Prevalence of dental caries in preschool children: a cross-sectional study

Prevalência da cárie dentária em pré-escolares: um estudo transversal

Abstract

Introduction  According to a survey conducted by the Ministry of Health, more than half of Brazilian children have experienced dental caries at 5 years old.

Objective  This research aims to assess the ceo-d Index (decayed teeth, teeth with indicated extraction, and filled teeth) of schoolchildren enrolled in preschool in the public education system in the city of Barreirinha city, state of Amazonas.

Material and method  Cross-sectional study, with 279 preschoolers between 02 and 06 years old, from the public education system of the city of Barreirinha. Dental caries were assessed following the recommendations of the World Health Organization based on the criteria established for dental conditions.

Result  279 preschoolers between 2 and 6 years old participated in the study. The prevalence of dental caries was 59.2%, the average ceo-d/CPO-D was 2.36 teeth, and the Significant Index of Dental Caries (Sic Index) was 5.72.

Conclusion  Preschool children show a high prevalence of dental caries and a high value of the decayed component (c), suggesting the need for health education and health promotion programs for preschool children in Barreirinha.

Descriptors:
Dental caries; epidemiology; child

Resumo

Introdução  Segundo levantamento realizado pelo Ministério da Saúde, mais da metade das crianças brasileiras apresentam experiência de cárie dentária aos cinco anos de idade.

Objetivo  O objetivo desta pesquisa é avaliar o índice ceo-d (dentes cariados, dentes com extração indicada e dentes obturados) dos escolares matriculados na pré-escola da educação infantil da rede pública de ensino do município de Barreirinha – Amazonas.

Material e método  Estudo transversal, com 279 pré-escolares, entre 02 e 06 anos de idade, da rede pública de ensino, Barreirinha. A avaliação da cárie dentária seguirá as recomendações da Organização Mundial da Saúde, conforme os critérios estabelecidos para as condições dentárias.

Resultado  Participaram do estudo 279 pré-escolares com idade entre dois e seis anos. A prevalência da cárie dentária foi de 59,2%, a média ceo-d/CPO-D foi de 2,36 dentes e o Índice Significativo de Cárie Dentária (Sic Índice) foi de 5,72.

Conclusão  Concluiu-se que os pré-escolares apresentam alta prevalência de cárie dentária e elevado valor do componente cariado (c), demonstrando a necessidade de programas de educação em saúde e promoção de saúde nos pré-escolares de Barreirinha.

Descritores:
Cárie dentária; epidemiologia; criança

INTRODUCTION

Currently, over 600 million children worldwide are affected by Early Childhood Caries (ECC)¹. In Brazil, the national baseline survey carried out in 2010 revealed that dental caries affects more than 50% of Brazilian children aged 5 years of age. It is worth noting that this disease is unevenly distributed across the country², being more frequent in the population with low socioeconomic status³-⁵.

IPC is defined as the presence of one or more decayed deciduous teeth (non-cavitated or cavitated lesions), restored or lost (due to caries)¹. It is a chronic disease resulting from an imbalance of multiple risk and protective factors over time⁶. In addition, it affects the teeth of children under six years of age³ and is determined by biological, behavioral, and psychosocial factors linked to an individual’s environment¹.

In this context, the literature has shown that sugar plays a key role in their development, making it an essential condition for the formation of dental caries⁷,⁸. Based on this, it is very important to adopt measures aimed at delaying the introduction of sugar into children's diets, or even to reduce the frequency of its use⁸.

Furthermore, it is crucial to identify the epidemiological profile of dental caries in children to avoid future problems caused by the disease, such as lack of space in the dental arch, the development of malocclusions, and the impaction of permanent teeth⁹ since deciduous teeth maintain the space for permanent teeth¹. In addition, there is pain, difficulty chewing, limited sleep, speech problems, general health disorders, and psychological problems, all of which will harm the quality of life of children and their families¹,³,¹⁰,¹¹. Preventive measures aimed at parents and health professionals should therefore be encouraged as a way of avoiding the onset of IPC6 and seeking to mitigate the negative effects of dental caries on individuals, families, and society³.

Therefore, gaining real knowledge of the problem through an epidemiological survey for dental caries is a key tool for recognizing the actual picture of the problem in this population¹², and detecting the groups with the highest number of individuals susceptible to this disease is the first step towards preventing it¹⁰. In this sense, the Significant Caries Index (SiC) allows us to diagnose the impact of dental caries on the groups with the highest prevalence of the disease¹³.

Given the relevance of the subject, this study aimed to outline the epidemiological profile of early childhood dental caries among preschoolers in the public school system in the municipality of Barreirinha, in the state of Amazonas.

MATERIAL AND METHOD

Study Design and Ethical Matters

This study was approved by the Research Ethics Committee of the Amazonas State University, with Opinion No. 5.699.561 of 10/14/2022 (CAAE: 63227922.7.0000.5016).

This is a cross-sectional, observational study involving preschoolers from the public school system in the municipality of Barreirinha, in the state of Amazonas. This municipality is located 331 km from the capital Manaus, state of Amazonas, accessed by river, with a population of 31,051 inhabitants¹⁴. The local healthcare network comprises a general hospital and three Basic Health Units, totaling four Oral Health Teams. It is estimated that oral health coverage in PHC will reach 100% in the municipality of Barreirinha in 2024¹⁵. Development Index (HDI) is 0.574¹⁶ and 78% of people benefit from the “Bolsa Família” program, the municipality can be considered to be highly socially vulnerable, hence the decision not to collect socio-economic information¹⁷.

Participants

Based on the nominal list provided by the municipality’s Department of Education and Culture, in 2022, the municipality's headquarters (urban area) had a total of two municipal public preschools, totaling 628 preschoolers enrolled. Indigenous preschoolers and those undergoing orthodontic treatment were excluded. A total of 299 informed consent forms were signed by parents, representing a response rate of 47.6% of pupils in the municipal network. Of these, 20 preschoolers met the exclusion criteria. The final sample consisted of 279 preschoolers aged between 2 and 6 who agreed to take part in the dental caries test. Participants were excluded due to difficulties in contacting parents, refusal by guardians to sign the authorization form, and absenteeism on the part of the students at the time of the examination.

Training and Calibration

To standardize the techniques, nine final-year dental students were previously calibrated by a teacher with expertise in the area who was also part of the research group. The training followed WHO recommendations and consisted of theoretical sessions (4 hours) and practical training (8 hours). The Kappa value for intra-examiner and inter-examiner agreement for dental caries ranged from 0.70 to 0.89 and 0.70 to 0.86, respectively.

Epidemiological Examination

The epidemiological examination was carried out between 2022 and 2024 in the institution, under natural light, with the child sitting on the chair in front of the examiner. The data collected was recorded by a note-taker on individual forms. Suitable clothing and personal protective equipment (PPE) were used, and the examination followed the World Health Organization (WHO) standard for diagnosing dental caries in deciduous teeth and the need for treatment¹⁸.

Indices

The diagnosis of dental caries was based on the index of deciduous teeth with caries lesions (component c), lost due to caries (component e), and restored (component o), known as the ceo-d, which is calculated individually based on the sum of the number of teeth with these conditions, while the group average is calculated using the arithmetic mean of the sum of each participant’s ceo-d divided by the number of children examined¹⁸.

The SiC index (Significant Caries Index) was also used to assess the severity of dental caries in the group of individuals with the most significant evidence of the disease. The sample was divided into two groups for the same analyses: one comprising the third of individuals with the highest caries rates – the SIC group (high caries level) – and the other comprising the remaining individuals with the lowest rates (low caries level)¹³.

10% of the sample was re-examined to find the percentage of intra-examiner agreement, achieving a value above 90% for caries and need for treatment¹⁸.

Health Education Activities

The health education activities were carried out with all the students in a space set aside by the school, through a conversation circle, addressing topics related to brushing techniques, the intelligent use of sugar, and the prevention of tooth decay.

Statistical Analysis

The statistical analysis was carried out on Microsoft Excel and SPSS, version 23.0. A descriptive analysis of the variables was carried out. The difference in the ceo-d and components between the ages evaluated was analyzed by the Kruskall Wallis test, run on SPSS version 20.0, with a significance level of 5%.

RESULT

A total of 279 preschoolers aged between 2 and 6 years took part in the study. 157 (56.3%) of the total examined were male. A prevalence of 59.2% (165 students) of caries was found among these students from the public school system in the municipality of Barreirinha, state of Amazonas, i.e. ceo-d ≥ 1, which is considered high (Table 1).

Table 1
Distribution of age and sex according to the mean ceo-d/CPO-D Index and its components, Significant Caries Index (SIC), caries-free, and standard deviation, city of Barreirinha, state of Amazonas, 2024

Age (years)	SEX	n	ceo-d/CPOD	C	E	O	SIC	Ceo-d/CPOD=0
			Mean	Mean				f (%)
2	Female	2						1 (25.0)
	Male	2						1 (25.0)
	Total	4	1.25	1.25	0.0	0.0	4.0	2(50.0)
3	Female	18						9(23.1)
	Male	21						10(25.6)
	Total	39	1.56	1.49	0.02	0.05	3.85	19(48.7)
4	Female	64						30(22.7)
	Male	68						26(19.7)
	Total	132	2.39	2.21	0,.10	0.08	6.02	56(42.4)
5	Female	33						15(16.7)
	Male	57						18(20.0)
	Total	90	2.54	2.3	0.24	0.0	5.86	33(36.7)
6	Female	5						2(14.3)
	Male	9						2(14.3)
	Total	14	3.36	2.93	0.43	0.0	6.4	4(28.6)
2-6	Female	122						57(20.4)
	Male	157						57(20.4)
	Total	279	2.36	2.16	0.15	0.05	5.72	114(40.8)
p			0.215	0,.268	0.006*	0.158

• ^*
  p<0.05 – statistically significant difference.

The average ceo-d from 2 to 6 years of age showed 2.36 teeth, with a standard deviation of 2.99 affected by the disease, and a minimum of zero and a maximum of 16. Of these, the average was higher in males (2.70) than in females (1.92). The decayed component (c) was the most prevalent, at 2.16. However, there was an increase in the ceo-d among the students as their age increased, hence the highest mean ceo-d at 6 years of age. Meanwhile, the Significant Index of Dental Caries (Sic Index) reached 5.72 between the ages of 2 and 6, showing the polarization of this disease in the municipality studied. Assessing the difference in the ceo-d and components between the ages of the participating children, a statistically significant difference was found in the component tooth loss due to caries (p=0.006), as described in Table 1.

More than half of the preschoolers examined – 203 (72.7%) – needed dental treatment. Of these, the greatest need was for restorative treatment, accounting for 150 of the preschoolers (53.7%), followed by pulp treatment, with 28 of the preschoolers (10.0%), and extraction, found in 25 of the preschoolers (8.9%). 120 preschoolers (43.0%) showed no need for dental treatment (Table 2).

Table 2
Need for treatment, according to age, city of Barreirinha, state of Amazonas, 2024

Age	Not required	Restoration	Pulp treatment and restoration	Exo
(years)
2	2 (0.72%)	1 (0.36%)	1 (0.36%)	-
3	20 (7.17%)	19 (6.81%)	1 (0.36%)	3 (1.1%)
4	59 (21.14%)	71 (25.44%)	10 (3.58%)	11 (3.9%)
5	34 (12.19%)	49 (17.56%)	12 (4.30%)	11 (3.9%)
6	5 (1.79%)	10 (3.58%)	4 (1.43%)	-
2-6	120 (43.0%)	150 (53.7%)	28 (10.0%)	25 (8.9%)

DISCUSSION

Our findings show that the target set by the World Health Organization of 50% of children between 5 and 6 years free of caries by the year 2000¹⁹ has not been met. Even after twenty-four years, this goal has yet to be achieved in the country (53.4%)², as well as in this study (59.2%). Previous studies have also found similar results, such as Costa et al.¹², Assis et al.²⁰, and Silva et al.⁴. The high prevalence of dental caries found in Barreirinha could be linked to its small size and high social vulnerability; according to the Ministry of Development and Social Assistance, 24,893 people living in this municipality benefit from the “Bolsa Família” program¹⁷. In addition, the literature shows that dental caries is associated with low socioeconomic conditions³-⁵,²¹-²³.

Although this study could not establish a cause-effect relationship, given its cross-sectional nature, it made relevant contributions by investigating dental caries in preschoolers in the public school system in the municipality of Barreirinha, state of Amazonas. In addition, according to Costa et al.¹², knowing the epidemiological profile of dental caries in preschoolers is a key tool for identifying the real problem in the population studied and developing strategies for planning and implementing actions in local Primary Care.

It is worth highlighting that the average ceo-d in Barreirinha was high, corroborating Costa et al.’s¹² study, which found an average ceo-d of 4.48 at five years, and Assis et al.’s²⁰ study, which found an average ceo-d of 2.7 in preschoolers between four and six years. By comparing the average ceo-d score found here with that of the Brazilian population survey carried out in 2010 for five-year-olds (ceo-d of 2.43)², a worrying result is observed in Barreirinha, given that the nationwide epidemiological survey carried out by the Ministry of Health took place more than ten years ago. This effect could be attributed to the study having been carried out in a municipality with a low HDI of 0.574¹⁶ and without fluoridation of the public water supply since a reduction in dental caries is expected with the use of this measure¹¹,²⁴.

In addition, component c (decayed deciduous teeth) remains high, accounting for approximately 91% of the total value of the ceo-d index. In addition, restorative treatment (53.7%) was the most common need for dental treatment, showing that the difficulty of accessing services to restore teeth remains a challenge in the municipality, corroborating the study by Brasil², Narvai et al.²⁴, and Costa et al.¹². These results point to the need to strengthen health education and health promotion actions for preschoolers in the municipality through the Health at School Program (PSE) and expand access to treatment by primary health care oral health teams.

A statistically significant difference also emerged in the component lost due to caries (p=0.006), with no teeth lost at the age of 2 and an increase in the average of this component as children got older, reaching 0.43 at the age of 6. This result reinforces the importance of oral health education activities with children's parents or guardians since children in this age group depend on their care and supervision for oral hygiene practices and access to health services.

The SiC Index found here shows an unequal distribution of the disease, with the highest prevalence concentrated in a smaller proportion of students, suggesting polarization of the disease, i.e. a lower percentage of children concentrating a greater burden of the disease in this group, corroborating the study carried out in the city of Barcelos, state of Amazonas, which found a ceo-d index of 4.23 and a Significant Caries Index of 7.55 at the age of six²⁵, while the study carried out in the city of Barreirinha, state of Amazonas, found a ceo-d index of 3.12 and a Significant Caries Index of 6.90 at the age of six²⁶. Although the municipality has 100% ESB coverage in the Family Health Strategy¹⁵, the high severity of the disease in this group could be linked to the low number of preventive actions implemented by the ESB of the School Health Program in the municipality, as well as the lack of knowledge on the importance of oral health by parents.

According to Nunes et al.¹⁰, this lack of information may lead parents to only visit the dentist when their child has painful symptoms. Programs aimed at providing schoolchildren with tooth brushing and fluoride toothpaste, as well as guidance on healthy eating habits, the etiology of tooth decay, raising awareness of oral health care among parents and schoolchildren and the relevance of longitudinal monitoring by the oral health team, are important and effective strategies for improving children’s oral health over time³,⁷-⁹,²³.

CONCLUSION

Our findings point to a high prevalence and severity of dental caries in the preschoolers studied. An unequal distribution of this disease was also observed, as a smaller proportion of students had a higher concentration of the disease, suggesting the existence of a polarized group with a high incidence of caries that needs attention, both in terms of oral health education and access to treatment.

These results reinforce that oral health prevention and care for preschool children remain a challenge for primary oral health care in the municipality studied, highlighting the need to reinforce oral health education and prevention actions with both children and their parents or guardians, thus helping to improve the oral health of these preschoolers.

• How to cite:
  Aranha LAR, Maklouf AES, Belém Júnior LA, Regis-Aranha G, Monteiro AX, Passos SMA, et al. Prevalence of dental caries in preschool children: a cross-sectional study. Rev Odontol UNESP. 2025;54:e20240041. https://doi.org/10.1590/1807-2577.04124
• ETHICAL STATEMENT
  Approved by the Resesrch Ethics Committee of the Amazonas State University No. 5.699.561 of 10/14/2022.
• FUNDING
  This research was supported by the Amazonas State University (UEA), Ordinance No. 067/2023 – GR/UEA (Process 01.02.011304.023338/2022-43).

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Publication Dates

• Publication in this collection
  18 Apr 2025
• Date of issue
  2025

History

• Received
  03 Dec 2024
• Accepted
  25 Feb 2025