If food or drink is taken too frequently the tooth
enamel does not have a chance to remineralise completely and caries
can start to occur. This is why nibbling or sipping continuously
throughout the day should be discouraged. The best advice is to limit
the consumption of food and drink containing carbohydrates to no
more than 6 occasions per day and ensure teeth are brushed with
fluoride toothpaste twice a day.
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Baby bottle caries or nursing caries is a condition in which
infants’ teeth are damaged by prolonged frequent exposure to drinks
containing sugars usually via a baby feeding bottle. In particular,
problems arise when infants are put to sleep with a bottle of formula or
juice. The flow of saliva is greatly reduced during sleep and the sweet
liquid pools around the teeth for extended periods of time. This
provides the perfect environment for tooth decay to develop.
Some foods help protect against tooth decay. For example hard
cheese increases the flow of saliva. Cheese also contains calcium,
phosphate and casein, a milk protein, which protects against
demineralisation. Finishing a meal with a piece of cheese helps
counteract acids produced from carbohydrate foods eaten at the same
meal. Milk also contains calcium, phosphate and casein, and the milk
sugar, lactose, is less cariogenic (caries causing) than other sugars.
Nevertheless caries have been found in children breastfed frequently
on demand.
Tooth -friendly products are formulated using sweetening
ingredients that cannot be fermented by the mouth bacteria. Intense
sweeteners such as saccharin, cyclamate, acesulfame-K and
aspartame, and sugar substitutes such as isomalt, sorbitol and xylitol
fall into this category.
Sugar-free chewing gums use these sweeteners. Both the sweet taste
and chewing stimulate salivary flow, which contributes to the
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prevention of caries. Such chewing gums may also contain minerals
such as calcium, phosphate and fluoride to enhance the repair process.
Studies have reported that chewing sugar-free gum after a meal
accelerates the clearance of food debris and reduces the rate of caries
development in children.
Tooth-friendly products have to comply with a specific test
regimen in order to get ‘safe for teeth’ approval.
Tooth erosion is the loss of dental hard tissue from the tooth
surface by chemical processes, usually acid, without involving plaque
bacteria. There are many acidic foods and drinks in our diet and it is
possible that in a susceptible individual in certain circumstances, for
example, a higher frequency of exposure to acidic foods and/or drinks,
erosion may occur. This increased frequency of exposure may override
the natural buffering capacity of the mouth, which varies between
individuals.
It is advised to avoid frequent nibbling and sipping of acidic foods
and drinks throughout the day, restricting their consumption preferably
to main meals, and to clean teeth at least twice per day using fluoride
toothpaste. It has been suggested that cleaning teeth immediately
after consuming an acidic food or drink should be avoided as this can
result in physical wear to the teeth resulting from tooth brushing in the
presence of acid. Chewing sugar free chewing gum to stimulate
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salivary secretion following an acid challenge helps neutralize the acid
effects.
The incidence of dental caries in children and adolescents in
most European countries has been declining for some years. This is
largely attributed to exposure to fluoride, primarily from fluoride
toothpaste, and improved oral hygiene. Over the same period the diet,
including the intake of sugar and other carbohydrates has remained
fairly constant. Where dental caries is largely under control by fluorides
and regular dental care (as in most European countries), moderate
consumption of sugars is not a major risk factor except in individuals
who are highly susceptible to dental caries or do not use fluoride
toothpaste properly.
More than half of all 5 to 7 year-old European children have no
dental caries in their primary (milk) teeth. In general, those who have
dental caries have only one tooth affected. The “DMF-T index” which
refers to the number of Decayed, Missing and Filled Teeth is used to
measure the prevalence of dental caries. In 12 year-old European
children dental caries levels began to fall during the 1980s and
continued to fall during the 1990s reaching the WHO global oral health
goals set for the year 2000. DMF-T figures in this age group range from
1 in Finland and the Netherlands, to 3 in Portugal, although it is higher
in some Eastern European countries. In some countries dental caries is
becoming polarised with 80% of decay being found in just 20% of the
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population. For these high-risk groups targeted intervention strategies
are recommended.
In many countries the reduction in dental caries seen in children
is now extending to adolescents and young adults. Elderly people are
now keeping their teeth longer. The risk of root caries, when gums
recede, can also be controlled by the preventive measures described.
Good oral hygiene and the use of fluoride are now considered the
main factors responsible for preventing tooth decay and promoting
good oral health. The following advice is also important for keeping
teeth caries-free.
Start dental care early, brush baby’s teeth with a fluoride
toothpaste as soon as they appear in the mouth. Do not
habitually allow infants to fall asleep while drinking from a
bottle of milk, formula, juice or sweetened drink. These
sweet liquids pool around the baby’s teeth for long periods
of time and can lead to “baby bottle tooth decay”.
Brush teeth twice a day with fluoride toothpaste. And if
possible, clean between the teeth with dental floss or
toothpicks once a day. Do not eat after cleaning teeth at
bedtime as salivary flow decreases as we sleep.
Visit the dentist about every 6 months for a check-up. And
seek dentist's advice before using aesthetic products (e.g:
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teeth whiteners) that could have a deleterious effect on the
teeth.
Do not nibble food or sip drinks continuously. Allow time
between eating occasions for saliva to neutralise acids and
repair the teeth.
People at high risk from tooth wear and erosion should
take special precautions, such as:
o decrease frequency and contact with acidic foods
and drinks;
o Avoid brushing teeth immediately after consuming
acidic foods, drinks, citrus fruits and juices. This allows
time for remineralisation to occur.
Fluoride mouthwashes and sugar-free chewing gum may be
useful after taking acidic food or drinks as they encourage
remineralisation.
Sugar-free chewing gum is “toothfriendly” as it helps
increase saliva flow and clears food debris from the mouth.
Good dental health is the responsibility of individuals,
communities and governments although their relative importance
varies. For example in some European countries water fluoridation is
not yet publicly acceptable and so responsibility for preventing tooth
decay lies largely with the individual.
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Dental professionals play an essential role in monitoring dental
health and treating or preventing any problems. Access to good dental
care, including regular check-ups is vital. For some people, especially
those from lower socio-economic groups, access to dental
professionals may be limited. These groups are important targets for
dental health education programmes. Schools also play an important
role in educating children on the importance of good oral hygiene and
diet. (Johnson, R. K. (2000). The 2000 Dietary Guidelines for
Americans: foundation of US nutrition policy. British Nutrition
Foundation Bulletin, 25:241-248)
Local Studies
The Philippine Nationwide Oral Health Survey conducted
between November 2005 and February 2006 in the country’s 17
regions found that, of the 4,000 pupils surveyed, 97 per cent of six-
year-olds and 82 per cent of 12-year-olds suffered from tooth decay.
One of the survey findings, however, offered hope, as it showed that
schools are the best place at which to institutionalize healthy habits.
Several pilot studies conducted in the country have shown that
implementing school-based daily fluoride tooth brushing could reduce
new dental caries by 40 per cent and oral infections by 60 per cent
(Zalwiczek, 2009).
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The baby or milk teeth are essential for good growth and
development of the child. Baby teeth allow the child to eat well and
speak clearly. Baby teeth also have the important function of guiding
the growth of the permanent teeth. The first baby or milk teeth to
appear are the lower front teeth, around the age of six to seven
months. By the time, children are two years old , nearly all the full set
of twenty baby teeth would have grown. The baby teeth will not begin
to fall till the age of five or seven years old. Care for baby teeth should
begin as soon as they appear. This includes cleaning the teeth after
meals. Pre-school children can develop tooth decay. It is important to
keep baby teeth healthy until the permanent teeth are ready to grow
which can be as late as eleven to twelve years old. It is especially
useful to bring children to the dentist for an assessment of the growth
of the teeth at ages seven, nine and eleven. At these ages, problems of
crowding or development of the jaws can be anticipated and if need
be, treated early to avoid more complex problems later. All throughout
childhood, the importance of daily hygiene and choice of healthy foods
can be inculcated in the child so that good habits can be formed and
kept for life. (Della Cruz 2002).
Foreign Studies
Often taken for granted, the monotonous task of brushing and
flossing our teeth daily has never been more important in order to
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avoid gum disease and the risks gum disease place on our overall
health. It has been estimated that 75% of Americans have some form
of gum disease, which has been linked to serious health complications
and causes various dental problems that are often avoidable.
Periodontal disease, also called gum disease, is mainly caused by
bacteria from plaque and tartar build up. Other factors that have the
potential to cause gum disease may include: Tobacco use, Clenching or
grinding your teeth, Certain medications and Genetics.
Types of Gum Disease Include: Gingivitis - The beginning stage
of gum disease and is often undetected. This stage of the disease is
reversible and Periodontitis - Untreated gingivitis may lead to this
next stage of gum disease. With many levels of periodontitis, the
common outcome is chronic inflammatory response, a condition when
the body breaks down the bone and tissue in the infected area of the
mouth, ultimately resulting in tooth and bone loss.
Signs of Gum Disease Include: Red, bleeding, and/or swollen
gums; Bad breath ; Mobility of the teeth; Tooth sensitivity caused by
receding gums; Abscessed teeth and Tooth loss.
Recent studies suggest gum disease may contribute to or be
warning signs of potentially life threatening conditions such as:
Heart Disease and Stroke - Studies suggest gingivitis may
increase the risk of heart disease and stroke because of the high levels
of bacteria found in infected areas of the mouth. As the level of
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periodontal disease increases, the risk of cardiovascular disease may
increase with it. Other studies have suggested that the inflammation in
the gums may create a chronic inflammation response in other parts of
the body which has also been implicated in increasing the risk of heart
disease and stroke.
Diabetes - People with diabetes often have some form of gum
disease, likely caused by high blood glucose, according to the CDC.
People with diabetes need to take extra care to ensure proper brushing
and flossing techniques are used to prevent the advancement of the
gum disease. Regular check-ups and cleanings with your dental
hygienist should be followed.
Chronic Kidney Disease - A study, conducted by Case Western
Reserve University, suggests that people without any natural teeth,
known as edentulous, are more likely to have chronic kidney disease
(CDK), than people with natural teeth. CDK affects blood pressure
potentially causing heart disease, contributed to kidney failure, and
affects bone health. (By Shawn Watson, 2010)
According to Shuter (2001) “Dental caries incidence is
affected by host factors that may be related to the structure of dental
enamel, immunologic response to cariogenic bacteria, or the
composition of saliva. Genetic variation of the host factors may
contribute to increased risks for dental caries. This systematic review
examined the literature to address the question, "Is the risk for dental
294
decay related to patterns of genetic inheritance?" Numerous reports
have described a potential genetic contribution to the risk for dental
caries. Studies on twins have provided strong evidence for the role of
inheritance. Establishing a basis for a genetic contribution to dental
caries will provide a foundation for future studies utilizing the human
genome sequence to improve understanding of the disease process.
Inherited disorders of tooth development with altered enamel structure
increase the incidence of dental caries. Specific genetic linkage has not
been determined for all of the syndromes of altered tooth
development. Consequently, genetic screens of large populations for
genes or mutations associated with increased caries susceptibility
have not been done. Altered immune response to the cariogenic
bacteria may also increase the incidence of caries. Association
between specific patterns of HLA genetic inheritance and dental caries
risk is weak and does not provide a predictable basis for predicting
future decay rates. The evidence supporting an inherited susceptibility
to dental caries is limited. Genetic linkage approaches on well-
characterized populations with clearly defined dental caries incidence
will be required to further analyze the relationship between inheritance
and dental caries.”
The following are abstracts of research on dental health surfed
from the Internet accessed March 20, 2010.
304
Why do Women get More Cavities Than Men? Reproduction
pressures and rising fertility explain why women suffered a more rapid
decline in dental health than did men as humans transitioned from
hunter-and-gatherers to farmers and more sedentary pursuits, says a
University of Oregon anthropologist. The conclusion follows a
comprehensive review of records of the frequencies of dental cavities
in both prehistoric and living human populations from research done
around the world. A driving factor was dramatic changes in female-
specific hormones, reports John R Lukacs, a professor of anthropology
who specializes in dental, skeletal and nutritional issues. His
conclusions are outlined in the October issue of Current Anthropology.
The study examined the frequency of dental caries (cavities) by sex to
show that women typically experience poorer dental health than men.
Among research reviewed were studies previously done by Lukacs.
Two clinical dental studies published this year (one done in the
Philippines, the other in Guatemala) and cited in the paper, Lukacs
said, point to the same conclusions and "may provide the mechanism
through which the biological differences are mediated." (University
of Oregon,2008)
Finnish Kids' Dental Health Decaying. The condition of
Finnish children's teeth is going downhill. Only about half of all twelve-
year olds have a healthy smile. Dentists say they have even been
314
forced to remove cavity-filled teeth from some children -- a procedure
quite uncommon in the past. Unhealthy eating is part of the problem.
More children are drinking soda and nibbling on unhealthy snacks than
ever before. But not all the blame can be placed on poor eating habits.
There are cracks in education as well. Schools aren't providing children
with sufficient information on dental hygiene -- mainly because they
lack proper instruction materials. Furthermore less than 40 percent of
boys between the ages of 14 and 18 brush their teeth twice a day. For
girls the number is over 50 percent. From the mid 1970s to the early
1990s, dentists saw a decline in the number of cavities in children's
teeth. Nowadays, Finnish children's teeth rank about average when
compared to other European countries. The condition of Finnish
children's teeth is going downhill. Only about half of all twelve-year
olds have a healthy smile. (Anja Eerola, 2008)
New Research Gives Dental Patients Hope; Stop Cavities
Before They Start. What if your dentist could detect the potential for
a cavity to form before it ever happened? A new testing device called
the CariScreen from an Oregon company, Oral BioTech, now makes
early detection possible. Cavities are caused by a bacterial infection
called dental caries. New research by leading experts worldwide
confirms that this infection while complex, is identifiable and treatable,
no needles or drills necessary. The CariScreen is a hand-held meter
324
that utilizes ATP bioluminescence technology to detect the levels of
acid-producing, decay-causing bacteria residing in an individual's
plaque. Contrary to popular belief, not all plaque is bad plaque. Only
when there has been a shift from the normal healthy micro flora of the
mouth to an unhealthy acidic bacterial population does dental decay
become possible. The CariScreen technology allows dentists to take a
quick, painless swab sample of patients' plaque and using the meter,
get a reading within 15 seconds as to whether there are too many of
these acidic bacteria present. The revolutionary aspect here is that this
shift in bacterial population can now be identified and health restored
before a cavity ever has a chance to form. (Albany, 2008)
Children Enrolled in Medicaid Have More Untreated Tooth
Decay. Children covered under Medicaid receive considerably less
dental care and have more untreated tooth decay than those who are
privately insured, witnesses testified during a recent hearing held by
the House Oversight and Government Reform Domestic Policy
Subcommittee, CQ HealthBeat reports.
According to CQ HealthBeat, a Government Accountability
Office report released last month found that an estimated 6.5 million
children covered by Medicaid had untreated tooth decay in 2005. Alicia
Cackley, acting director of health care at GAO, in written testimony
334
said that children covered by Medicaid between 1999 and 2004 were
almost twice as likely to have untreated tooth decay. She added that
15% of children in Medicaid had difficulty receiving dental care
because the provider did not accept their insurance plan, compared
with 2% of privately insured children.
According to James Crall 2008, director of the National Oral
Health Policy Center at University of California-Los Angeles, said
"chronically low" reimbursement rates discourage many dentists from
participating in the program. He added that increases in provider
reimbursement have increased the rate of children covered by
Medicaid using dental services in several states. He also suggested
streamlining provider enrollment and separating dental benefits from
the rest of the Medicaid program to "allow states to retain greater
control in setting reimbursement rates, and allow for reasonable profits
on the part of the dental benefits managers while eliminating the
incentive to reduce payments to dentists who provide dental services
to Medicaid beneficiaries."
Parents Blamed for State of Children’s Teeth. Bad
parenting is today blamed for the shocking state of children’s teeth in
Wales. A politician launched the astonishing attack on parents as
dentists told the Western Mail it is “not unusual” for children as young
as three in Wales to have their milk teeth filled. Thousands of Welsh
children are undergoing a general anaesthetic in hospital every year to
344
have decayed teeth removed. And other experts have revealed that
some young children in the South Wales Valleys do not know what a
toothbrush is or even recognize the taste of toothpaste.
According to Jonathan Morgan 2008, the Conservatives’
shadow health minister, blamed “parental neglect” for three-year-olds
with bad teeth. He said: “Looking after a child’s teeth is fundamentally
important – not looking after their teeth is as bad as allowing them to
go outdoors without shoes. Why do we tolerate it when parents do not
ensure that their children’s teeth are clean?
Changing Dental Caries and Periodontal Disease Patterns
Among a Cohort Of Ethiopian Immigrants to Israel: 1999-2005.
Dental epidemiology has indicated that immigrants and minority ethnic
groups should be regarded as high risk populations on the verge of oral
health deterioration. The objectives of this study were to measure the
changing pattern of dental caries, periodontal health status and tooth
cleaning behavior among a cohort of Ethiopian immigrants to Israel
between the years 1999-2005. The method used was to identify
increment of dental caries and periodontal health status was recorded
among a cohort of 672 Ethiopian immigrants, utilizing the DMFT and
CPI indices. Data were gathered during 1999-2000 and five years later,
during 2004-2005. Participants were asked about their oral hygiene
habits in Ethiopia and in Israel five years since their immigration.
354
(Yuval Vered, Avi Zini, Alon Livny, Jonathan Mann and Harold
Sgan-Cohen, 2008)
Dental Care Can Reduce Risk of Preterm Birth by Nearly
50 Percent.
According to a study conducted by Aetna and Columbia
University College of Dental Medicine 2003, women who received
dental care before or during their pregnancy had a lower risk of giving
birth to a preterm or low birth weight baby than pregnant women who
didn't seek dental care at all. The study, conducted between January 1,
2003 and September 30, 2006, reviewed medical and dental insurance
data for 29,000 pregnant women who each had medical and dental
coverage with Aetna to determine if there was an association between
dental treatment and the likelihood of experiencing either birth
outcome. "Further studies need to be done but our findings show that
dental treatment had a protective effect on adverse birth outcomes in
women who sought dental treatment," said David A. Albert, DDS, MPH,
Director, Division of Community Health, College of Dental Medicine,
Columbia University.
The Save-A-Tooth system can be used to transport teeth
destined for cryopreservation and stem cell treatment of disease.
Recent research has shown that normally shedding baby teeth and
extracted wisdom teeth can be a source of stem cells that are the
364
equivalent of umbilical cord blood stem cells. The use of umbilical cord
blood as a source of stem cells has been routine for several years.
However, this method has many problems. The window of time for the
retrieval of the cord blood is very short, the hospital staff needs to be
well trained in the technique and it is expensive. Every child loses 20
baby teeth over a period of six to eight years, and 1.4 million wisdom
teeth are extracted each year. Each of these is a rich source of stem
cells In the past, these teeth were thrown in the trash, but now they
can be saved and shipped to a cryo- preservation facility and the stem
cells stored until needed for the many possible future clinical
applications. “This potential source of stem cells from teeth is a
tremendous breakthrough,” said Dr. Paul Krasner, professor of
endodontics at Temple University School of Dentistry. “Four million
baby teeth a year normally fall out, and for a small cost and virtually
no effort, each can have their stem cells stored for future medical use.”
(Michmershuizen, 2009)
The foregoing related literature and studies had given the
researchers, being nursing students, adequate information and insight
into the conduct of their present study; specifically on the identification
of dental diseases, diagnosis, signs, symptoms, prevention and
treatment. Furthermore, the information on the factors contributing to
occurrence of dental diseases and the means of measuring the level of
dental health through the DMFT index are very useful to the
374
researchers’ current study wherein they are tasked to measure
incidence of dental diseases as caries and erosion among school-age
children in five barangays of Pakil, Laguna.
Chapter III
METHODS AND PROCEDURE
This chapter presents the research design, sources of data,
respondents of the study, research setting, data gathering and
statistical treatment of data gathered in the pursuit of the objectives of
the study.
Research Design
The descriptive survey research design was used in this study.
Best (1998), defined descriptive investigation as a method used
in research study which includes all those that present facts
concerning the nature and status of anything, a group of persons, a
number of objects, a set of conditions, a class of events, a system of
thought, or any kind of phenomena which one may wish to study.
Survey research involves researchers asking respondents
questions about a particular topic or issue and can be in a number of
384
ways – face to face, by mail through a questionnaire or by phone
(Fraenkel and Wallen 1994).
In this study, the questionnaire-checklist and interview technique
were used to elicit responses and to obtain the pertinent data needed
by the researchers.
Sources of Data
The data were derived from the responses to the questionnaire-
checklist constructed by the researchers and obtained through
interview of parents of the children-respondents and actual inspection
of the children’s teeth to determine the level of mean DMFT and the
profile and other person-related factors included in this study.
Respondents of the Study
The respondents of this study were consist of parents of school
age children from 6 to 8 years old, residing in the six barangay located
near the town proper of Pakil, Laguna. Table 1 shows the distribution of
respondents by barangay and gender.
Table 1. Distribution of School Age Respondents by Barangay and Gender.Barangay Male Female Total Percentage
1. Baño 10 10 20 19.602. Burgos 10 10 20 19.603. Gonzales 10 10 20 19.604. Rizal 10 10 20 19.605. Tavera 11 11 22 21.60
Total 51 51 102 100.00
394
Research Setting
The study will be conducted in the five (5) barangays within the
town proper of the Municipality of Pakil, Laguna. (Pls.see attached
location map in Appendix_____).
Data Gathering
A questionnaire-checklist survey form was constructed to gather
the pertinent data needed to answer the specific questions outlined in
Chapter 1 using the interview technique. The research instrument was
content-validated by their adviser and some professors of the college.
Revisions was done . Upon approval of the final draft, the researchers
proceeded to the research setting, secured the necessary permission
from the school and local authorities and conducted the study in
pursuit of the objectives of the study. The data gathered were
encoded, organized and were descriptively analyzed using the
statistical tools described in Chapter 3 in consultation with a
statistician. The final draft of the manuscript was prepared for oral
defense on the prescribed schedule.
404
Statistical Treatment of Data
The data gathered were analyzed using the following descriptive
statistical tools:
Analysis Statistical Tools
1. Profile of the respondent-children in terms of age, gender, grade level
2. Common factors that contribute to the development of dental problems among the children
3. Common dental diseases among the children
4. Common dental practices done by the children of the parent-respondents
5. The strategies or recommendations to improve dental health
1. frequency, percentage and rank
2. frequency, percentage and rank
3. frequency, percentage rank, mean or average
.
4. frequency, percentage, rank, mean or average
5. frequency, percentage, rank
Formulas Used:
FrequencyPercentage = ---------------------------- X 100
Total No. of Respondents
Sum of all observationsAverage or Mean = ------------------------------
414
Total No. of Respondents
Chapter IV
PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA
This chapter presents analyses and interprets the data gathered
in determining the incidence of dental-related diseases in five (5)
barangays of Pakil, Laguna.
The findings are presented according to the sequence of the
specific questions outline in Chapter 1.
Problem 1. What is the profile of the children in terms of age, gender
and grade level?
Table 2.1. Distribution of School Age Children According to Age
Age Frequency Percentage Rank
6 29 28.43 2.5
7 44 43.14 1
8 29 28.43 2.5
Total 102 100.00
Table 2.1 describes the distribution of school age children
according to age. The findings revealed that 46.14 percent of the
children were seven (7) years old followed by those with ages six(6)
years and eight(8) years each contributing 28.43 percent to the total
424
respondent children of 102. The average age of the children was
seven(7) years old.
According (Zalwiczek, 2009)One of the survey findings,
however, offered hope, as it showed that schools are the best place at
which to institutionalize healthy habits. Several pilot studies conducted
in the country have shown that implementing school-based daily
fluoride tooth brushing could reduce new dental caries by 40 per cent
and oral infections by 60 percent.
Table 2.2. Distribution of School Age Children According to Gender
Gender Frequency Percentage Rank
Male 51 50 1.5
Female 53 52 1.5
Total 104 102
Table 2.2 shows the distribution of children in terms of gender.
Since the sampling design used was purposive following a 1:1 male to
female ratio; 50 percent of them are male and 50 percent are female.
This was done to have equal representation of male and female
respondent-children.
According to John R. Lukacs reproduction pressures and rising
fertility explain why women suffered a more rapid decline in dental
434
health than did men as humans transitioned from hunter and gatherers
to farmers and more sedentary pursuit.
Table 2.3. Distribution of School Age Children According to Grade Level
Grade Level Frequency Percentage Rank
1 32 31.37 2
2 41 40.20 1
3 29 28.43 3
Total 102 100.00
In terms of grade level, 40.20 percent were Grade 2, 31.37
percent were Grade 2 and 28.43 percent were Grade 3.
The profile of the children involved in this study revealed that most of
the respondents were seven (7) years old and Grade 2 pupils.
According (Zalwiczek, 2009) One of the survey findings,
however, offered hope, as it showed that schools are the best place at
which to institutionalize healthy habits. Several pilot studies conducted
in the country have shown that implementing school-based daily
fluoride tooth brushing could reduce new dental caries by 40 per cent
and oral infections by 60 percent.
444
Problem 2. Common factors that contribute to the development of dental problems among the children
Table 3.1.Common Factors that Contributed to the Development of Dental Problems Among the Children- Visit to the Dentist
Number of Visits to the Dentist Per Year
Frequency Percentage Rank
None/ Never 75 73.53 1
Once 12 11.76 3
Twice 15 14.71 2
Total 102 100.00
It could be gleaned from Table 3.1 that 73.53 percent had not had any
dental checkup or visit for their children. About 14.71 percent had
visited the dentist twice a year and 11.76 percent had a dental
checkup at least once a year. This implies that about three-fourth of
the children had never been attended by the dentist every year.
According to Salwiczek, 2009 regular check-ups can help
detect and monitor potential problems. Regular plaque control and
removal can help diminish the incidence of dental caries. If very little
plaque is present, the amount of acid formed is significant and decay
cannot occur. Although the decline in tooth decay in many countries
has been largely linked to fluoride exposure and improved dental
hygiene, eating habits still affect the risk of tooth decay.
454
Table 3.2.Common Factors that Contributed to the Development of Dental Problems Among the Children- Weekly Diet
Weekly DietNumber of Times Eaten per Week
MinimumMaximu
m Average Rank
Rice 9 21 16.12 1
Vegetables 1 6 2.24 7
Fish 2 9 5.61 2
Meat 1 8 3.06 5
Fruits 1 7 2.46 6
Eggs 1 7 4.35 3
Milk 0 7 0.93 8
Sweets/ soft drinks 0 7 3.21 4
Table 3.2 above reveals the weekly diet of the children and the
number of times each type of food was eaten on a weekly basis.
The data collected showed that rice comprised a bigger share of
the children’s diet where a minimum of nine and a maximum of 21
times rice was eaten; on the average the respondent-children ate rice
16.12 times a week which a little bit more than twice a day. Secondly,
fish was eaten from 2 to 9 times a week or an average of 5.61 times a
week. Thirdly, eggs were part of the diet from one to 7 times a week or
an average of 4.35 times a week. Fourthly, sweets and soft drinks were
eaten or taken 3.21 times a week or every other day. Least-taken was
milk which was taken 0.93 times a week or less than one time a week.
Milk is known to be rich in calcium, vitamins and minerals which help
464
strengthen our bones including our gums and teeth. This particular
food was found wanting in the diet of the respondent-children.
According to Salwiczek, 2009 that longer carbohydrates-
containing foods are around the teeth, the more time bacteria have to
produce acid and the greater the chance of demineralization.
Problem 3. What are the common dental diseases among the
children?
Table 4.1 describes the common dental diseases observed
among the respondent-children which included decayed, missing, and
filled teeth; gingivitis and bad breath.
Table 4.1. Common Dental Diseases Observed Among the Children
Number of
Teeth Affecte
d
Common Dental DiseasesDecayed Missing Filled Gingivitis Bad Breath
Freq
%freq
%Freq
%freq
%Freq
%
None 64 62.75 51 50.00 97 95.10 88 86.27 53 5196
One 12 11.76 14 13.73 4 3.92 14 13.73 49 48.04
Two 18 17.65 14 13.73 1 0.98 0 0.00 0 0.00
Three 7 6.86 15 14.71 0 0.00 0 0.00 0 0.00
Four 1 0.98 8 7.84 0 0.00 0 0.00 0 0. .00
Total 102 100.00 102 100.00 102 100.00 102 100.00 102 100.00
Percent affected
37.25 50.00 4.90 13.73 48.04
Rank 3 1 5 4 2
474
The findings revealed that 50 percent of the children had missing
teeth or tooth loss; 48.04 percent had bad breath which could be
attributed to decayed teeth; 37.25 percent had decayed teeth; 13.73
percent had gingivitis or gum bleeding; and 4.90 percent had
filled teeth which is seldom done at this age of the respondent-
children.
As mentioned in the introduction of Chapter 1, according to the
latest national oral health survey, 97 percent of first-graders in public
schools had tooth decay while in this study, 37.25 percent of the
respondent-children had tooth decay which is 60 percent below the
national survey.
According also to the aforementioned survey, six-year olds
had an average nine decayed teeth while in this study, the average
decayed teeth per respondent-child is 0.72. Thus, this study negated
the findings of the National Oral Health Survey.
484
Problem 4. What are the common dental practices done by the
children as observed by the parents?
Table 5.1 presents the common dental practices done by the
respondent-children as observed by the parents with respect to
brushing of teeth
Table 5.1. Common dental practices done by the children as observed by the parents- Brushing of Teeth
Number of Times of Brushing the Teeth per Day
Frequency Percentage Rank
Once a day 30 29.41 2
Twice a day 41 40.20 1
Three times a day 29 28.43 3
Four times a day 2 1.96 4
Total 102 100.00
It was observed that 40.20 percent of the respondent-children
brushed their teeth twice a day; 29.41 percent brushed their teeth
once a day; 28.43 percent brushed their teeth here times a day; and
1.96 percent brushed their teeth four times a day. The findings imply
that the respondent-respondents had the habit of brushing their teeth
every day not only once but twice or thrice.
According to (Johnson, R. K. (2000).An increase in oral
hygiene including regular brushing and flossing to remove plaque and
494
the use of fluoridated toothpaste, combined with regular dental check-
ups, is thought to be responsible for the improvement.
Table 5.2. Common Oral Hygiene that usually used among children Contributed to the Development of Dental Problems Among the Children- Use of Toothpaste, Rinsing Agent or Mouthwash
Use of Toothpaste, Rinsing Agent or Mouthwash
Frequency Percentage Rank
Toothpaste
Yes 94 92.16 1
No 8 7.84 2
Total 102 100.00
Rinsing Agent
Yes 4 3.92 2
No 98 96.08 1
Total 102 100.00
Salt and Water
Yes 9 8.82 2
No 93 91.18 1
Total 102 100.00
The findings shown in Tables 5.1 and 5.2 may have contributed
to low incidence of tooth decay among the respondent children. Even
though 97 percent of the respondent-children had never visited a
dentist for a dental checkup, they had good dental care practices such
as daily brushing of their teeth with toothpaste had somehow lessened
the incidence of decayed teeth as compared to national figure.
504
Problem 5. What are the strategies or recommendations to improve
dental health?
Based on the findings of this study, the state of oral health
among school age children in Pakil, Laguna is not very alarming as
compared to the national status. However, one-third of the respondent-
children having decayed teeth is not a comfortable figure. As the
saying goes “An ounce of prevention is always better than a pound of
cure.” There is a need to formulate strategies or recommendation to
still lessen or totally eradicate the incidence of tooth decay and dental
problems among school-age children and even adults. Attached in the
appendices is an example of an Oral Health Care program which the
researchers recommend for adoption and implementation of concerned
agencies or organizations: Implementing a Tooth Brushing
Program to Promote Oral Health and Prevent Tooth Decay.
Chapter V
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
514
This chapter presents the summary of findings, the conclusions
arrived at and the recommendations offered by the researchers in the
process of determining the incidence of dental diseases among 102
school age children, 6 to 8 years old, in five barangays of Pakil,
Laguna. Specifically, it sought answers to the following questions:
1. What is the profile of the children of the parent-respondents in
terms of
1.1. age;
1.2. gender; and
1.3. grade level?
2. What are the common factors that contribute to development of
dental problems among the children?
3. What are the common dental diseases observed among the children
of the parent-respondents?
4. What are the common dental practices done by the children as
observed by the respondent-parents?
5. What are the strategies or recommendations to improve dental
health?
Summary of Findings
The following are the summary of findings of the study”
1. The findings revealed that 46.14 percent of the children were
seven (7) years old followed by those with ages six (6) years
524
and eight (8) years each contributing 28.43 percent to the total
respondent children of 102. The average age of the children
was seven (7) years old; 50 percent of them are male and 50
percent are female; 40.20 percent were Grade 2, 31.37 percent
were Grade 2 and 28.43 percent were Grade 3.
2. Seventy three and 53 hundredths (73.53) percent had not had
any dental checkup or visit for their children. About 14.71
percent had visited the dentist twice a year and 11.76 percent
had a dental checkup at least once a year. In terms of weekly
diet, on the average the respondent-children ate rice 16.12
times a week. Secondly, fish was eaten an average of 5.61
times a week. Thirdly, eggs were part of the diet for an
average of 4.35 times a week. Fourthly, sweets and soft drinks
were eaten or taken 3.21 times a week or every other day.
Least-taken was milk at 0.93 times a week or less than one
time a week. Milk is known to be rich in calcium, vitamins and
minerals which help strengthen our bones including our gums
and teeth. This particular food was found wanting in the diet of
the respondent-children.
3. The findings revealed that 50 percent of the children had
missing teeth or tooth loss; 48.04 percent had bad breath
which could be attributed to decayed teeth; 37.25 percent had
decayed teeth; 13.73 percent had gingivitis or gum bleeding;
534
and 4.90 percent had filled teeth which is seldom done at this
age of the respondent-children; 97 percent of first-graders in
public schools had tooth decay while in this study, 37.25
percent of the respondent-children had tooth decay which is 60
percent below the national survey. According also to the
aforementioned survey, six-year olds had an average nine
decayed teeth while in this study, the average decayed teeth
per respondent-child is 0.72. Thus, this study negated the
findings of the National Oral Health Survey.
4. It was observed that 40.20 percent of the respondent-children
brushed their teeth twice a day; 29.41 percent brushed their
teeth once a day; 28.43 percent brushed their teeth three
times a day; and 1.96 percent brushed their teeth four times a
day. The findings imply that the respondent-respondents had
the habit of brushing their teeth every day not only once but
twice or thrice. The findings revealed that 92.16 percent used
toothpaste; 96.08 percent did not use any rinsing agent or
mouth wash; and 8.82 percent used salt and water as a rinsing
agent or mouthwash. Even though 97 percent of the
respondent-children had never visited a dentist for a dental
checkup, they had good dental care practices such as daily
brushing of their teeth with toothpaste had somehow lessened
the incidence of decayed teeth as compared to national figure.
544
5. There is a need to formulate strategies or recommendation to
still lessen or totally eradicate the incidence of tooth decay and
dental problems among school-age children and even adults.
Attached in the appendices is an example of an Oral Health
Care program which the researchers recommend for adoption
and implementation of concerned agencies or organizations:
Implementing a Tooth Brushing Program to Promote
Oral Health and Prevent Tooth Decay.
Conclusions
Based on the findings and objectives of this study, it is concluded
that the state of oral health in the five barangays of Pakil, Laguna is
not as alarming as the national status.
It is further concluded that the respondent-children had a good
dental habit in terms of daily brushing of teeth but need to visit the
dentist at least twice a year for dental check-up and have to improve
their diet to include milk and lessen intake of sweets and soft drinks to
maintain good oral health.
Recommendations
In the light of the conclusions arrived at, it is recommended that
the attached program on Growing Healthy Smiles in the Child Care
Setting which is a Tooth Brushing Program to Promote Oral Health and
Prevent Tooth Decay be considered for implementation in the pre-
school and elementary schools.
554
It is further recommended that parallel studies be undertaken by
other researchers with a wider scope and more variables in order to
affirm or negate the findings of this study.
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Best, John W and James V. Kahn.((1998). Research in Education. Singapore: Allyn and Bacon.
Fraenkel, Jack R. and Norman E. Wallen. (1994). How to Design and Evaluate Research in Education. New York: MxGraw Hill, Inc.
Walpole, Ronald E. Introduction to Statistics. 3 rd Edition, Prentice Hall. 1982.
B. Web
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Changing Dental Caries and Periodontal Disease Patterns Among a Cohort Of Ethiopian Immigrants to Israel: 1999-2005 http://7thspace.com/headlines/294319/changing_dental_caries_and_periodontal_disease_patterns_among_a_cohort_of_ethiopian_immigrants_to_israel_1999_2005.html
Children Enrolled in Medicaid Have More Untreated Tooth Decay http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=
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Why do Women get More Cavities Than Men? (University of Oregon,2008)
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