CARIES, ORAL HYGIENE STATUS AND DATES CONSUMPTION AMONG
SAUDI FEMALE UNIVERSITY STUDENTS*
Noura A. Al Essa BDS**
Manal A. Al Mutairi BDS**
Hadeel M. Al Ohali BDS**
Ahmed El Hejazi BDS, MSc, PhD***
Arham Chohan BDS, BSc, MSc, FPFA, FADI****
‫ملخص‬
‫أهددف ال رف سددملرفة ددمل اددنال حس د صحة صرمل ددسمل ر ددتلو سددن طال رن ددن لعدداللعصريددص ل ر صرفددمل راددفن ص ل‬
‫لرددللعصريددص ل ر صرفددمل ددتل رن ددعلفةددا للر فة ددمل صرددمل اددنال حس د صحلول ددسمل ر ددت ل ر فةنرددص ل‬604‫ع ددن ل‬
‫ر نفةقملعف ص مل سمل ر تلول سن طال رن ن لقفلج فتلرللخطللل سنياصحلذ يلرخصصلردلر ل ل ر ندصج لوجدف صلأحل‬
‫ل( ال سدة ال‬7‫ة‬,,‫)للوادصحلرفدفلل ر خدن لل‬6‫ة‬,1‫ل( ال سدة ال ر فادص ل‬10‫ة‬01‫رففلل ر خةلو رس نلو رخةد لادصحل‬
‫ل‬0‫ة‬01‫)لول ر ننحل رس ن لع فدفلل‬1‫ة‬66‫ل(ل ال سة ال ر فاص ل‬0‫ة‬,0‫)ةل ر ننحلل ر خةن للع ففلل‬6‫ة‬,,‫ر فاص ل‬
‫)لعدالل جدص لرفدفلل‬P>0‫ة‬07(‫) لاصحله صال خنطالرةسنظلع اننىل الرملإ صدصجامل‬0‫ة‬,,‫( ال سة ال ر فاص ل‬
‫ر خددةلو رس ددنلو رخة د للرة صريددص لرددللرخنةددعلأقاددصةل رف ددة لو نا ددمللفددللذر د ل ق د ل ع د لفددف ل ر صريددص لع ادديمل‬
‫)لعددالل جددص لرفددفلل ر خدةلو رس ددنلو رخة د ل‬P>0‫ة‬001(‫لعصددسمل ن ددملجاددفظ لرددن ل يددصعل ددصعيلل‬%,7‫ة‬47
‫ل اددنف ةلل ر ةةددصظلرن أاددعلأس د ص ل ليصرياددمل ر صريددص لاددلل د أ لل‬%,,‫ة‬0‫و ددسمل ر ددت ليصرياددمل ر صريددص لع ادديمل‬
‫)ل‬%1,‫ة‬0(‫)ل نرادصلول قد ل دن ريلو دفظلردللف دةظلعصريدص ل‬%,,‫ة‬6(‫)لأولثطثلردة ل‬%6,‫ة‬0(‫أس ص للرة الل‬
‫)ل دكاةلل رن ددةلول ددن ريل عد لفددف ل‬%,1‫ة‬0(‫ادنف ةلل راددن الرن أاددعلأسد ص ل لأاالدةلرددللثددطثلأ عددص ل ر صريددص ل‬
‫)لعددالل خددن ل حسد صحلول سددن طال‬P>0‫ة‬07(‫ل يددص لعددصرانة لرددتل أ ددةلأ لفطقددمل‬10-7‫)ل ددكاةلل‬%,6‫ة‬6(‫ر صريددص ل‬
‫رن ن لخط مل رقنللأحلرففلل ايمل انال حس صحلوخ ن هلاص تلفصراملجف ل ق ل ايملقةاةملرلل ر صريص لاصحل‬
‫رف لل سمل ن ملجافظلوث ص املرللاللف ةظلعصريص لالل كاةلل رن ة نراصًَ ل‬
‫للللللل‬
ABSTRACT
The objectives of the present study were to determine the caries experience, oral hygiene
status and consumption of dates among Saudi female University students. A total of 406
female University students were examined for dental caries and oral hygiene. The information
about oral hygiene practices and consumption of dates was obtained through a selfadministered questionnaire. The mean DMFT was 10.01 (SD 4.71) with a decay (D)
component of 5.87 (SD 4.28), missing (M) component of 0.83 (SD 1.44) and filled
component of 3.31 (SD 3.92). There was significant (p< .05) difference observed between the
mean DMFT scores of the students from various age groups. Only one-fourth (25.6%) of the
students had good oral hygiene. A positive correlation (p< .0001) was exhibited between the
mean DMFT scores and oral hygiene. Almost all (98.0%) students used brush to clean their
teeth. A majority of the students were cleaning their teeth twice (47.0%) or thrice (22.4%)
daily and only about one in ten (12.3%) students’ used miswak to clean their teeth. More than
three-fourth (81.0%) students were eating dates and about one-fourth (24.4%) of the students
were eating 5-10 dates per day. No significant (p> .05) correlation was observed between
caries and dates consumption. It was concluded that the caries prevalence and severity was
very high. Only small percentage of the students had good oral hygiene and eight in every ten
students was eating dates daily.
*
**
***
****
Internship Research Presentation. 6th March, 2007 (16 Safar, 1428 H).
Internship Program, College of Dentistry, King Saud University,
Riyadh, Kingdom of Saudi Arabia.
Intern, King Saud University College of Dentistry
Associate Professor, RDS Department, Operative Dentistry Division, King Saud University
College of Dentistry, Riyadh.
Lecturer, PDS Department, Pediatric Dentistry Division, King Saud University College of
Dentistry, Riyadh
hygiene status was good9. Therefore, it
would be interesting to determine the
oral hygiene status and practices of
female university students.
INTRODUCTION
It is an established fact that in many
countries the university students
occupy a significant position in public
life. They are considered as the role
model for the society and opinion
leaders of the future in their field. It is
assumed that significance of health
perception is better understood in
students of health sciences than those
in the other fields. Therefore, the
pattern of health behaviors and beliefs
of these university students are of
particular importance.
The date palm (Phoenix dactylifera) is
one of mankind's oldest cultivated
plants and important produce in many
Arabian Gulf Countries. It has been
used as food for 6000 years14. It could
be used for the generations to come,
due to its remarkable nutritional, health
and economic value in addition to its
aesthetic and environmental benefits15.
The fruits (dates) of the date palm
contain a high percentage of
carbohydrate (total sugars 44-88%), fat
(0.2-0.5%), 15 salts and minerals,
protein (2.3-5.6%), vitamins, a high
percentage of dietary
fiber (6.411.5%) and common pH values for
dates range from 5.3 to 6.315,16.
Historically, it was found that when
dates were consumed as large portion
of diet, which then lead to high caries
incidence and accelerated tooth loss
and evidence of this was found in a
skeletal series from the late Iron Age in
the Sultanate of Oman17. In the
literature no study has been conducted
to find out the relationship between
consumption of dates with caries.
Dental caries is still one of the most
prevalent disease in different parts of
the world. Many studies conducted in
Western countries have reported a
general decline in caries prevalence1.
Studies undertaken in countries on the
Arabian Peninsula have reported a very
high caries severity, commonly
associated with relatively high and
frequent consumption of sweets2-4. In
contrast, several studies in Saudi
Arabia have reported a very high caries
prevalence in school children5-8.
Recently a study was conducted on
female dental students, which also
showed high caries prevalence9.
Although, there are no studies on
caries prevalence in Saudi female
university students, therefore, a high
caries prevalence is also expected in
these university students.
The objectives of the present study
were:
It has been observed that optimal
gingival and periodontal health is
related to good oral hygiene. Studies
done by Alexander (1970)10 and
Horowitz (1980)11 have shown a
positive correlation between oral
hygiene
and
gingival/periodontal
disease. Similarly, a correlation has
also been reported between oral
hygiene and dental caries12,13. The
study conducted on female dental
students showed that overall oral
2
-
To determine the caries
prevalence and severity in
female university students.
-
To determine their oral
hygiene
status
and
practices.
-
To see if there was any
difference between the
students of various age
groups in relation to caries
and oral hygiene status.
-
To see if there was any
correlation between dates
consumption and caries
severity.
Oral hygiene index:
The oral hygiene index described by
James et al (1960)19 was utilized by the
study. The index has three categories
of dental cleanliness.
SUBJECTS AND METHODS
The subjects used for this study were
Saudi female University students
residing in the hostels of King Saud
University and Al-Tarbyia College.
The hostels which were selected for
this study had the facility of dental
setup where the students receive
routine dental treatment for their dental
problems. Prior to the commencement
of the study permission was taken from
the hostel administration by stating the
aims and objectives of the study. In
addition, students were also informed
about the study and their consent was
taken to carry out dental examination.
The students were divided into three
age groups: <20 years, 20-22 years and
>= 23 years. The students were
examined by two examiners (NE and
HO) on a dental chair utilizing a dental
mirror and explorer and the third
examiner
(MM)
recorded
the
information. The examiners ware
calibrated with a senior KSUCD
faculty member. The data obtained
during the examination were recorded
on a form especially designed for the
study. The following indices were used
to assess the caries and oral hygiene in
the sample.
-
-
Good: The teeth are clean.
There is no sign of food debris
or materia alba.
Poor: The teeth are very dirty.
There is considerable longstanding food debris, materia
alba.
Fair: This class falls between
the two preceding ones. There
is some evidence of debris, but
not of the degree recognized as
poor.
The information about oral hygiene
practices, consumption of dates and
sugary products and drinking water
was obtained through a selfadministered questionnaire.
The
following details were covered in the
questionnaire.
-
-
-
Dental caries:
The WHO criteria were used for the
diagnosis of dental caries18. The caries
was diagnosed on visual evidence,
after drying and removing the debris
from the teeth with the help of explorer
and mirror. No radiographs were taken.
Demographic information
such as age, marital status
and place of residence.
Oral hygiene methods used
such as toothbrush, miswak
and its frequency.
Use of mouthwash and
dental floss.
Type of dates and its
frequency.
Consumption of sugary
products.
Type of drinking water
used.
The data were then entered into a
computer using the FOXPRO software
and analyzed utilizing the Statistical
Program for Social Sciences (SPSS)
version #10. Various frequencies were
generated. The Pearson Chi-square test
was used to test the difference between
3
various age groups in term of oral
hygiene status, oral hygiene practices,
consumption of dates and sugary
products. ANOVA was utilized to test
the difference between mean DMFT
scores of various age groups, mean
DMFT scores with oral hygiene status,
Correlation between caries and dates
consumption and any significance
between mean DMFT and drinking
water.
Table 1: Caries experience of the
students with age groups.
Age
group
Mean
DMFT
SD
Mean
decay
SD
Mean
missing
SD
Mean
filled
SD
< 20
years
9.29
4.52
6.02
4.38
0.57
1.08
2.70
3.58
20-22
years
10.06
4.52
5.58
4.11
0.94
1.60
3.54
4.19
> 23
years
11.85
5.27
6.26
4.45
1.28
1.67
4.31
3.73
Total
10.01
4.71
5.87
4.28
0.83
1.44
3.31
3.92
RESULTS
A total of 406 Saudi female students of
King Saud University participated in
the study with the mean age of 20.38
years and a range of 18-28 years.
There were 210 students from arts
college, 37 students from science
college and 159 students from
medicine and dentistry colleges. The
intra-examiner and inter-examiner
reliability was determined utilizing
Kappa method and it was 0.91 and
0.89 respectively.
P>
.05
P <.05
P <.05
Only one-fourth (25.6%) of the
students had good oral hygiene (Table
2). A slight decrease was observed in
the percentage of students with poor
oral hygiene from age group < 20
years to >= 23 years but the difference
was not significant (p> 0.05) (Table 2).
A statistically significant (p< 0.001)
correlation was observed when the
mean DMFT scores were compared
with oral hygiene status (Table 3).
The overall caries prevalence was
98.8% with 98.6 % in arts students,
100% in science students and 98.7% in
medicine and dentistry students were
having caries. Furthermore, 97.6% of
age group <20 years, 99.4% of age
group 20-22 years and 100% of age
group >=23 years were having caries.
The overall mean DMFT was 10.01
(SD 4.71) with a decay (D) component
of 5.87 (SD 4.28), missing (M)
component of 0.83 (SD 1.44) and filled
component of 3.31 (SD 3.92). There
was significant (p< 0.05) difference
observed between the mean DMFT
scores of the students with various age
groups (Table 1). However, the
missing (M) and filled (F) component
of the DMFT significantly (P<.05)
increased with the increase in age
(Table 1).
Table 2: Oral hygiene status of the
students.
Oral hygiene Status
4
Age group
Good (%)
Fair (%)
Poor (%)
< 20 years
46 (27.4)
101 (60.1)
21 (12.5)
20-22 years
41 (23.2)
125 (70.6)
11 (6.2)
>=23 years
17 (27.9)
40 (65.6)
4 (6.6)
Total
104 (25.6)
266 (65.5)
36 (8.9)
P < .05
Majority of the students were cleaning
their teeth twice (47.0%) or thrice
(22.4%) daily and only about one in
ten (8.2%) students cleaned their teeth
sometimes (Table 5). In the tooth
cleaning frequency no particular trend
was observed in relation to different
age groups (Table 5).
Table 3: Correlation between mean
DMFT scores and Oral hygiene
status
DMFT
Oral
Hygiene
Number
Mean
SD
P value
Good
104
7.40
4.73
< 0.001
Fair
266
10.59
4.29
< 0.001
Poor
36
13.28
4.15
< 0.001
Table 5: Frequency of tooth cleaning
among the students.
Frequency of tooth cleaning
Total
406
10.01
4.71
Age group
Once
(%)
Twice
(%)
Thrice
(%)
Sometime
(%)
Total
(%)
< 20 years
39
(23.2)
78
(46.4)
32
(19.0)
19
(11.4)
168
(100.0)
20-22 years
40
(22.6)
87
(49.2)
39
(22.0)
11
(6.2)
177
(100.0)
>=23 years
12
(19.7)
26
(42.6)
20
(32.8)
3
(4.9)
61
(100.0)
Total
91
(22.4)
191
(47.0)
91
(22.4)
33
(8.2)
406
(100.0)
< 0.001
A great majority (98.0%) of the
students were using tooth brush to
clean their teeth, whereas in contrast
about one in ten students were using
miswak as an oral hygiene tool (Table
4). The use of dental floss significantly
(p< 0.05) increased in students from
<20 years to >=23 years age group
(Table 4).
Almost three-fourth (76.4%) of the
students were drinking bottle water
(Table 6). No statistically significant
(p> 0.05) correlation was observed
between the mean DMFT scores and
the type of water consumed (Table 6).
Table 4: Various oral hygiene
methods used by the students.
Table 6: Correlation between mean
DMFT scores and Type of drinking
water consumed
ORAL HYGIENE METHODS
Brush only
(%)
Miswak
(%)
Floss
(%) *
Mouth wash
(%)
< 20 years
165 (98.2)
24 (14.3)
30 (17.9)
17 (10.1)
20-22 years
174 (98.3)
17 (9.6)
55 (31.3)
16 (9.0)
Water
Number
Mean
SD
P value
>=23 years
59 (96.7)
9 (14.8)
22 (36.1)
5 (8.2)
Bottle
310
10.11
4.82
> 0.05
Total
398 (98.0)
50 (12.3)
107
(26.4)
38 (9.4)
Tap
16
8.81
4.65
> 0.05
Bottle + Tap
80
9.89
4.26
> 0.05
Total
406
10.01
4.71
> 0.05
Age group
DMFT
* P <.05
5
Table 7 : Responses to questions
about dates type and consumption.
Table 8 : Responses to questions
about sugary products.
_______________________________________________
_______________________________________________
Question
n
%
_______________________________________________
Question
n
%
_______________________________________________
Which type of date you eat?
1. Barhi
2. Kalas
3. Sukary
4. Others
17
193
184
12
17.2
47.5
45.3
3.0
Frequency of eating dates per day:
1. Once daily
329
2. Twice daily.
53
3. Thrice or more than three times. 24
81.0
13.1
5.9
Do you eat / or drink sugary products?
1. Yes
386
2. No
20
95.1
4.9
What kind of sugary products do you consume?
1. Sweet (Chocolate/candies).
232
2. Soft drinks.
173
3. Sweetened milk.
246
4. Confectionary
211
57.1
42.6
60.6
52.0
How often do you consume sugary products?
1. Daily.
293
72.1
2. Every week.
35
8.6
3. Occasionally.
78
19.2
_______________________________________________
How many dates you eat per day?
1. < 5 dates per day.
282
69.4
2. 5 – 10 dates per day
99
24.4
3. > 10 dates per day
25
6.2
______________________________________________
DISCUSSION
Table 7 summarizes the responses to
question about the type, frequency and
consumption of dates. A great majority
of the students were eating dates once
(81.0%) and twice (13.1%) daily.
Almost (69.4%) of the students were
eating < 5 dates per day, whereas
(24.4%) were eating 5-10 dates per
day. On analyzing the relationship of
caries with dates, no statistically
significant (p> 0.05) correlation was
observed. It was seen that majority
(95.1%) of the students were also
consuming sugary products (Table 8).
Almost three-fourth (72.1%) of the
students were eating/or drinking
different kinds of sugary products
(Table 8).
The present study has provided an
interesting
insight
into
caries
experience, oral hygiene status and
practices, consumption of dates and
sugary products among Saudi female
university students. The results will be
utilized in motivating the students to
improve their oral health behaviors and
practices in the study areas. These
results will also serve as base-line data
for the future comparisons because; the
literature has not reported any study
conducted among Saudi females in this
age group.
The mean DMFT of the study
population was very high. However, it
was not unexpected. The recent studies
of Saudi schoolchildren and female
dental students have reported similar
levels of caries6-9 and it shows that the
children continue to carry the disease
with them from schools to universities.
Nevertheless, such a high level of
caries is alarming in any population.
This situation of high caries prevalence
and severity in Saudi Arabia has been
identified by several authors and they
have pleaded for immediate measures
to ameliorate preventive efforts6-8.
AlDossai et al (2001)20 and Wyne et al
6
(2002)7 have suggested to organize
school based preventive programs
which will impart awareness and
knowledge about oral health.
dental students9. Several studies have
reported on the usefulness of miswak
for dental health24,25. Therefore, it
would be beneficial to use a
combination of brush and miswak for
optimum
oral
health.
Most
importantly, the use of miswak has
been encouraged through the religious
and cultural hygiene guidelines and
traditions. The increased use of dental
floss could also be attributed to
increased awareness about oral health
and also to increased number of
restored teeth, which sometime makes
it
compulsory
to
clean
the
interproximal areas with dental floss.
The results are in agreement with the
study by Al-Zahrani et al (2004)9.
There was statistically significant (p<
0.05) difference observed between the
mean DMFT scores of the students
from various age groups and also the
mean DMFT scores continued to
increase across the years. More and
more students got their carious teeth
restored or extracted, probably as a
result of increased awareness about the
disease. Similar results were reported
in the study conducted in young
adults10 but not in agreement with
results reported in Danish20 and Saudi9
dental students. There are no such
recent data available on similar age
Saudi population.
It was observed in our study that
majority of the students had
appropriate brushing habits. Moreover,
three-fourth of the students were
drinking bottle water which contains
fluoride which is an anti cariogenic
agent in preventing tooth decay but on
the other hand a very high caries
prevalence was unusual. Furthermore,
a large number of students were eating
dates and consuming sugary products
but no statistical significance was
observed in relation to caries severity
with dates and sugary products
consumption. It is a matter of serious
concern that majority of the students
were unaware of the harmful effects of
sweets, soft drinks, sweetened milk
and confectionaries. Dates contain a
high concentration of sugar, which is
considered the main component .This
carbohydrate in dates mainly helps in
reducing sugars in the form of glucose,
fructose, mannose and maltose and
non-reducing
sugars
(primarily
sucrose), as well as small amounts of
polysccharides such as cellulose and
starch26. So because of these properties
of dates it could be inferred that dates
eaten in normal quantity does not
directly causes tooth decay.
It has been reported that women in
general have cleaner teeth than men,
and that the trend prevails within
various age groups21. In our study
population one-fourth of the students
had good oral hygiene. However,
overall small improvement in oral
hygiene was observed with the
advancement in age. This improvement
in oral hygiene could be because of the
awareness from different sources and
as well as from peer interaction. The
results were in agreement with those of
Lang et al (1977)22 and Howat et al
(1979)23 who reported an improvement
in oral hygiene through the years in
students. A significant correlation (p<
.001) was observed between mean
DMFT scores and oral hygiene, which
mean that because of bad oral hygiene
the prevalence in caries severity
increased.
It was worth noting that a great
majority of the students were using
tooth brush to clean their teeth whereas
very few students were using miswak.
Similar results were reported in female
7
The responses obtained through a
questionnaire have to be considered
with caution. There is a potential
tendency towards favorable response.
The possibility of a bias created by
favorable response could not be ruled
out. Nevertheless, it is hoped that the
study has provided useful information
about the caries, oral hygiene and dates
consumption in the study population.
-
ACKNOWLEDGEMENT
We wish to thank the hostel
administration
for
giving
the
permission to carry out the study. We
also deeply appreciate the participation
and cooperation of all the students, and
wish them a good health and success in
their studies. We are also thankful to
Dr. Nazeer Khan for helping in
statistical analysis.
CONCLUSION
-
-
-
-
The caries prevalence and
severity was very high
among the Saudi female
university students.
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Caries prevention: a continued
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Only one-fourth of the
students had good oral
hygiene. A great majority
of the students were using
toothbrush to clean their
teeth.
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M,
Hussain
J, Babeely
K,
Behbehani J , Al -Za'abi F.
Nursing bottle syndrome in
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Majority of the students
were not aware of the
harmful effects of the
sugary products
RECOMMENDATIONS
-
-
Further research is needed
to be carried out in larger
sample size.
4. Al-Hosani E, Rugg Gunn AJ.
The relationship between diet
and dental caries in 2 and 4
years old children in the
Emirate of Abu Dhabi . Saudi
Dent J 2000; 12:149-155.
The university students
should be screened for
dental disease at the start of
their course and encouraged
to
seek
treatment
immediately.
5. Stewart BL, Al Juhani TS,
Al Akeel AS, Al-Deghaishem
FA ,
Abdulla
B. Caries
experience in grades 1 and 6
children attending elementary
school at King Abdul-Aziz
Military City , Tabuk, Saudi
A follow-up mechanism
and
continuous
reinforcement should be
provided.
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