Epidemiological profile of caries disease in children aged 5 to 7 years in municipal and private schools

Perfil epidemiológico da doença cárie em crianças de 5 a 7 anos em escola municipal e privada

ABSTRACT

Objective  Caries is a multifactorial problem that mainly affects children from lower socioeconomic backgrounds, influenced by factors such as dietary habits, hygiene practices and access to dental care.

Methods  This cross-sectional study assessed the prevalence of caries in 207 children aged 5 to 7 years from municipal and private schools in Bragança Paulista (SP). The DMFT and dmft indices were used, according to the criteria of the World Health Organization.

Results  The results showed that, although the absolute number of cases was higher in private schools, the proportion of affected children was significantly higher in municipal schools (42%) compared to private schools (19%).

Conclusion  The analysis also highlighted the impact of socioeconomic factors on the prevalence of caries, highlighting the need for preventive interventions focused on education and dental care for vulnerable populations.

Keywords
Dental caries; Oral health; Socioeconomic factors; Epidemiology

RESUMO

Objetivo  A cárie é um problema multifatorial que afeta principalmente crianças de origens socioeconômicas mais baixas, influenciado por fatores como hábitos alimentares, práticas de higiene e acesso a cuidados odontológicos.

Métodos  Este estudo transversal avaliou a prevalência de cárie em 207 crianças de 5 a 7 anos de escolas municipais e particulares de Bragança Paulista (SP).

Resultados  Foram utilizados os índices CPOD e ceo-d, de acordo com os critérios da Organização Mundial da Saúde. Os resultados mostraram que, embora o número absoluto de casos tenha sido maior nas escolas particulares, a proporção de crianças afetadas foi significativamente maior nas escolas municipais (42%) em comparação às escolas particulares (19%).

Conclusão  A análise também destacou o impacto de fatores socioeconômicos na prevalência de cárie, ressaltando a necessidade de intervenções preventivas focadas em educação e cuidados odontológicos para populações vulneráveis.

Palavra-chave
Cárie dentária; Saúde bucal; Fatores socioeconômicos; Epidemiologia

INTRODUCTION

Dental caries is a major public health problem, with significant impacts on well-being and quality of life. Considered a multifactorial disease, its etiology is associated with factors such as excessive sugar intake, poor oral hygiene, socioeconomic factors, and barriers to accessing dental care [¹-⁴]. In Brazil, although public policies exist to expand access to dental services, studies show that socioeconomic inequalities still play a fundamental role in the prevalence of dental caries in preschoolers. According to the literature, children from low-income families are more susceptible to tooth decay due to limited access to information and preventive care. Epidemiological data indicate that children with tooth decay in their primary teeth can compromise their permanent teeth. In the municipality of Bragança Paulista, São Paulo, analyzing the oral health of preschoolers was crucial to understanding the differences between socioeconomic groups and proposing effective intervention strategies [⁵-⁹]. This study aimed to assess the prevalence of tooth decay in children aged 5 to 7 enrolled in municipal and private schools, and the relationship between socioeconomic status and tooth decay [¹⁰-¹⁴].

METHODS

This cross-sectional and descriptive study was carried out in Bragança Paulista (SP), in the first half of 2023. The sample consisted of 207 children of both sexes, aged between 5 and 7 years, from municipal and private schools (tables 1 and 2).

Table 1
Distribution of children by type of institution and age.

Age in Years	Public Institution 1	Public Institution 2	Private Institution 1	Private Institution 2	Total
5	12	12	22	28	74
6	31	11	8	27	77
7	8	13	9	26	56
Total	51	36	39	81	207

Table 2
List of school names and number of students per school.

Name of Schools	Students (n)
Doctor Jorge Tibiriçá Municipal School	38
Small Steps School	56
João Rizzardi Municipal School	29
Santa Terezinha Educational Institute	85

Inclusion and exclusion criteria

Children with parental consent provided through a Free and Informed Consent Form were included. Children whose guardians did not authorize participation were excluded.

Procedures

Data collection was performed by a calibrated examiner (Kappa = 0.92), following the criteria established by the World Health Organization (WHO) for the diagnosis of caries lesions. The DMFT (decayed, missing, and filled teeth) and dmft (decayed, extracted, or filled primary teeth) indices were applied. Clinical evaluations took place in spaces provided by the schools, under artificial lighting, using sterile gauze, a tongue depressor, and disposable protective equipment.

Socioeconomic analysis

In addition to the clinical examination, a questionnaire was administered to assess factors such as the children’s diet and socioeconomic conditions, including the average family income by type of institution.

Ethical aspects

The study was approved by the Research Ethics Committee of the University of São Francisco (CAAE: 67266823.0.0000.5514) and followed the ethical guidelines for research with human beings.

RESULTS

A total of 207 children were evaluated, 141 from private schools and 66 from municipal schools. The analysis revealed significant differences in the prevalence of cavities between the groups (chart 1 and table 3):

Chart 1
Code proposed by World Health Organization (1997) and its respective clinical meanings.

Presence of Caries
Risk A	Absence of caries or previous history of caries.
Risk B	Presence of restored tooth.
Risk C	Presence of chronic caries lesions and/or presence of temporary restoration.
Risk D	Presence of active white spot.
Risk E	Presence of Black Class I caries lesion, without evident pulp involvement (no pain)
Risk F	Presence of Black Class II, III, IV, or V caries lesions, without evident pulp involvement (no pain)
Risk G	Pulp and/or periapical involvement: presence of pain, pulpitis, abscess and/or residual foci.
Presence of Biofilm
Negative (-)	Absence of plaque and/or gingivitis
Positive (+)	Presence of plaque and/or gingivitis

Table 3
Percentage of children with and without caries lesions in municipal and private institutions.

	Public school			Private school
	No cavities	With caries		No cavities	With caries
	38	28		114	27
Total children (n)	66			141
Geral (%)	18	14		55	13
By network (%)	58	42		81	19
	Children
	n			%
Boys	107			51.70
Girls	100			48.30
Total with cavities	55			27.00
Totally without cavities	152			73.00

• Private schools: 19% of children had cavities (n=27).

• Municipal schools: 42% of children had cavities (n=28).

Although the number of cases was higher in private schools, the proportional prevalence was significantly higher in municipal schools.

The average dmft index was higher in municipal schools, indicating greater dental impairment among children from low socioeconomic backgrounds. The data also showed that children with more limited access to oral health care had higher rates of dental biofilm.

The results of this study highlight the importance of oral health and the relationship between socioeconomic factors, signaling the need for prevention and intervention strategies aimed at vulnerable populations (figures 1 and 2).

Figure 1
Average salary by institution.

Figure 2
Difference between CPO-D and ceo-d indices.

DISCUSSION

The results of this study confirm the influence of socioeconomic factors on the oral health of preschool children. Although a larger number of children were assessed in private schools, the prevalence of caries lesions was significantly higher in municipal schools [¹⁶-²⁰]. Studies show an association between low-income families and a higher risk of caries due to dietary practices containing excessive sugar, poor oral hygiene, and barriers to accessing preventive care.

The dmft and DMFT indices presented show that children in municipal schools are more affected by caries lesions, which may be related to lower frequency of dental visits and difficulties in implementing oral hygiene practices within the family environment [²¹-²³]. These factors also reflect inequalities in access to education and oral health awareness, as observed in other regions of Brazil. Private schools had a higher number of children with cavities. However, this discrepancy can be explained by the sample size and the greater number of children evaluated in this group [¹⁵,²⁴,²⁵]. Nevertheless, the dental biofilm rate found in private schools indicates the need for stronger educational and preventive programs, even in populations with higher family incomes [²⁶].

The results highlight the importance of interventions focused on oral health education, focusing on populations with lower socioeconomic status. Public policies that promote regular dental visits, topical fluoride application, and educational initiatives for parents and children can contribute to reducing inequalities in children’s oral health.

CONCLUSION

This study revealed that children in municipal schools have a higher prevalence of cavities, reinforcing the link between socioeconomic conditions and oral health. Although the municipality of Bragança Paulista already adopts preventive measures, the data indicate the need for improved public policies, such as increasing the frequency of school dental visits, greater parental involvement, and expanding educational programs. Understanding socioeconomic inequalities in oral health is essential for planning effective prevention and treatment strategies. Investing in initiatives that address the specific needs of vulnerable populations can reduce the incidence of cavities and improve children’s quality of life.

• Article aligned with the Good Health and well-being and Quality education goal of the Sustainable Development Goals (SDGs)
• How to cite this article
  Silva GA, Tognetti VM, Vieira GL, Machado RS. Epidemiological profile of caries disease in children aged 5 to in municipal and private schools. RGO, Rev Gaúch Odontol. 2025;73:e20250041. http://dx.doi.org/10.1590/1981-86372025004120240096

Data availability

The research data are available in the body of the document.

REFERENCES

• ¹ Alcantara E, Batista MJ, Gibilini C, Ferreira N, Sousa MLR. Fatores associados à saúde bucal de pré-escolares inseridos em programa educativo preventivo no município de Piracicaba/SP. RPG Rev Pós Grad. 2023;18(2):102-7.
• ² Ardenghi TM, Piovesan C, Antunes JLF. Desigualdades na prevalência de cárie dentária não tratada em crianças pré-escolares no Brasil. Rev Saúde Pública. 2013;47:129-37. https://doi.org/10.1590/S0034-8910.2013047004352
  » https://doi.org/10.1590/S0034-8910.2013047004352
• ³ Assis MAA, Benedet J, Kerpel R, Vasconcelos Fde A, Di Pietro PF, Kupek E. Validação da terceira versão do Questionário Alimentar do Dia Anterior (QUADA-3) para escolares de 6 a 11 anos. Cad Saúde Pública. 2009;25(8):1816-26. https://doi.org/10.1590/S0102-311X2009000800018
  » https://doi.org/10.1590/S0102-311X2009000800018
• ⁴ Berti M, Furlanetto DLC, Walker MMS, Baltazar MMM, Bianchi FJ. Levantamento epidemiológico de cárie dentária em escolares de 5 e 12 anos de idade do município de Cascavel, PR. Cad Saúde Coletiva. 2013;21(4):403-6.
• ⁵ Bragança Paulista. Lei nº 4053, de 31 de julho de 2009. Dispõe sobre a instituição da carteira de saúde bucal e dá outras providências. Bragança Paulista: Prefeitura Municipal; 2009 [citado 2023 maio 15]. Disponível em: http://leismunicipa.is/cbnik
  » http://leismunicipa.is/cbnik
• ⁶ Osta ÉVS, Freitas CASL, Ximenes Neto FRG, Silva MAM, Lourenção LG. Epidemiologia da cárie dentária em crianças pré-escolares de um município do Nordeste Brasileiro. Enferm Foco. 2020;11(2):146-53.
• ⁷ Fraiz FC, Walter LRF. O comportamento infantil durante a higiene bucal domiciliar e alguns fatores associados à cárie. JBP J Bras Odontopediatr Odontol Bebê. 2001;4:398-404.
• ⁸ Melo MMDC, Souza WV, Lima MLC, Braga C. Fatores associados à cárie dentária em pré-escolares do Recife, Pernambuco, Brasil. Cad Saúde Pública. 2011;27(3):471-85. https://doi.org/10.1590/S0102-311X2011000300008
  » https://doi.org/10.1590/S0102-311X2011000300008
• ⁹ Ministério da Saúde, Secretaria de Políticas Especiais de Saúde, Área Técnica de Saúde Bucal (Brasil). Levantamento epidemiológico em saúde bucal – 1996: primeira etapa – cárie dental. Brasilia: Datasus; 1999.
• ¹⁰ Narvai PC, Biazevic MGH, Junqueira SR, Pontes ERCJ. Diagnóstico da cárie dentária: comparação dos resultados de três levantamentos epidemiológicos numa mesma população. Rev Bras Epidemiol. 2001;4(2):72-80. https://doi.org/10.1590/S1415-790X2001000200002
  » https://doi.org/10.1590/S1415-790X2001000200002
• ¹¹ Nóbrega AV, Moura LFAD, Andrade NS, Lima CCB, Dourado DG, Lima MDMd. Impacto da cárie dentária na qualidade de vida de pré-escolares mensurado pelo questionário PedsQL. Ciênc Saúde Coletiva. 2019;24(11):4031-42. https://doi.org/10.1590/1413-812320182411.04712018
  » https://doi.org/10.1590/1413-812320182411.04712018
• ¹² Oliveira AGRC, Unfer B, Costa ICC, Arcieri RM, Guimarães LOC, Saliba NA. Levantamentos epidemiológicos em saúde bucal: análise da metodologia proposta pela Organização Mundial da Saúde. Rev Bras Epidemiol. 1998;1(2):177-89. https://doi.org/10.1590/S1415-790X1998000200008
  » https://doi.org/10.1590/S1415-790X1998000200008
• ¹³ Pagano S, Lombardo G, Coniglio M, Donnari S, Canonico V, Antonini C, et al. Autism spectrum disorder and paediatric dentistry: A narrative overview of intervention strategy and introduction of an innovative technological intervention method. Eur J Paediatr Dent. 2022;23(1):54-60. https://doi.org/10.23804/ejpd.2022.23.01.10
  » https://doi.org/10.23804/ejpd.2022.23.01.10
• ¹⁴ Pattussi MP, Marcenes W, Croucher R, Sheiham A. Social deprivation, income cohesion and dental caries in Brazilian school children. Soc Sci Med. 2001;53(7):915-25. 10.1016/s0277-9536(00)00391-9
  » https://doi.org/10.1016/s0277-9536(00)00391-9
• ¹⁵ World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO Consultation on Obesity, Geneva, 3–5 June 1997. Geneva: WHO; 1998.
• ¹⁶ Petersen P, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005;83(9):661-9.
• ¹⁷ Queiroz FS, Braga MLA, Silvestre TLA, Batista ÉPC, Costa LED, Almeida ER. Qualidade de vida de crianças pré-escolares e sua relação com a cárie dentária e fatores sociodemográficos. Arch Health Invest. 2021;10(7):1090-8. https://doi.org/10.21270/archi.v10i7.5078
  » https://doi.org/10.21270/archi.v10i7.5078
• ¹⁸ Sabará Hospital Infantil. Cárie na primeira infância: desenvolvimento infantil. São Paulo: Sabará Hospital Infantil; 2020 [citado 2023 jan 5]. Disponível em: https://www.hospitalinfantilsabara.org.br/carie-na-primeirainf ancia/
  » https://www.hospitalinfantilsabara.org.br/carie-na-primeirainf ancia/
• ¹⁹ Saito SK, Deccico HMU, Santos MN. Efeito da prática de alimentação infantil e de fatores associados sobre a ocorrência da cárie dental em pré-escolares de 18 a 48 meses. Rev Odontol Univ São Paulo. 1999;13(1):5-11. https://doi.org/10.1590/S0103-06631999000100004
  » https://doi.org/10.1590/S0103-06631999000100004
• ²⁰ Santos APP, Soviero VM. Caries prevalence and risk factors among children aged 0 to 36 months. Pesqui Odontol Bras. 2002;16(3):203-8. https://doi.org/10.1590/S1517-74912002000300004
  » https://doi.org/10.1590/S1517-74912002000300004
• ²¹ Secretaria de Estado da Saúde de São Paulo, Faculdade de Saúde Pública da Universidade de São Paulo. Levantamento epidemiológico em saúde bucal: Estado de São Paulo, 1998. São Paulo: USP; 1999 [citado 2025 out. 16]. Disponível em: https://www.saude.sp.gov.br/resources/ses/perfil/profissional-da-saude/grupo-tecnico-de-acoes-estrategicas-gtae/saude-bucal/artigos-e-teses/estudos-epidemiologicos/estudosepidemiologicos/levantamento_epidemiologico_-_1998.pdf
  » https://www.saude.sp.gov.br/resources/ses/perfil/profissional-da-saude/grupo-tecnico-de-acoes-estrategicas-gtae/saude-bucal/artigos-e-teses/estudos-epidemiologicos/estudosepidemiologicos/levantamento_epidemiologico_-_1998.pdf
• ²² Scavuzzi AIF. Fatores socioeconômico-demográficos, comportamentais, de saúde geral e bucal relacionados ao incremento de cárie dental em crianças de 12 a 30 meses de idade, residentes em Feira de Santana-BA: um estudo longitudinal [tese]. Camaragibe: Universidade de Pernambuco; 2000.
• ²³ Schnabl D, Schanner LL, Barbieri F, Laimer J, Bruckmoser E, Steiner R, et al. Is dental general anaesthesia in children an outdated concept? A retrospective analysis. Eur J Paediatr Dent. 2020;21(4):283-6. https://doi.org/10.23804/ejpd.2020.21.04.5
  » https://doi.org/10.23804/ejpd.2020.21.04.5
• ²⁴ Watt R. Strategies and approaches in oral disease prevention and health promotion. Bull World Health Organ. 2005;83(9):711-8.
• ²⁵ World Health Organization. Oral health surveys: basic methods. 2nd ed. Geneva: ORH/EPID; 1977.
• ²⁶ Zerman N, Zotti F, Chirumbolo S, Zangani A, Mauro G, Zoccante L. Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new. Front Oral Health. 2022;3:998831. https://doi.org/10.3389/froh.2022.998831
  » https://doi.org/10.3389/froh.2022.998831

Edited by

• Assistant editor:
  Luciana Butini Oliveira

Publication Dates

• Publication in this collection
  21 Nov 2025
• Date of issue
  2025

History

• Received
  17 Dec 2024
• Reviewed
  31 May 2025
• Accepted
  27 Aug 2025