Manu Batra1, Ambarkova Vesna2*, Marija Stevanovic1, Mira Jankulovska1, Aasim Farooq Shah3, Aasim Ishrat4 and Mudit Gupta5
1Department of Public Health Dentistry, Surendera Dental College & Research Institute, Sri Ganganagar, Rajasthan, India
2Department for preventive and pediatric dentistry, Faculty of dentistry, University Ss. Cyril & Methodius-Skopje, Republic of Macedonia
3Department Of Public Health Dentistry, Government Dental College & Hospital, Shreen Bagh, Srinagar, Kashmir, India
4Dental Surgeon [School Health Program], J&K Government Health Services. Srinagar, Jammu and Kashmir, India
5Department of Oral Medicine & Radiology, Uttaranchal Dental & Medical Research Institute, Dehradun, India
Received: 27 August, 2015; Accepted: 02 November, 2015; Published: 03 November, 2015
Vesna Ambarkova, PhD. MSc, DDS, University St. Cyril and Methodius, Faculty of Dental Medicine, Department of Paediatric and Preventive Dentistry, Vodnjanska 17 University Dental Clinic Center Sv. Pantelejmon, Skopje 1000 , Republic of Macedonia, Tel: +38970686333; E-mail:
Batra M, Vesna A, Stevanovic M, Jankulovska M, Shah AF, et al. (2015) Dental Caries Experience among 12 Year Old School Children from Macedonia and India. J Dent Probl Solut 2(3): 044-047. DOI: 10.17352/2394-8418.000017
© 2015 Batra M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Macedonia; India; Caries; DMFT index
The aim of the present study was to compare the dental caries status of the 12 year old children of the eastern region of Macedonia and Budgam district of Jammu and Kashmir state of India.
Material and Method: In this comparative study (N=396) 12-year old children from Macedonia and 592 from India were included. Dental status of participants was evaluated using the 2013 World Health Organization caries diagnostic criteria for Decayed, Missing or Filled Teeth (DMFT) by 2 calibrated examiners in Macedonia and by the single examiner in India.
Results: The mean value of the DMFT index for the whole sample of India was 1.91 ± 1.76 whereas for Macedonia it was 3.46 ± 2.90, and the difference was statistically significant (p< 0.001). In the Indian sample, 152 (25.68%) and in Macedonia sample 81 (21.46%) of the individuals were caries free (DMFT=0).In both countries, the female children have higher mean DMFT values. The filled component of DMFT was more among the Macedonian children which shows the higher utilization rates of dental care in that region in comparison to Indian counterparts.
Conclusion: The mean DMFT of children from Macedonia was higher in comparison with children from India. The most possible reason for this can be the fact that sugar consumption in India was less in comparison with Macedonia.
Dental caries is the most prevalent dental affliction of childhood. Despite credible scientific advances and the fact that caries is preventable, the disease continues to be a major public health problem. In the developing countries changing life-styles and dietary patterns are markedly increasing the caries incidence . Growing children need proper guidance for healthy growth, upkeep and hygiene of their teeth [2,3].
The oral health of children 12 years old is the object of several epidemiological studies conducted around the world . According to the World Health Organization (WHO, 2013) , the importance given to this age group is due to the fact that it is the age that children leave primary school. Thus, in many countries, is the last age at which data can be easily obtained through a reliable sample of the school system. Moreover, it is possible that at this age all the permanent teeth except third molars, have already erupted. Thus, the age of 12 was determined as the age of global monitoring of caries for international comparisons and monitoring of disease trends.
To assess the difference in rate of dental caries among children in the developing nations, we have considered children 12 years old from India and Macedonia, although both are in different continents and have differences in respect to demographic parameters. India being the second largest populated country in world, Macedonia takes the central part of the Balkan Peninsula in Europe. The whole territory of the Republic of Macedonia consists of just 8 non-administrative units-statistical regions and 84 municipalities as administrative units , whereas India has 29 states and 7 union territories. But the currency rate of two countries are almost similar with Macedonian Denar is marginally higher than Indian Rupee.
For the current study, Eastern region of Macedonia is taken and Budgam district from Jammu & Kashmir district of India. The reason of for taking these two sites is that in Macedonia, there are couple of programs concerning oral health of children - National Caries Preventive Program and National Strategy of Prevention of Oral Diseases in children at age 0-14years . In India there is no nationwide government funded preventive program regarding oral health but state of Jammu & Kashmir state runs a school health program which comprises dental health and is envisaged as an important tool to provide preventive, primitive and curative health services to the children.
The East Region is mainly a mountainous region and comprises the extreme East of the Republic of Macedonia. It spreads along the Bregalnica River, over the basins of Shtip, Maleshevo and Pijanec and the field of Kochani. The region comprises 14.2% of the total area of the Republic of Macedonia, with 8.7% of the total population in 2011, and it is one of the least densely populated regions with 50.7 citizens per km2. On the other hand Budgam is one of the newly formed districts of the Jammu and Kashmir state, situated at an average height of 5,281 feet above sea-level. The topography of the district is mixed with both mountainous and plain areas. The total population of the district is 7.35 Lacks with a literacy rate of 57.98%. The density of population in the district is 537 citizens per km .
The AIM of the present study was to compare the dental caries status of the 12 years old children of the Eastern region of Macedonia and Budgam district of Jammu and Kashmir state of India.
Materials and Methods
The samples of the study were taken from two countries- India and Macedonia. Ethical clearance was taken separately at both countries from the concerned authorities, for Macedonia it was Ministry of Health and for India it was Chief Medical Officer, Budgam district, Jammu & Kashmir state. At both sites, it was decided to use cluster sampling because it was more economical and achievable within the constraints of resources and finance.
For Indian sample, the study was carried out in Budgam District of Kashmir Division of Jammu and Kashmir State.
A two-stage sampling technique was used to achieve representative sample of 592. In first stage, the schools were randomly selected. Four government schools were selected based on probability proportional to enrolment size (PPE). According to PPE, the schools with high number of regularly attending students were more likely to be selected than schools with low number of students regularly attending. In second stage, the students from these schools were randomly selected to be included in the study through simple random sampling procedure.
For a national pathfinder survey, between 10 and 15sampling sites are usually sufficient. A two-stage sampling technique was used to achieve representative sample of 396.The sampling in eastern region of the Republic of Macedonia is based on the administrative divisions. In our survey we included main urban centres and small towns and rural areas. Random sampling of subjects within each school was applied.
The Macedonian sample involved 396 school children from sixth and seventh grades, attending 9 central and 13 regional schools in the cities and villages from the Eastern region of Macedonia. Based on the information from the Macedonian State Statistical Office  there are approximately 3844 children attending sixth grade and 1945 attending seventh grade of the primary school in this region. Permission for the study was obtained from the school authorities, who sought and obtained consent from the parents of the children concerned. Children from all classes (sixth and seventh grades) in these schools were included in the study. Two calibrated dental examiners conducted the dental examination and the clinical part of the form was filled out by two other trained dentists (kappa values for inter-examiner reliability was 0.85).
Clinical data for both samples was collected by means of Type III clinical examination in daylight using plain dental mirrors and probe, which took place in a separate room with the subject seated on the chair. At both sites, World Health Organization 2013  caries diagnostic criteria were followed. The Decayed, Missed, or Filled Teeth (DMFT) was used to evaluate children's dental caries experience.
Simple descriptive statistical tests were used in the form of percentage and frequency distribution. T-Test was used for the comparison of means. The SPSS software version 20.0 was used for performing the statistical analysis. The level of significance was set at P < 0.05.
Total 396 and 592 subjects were included in the study for Macedonian and Indian sample respectively. The distribution of subjects in terms of gender and according to area of residence is shown in Table 1.
The mean value of the DMFT index for the whole sample of India was 1.91 ± 1.76 whereas for Macedonia it was 3.46 ± 2.90, and the difference was statistically significant (p < 0.001). In the Indian sample, 152 (25.68%) and in Macedonian sample 81(21.46%) of the individuals were caries free (DMFT=0) (Table 2).
In Figure 1, the box plot of DMFT score for both Indian and Macedonian is given, showing the range, quartiles and outliers.
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