PREVALENCE OF DENTAL CARIES AND ASSOCIATED FACTORS AMONG PATIENTS VISITING A DENTAL TEACHING HOSPITAL OF KATHMANDU

Dental caries is the most common oral health issue for the general population. Dental caries not only affects the quality of life but also brings economic burden to individual and society. The aim of this study was to determine the prevalence of dental caries and associated factors among patients. An analytical, cross-sectional study was conducted among the patients visiting Department of Oral Medicine of Nepal Medical College Dental Hospital of Kathmandu. The results showed that overall prevalence of dental caries was 81.6%. Dental caries among participants between 25-34 years was highest (33.1%) and more among females (84.9%). Majority of the participants used toothbrush 96.8%, while 78.3% used fluoridated toothpaste. Even though most study participants claimed to use toothbrush and fluoridated toothpaste, prevalence of dental caries was high.


INTRODUCTION
Dental caries is one of the most common oral health issues throughout the world, which develops over time and affects any age group. 1 Dental caries causes the destruction of hard parts of a tooth by interaction between bacteria and fermentable carbohydrates. 2 The development of dental caries is associated with many factors, including biological, behavioral and socioeconomic status. 3 Some of the primary factors for dental caries are poor dietary habits, poor oral hygiene habit and lack of dental care. 4 Dental caries is not always life threatening but its complications affect the quality of life. Individuals experience pain and, discomfort, and it may also impair social interactions. Dental caries is one of the major public oral health problems. 5,6 The high cost of treating oral disease is an economic burden to an individual, families and society. 7 Despite vast improvement in global oral health issues, the prevalence of dental caries among adults is still high and the disease affects most of the population in both developed and developing countries. 8 The prevalence of dental caries among adults was found to be 83.0%, 57.7%, 57.4% and 33.0% in different regions of Nepal. [9][10][11][12] In a study conducted in Ethiopia, 57.8% of the total participants suffered from dental caries and dental caries was highly prevalent among 15-20 year age group. 13 In a study conducted by Sehdev et al. 13 among the Ethiopian participants, two third of the male respondents had caries.
Many of the studies on dental caries in Nepal have mainly focused on school going children rather than adult population. So, this study was done to identify the prevalence of dental caries, affected age groups and associated factors among Nepalese patients.

MATERIALS AND METHODS
This study is an analytical, cross-sectional study. The study was conducted in Department of Oral Medicine and Radiology, Nepal Medical College Dental Hospital between August to October, 2022. Data was collected by the help of structured predesigned questionnaire with different sections. The first section included socio-demographic details, the second section was concerned with questions on oral hygiene practices, and section three was related to food consumption habits. The questionnaire was adopted from a previous study. 14

RESULTS
A total of 338 study participants were included in the study. Majority of the participants were between age group 25-34 years (33.1%). Total female participants were (62.7%), among them (69.5%) were married, and 43.8% were of lower middle socioeconomic status (Table 1). Overall prevalence of dental caries was 81.6%. The prevalence of dental caries among female participants was higher 84.9% than the male participants 76.2%.
Majority of the study participants (96.8%) used toothbrush and among them 52.0% brushed once a day, 48.6% brushed in the morning and 78.3% used fluoridated tooth paste. Few (21.6%) consumed sweet food and drinks before bed ( Table 2).
The mean number of times the patient ate between meals was 2.32±1.13 and number of times the patient ate candies and sweets between meals was 1.48±0.73 (Table 3).
Statistically significant association was seen between dental caries and gender (p = 0.04).
There was no statistically significant association of the presence or absence of dental caries with number of times the patient eats between meals (p = 0.46) and number of times the patient eats candies and sweets between meals (p = 0.25) ( Table 5).   This study showed that majority used tooth brush for cleaning their teeth which was similar to various other studies. 11,15 Majority of the participants (52.0%) brushed once daily which was supported by another study. 16 Majority of the participants used fluoridated toothpaste (78.3%) which was similar (71.4%) to a study conducted in terai of Nepal but higher than studies conducted in Africa (18.0%) and China (5.0%). [16][17][18] This study showed that the prevalence of dental caries was 81.6%. Similar finding was seen in a study done in Egypt 86.6% and Kosovo 72.80%. 19,20 However, lower prevalence was seen in other studies done in different parts of Nepal. 10,11 This difference might be due to the sociodemographic differences in the study population.
The prevalence of dental caries was found to be highest among the age group 35-44 years, which was supported by another study. 21 On the contrary, other studies 10,22 showed higher prevalence of caries among age group 18-34 years. This study showed that as age advanced, the prevalence of caries decreased, which was supported by a study done in Kosovo. 20 The reason for low prevalence among this age group may be that with advance age more teeth were missing in comparision to young 20 and root caries is more prevalent among elderly 23 when DMFT index is not for root caries assessment.
In this study, the prevalence of dental caries was higher among the female participants (84.9%) than the male participants (76.2%) which was supported by similar studies. 10,22,24,25 The reason for higher prevalence of dental caries among female might be due early eruption of tooth in female which leads to long exposure time in oral environment and other risk factors like salivary composition, saliva flow rate, genetic variations, dietary habits, hormonal, psychological and economic factors. 26 In this study, the prevalence of dental caries was higher among married individuals (69.5%) which was similar to another study. 27 The result showed less prevalence of caries among participants using toothbrush which was similar to another study. 14 In this study, the prevalence of dental caries was high among participants brushing in the morning which was similar to other studies. 14,27 This may be due to more time for plaque accumulation, food trapped between teeth putting the teeth at risk.
This study has some limitations. This study was done in one hospital premises and focused on patients who visited dental hospital for various dental issue. Therefore, the findings cannot be generalised.
In conclusion, the prevalence of dental caries among the study participants was high, although majority used toothbrush and fluoridated toothpaste for oral hygiene maintenance. Prevalence of caries among female was higher than that in male. Brushing once a day was a common practice. To reduce the prevalence of dental caries and to minimize its impact on the overall population, oral health education should be given at community level.