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Original Article

Dental Caries and Oral Hygiene Status: Survey of

Schoolchildren in Rural Communities, Southwest Nigeria
Clara Arianta Akinyamoju, David Magbagbeola Dairo1, Ikeola Adejoke Adeoye1, Akindayo Olufunto Akinyamoju2
Department of Family Dentistry, University College Hospital, Departments of 1Epidemiology and Medical Statistics and 2Oral Pathology, University of Ibadan,
Ibadan, Oyo State, Nigeria

Purpose: Dental caries and poor oral hygiene cause pain and have an effect on activities of children such as playing, sleeping, eating
and school attendance. Previous studies on the prevalence of dental caries and poor oral hygiene have focused more on urban than rural
communities in the developing countries. The objective of the study was to assess dental caries and oral hygiene status of schoolchildren in
rural communities. Materials and Methods: It was a cross‑sectional study involving 778 schoolchildren from 12 public primary schools.
A pre‑tested, semi‑structured interviewer‑administered questionnaire was used to obtain information on socio‑demographics and oral health
practice. Dental caries was assessed using the decayed, missing and filled teeth (DMFT) index and oral hygiene status by the simplified oral
hygiene and gingival indices. Results: The mean age of the children was 11.0 ± 1.8 years, and the prevalence of dental caries was 12.2%
with a mean DMFT/dmft of 0.2 ± 0.7. Children aged 10–12 years were 3 times more likely to have caries on ≥1 tooth (P = 0.01, confidence
interval = 1.3–6.7). Herbal remedies were more often (35.3%) used to manage dental problems. The mean simplified oral hygiene and gingival
indices were 1.7 ± 0.9 and 1.1 ± 0.5, respectively. Conclusion: The occurrence of dental caries appears to be increasing in rural Nigerian
schoolchildren, but still within WHO limits. Oral hygiene status was poor and gingivitis was common.

Keywords: Oral health, rural, schoolchildren

Introduction can be considered as means for health promotion in children

and adolescents.
Dental caries is a common oral health problem in children
and occurs in individuals of all socio‑economic strata. Poor This phase of life is the time of change from a deciduous
oral hygiene has also been seen to be quite high in children dentition to permanent. At this vital period of development,
especially those living in rural areas.[1,2] Lack of dental services oral health behaviour can be influenced.[7,8] At present in
at the primary health‑care level is said to account for the poor Nigeria, there is a scarcity of information that can be used for
oral health status of rural children in Nigeria.[2] Rural areas meaningful planning of oral health‑care services, especially in
usually have fewer dentists per population and are more rural communities.[9] Thus, this study aimed to assess the caries
deprived, thereby reducing access to dental care for children experience, oral hygiene status and their association with
in these communities.[3,4] each other in primary schoolchildren in rural communities
to provide adequate epidemiological data necessary for
Furthermore, the disparity in health outcomes between rural
planning oral health promotion activities through a school
and urban areas continues to expand and is very obvious in oral
health programme.
health‑care delivery in rural settlements.[5] In a study of a rural
community in Nigeria, it was reported that about half of the
decayed teeth remained untreated, only 2.8% of the decayed Address for correspondence: Dr. Clara Arianta Akinyamoju,
Department of Family Dentistry, University College Hospital, Queen Elizabeth
teeth were restored. The authors stated poor utilisation of oral Road, Oritamefa, PMB 5116, Ibadan, Oyo State, Nigeria.
health services as a reason for the latter observations.[6] In view E‑mail:
of the aforementioned challenges, school health programmes
in combination with other community‑based interventions
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How to cite this article: Akinyamoju CA, Dairo DM, Adeoye IA,
DOI: Akinyamoju AO. Dental caries and oral hygiene status: Survey of
10.4103/npmj.npmj_138_18 schoolchildren in rural communities, Southwest Nigeria. Nigerian Postgrad
Med J 2018;25:239-45.

© 2018 Nigerian Postgraduate Medical Journal | Published by Wolters Kluwer - Medknow 239
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Akinyamoju, et al.: Dental caries and oral hygiene in rural schoolchildren

Materials and Methods procedure was done using a plain mouth mirror and a blunt
probe (CPITN periodontal probe) under natural light by three
This was a cross‑sectional survey conducted amongst 778
dental surgeons. The examiners were calibrated before the
primary schoolchildren aged 7–17  years in classes 3–6 at
commencement of the study. Measurements of intra‑ and
Obafemi Owode local government area  (LGA) Ogun state,
inter‑examiner reproducibility were based on repeated clinical
Southwest Nigeria. The communities that make up the LGA are
examinations. Measurements of the intra‑ and inter‑examiner
predominantly rural, and the residents are mainly farmers and
agreement using Kappa statistics yielded values ranging from
traders. Ethical clearance for the study was obtained from the
0.85 to 0.96.
joint University of Ibadan/University College Hospital Ethical
Review Committee (UI/EC/10/0190) on the 17th March 2011. The decayed, missing and filled teeth (DMFT/dmft) index was
Approval for the study was obtained from the Schools’ Board. used to assess the caries experience of the participants; it describes
Informed consent was obtained from the Parents/Teachers the amount of dental caries in an individual. It numerically
Associations of the various schools and assent was given expresses the caries prevalence by calculating the number of
verbally by the pupils before participation in the study. Data decayed, missing due to caries and filled teeth using the WHO
were collected between November and December 2012. diagnostic criteria.[10] The sum of the three figures obtained gives
the DMFT/dmft value. Lesions in a pit or fissure or on a smooth
A multistage sampling technique was used: Obafemi zone
tooth surface and had a detectable softened floor undermined
was purposively selected from the three zones in the LGA
enamel or softened wall were coded as carious. Teeth having
because the Aladura Rural Health Outreach Programme of
permanent restorations and no caries adjacent to previously filled
the Department of Epidemiology and Medical Statistics,
areas on a tooth or other areas with primary caries were coded as
Faculty of Public Health, University of Ibadan is located in
filled without decay. Extractions as a result of caries were regarded
the zone. The Aladura Rural Health Outreach Programme
as missing due to caries. The DMFT indicates caries prevalence in
is a private‑public collaboration between the Joseph Ijaola
the permanent dentition while dmft for the deciduous dentition.[10]
Memorial Foundation, College of Medicine, University of
Ibadan and the University College Hospital, Ibadan. The The oral hygiene status was assessed using the simplified oral
health outpost is a proposed referral and coordinating centre hygiene (OHI‑S) index and the gingival index for gingivitis. The
for a school health programme. Ajebo and Ogunmakin were OHI‑S index is made up of debris and calculus components.
selected out of the four educational sectors in the zone. A list of The OHI‑S score was obtained by summing the debris index
all the schools in alphabetical order was obtained from the LGA and calculus index scores of an individual after examination of
office. The schools to be studied were then randomly selected the buccal and lingual surfaces of the six index teeth (the upper
from the list using a table of random numbers. The accessibility first molars, lower first molars, upper right central and lower left
of each school was determined based on the condition of the central incisors). A score of 0–1.2 indicates good, 1.3–3.0: Fair
roads to the school; those that were inaccessible because and 3.1–6.0: Poor oral hygiene. For assessment of gingivitis,
of poor road condition were excluded from the selection the scores obtained for the buccal, lingual, mesial and distal
procedure. Twelve schools were selected from a total of 31 surfaces of the index teeth (upper right first molar and lateral
schools. All the children present in school on the day their incisor, upper left first premolar, lower right first premolar,
schools were visited participated in the study. lower left lateral incisor and first molar) examined were added
and divided by the number of teeth (six) examined to derive the
A pre-tested, semi-structured interviewer-administered
gingival index for an individual. A score of 0.1–1 denoted mild
questionnaire was used to obtain data on their socio‑demographic
gingivitis, 1.1–2: moderate gingivitis and 2.1–3 severe gingivitis.
characteristics and oral hygiene practice such as frequency of
Each study participant was given a toothbrush and toothpaste;
cleaning the mouth, type of mouth cleaning device used and
oral health education was also given to the schoolchildren as
frequency of change of mouth cleaning device, frequency
benefits for participating in the study. In addition, children with
of sugar snack consumption and action taken by parents to
complications from oral diseases such as dental caries were given
manage dental problems. The questionnaire was pretested
referrals to the nearest government dental facility.
among 30 class 4 primary school pupils in a single school.
Oral examination was not done for this group of pupils. The The data were analysed using Statistical Package for Social
questionnaire was translated into the local language (Yoruba) Sciences version 19, (Chicago, IL, USA). Chi‑square test was
and back‑translated into English. It was administered in the used to determine the association between DMFT/dmft and
local language where this was preferred by the participant. age, gender; oral hygiene status and age, gender. Multivariate
The interviews were conducted by an auxiliary nurse and a logistic regression analysis was performed to assess the
dental surgeon; they had good knowledge and were fluent in variables which were potentially significant predictors of oral
speaking the English and Yoruba languages. The questionnaire health status. The level of significance was set at 0.05.
was administered to 779 schoolchildren, but 778 of them had
both questionnaire and oral examination. Results
The oral examination was done with participants sitting on A total of 778 primary schoolchildren in 12 primary
a plastic chair under a tree in the school compound. The schools were administered questionnaires and had oral

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Akinyamoju, et al.: Dental caries and oral hygiene in rural schoolchildren

examination. The pupils were made up of 424  (54.5%) teeth while 77 (45.8%) were permanent teeth [Table 2]. The
males and 354  (45.5%) females. The mean age of the permanent teeth most 70(41.7%) affected by caries were the
children was 11.0 ± 1.8 years [Table 1]. Ninety‑five (12.2%) first permanent molars [Figure 1]. The D/d (decayed) was the
children had a DMFT/dmft score  ≥1 involving 168 teeth. dominant component (100%) of the DMFT/dmft score. The
Most 120  (71.4%) of the teeth affected by caries were in mean DMFT/dmft was 0.2 ± 0.7.
the mandible. Ninety‑one  (54.2%) of them were deciduous
More males 50 (52.6%) had a DMFT/dmft ≥1 than females
45  (47.4%). More than half  (60.0%) of the children with
Table 1: Characteristics of schoolchildren by
DMFT/dmft ≥1 were in the 10–12 years age group. The
sociodemographics and oral health practice
latter group of children was 3  times more likely to have
Variables Frequency (N=778), n (%) a DMFT/dmft  ≥1 compared with those in the 7–9  years
Age group age group (P = 0.01, 95% confidence interval = 1.3–6.7)
7-9 162 (20.8) [Table 3]. Children who cleaned their teeth once daily had
10-12 479 (61.6) a higher 71  (74.7%) caries prevalence. Caries prevalence
≥13 137 (17.6)
was less in those who replaced their tooth cleaning device
Male 424 (54.5)
Female 354 (45.5) 80

Number of teeth affected by dental caries

Father’s education 70

No formal education 68 (8.7) 60

Primary 307 (39.5) 50
Secondary 330 (42.4) 40
Post‑secondary 73 (9.4) 30
Mother’s education 20
No formal education 88 (11.3) 10
Primary 330 (42.4) 2 3 1 5
Secondary 360 (46.3) Deciduous !st 2nd 1st 2nd 1st 2nd
incisors deciduous deciduous premolars premolars permanent permanent
Frequency of cleaning the teeth molars molars molars molars
Not every day 55 (7.1) Type of teeth affected by dental caries
Once daily 577 (74.1)
Figure 1: Frequency distribution of teeth series affected by dental caries
≥ Twice daily 146 (18.8)
Mouth cleaning device used
Chewing stick 48 (6.2)
Table 2: Distribution of the oral health features of the
Toothbrush and paste 512 (65.8)
Toothbrush, toothpaste and chewing 193 (24.8)
stick Frequency (N=778), n (%)
Others‑ash and cotton wool, cotton 25 (3.2) Presence of caries
wool and water, water only Yes 95 (12.2)
Frequency of changing mouth No 683 (87.8)
cleaning device*
Mean DMFT/dmft 0.2±0.7
Once in 3 months 105 (14.9)
Location of teeth affected by caries
Once in 6 months 49 (6.9)
Mandible 120 (71.4)
When bristles get frayed 334 (47.4)
Maxilla 48 (28.6)
I don’t know exactly 217 (30.8)
Type of teeth affected by caries
Frequency of sugar snacking
Deciduous 91 (54.2)
Daily 494 (63.5)
Permanent 77 (45.8)
≥ twice a week 60 (7.7)
Oral hygiene status
Once a week 166 (21.3)
Poor 58 (7.5)
Rarely 58 (7.5)
Fair 449 (57.7)
Parental management of dental
Good 271 (34.8)
Mean oral hygiene index 1.7±0.9
Medication from local medicine 52 (22.9)
shop Gingivitis
Use of local herbs 80 (35.3) Nil 16 (2.1)
Hospital 25 (11.0) Mild 367 (47.2)
Did nothing 60 (26.4) Moderate 393 (50.5)
Others: Alcohol and camphor, 10 (4.4) Severe 2 (0.3)
pepper, battery water, salt and water Mean gingival index 1.1±0.5
*n=705 (those using toothbrush and toothpaste), †n=227 DMFT/dmft: Decayed, missing teeth due to caries and filled teeth for
(pupils reporting dental problems) permanent/deciduous teeth (WHO diagnostic criteria 1997)

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Akinyamoju, et al.: Dental caries and oral hygiene in rural schoolchildren

Table 3: Dental caries of the schoolchildren by sociodemographics and oral health practices
Caries present in ≥1 teeth Caries absent Crude OR P Adjusted OR P
Age group (years)
7-9 29 (305) 133 (19.5)
10-12 57 (60.0) 422 (61.8) 2.7 (1.2-6.0) 0.16 2.9 (1.3-6.7) 0.01
≥13 9 (9.5) 128 (18.7) 1.9 (0.9-3.9) 0.10 2.0 (0.9-4.2) 0.07
Male 50 (52.6) 369 (54.0)
Female 45 (47.4) 314 (46.0) 1.02 (0.7-1.6) 0.92
Father’s education
No formal 8 (8.4) 59 (8.6)
Primary 46 (48.4) 263 (38.5) 0.5 (0.2-1.3) 0.17 0.4 (0.1-1.2) 0.11
Secondary 26 (27.4) 303 (44.4) 0.7 (0.4-1.3) 0.26 0.6 (0.3-1.2) 0.51
Post‑secondary 15 (15.8) 58 (8.5) 0.4 (0.2-0.7) 0.01 0.4 (0.2-0.7) 0.01
Mother’s education
No formal 13 (13.8) 75 (11.1)
Primary 46 (47.9) 285 (41.7) 0.5 (0.7-3.3) 0.31
Secondary 36 (38.3) 323 (90.0) 1.3 (0.8-2.3) 0.34
Frequency of sugar snack consumption
≥ three times weekly 67 (70.5) 501 (73.4)
Once a week 23 (24.2) 145 (21.2) 0.9 (0.5-1.4) 0.54
Not at all 5 (5.3) 37 (5.4) 0.9 (0.4-2.1) 0.74
Mouth cleaning device used
Chewing stick 4 (4.2) 44 (6.4)
Toothbrush/paste 61 (64.2) 451 (66.0) 0.9 (0.2-5.6) 0.93
Toothbrush/paste/chewing stick 28 (29.5) 165 (24.2) 2.2 (0.5-10.4) 0.31
Others (ash + cotton wool, cotton 2 (2.1) 23 (3.4) 1.7 (0.4-7.6) 0.50
wool + water, water only)
Frequency of cleaning the mouth
Not every day 6 (6.3) 49 (7.2)
Once daily 71 (74.7) 505 (73.9) 0.57 (0.24-1.34) 0.20
≥twice daily 18 (18.9) 129 (18.9) 0.48 (0.17-1.37) 0.17
OR: Odds ratio

more frequently [Table 3]. In addition, the children whose Improved oral hygiene status did not mean a lower prevalence
mothers had no formal education had fewer carious lesions of caries. There was no significant association between caries
13  (13.8%) compared with children whose mothers had a prevalence and level of oral hygiene. Children with poor oral
primary 46  (47.9%) or secondary 36  (38.3%) education. hygiene level had fewer carious teeth.
A child’s father’s level of education was also seen to be
significantly associated with the prevalence of caries in the Discussion
child (P = 0.01) [Table 3]. Oral health is an essential part of overall health and quality of
Concerning their oral hygiene, a little more than half life; hence requires close monitoring and early treatment where
442 (57.7%) of them had fair oral hygiene. The mean simplified necessary.[11] Amongst this study population, the D/d (decayed)
oral hygiene and gingival indices were 1.7 ± 0.9 and 1.1 ± 0.5 was the predominant component of the DMFT/dmft, which is
respectively, [Table  2]. The mean oral hygiene index by similar to observations in other rural Nigerian children.[6,12,13]
gender was 1.8  ±  0.9 for males and 1.6  ±  0.9 for females Likewise in several studies on rural African children.[14-16] The
(t = 2.75, P = 0.006). Females were 1.4 times more likely to high level of untreated dental caries in the above populations
have a good oral hygiene compared with males (P = 0.03). Poor reflects a low utilisation of dental services, which may be as
oral hygiene was more common 139 (60.2%) in the 10-12 year a result of limited access to dental care in terms of cost and
old children [Table 4]. availability.[17] This corroborates the fact that untreated dental
caries is experienced much more often by socio-economically
The percentage of children with good oral hygiene increased disadvantaged children.[18] Moreover, in developing countries,
as the level of education of their mothers increased; this there is low oral health workforce, inadequate oral health
observation was not statistically significant. Children whose facilities and most dental clinics are located in urban settings; so
mothers had no formal education 25 (10.8%) were less likely rural children who need dental care may have to visit a dentist
to have good oral hygiene [Table 4]. in a major neighbouring town.[3]

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Akinyamoju, et al.: Dental caries and oral hygiene in rural schoolchildren

Table 4: Oral hygiene status of schoolchildren by sociodemographics and oral health practices
Fair oral hygiene Poor oral hygiene Crude OR P Adjusted OR P
Age group (years)
7-9 114 (20.8) 48 (20.8)
10-12 340 (62.2) 139 (60.2) 1.0 (0.5-1.5) 0.74
≥13 93 (17.0) 44 (19.0) 0.9 (0.6-1.3) 0.48
Male 279 (50.8) 141 (61.0)
Female 268 (49.2) 90 (39.0) 1.5 (1.1-2.1) 0.009 1.38 (1.03-1.86) 0.03
Mothers’ education
No formal 62 (11.2) 25 (10.8)
Primary 229 (41.9) 103 (44.6) 1.0 (0.6-1.7) 0.99
Secondary 256 (46.8) 103 (44.6) 1.1 (0.8-1.5) 0.50
Fathers’ education
No formal 53 (9.7) 14 (6.1)
Primary 203 (37.1) 106 (45.9) 0.6 (0.3-1.2) 0.16 0.89 (0.43-1.87) 0.77
Secondary 241 (44.1) 88 (38.1) 1.1 (0.7-2.0) 0.65 1.78 (1.01-3.17) 0.05
Post‑secondary 50 (9.1) 23 (10.0) 0.8 (0.5-1.4) 0.41 0.93 (0.55-1.58) 0.79
Mouth cleaning device used
Chewing stick 35 (5.4) 13 (5.2)
Toothbrush and paste 351 (67.2) 161 (72.4) 1.9 (0.6-6.8) 0.30
Toothbrush, paste/chewing stick 140 (25.3) 53 (17.2) 1.8 (0.6-5.7) 0.30
Others 21 (2.0) 4 (5.2) 2.4 (0.8-7.3) 0.13
Frequency of cleaning the mouth
Not daily 50 (6.1) 17 (3.4)
Once daily 398 (77.4) 178 (79.3) 1.2 (0.6-2.3) 0.59
≥ twice daily 99 (16.5) 36 (17.2) 1.1 (0.5-2.0) 0.94
OR: Odds ratios

The percentage of children (12.2%) with caries in this study and longer to the risk of attack by caries. However, in this
was higher than 5.7% reported for some rural schoolchildren study, more males were affected by caries.[25]
in the southwest of Nigeria.[16] Notwithstanding the increase in
Dixit et  al.[26] and Ohalete et  al.[27] observed that younger
caries prevalence in this study, it is lower than that observed in
children were more affected by caries, this is in agreement
similarly aged children residing in rural areas in other countries
with the findings in this study. Younger children are said to
such as India and Australia.[19,20] A higher prevalence of caries
have a higher consumption of sugar and sugary products, and
was seen in the deciduous dentition of the schoolchildren in
this study, compared with that seen amongst rural Ugandan this is important in the pathogenesis of caries.[28] The frequency
children.[21] The children being in the early to late mixed of consumption of sugar snacks by the schoolchildren in this
dentition stage may account for this, as the permanent teeth study was higher than that previously reported in other African
present in their mouths have not been exposed to the same oral children. Mafuvadze et al.[23] stated the pattern of sugar snack
environment for as long as the deciduous teeth. consumption in rural Zimbabwean children as 0.0% and 41.6%
for daily and occasional consumption, respectively. Ayele
Considering the tooth series most commonly affected by caries, et al.[29] also reported that 23.6% of Ethiopian schoolchildren
epidemiological survey data have revealed that caries in the eat sugar snacks daily. However, a higher prevalence of caries
permanent dentition is usually found in the first molars.[22] was seen in the latter study populations. This may be due to
The observations in this study are in agreement with the the fact that fewer children used fluoride‑containing toothpaste
latter finding. Owino et  al.[16] and Mafuvadze et  al.[23] also to clean their teeth.[23]
observed a similar pattern in their respective studies. The
clinical crown morphology of these teeth is thought to make On the other hand, despite reports of high use of the
them more susceptible to decay, as well as the fact that they toothbrush and toothpaste by some rural African children, the
are the first permanent teeth to erupt and are exposed to the prevalence of poor oral hygiene is still high.[6,30] Inadequate
oral environment earlier. With respect to sex, Okoye and knowledge on the proper use of these tooth cleaning aids
Ekwueme[6] reported higher caries prevalence for females may account for the poor oral hygiene. The oral hygiene
amongst rural children in Enugu, Nigeria. Commonly, females status of the children in this study was similar to that of
have been seen to have higher caries prevalence than males rural children reported in previous studies in Nigeria[30,31] and
of the same chronological age.[24] The explanation is that girls amongst children in Kuwait.[32] Although the frequency with
erupt their teeth earlier than boys, as such are exposed earlier which the children in this study cleaned their mouth differed

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Akinyamoju, et al.: Dental caries and oral hygiene in rural schoolchildren

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experience values may be an underestimation of the caries 7‑12 year old school children in rural and urban population of Nellore
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Financial support and sponsorship visual examination for epidemiology in children. BMC Oral Health
Nil. 23. Mafuvadze BT, Mahachi L, Mafuvadze B. Dental caries and oral health
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