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Oral Survey for Children of Savannakhet Province, Laos
Int J Clin Prev Dent 2023;19(4):99-106
Published online December 31, 2023;  https://doi.org/10.15236/ijcpd.2023.19.4.99
© 2023 International Journal of Clinical Preventive Dentistry.

Yong-Soo Park1, Ja-Won Cho1, Hyun-Jun Yoo1, Phommavongsa Nitthasack2, Cheon-Hee Lee3

1Department of Preventive Dentistry, College of Dentistry, Dankook University, Cheonan, Korea, 2Department of Pediatric Dentistry, Faculty of Dentistry, University of Health Science, Vientiane, Laos, 3Department of Dental Hygiene, Andong Science College, Andong, Korea
Correspondence to: Cheon-Hee Lee
E-mail: arisu0515@hanmail.net
https://orcid.org/0000-0002-3203-8025
Received December 1, 2023; Revised December 20, 2023; Accepted December 28, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: The objective of this study is to establish the level of dental caries among students in the Savannakhet Province of Laos.
Methods: We conducted oral examinations on a total of 308 children, including 99 elementary school students, 102 middle school students, and 107 high school students in the Savannakhet region to assess the extent of dental caries experience.
Results: Among 12-year-old children corresponding to first graders in middle school, the Permanent Teeth Decayed, Missing, and Filled Teeth (P-DMFT) index was 1.35, the Permanent Teeth Decayed, Missing, and Filled Surfaces (P-DMFS) index was 2.25, with a P-DMFT caries prevalence of 50.0%, P-DMFS caries prevalence of 90.6%, a caries treatment rate of 8.70%, and a caries index of 7.25%.
Conclusion: Dental caries prevalence was high across most age groups, with a permanent tooth decay rate ranging from approximately 80% to 89%. Notably, the primary tooth decay rate was found to be exceptionally high, at around 95%. The dental caries fatality rate also stood at approximately 7% to 18%, emphasizing the need for concurrent preventive initiatives and treatment programs in Laos to halt the progression of dental caries and reduce dental caries fatality rates.
Keywords : oral survey, decayed teeth, missing teeth, filled teeth
Introduction

The World Health Organization has defined health as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’ [1,2]. In other words, health can be described as a state where not only is one free from disease and weakness but also enjoys physical, mental, and social well-being [1,2]. Among this, oral health, particularly the self-care actions taken to preserve the longevity of teeth, can be specifically termed as dental health [1,2]. Such oral health is a determinant of quality of life while engaging in social activities, with dental caries being a major oral disease hindering this wellness [1,2].

Laos, or the Lao People’s Democratic Republic, is the only landlocked country in Southeast Asia, bordered by China to the north, Vietnam to the east, Myanmar and Thailand to the west, and Cambodia to the south. Its GDP per capita is approximately 1,600 dollars, placing it among the lower tier of Southeast Asian nations [3-5].

In South Korea, school oral health offices are operated targeting elementary students with the aim of preventing caries and other oral diseases. These initiatives include toothbrushing programs, fluoride mouth rinsing, and dental sealant applications [6,7].

In Laos, oral health initiatives include the distribution of fluoride-containing salt and the SMART (Simplified and Modified Atraumatic Restoration Treatment) program. The SMART program is a treatment based on the non-extraction caries prevention filling method, using hand instruments instead of electric ones to remove carious lesions and then filling them with glass ionomer cement [8-13].

With these considerations, the author aims to survey the status of dental caries experience among children in the Savannakhet province area as part of the research for implementing the Oral Health Program by the Lao government and to utilize it as foundational data for Laos’s Oral Health Program.

Materials and Methods

1. Study subjects

This study targeted children aged 6 in elementary schools, 12 in middle schools, and 15 in high schools within the Savannakhet Province of Laos. It distinguished between urban and rural areas, selecting respective elementary, middle, and high schools in each region following recommendations from the Lao Dental Association and the Lao Ministry of Education. Subsequently, students from these schools were chosen as the subjects for this research (Table 1).

Table 1 . Age and gender distribution of study participants

AgeSavannakhetUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
Total308123185147638416160101
6-year-old994554492623501931
12-year-old1023765491633532132
15-year-old1074166492128582038


2. Methods

1) Examination team composition

The examination team was formed with a total of 13 individuals: 7 dentists from South Korea, 3 from Laos, one person responsible for examination support and recording, and two in administrative roles. To ensure uniformity in survey standards, the team underwent a training session right before the survey was conducted.

2) Examination schedule

The assessment occurred in two stages, with the schedule detailed as follows:

Stage one (Urban sector): February 7th, 2019

Stage two (Rural sector): February 8th, 2019

3) Inspection standards

The guidelines for the dental examination are as follows [14,15].

0: Unaffected teeth: No active carious process and no marks of previous caries interventions.

1: Cavity-affected teeth: Presence of lesions with softened dentin or exposed by caries.

3: Caries-treated teeth: Teeth restored with permanent fillings without additional decay and teeth with crowns due to caries.

4: Caries-caused extracted teeth: Permanent teeth removed because of caries, including those replaced with prosthetics, except the abutment teeth.

5: Extracted teeth not due to caries: Permanent teeth extracted for reasons other than caries (trauma, born without certain teeth, periodontal disease, for orthodontic purposes) and not included in the caries-experienced count.

6: Teeth with sealants: Teeth that have been treated with dental sealants.

7: Restored teeth not due to caries: Permanent teeth with artificial crowns or bands due to non-caries factors (trauma, developmental defects, prosthetics, orthodontic devices) and not included in the caries-experienced count.

8: Impacted teeth.

9: Indeterminate teeth.

4) Statistical evaluation

The oral health examination data were recorded using the statistical tool EXCEL (Version 2016, Microsoft Inc, USA) and processed for descriptive statistical measures in SPSS version 24.0. For the 6-year-old children in elementary schools, various dental health indicators were calculated including the primary teeth caries and filling rate (df rate), caries and filling index for primary teeth (dft index), caries and filling surface index for primary teeth (dfs index), decay rate of primary teeth (dt rate), and filling rate of primary teeth (ft rate). In the case of 12-year-old students in middle schools and 15-year-old students in high schools, metrics such as the permanent teeth decay, missing, and filling rate (DMF rate), decay, missing, and filling index for permanent teeth (DMFT index), decay, missing, and filling surface index for permanent teeth (DMFS index), decay rate of permanent teeth (DT rate), and filling rate of permanent teeth (FT rate) were also computed.

Results

1. Primary teeth caries experience among 6-year-old primary school students

The primary teeth caries experience among primary school students in the Savannakhet region is presented in Table 2 and Table 3.

Table 2 . Primary teeth caries experience among savannakhet primary school students (1)

IndexValueSavannakhetUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
stMean11.0710.8711.2410.8210.0411.7011.3212.0010.90
SD4.484.234.714.294.404.094.693.825.17
dtMean6.476.696.307.127.966.175.844.956.39
SD4.224.234.244.234.403.904.153.364.54
ftMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
setMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
utMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
etMean1.421.601.281.962.501.350.900.371.23
SD2.312.572.082.633.051.941.820.682.20
dftMean6.476.696.307.127.966.175.844.956.39
SD4.224.234.244.234.403.904.153.364.54
df rate%94.9597.7892.5991.8496.1586.9698.00100.0096.77
dt rate%100.00100.00100.00100.00100.00100.00100.00100.00100.00
ft rate%0.000.000.000.000.000.000.000.000.00

st: number of sound primary teeth, dt: number of decayed primary teeth, ft: number of filled primary teeth due to caries, set: number of sealant treated primary teeth, ut: number of un-erupted primary teeth, et: number of primary teeth indicated for extraction, dft: number of decayed and filled primary teeth, df rate: primary teeth caries experience rate, dt rate: decay rate for primary teeth, ft rate: filling rate for primary teeth, SD: standard deviation.


Table 3 . Primary teeth caries experience among Savannakhet primary school students (2)

IndexValueSavannakhetUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
ssMean63.5963.4063.7463.5361.0066.3963.6466.6861.77
SD16.1115.0917.0515.4216.3914.0616.9112.8218.95
dsMean14.3214.6714.0416.0618.8812.8712.628.8914.90
SD13.4513.5813.4614.0415.4611.7612.767.6214.73
fsMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
sesMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
dfsMean14.3214.6714.0416.0618.8812.8712.628.8914.90
SD13.4513.5813.4614.0415.4611.7612.767.6214.73

ss: number of sound primary tooth surfaces, ds: number of decayed primary tooth surfaces, fs: number of filled primary tooth surfaces due to caries, ses: number of sealant treated primary tooth surfaces, dfs: number of decayed and filled primary tooth surfaces, SD: standard deviation.



2. Permanent teeth caries experience among 12-year-old middle school students

The permanent teeth caries experience among middle school students in the Savannakhet region is presented in Table 4 and Table 5.

Table 4 . Permanent teeth caries experience among Savannakhet middle school students (1)

IndexValueSavannakhetUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
STMean22.7522.9522.6523.2223.5623.0622.3222.4822.22
SD4.053.954.143.743.613.854.314.214.43
DTMean1.230.701.521.120.811.271.320.621.78
SD1.841.431.991.811.801.821.881.122.14
FTMean0.120.140.110.180.130.210.060.140.00
SD0.470.420.500.600.340.700.300.480.00
MTMean0.010.000.020.020.000.030.000.000.00
SD0.100.000.120.140.000.170.000.000.00
ATMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
SeTMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
XTMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
UTMean7.898.227.717.457.507.428.308.768.00
SD3.613.873.482.943.372.774.134.214.11
ITMean0.090.110.080.060.000.090.110.190.06
SD0.350.390.320.240.000.290.420.510.35
DMFTMean1.350.841.651.330.941.521.380.761.78
SD1.861.442.011.881.811.911.861.142.14
DMF rate%50.0037.8456.9246.9437.5051.5252.8338.1062.50
DT rate%90.5883.8792.5284.6286.6784.0095.8981.25100.00
FT rate%8.7016.136.5413.8513.3314.004.1118.750.00
MT rate%0.720.000.931.540.002.000.000.000.00
Mortal rate%7.2512.905.616.150.008.008.2225.003.51

ST: number of sound permanent teeth, DT: number of decayed permanent teeth, FT: number of filled permanent teeth due to caries, MT: number of missing permanent teeth due to caries, AT: number of missing permanent teeth not due to caries, SeT: number of sealant treated permanent teeth, XT: number of permanent teeth with non-caries treatments, UT: number of un-erupted permanent teeth, IT: number of permanent teeth indicated for extraction, DMFT: number of decayed, missing, and filled permanent teeth, DMF rate: permanent teeth caries experience rate, DT rate: decay rate for permanent teeth, FT rate: filling rate for permanent teeth, MT rate: missing rate for permanent teeth due to caries, SD: standard deviation.


Table 5 . Permanent teeth caries experience among Savannakhet middle school students (2)

IndexValueSavannakhetUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
SSMean107.04106.38107.42108.90109.94108.39105.32103.67106.41
SD17.6218.0317.5115.2015.4415.3019.5819.7219.72
DSMean2.041.492.352.021.312.362.061.622.34
SD3.533.253.683.923.484.133.173.143.21
FSMean0.160.190.140.270.250.270.060.140.00
SD0.640.620.660.860.770.910.300.480.00
MSMean0.050.000.080.100.000.150.000.000.00
SD0.500.000.620.710.000.870.000.000.00
AFMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
SeSMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
XSMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
USMean38.7239.9538.0236.7136.5036.8240.5742.5739.25
SD17.2218.0716.8114.1215.8013.4819.6119.5919.82
DMFSMean2.251.682.572.391.562.792.111.762.34
SD3.613.223.804.083.484.333.153.103.21

SS: number of sound permanent tooth surfaces, DS: number of decayed permanent tooth surfaces, FS: number of filled permanent tooth surfaces due to caries, MS: number of missing permanent tooth surfaces due to caries, AS: number of missing permanent tooth surfaces not due to caries, SeS: number of sealant treated permanent tooth surfaces, XS: number of permanent tooth surfaces with non-caries treatments, US: number of un-erupted permanent tooth surfaces, DMFS: number of decayed, missing, and filled permanent tooth surfaces, SD: standard deviation.



3. Permanent teeth caries experience among 15-year-old high school students

The permanent teeth caries experience among high school students in the Savannakhet region is presented in Table 6 and Table 7.

Table 6 . Permanent teeth caries experience among Savannakhet high school students (1)

IndexValueSavannakhetUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
STMean27.0427.2026.9426.8227.1926.5427.2227.2027.24
SD1.811.521.971.821.631.931.791.441.97
DTMean0.930.830.980.960.811.070.900.850.92
SD1.291.241.321.401.121.591.191.391.10
FTMean0.150.020.230.160.050.250.140.000.21
SD0.640.160.800.750.220.970.540.000.66
MTMean0.070.070.080.120.140.110.030.000.05
SD0.300.260.320.390.360.420.180.000.23
ATMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
SeTMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
XTMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
UTMean3.813.883.773.943.814.043.713.953.58
SD0.800.710.860.590.870.190.940.511.08
ITMean0.140.050.200.080.000.140.190.100.24
SD0.480.220.590.340.000.450.580.310.68
DMFTMean1.150.931.291.241.001.431.070.851.18
SD1.551.371.651.731.381.951.401.391.41
DMF rate%51.4048.7853.0348.9847.6250.0053.4550.0055.26
DT rate%80.4989.4776.4777.0580.9575.0083.87100.0077.78
FT rate%13.012.6317.6513.114.7617.5012.900.0017.78
MT rate%6.507.895.889.8414.297.503.230.004.44
Mortal rate%18.7013.1621.1816.3914.2917.5020.9711.7624.44

ST: number of sound permanent teeth, DT: number of decayed permanent teeth, FT: number of filled permanent teeth due to caries, MT: number of missing permanent teeth due to caries, AT: number of missing permanent teeth not due to caries, SeT: number of sealant treated permanent teeth, XT: number of permanent teeth with non-caries treatments, UT: number of un-erupted permanent teeth, IT: number of permanent teeth indicated for extraction, DMFT: number of decayed, missing, and filled permanent teeth, DMF rate: permanent teeth caries experience rate, DT rate: decay rate for permanent teeth, FT rate: filling rate for permanent teeth, MT rate: missing rate for permanent teeth due to caries, SD: standard deviation.


Table 7 . Permanent teeth caries experience among Savannakhet high school students (2)

IndexvalueSavannakhetUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
SSMean126.47126.68126.33125.57126.57124.82127.22126.80127.45
SD5.594.626.154.975.724.286.003.227.07
DSMean1.921.512.171.941.572.211.901.452.13
SD3.072.443.402.992.643.253.172.283.56
FSMean0.190.050.270.200.100.290.170.000.26
SD0.730.310.890.820.441.010.650.000.79
MSMean0.370.370.380.610.710.540.170.000.26
SD1.491.321.601.951.792.080.920.001.13
AFMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
SeSMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
XSMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
USMean19.0619.3918.8519.6719.0520.1418.5319.7517.89
SD4.003.574.262.934.360.764.682.555.41
DMFSMean2.481.932.822.762.383.042.241.452.66
SD3.703.034.054.003.604.323.462.283.90

SS: number of sound permanent tooth surfaces, DS: number of decayed permanent tooth surfaces, FS: number of filled permanent tooth surfaces due to caries, MS: number of missing permanent tooth surfaces due to caries, AS: number of missing permanent tooth surfaces not due to caries, SeS: number of sealant treated permanent tooth surfaces, XS: number of permanent tooth surfaces with non-caries treatments, US: number of un-erupted permanent tooth surfaces, DMFS: number of decayed, missing, and filled permanent tooth surfaces, SD: standard deviation.


Discussion

Generally, it’s known that children in developed countries are experiencing an increase in dental caries due to the consumption of soft foods and beverages high in sugar. However, recent developments in fluoride usage, dental sealants, and dietary control methods have led to a decrease in the incidence of caries in developed countries [16,17]. Conversely, in developing or less developed countries, there is a trend of increasing dental caries due to the rise in consumption of fruit drinks, carbonated beverages, and sugary snacks [1-4]. In this context, the author sought to create baseline data for initiating oral health programs targeting Laotian students [18].

Laos is divided into the capital city of Vientiane and 16 other provinces [19,20]. Among these, Savannakhet Province is a representative region in central Laos. The name ‘Savannakhet’ derives from ‘Savanh Nakhone,’ which means ‘heaven’ or ‘land fertile for agriculture,’ similar in meaning to the Thai city of Nakhon Sawan. Savannakhet Province is located in the southern part of central Laos and is the largest province in the country. It is bordered by Khammouane Province to the north, Quảng Trị and Thừa Thiên–Huế Provinces of Vietnam to the east, Salavan Province to the south, and Nakhon Phanom and Mukdahan Provinces of Thailand to the west. The second Thai-Laos Friendship Bridge, crossing the Mekong River, connects Mukdahan Province in Thailand with Savannakhet in Laos, with the provincial capital being the city of Savannakhet, also known as Kaysone Phomvihane or Muang Khanthabouly, the second-largest city in Laos after Vientiane [21]. The area of Savannakhet Province is 21,774 km2, and as of the 2015 census, it had the largest population in Laos, with approximately 970,000 inhabitants [21].

To assess the extent of dental caries experience among children in the Savannakhet region, the author analyzed the results of oral examinations conducted on a total of 308 individuals, including 99 primary school students, 102 middle school students, and 107 high school students. The decayed primary teeth index for 6-year-old primary school children was 6.47, the decayed primary tooth surface index was 14.32, the primary teeth caries experience rate was 94.95%, the decayed primary teeth rate was 100%, and the treated primary teeth rate was 0%.

Additionally, the decayed permanent teeth index for 12-year-old middle school students was 1.35, the decayed permanent tooth surface index was 2.25, the permanent teeth caries experience rate was 50.00%, the decayed permanent teeth rate was 90.58%, the treated permanent teeth rate was 8.70%, and the caries fatality rate was 7.25%. For 15-year-old high school students, the decayed permanent teeth index was 1.15, the decayed permanent tooth surface index was 2.48, the permanent teeth caries experience rate was 51.40%, the decayed permanent teeth rate was 80.49%, the treated permanent teeth rate was 13.01%, and the caries fatality rate was 18.70%.

The decayed permanent teeth index of 1.35 for 12-year-olds in the Savannakhet region was lower than the national average of 2.18 for 12-year-olds in Laos in 2009, and the index of 1.15 for 15-year-olds was also lower than the national average of 3.20 for all children in 2009, indicating a decrease in dental caries experience [22]. In comparisons between urban and rural areas, the decayed permanent teeth index for 12-year-olds was 1.33 in urban areas and 1.38 in rural areas, while for 15-year-olds, it was 1.24 in urban areas and 1.07 in rural areas, showing no significant difference.

The caries experience rate was high across most age groups, with a decayed permanent teeth rate of 80-89% and particularly a decayed primary teeth rate of around 95%. The caries fatality rate was also high at 7-18%. In Laos, treatment programs should be conducted alongside prevention programs to halt further progression of caries and lower the caries fatality rate.

As a former communist country now embracing market economy principles, Laos has one dental college, but there is a shortage of dental healthcare personnel. To enhance the quality of dental care, it’s essential to anticipate the appropriate workforce needed to meet the population’s needs and make efforts to produce a workforce through medical education that meets a certain standard.

Conclusion

The authors conducted oral examinations on a total of 308 children, including 99 elementary school students, 102 middle school students, and 107 high school students in the Savannakhet region to assess the extent of dental caries experience. The following conclusions were drawn from the analysis:

1. Among 6-year-old children corresponding to first graders in elementary school, the decayed, missing, and filled teeth (DMFT) index was 6.47, the decayed, missing, and filled surfaces (DMFS) index was 14.32, with a DMFT caries prevalence of 94.95%, DMFS caries prevalence of 100%, and a caries treatment rate of 0%.

2. Among 12-year-old children corresponding to first graders in middle school, the permanent teeth decayed, missing, and filled teeth (P-DMFT) index was 1.35, the permanent teeth decayed, missing, and filled surfaces (P-DMFS) index was 2.25, with a P-DMFT caries prevalence of 50.00%, P-DMFS caries prevalence of 90.58%, a caries treatment rate of 8.70%, and a caries index of 7.25%.

3. Among 15-year-old children corresponding to first graders in high school, the permanent teeth decayed, missing, and filled teeth (DMFT) index was 1.15, the permanent teeth decayed, missing, and filled surfaces (DMFS) index was 2.48, with a P-DMFT caries prevalence of 51.40%, DMFS caries prevalence of 80.49%, a caries treatment rate of 13.01%, and a caries index of 18.70%.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

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