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Dental Caries Experience of Students in Luang Namtha, Laos
Int J Clin Prev Dent 2023;19(4):61-68
Published online December 31, 2023;  https://doi.org/10.15236/ijcpd.2023.19.4.61
© 2023 International Journal of Clinical Preventive Dentistry.

Dong-Hyeon Kim1, Ja-Won Cho1, Hyun-Jun Yoo1, Phommavongsa Nitthasack2, Su-Kyung Jwa3

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, Ulsan College, Ulsan, Korea
Correspondence to: Su-Kyung Jwa
E-mail: chwa7179@naver.com
https://orcid.org/0000-0002-1583-0280
Received December 10, 2023; Revised December 14, 2023; Accepted December 20, 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 authors aim to investigate the dental caries experience among students in the Luang Namtha region of Laos.
Methods: We analyzed the results of oral examinations conducted on a total of 288 individuals in the Luang Namtha region, including 95 primary school students, 96 middle school students, and 97 high school students, to assess the extent of dental caries experience among these children.
Results: The decayed permanent teeth index for 12-year-old children was 1.08, the decayed permanent tooth surface index was 1.96, the permanent teeth caries experience rate was 45.83%, the decayed permanent teeth rate was 98.08%, the treated permanent teeth rate was 0.96%, and the caries fatality rate was 14.42%.
Conclusion: The prevalence of dental caries experience was high across most age groups, with a permanent tooth decay rate of approximately 95-98%, and notably, primary tooth decay was found to be around 99%. The dental caries fatality rate was also estimated at 15-19%, highlighting the need for concurrent preventive and treatment programs in Laos to halt the progression of dental caries and reduce fatality rates.
Keywords : dental caries, oral examination, oral examination, tooth decay, periodontal diseases
Introduction

The Lao People’s Democratic Republic is located within the Indochinese peninsula in Southeast Asia and, although it is considered a developing country, it has achieved rapid economic development in recent years [1]. Laos receives economic, social, and medical support from many countries including Korea, Japan, and China in the form of non-governmental organizations, providing volunteer services such as epidemic prevention [2].

Currently, Laos has public or national organizations such as the Ministry of Health, National Medical University, and hospitals, as well as dental hospitals, dental colleges, para-medical professional schools, central health centers, and local depart-ments. However, efforts to improve health and prevent diseases are insufficient, especially in the area of oral health programs [3-7].

In Laos, the government, influenced by the communist society, has primarily managed the dental delivery system, which is slowly transitioning to a private dental practice system available only in the evenings. According to market theory, the prevalence of basic oral diseases such as dental caries and periodontal diseases remains high due to the current lack of public oral health programs [3-7]. A representative oral health program attempted in Laos is the SMART (simplified and modified atraumatic restorative technique) program, which is a modification of the ART (atraumatic restorative technique) program developed in Thailand [3-7].

There are approximately 924 dentists in Laos, with an estimated 7,467 patients per dentist. There are 387 private dental clinics and 15 dental laboratories operating in the country [2]. In this study, the author aims to survey the status of dental caries experience among children in the Luang Namtha province area to use as baseline data for the implementation of public oral health projects by the Lao government.

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 Luang Namtha Province of Laos. The study differentiated between urban and rural areas, selecting elementary, middle, and high schools in each area based on recommendations from the Lao Dental Association and the Lao Ministry of Education. The students from these schools were then chosen as the subjects for this research (Table 1).

Table 1 . Age and gender distribution of study participants

AgeLuang NamthaUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
Total28811916914763841415685
6-year-old954154492227461927
12-year-old964848522428442420
15-year-old973067461729511338


2. Methods

1) Composition of the research team

The survey team was composed of 13 members in total, including 7 dentists from South Korea, 3 dentists from Laos, 1 assistant and recorder, and 2 administrative staff. Training for the survey team was conducted just before the survey to standardize the criteria and ensure consistency among all team members.

2) Research schedule

The survey was conducted in two phases, with the schedule as follows:

First phase (Urban area): September 24, 2018

Second phase (Rural area): September 25, 2018

3) Survey criteria

The examination standards for the teeth under inspection are as follows [8-11]:

0: Sound teeth: Teeth without active carious lesions and no evidence of treated caries.

1: Carious teeth: Teeth with softened dentin or exposed dentin due to caries.

3: Caries-experienced treated teeth: Teeth filled with permanent filling materials without surrounding decay and teeth with prosthetic crowns due to caries.

4: Caries-experienced extracted teeth: Permanent teeth extracted due to caries, including prosthetic teeth but excluding abutment teeth of prosthetics.

5: Non-caries-experienced extracted teeth: Permanent teeth lost due to reasons other than caries (trauma, congenital anodontia, periodontal disease, orthodontic extraction) and not counted as caries-experienced.

6: Fissure-sealed teeth: Teeth that have undergone fissure sealing.

7: Non-caries-experienced treated teeth: Permanent teeth with prosthetic crowns or bands due to reasons other than caries (trauma, developmental disorders, prosthetics, orthodontic appliances) and not counted as caries-experienced.

8: Un-erupted teeth.

9: Unrecordable teeth.

4) Statistical processing

The results of the oral examinations were entered using the statistical software EXCEL (Version 2016, Microsoft Inc, USA). Descriptive statistics were then calculated in SPSS version 24.0. For the 6-year-old primary students, the decayed and filled primary teeth rate (df rate), decayed and filled teeth index (dft index), decayed and filled tooth surfaces index (dfs index), decayed primary teeth rate (dt rate), and filled primary teeth rate (ft rate) were computed. Similarly, for the 12-year-old middle school and 15-year-old high school students, the decayed, missing, and filled permanent teeth rate (DMF rate), decayed, missing, and filled teeth index (DMFT index), decayed, missing, and filled tooth surfaces index (DMFS index), decayed permanent teeth rate (DT rate), and filled permanent teeth rate (FT rate) were calculated.

Results

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

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

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

IndexValueLuang NamthaUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
stMean14.0014.2213.8313.3713.2713.4414.6715.3214.22
SD4.063.704.344.163.514.693.883.704.00
dtMean5.124.715.435.515.775.304.703.475.56
SD3.793.523.983.943.534.303.623.173.72
ftMean0.020.020.020.020.050.000.020.000.04
SD0.140.160.140.140.210.000.150.000.19
setMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
utMean0.020.000.040.040.000.070.000.000.00
SD0.210.000.270.290.000.380.000.000.00
etMean1.091.151.061.451.771.190.720.420.93
SD1.921.891.962.062.331.821.700.772.11
dftMean5.144.735.445.535.825.304.723.475.59
SD3.813.564.003.963.584.303.653.173.76
df rate%88.4290.2487.0487.7690.9185.1989.1389.4788.89
dt rate%99.5999.4899.6699.6399.22100.0099.54100.0099.34
ft rate%0.410.520.340.370.780.000.460.000.66

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 Luang Namtha primary school students (2)

IndexValueLuang NamthaUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
ssMean73.0372.9073.1370.2469.7770.6376.0076.5375.63
SD12.7112.1613.2213.3912.9813.9511.3410.2912.20
dsMean11.4910.7612.0613.3514.3612.529.526.5811.59
SD10.8310.2511.3011.4411.2911.729.877.1211.08
fsMean0.060.120.020.100.230.000.020.000.04
SD0.520.780.140.711.070.000.150.000.19
sesMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
dfsMean11.5610.8812.0713.4514.5912.529.546.5811.63
SD10.9110.4611.3211.5711.5611.729.897.1211.10

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 Luang Namtha region is presented in Table 4 and Table 5.

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

IndexValueLuang NamthaUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
STMean22.6623.3122.0022.1323.2521.1823.2723.3823.15
SD4.964.755.124.503.645.005.435.725.20
DTMean1.060.981.151.060.881.211.071.081.05
SD1.551.491.611.331.191.451.781.771.85
FTMean0.010.020.000.020.040.000.000.000.00
SD0.100.140.000.140.200.000.000.000.00
MTMean0.010.000.020.020.000.040.000.000.00
SD0.100.000.140.140.000.190.000.000.00
ATMean0.010.020.000.020.040.000.000.000.00
SD0.100.140.000.140.200.000.000.000.00
SeTMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
XTMean0.040.000.080.080.000.140.000.000.00
SD0.410.000.580.550.000.760.000.000.00
UTMean8.217.678.758.677.799.437.667.547.80
SD4.844.595.084.683.925.195.035.254.88
ITMean0.140.190.080.130.170.110.140.210.05
SD0.430.490.350.400.380.420.460.590.22
DMFTMean1.081.001.171.100.921.251.071.081.05
SD1.551.501.621.351.211.461.781.771.85
DMF rate%45.8343.7547.9248.0841.6753.5743.1845.8340.00
DT rate%98.0897.9298.2196.4995.4597.14100.00100.00100.00
FT rate%0.962.080.001.754.550.000.000.000.00
MT rate%0.960.001.791.750.002.860.000.000.00
Mortal rate%14.4220.838.9315.7922.7311.4312.7719.234.76

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 Luang Namtha middle school students (2)

IndexValueLuang NamthaUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
SSMean105.48108.13102.83103.15107.4299.50108.23108.83107.50
SD23.1822.1824.0821.8818.3424.2424.6025.8423.66
DSMean1.851.831.881.711.671.752.022.002.05
SD3.623.423.842.602.352.844.564.275.00
FSMean0.050.100.000.100.210.000.000.000.00
SD0.510.720.000.691.020.000.000.000.00
MSMean0.050.000.100.100.000.180.000.000.00
SD0.510.000.720.690.000.940.000.000.00
AFMean0.040.080.000.080.170.000.000.000.00
SD0.410.580.000.550.820.000.000.000.00
SeSMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
XSMean0.040.000.080.080.000.140.000.000.00
SD0.410.000.580.550.000.760.000.000.00
USMean40.4837.8543.1042.7938.5446.4337.7537.1738.45
SD23.2622.0724.3422.5919.1524.9424.0025.0523.30
DMFSMean1.961.941.981.901.881.932.022.002.05
SD3.783.593.993.002.833.184.564.275.00

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 Luang Namtha region is presented in Table 6 and Table 7.

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

IndexValueLuang NamthaUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
STMean26.9526.8327.0026.3326.0026.5227.5127.9227.37
SD2.252.212.282.772.572.911.460.861.60
DTMean1.111.101.121.541.761.410.730.230.89
SD1.841.831.862.342.172.461.130.601.23
FTMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
MTMean0.050.030.060.110.060.140.000.000.00
SD0.270.180.300.380.240.440.000.000.00
ATMean0.010.030.000.020.060.000.000.000.00
SD0.100.180.000.150.240.000.000.000.00
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
UTMean3.884.003.824.004.123.933.763.853.74
SD1.000.451.171.140.331.410.860.550.95
ITMean0.150.170.150.300.290.310.020.000.03
SD0.530.530.530.730.690.760.140.000.16
DMFTMean1.161.131.181.651.821.550.730.230.89
SD1.901.891.922.412.242.541.130.601.23
DMF rate%44.3343.3344.7852.1764.7144.8337.2515.3844.74
DT rate%95.5897.0694.9493.4296.7791.11100.00100.00100.00
FT rate%0.000.000.000.000.000.000.000.000.00
MT rate%4.422.945.066.583.238.890.000.000.00
Mortal rate%18.5820.5917.7226.3222.5828.892.700.002.94

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 Luang Namtha high school students (2)

IndexValueLuang NamthaUrban areaRural area



TotalMaleFemaleTotalMaleFemaleTotalMaleFemale
SSMean126.10125.33126.45123.89122.94124.45128.10128.46127.97
SD7.457.227.589.168.589.594.742.995.23
DSMean2.232.402.153.504.003.211.080.311.34
SD4.685.574.276.337.045.981.810.851.98
FSMean0.000.000.000.000.000.000.000.000.00
SD0.000.000.000.000.000.000.000.000.00
MSMean0.250.130.300.520.240.690.000.000.00
SD1.290.731.481.850.972.210.000.000.00
AFMean0.040.130.000.090.240.000.000.000.00
SD0.410.730.000.590.970.000.000.000.00
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
USMean19.3820.0019.1020.0020.5919.6618.8219.2318.68
SD5.012.275.835.681.667.064.312.774.75
DMFSMean2.472.532.454.024.243.901.080.311.34
SD4.965.714.636.647.176.441.810.851.98

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

Dental caries refers to the demineralization of tooth calcium by acids produced after the breakdown of sugars by various microbes in the mouth, including S. mutans and Lacto-bacillus, making it an infectious disease. Numerous public oral health programs exist to prevent such dental caries. Among them, the atraumatic restorative technique (ART) is well-known as an excellent program for public oral health in developing countries like Laos because it does not require extensive equipment or highly specialized skills to perform and supply [12-15]. The concept of prevention and early treatment is critical, especially for pediatric dental care. However, it has limitations in case selection, as it is crucial in determining the targeted subjects. The technique requires manual tools and struggles to completely remove extensive or deep cavities, hence the high risk of secondary caries [14-16].

The simplified and modified atraumatic restorative technique (SMART) program is also recommended for preschool children in Vientiane, Laos, as there is a risk of recurrent caries. In this program, sealants are provided to both preschool and school-aged children who have been identified as needing them, with prior consent from their parents. Such programs are being implemented in various regions of Laos.

Luang Namtha (ຫລວງ ນໍ້າ ທາ), meaning ‘Royal sugar farm’ or ‘Royal green river,’ is located in the northern province of Laos. It was established along with Houakhong and Bokeo provinces from 1966 to 1976. The Luang Namtha Province covers an area of 9,325 square kilometers (3,600 square miles). The provincial capital is Luang Namtha city. Geographically, it is bordered by China’s Yunnan to the north, Udomxai to the east, Bokeo to the southeast, and Myanmar to the northwest [17-19].

This province includes the Nam Ha National Biodiversity Conservation Area and is one of the main sugarcane and rubber production regions in Laos. Therefore, to develop baseline data for implementing public oral health programs in this area, which is considered one of the most underdeveloped in northwestern Laos, the author aimed to assess the extent of dental caries experience among children in the Luang Namtha region. The oral examination of 288 individuals, including 95 primary school students, 96 middle school students, and 97 high school students, revealed that the decayed primary teeth index for 6-year-olds was 5.14, the decayed primary tooth surface index was 11.56, the primary teeth caries experience rate was 88.42%, the decayed primary teeth rate was 99.59%, and the treated primary teeth rate was 0.41%. Additionally, the decayed permanent teeth index for 12- year-olds was 1.08, the decayed permanent tooth surface index was 1.96, the permanent teeth caries experience rate was 45.83%, the decayed permanent teeth rate was 98.08%, and the treated permanent teeth rate was 0.96%. The caries fatality rate was 14.42%. For 15-year-olds, the decayed permanent teeth index was 1.16, the decayed permanent tooth surface index was 2.47, the permanent teeth caries experience rate was 44.33%, the decayed permanent teeth rate was 95.58%, and the treated permanent teeth rate was 0.00%, with a caries fatality rate of 18.58%.

The decayed permanent teeth index of 1.08 for 12-year-olds in the Luang Namtha region was lower than the national average of 2.18 for 12-year-olds in Laos in 2009, and the index of 1.16 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 [20,21].

Comparing urban and rural areas, the decayed permanent teeth index for 12-year-olds was 1.10 in urban areas and 1.07 in rural areas, showing no significant difference. However, for 15-year-olds, the index was higher in urban areas at 1.65 compared to 0.73 in rural areas. The caries experience rate was generally high across most age groups, with the decayed permanent teeth rate being very high at around 95-98%, and notably, the decayed primary teeth rate was as high as approximately 99%. The caries fatality rate was also substantial at 15-19%. In Laos, it is considered that treatment programs should be conducted alongside prevention programs to halt further progression of caries and reduce the caries fatality rate. Furthermore, continued attention from the Lao Ministry of Health and the Dental Association is required, and external volunteer organizations should establish and proceed with long-term plans rather than short-term projects.

Conclusion

The authors analyzed the results of oral examinations conducted on a total of 288 individuals in the Luang Namtha region, including 95 primary school students, 96 middle school students, and 97 high school students, to assess the extent of dental caries experience among these children and reached the following conclusions:

1. The decayed primary teeth index for 6-year-old children was 5.14, the decayed primary tooth surface index was 11.56, the primary teeth caries experience rate was 88.42%, the decayed primary teeth rate was 99.59%, and the treated primary teeth rate was 0.41%.

2. The decayed permanent teeth index for 12-year-old children was 1.08, the decayed permanent tooth surface index was 1.96, the permanent teeth caries experience rate was 45.83%, the decayed permanent teeth rate was 98.08%, the treated permanent teeth rate was 0.96%, and the caries fatality rate was 14.42%.

3. The decayed permanent teeth index for 15-year-old children was 1.16, the decayed permanent tooth surface index was 2.47, the permanent teeth caries experience rate was 44.33%, the decayed permanent teeth rate was 95.58%, the treated permanent teeth rate was 0.00%, and the caries fatality rate was 18.58%.

Conflict of Interest

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

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