thesis-edited

Chapter I

THE PROBLEM AND ITS BACKGROUND

Introduction

The oral-health status of children in the Philippines is in an

alarming state, and this is true for other countries in Asia as well.

The latest National Oral Health Survey has revealed that 97 per

cent of first-graders in public schools in the Philippines suffer from

tooth decay. Dental caries amongst public school children remains

completely untreated, leading to unnecessary pain and intra-oral

infections. The National Oral Health Survey last 2009 revealed that

six-year-old children had on average nine decayed teeth in their mouth

with 40 percent of these teeth presenting caries with pulp

involvement. Twenty percent of six-year-old children also reported

toothache during the time of the survey and the condition is the main

reason for school absenteeism in the Philippines.

According to Zimmerman 2009, the main reasons for the

neglect of oral health care are an unhealthy diet and lack of access to

appropriate levels of fluoride. Daily tooth-brushing with fluoride

toothpaste is not yet a habit for the majority of Filipino children in their

family life. The National Oral Health Survey found the highest caries

levels in highly urbanized areas and easily accessible areas (near

highways), where money for soft drinks and junk food is available,

while caries levels in remote areas are lower, most probably owing to

traditional nutritional habits (Zimmermann 2009).

The researchers, being nursing students, opted to conduct this

study on the incidence of dental-related diseases in Pakil, Laguna, in

order to gain an insight into the actual situation prevailing in the field

of oral health and dental care which according to the latest National

Oral Health Survey is in an alarming state. The researchers would like

to find out whether such alarming situation also exists in the five

barangays of Pakil. This study is relevant to Nursing Care Management,

NCM 101 and 102; the researchers believe that the theories learned in

nursing care and management could be applied in this particular

situation- oral health being a part of nursing care.

Background Information

Dental diseases have a considerable impact on self-esteem,

eating ability, nutrition and health both in childhood and older age.

Teeth are important in enabling consumption of a varied diet and in

preparing the food for digestion. In modern society, the most important

role of teeth is to enhance appearance; facial appearance is very

important in determining an individual’s integration into society. Teeth

also play an important role in speech and communication. The second

International Collaborative Study of Oral Health Systems revealed that

in all countries covered by the survey substantial numbers of children

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and adults reported impaired social functioning due to oral disease,

such as avoiding laughing or smiling due to poor perceived appearance

of teeth. Throughout the world, children frequently reported

apprehension about meeting others because of the appearance of their

teeth or that others made jokes about their teeth. In addition, dental

diseases cause considerable pain and anxiety. These factors are likely

to be exacerbated in less developed societies where pain control and

treatment are not readily available.

Dental decay also results in tooth loss, which reduces the ability

to eat a varied diet. It is, in particular, associated with a diet low in

fruits, vegetables and non-starch polysaccharides, and with a low

plasma vitamin C level. Non-starch polysaccharides intakes of less than

10 grams per day fruits and vegetable intakes of less than 160 grams

per day have been reported in edentulous subjects. Tooth loss may,

therefore, impede the achievement of dietary goals related to the

consumption of fruits, vegetables and Non-starch polysaccharides.

Tooth loss has also been associated with loss of enjoyment of food and

confidence to socialize. It is, therefore, clear that dental diseases have

a detrimental effect on quality of life both in childhood and older age.

Dental caries. The deciduous teeth erupt from 6 months and

two years of age and are lost by the early teens. The permanent

dentition replaces the deciduous dentition from the age of 6 years and

is complete by age 21. Teeth are most susceptible to dental caries

34

soon after they erupt; therefore, the peak ages for dental caries are 2–

5 years for the deciduous dentition and early adolescence for the

permanent dentition.

Nutritional status affects the teeth during the pre-eruptive stage,

however, this nutritional influence is much less important than the

post-eruptive local effect of dietary practices on caries formation.

Deficiencies of vitamin D, vitamin A and protein energy malnutrition

(PEM) have been associated with enamel hypoplasia. PEM and vitamin

A deficiency are also associated with salivary gland atrophy which

subsequently reduces the mouth’s defense against infection and its

ability to buffer plaque acids.

Dental caries occurs due to demineralization of enamel and

dentine (the hard tissues of the teeth) by organic acids formed by

bacteria in dental plaque through the anaerobic metabolism of sugars

derived from the diet. Caries occurs when demineralization exceeds re-

mineralization. The development of caries requires sugars and bacteria

to occur but is influenced by the susceptibility of the tooth, the

bacterial profile, quantity and quality of the saliva, and the time for

which fermentable dietary carbohydrates are available for bacterial

fermentation.

Dental erosion. Dental erosion is the progressive irreversible

loss of dental hard tissue that is chemically etched away from the

tooth surface by extrinsic and/or intrinsic acids and/or chelation by a

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process that does not involve bacteria. Erosion is often associated with

other forms of tooth wear such as abrasion and attrition (from over

zealous oral hygiene and grinding of teeth, for example). Poor salivary

flow or salivary deficiencies are thought to make some individuals

more susceptible to acid challenges. Low salivary flow rate or

inadequate buffering capacity are factors that exacerbates erosion.

Intrinsic acids are from vomiting and regurgitation. The extrinsic acids

are from the diet, e.g. citric acid, phosphoric acid, ascorbic acid, malic

acid, tartaric acid and carbonic acids found in fruits and fruit juices,

soft drinks—both carbonated and still, some herbal teas, dry wines and

vinegar-containing foods. The critical pH of enamel is 5.5 and therefore

any drink or food with a lower pH may cause erosion. Erosion reduces

the size of the teeth and in severe cases leads to total tooth

destruction. Extensive dental erosion requires expensive restorative

treatment. (Moynihan and Petersen 2000)

In this study, the researchers will evaluate the incidence of

dental diseases among school-age children, 6 to 8 years old, in terms

of the number of decayed, missing and filled teeth.

Conceptual Framework

Figure 1 below depicts the conceptual framework of this study

using the Input-Process-Output model. The Input frame houses the

profile of the children of the parent-respondents in terms of age,

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gender, grade level, The common factors that contribute to

development of dental problems among the children, The common

dental diseases observed among the children of the parent-

respondent, The common dental practices done by the children as

observed by the respondent-parents, The strategies or

recommendations to improve dental health. The Process frame

includes the interview and documentation of results. The Output frame

includes the implication based on the findings obtained in the

Incidence of Dental related Diseases Among School-Age children in

Pakil, Laguna.

INPUT PROCESS OUTPUT

1. Profile of the Children of Parent-respondents:

Age

Gender

Grade level

2. What are the

common factors that

contribute to

InterviewSurvey

Questionnaire-checklist

Documentation

Analysis

This implication is

based on the findings

obtained in the

Incidence of Dental

related Diseases

Among School-Age

children in Pakil,

Laguna

64

development of

dental problems

among the children?

3. What are the

common dental

diseases observed

among the

children of the

parent-

respondents?

4. What are the

common dental

practices done by

the children as

observed by the

respondent-

parents?

5. What are the

strategies or

recommendations

to improve dental

health?

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Figure 1. Conceptual Model Showing the Input, Process and Output of the Study.

Statement of the Problem

The study aims to find out the incidence of dental-related

diseases in the five barangays of Pakil, Laguna.

Specifically, it sought to answer the following questions:

1. What is the profile of the children of the parent-respondents in

terms of

a. 1.1 age;

b. 1.2 gender; and

c. 1.3 grade level?

2. What are the common factors that contribute to development of

dental problems among the children?

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3. What are the common dental diseases observed among the

children of the parent-respondents?

4. What are the common dental practices done by the children as

observed by the respondent-parents?

5. What are the strategies or recommendations to improve dental

health?

Significance of the Study

The result of this study may benefit the following:

The school age children may benefit from the study through

institution of a dental care program initiated by the local Department

of Health. The data gathered on the level of DMFT if found alarming

may trigger local officials to find ways to improve the dental health

concerns of their constituents.

The parents may become aware of the importance of dental

care and nutrition of their children. Thus, they may help in developing

good dental care and habit among their children.

The findings of this study can help triangulate the previous

findings of health organizations like the World Health Organization

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on the standard level of Decayed Missing Filled Teeth for the country

as compared to other countries. The findings may also affirm or negate

the result of the latest National Oral Health Survey which found that

the Philippines Oral Health for children is in alarming state.

The result of this study may serve as a springboard for future

researchers to conduct parallel studies with a wider scope and more

variables to consider.

Scope and Delimitation

Subject Delimitation. In this investigation, the population or

respondents covered are the 102 randomly selected children and their

parents from barangays Baño, Burgos, Gonzales, Rizal and Tavera of

Pakil, Laguna, belonging to the age group of 6 to 8 years old..

Time Delimitation. The time coverage of the study falls on the

second semester of the school year 2009 – 2010.

Definition of Terms

For clarity of understanding, the following terms are

operationally defined.

Dental diseases include dental caries, developmental defects

of enamel, dental erosion and periodontal disease (gum disease). In

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this study, dental decay, missing, filled teeth, gingivitis and bad breath

were observed and recorded.

Dental caries is synonymous to tooth decay due to action of

bacteria and sugars.

Dental erosion is the progressive irreversible loss of dental

hard tissue that is chemically etched away from the tooth surface by

extrinsic and/or intrinsic acids and/or chelation by a process that does

not involve bacteria.

Decayed Missing Filled Teeth (DMFT) is the index of

incidence of dental diseases especially among school age (6 – 12 years

old) children used by the World Health Organization (WHO) in

monitoring and evaluating dental health among countries which should

not be more than the mean DMFT of 3.0.

Dental practices of respondent-children include number of

times of daily brushing, use of toothpaste, rinsing agent and salt and

water solutions.

Factors contributing to dental problems include number of

times the respondent-children visit the dentist in a year and their

weekly diet.

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Chapter II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents a review of local and foreign related

literature and studies obtained from local libraries and surfed from the

Internet.

Local Literature

The Philippines Comprehensive Dental Health Program aims to

improve the quality of life of the people through the attainment of the

highest possible oral health. Its objective is to prevent and control

dental diseases and conditions like dental caries and periodontal

diseases thus reducing their prevalence.

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Targeted priorities are vulnerable groups such as the 5-12 year

old children and pregnant women. Strategies of the program include

social mobilization through advocacy meetings, partnership with

government organizations and non-government organizations,

orientation/updates and monitoring adherence to standards.

To attain orally fit children, the program focuses on the following

package of activities: oral examination and prophylaxis; sodium

fluoride mouth rinsing; supervised tooth brushing drill; pit and fissure

sealant application; a-traumatic restorative treatment and IEC. The

Program also integrates its activities with the Maternal and Child

Health Program, the Nutrition Program and the Garantisadong

Pambata activities of the Women’s Health and Safe Motherhood Project

(WHSMP). (Jerome, 2006)

The Department of Education of the Philippines is planning to

expand its hygiene program in a bid to improve public school health

care.

According to Education Secretary Jesli Lapus, the new

Essential Health Care Package is expected to be endorsed by public

elementary schools across the country in the next school year.

The Essential Health Care Package will include hand soap,

toothbrushes, toothpaste, and deworming tablets, he told reporters at

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a press conference. “Our goal is to reduce dental caries up to 50 per

cent and cut down on parasitic infection by another 50 per cent,”

Lapus stated. “We want our students to be in their best physical form

to perform better in school.” (Salwiczek, 2009)

Foreign Literature

Dental health refers to all aspects of the health and functioning

of our mouth especially the teeth and gums. Apart from working

properly to enable us to eat, speak, laugh (look nice), teeth and gums

should be free from infection, which can cause dental caries,

inflammation of gums, tooth loss and bad breath.

Dental caries, also known as tooth decay or cavities, is the most

common disorder affecting the teeth. The main factors controlling the

risk of dental caries are oral hygiene, exposure to fluoride and a

moderate frequency of consumption of cariogenic foods.

Teeth are also affected by “tooth wear” or erosion. This condition

is a normal part of aging where tooth enamel is lost due to exposure

from acids other than those produced by plaque.

Attrition and abrasion are other forms of tooth wear. Attrition

occurs when teeth are eroded by tooth-to-tooth contact such as teeth

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grinding. Abrasion is caused by external mechanical factors such as

incorrect tooth brushing.

Periodontal disease, also known as gum disease, is caused by

infection and inflammation of the gingiva (gum), the periodontal

connective tissues and the alveolar bone. Periodontal disease can lead

to tooth loss.

The health of our teeth and mouth are linked to overall health

and well-being in a number of ways. The ability to chew and swallow

our food is essential for obtaining the nutrients we need for good

health. Apart from the impact on nutritional status, poor dental health

can also adversely affect speech and self-esteem. Dental diseases

impose both financial and social burdens as treatment is costly and

both children and adults may miss time from school or work because of

dental pain.

Dental caries, the most common disorder affecting the teeth, is

an infectious transmissible disease where acids produced by bacteria

dissolve the teeth.

Certain bacteria such as Streptococci mutans and Lactobacilli,

can be transmitted for example from parents to children. These

bacteria are cariogenic, which means decay-causing. They initiate a

sticky film, known as dental plaque, on the surface of the tooth.

Bacteria in dental plaque use fermentable carbohydrates to form acids.

Fermentable carbohydrates are sugars and other carbohydrates from

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food and drink that can be fermented by bacteria. The acids formed

dissolve minerals such as calcium and phosphate from the tooth. This

is called demineralisation.

But tooth decay is not inevitable. Saliva clears food debris from

the mouth, neutralises acids produced from plaque bacteria and

provides calcium and phosphate to the teeth in a process called

remineralisation. Saliva also acts as a reservoir for fluorides from

toothpaste or from fluoridated water. Fluoride helps control dental

caries by remineralising the teeth and inhibiting bacterial acid

production, which reduces or slows the decay process.

Tooth decay only occurs when the process of demineralisation

exceeds re-mineralisation over a period of time.

The following factors have an important impact on dental health:

Susceptibility to dental caries varies between individuals and between

different teeth within one person’s mouth. The shape of the jaw and

oral cavity, tooth structure and the quantity and quality of saliva are all

important in determining why some teeth are simply more susceptible

to decay than others. For example, some teeth may have pits, small

cracks or fissures that allow bacteria and acids to infiltrate more easily.

In some cases, the structure of the jaw/dentition renders teeth more

difficult to clean or floss.

The quantity and quality of saliva determines the extent to which

teeth remineralise. For example relatively fewer caries are generally

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found in the lower front part of the mouth where teeth are more

exposed to saliva.

The type and number of caries-causing bacteria present in the

mouth is also relevant. All bacteria can turn carbohydrates into acids

but certain families of bacteria such as Streptococci and Lactobacilli

are more powerful acid producers. The presence of this type of

bacteria in plaque increases the risk of decay. Some people have

higher levels of decay-causing bacteria than others due to neglected or

inappropriate oral hygiene.

In recent years there has been a reduction in the incidence of

dental caries in most European countries. An increase in oral hygiene

including regular brushing and flossing to remove plaque and the use

of fluoridated toothpaste, combined with regular dental check-ups, is

thought to be responsible for the improvement.

Fluoride inhibits demineralisation, encourages remineralisation

and increases the hardness of the tooth enamel making it less acid

soluble. The proper amount of fluoride helps prevent and control

caries. Fluoride can be supplied systemically through fluoridated

community drinking water, other fluoridated beverages or by

supplementation. Alternatively it can be provided topically direct to the

tooth surface via toothpaste, mouth rinses, gels and varnishes.

In some countries, salt, milk or other beverages have fluoride

added and supplements in the form of tablets or liquid are also

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available. The level of fluoride in drinking water and food needs to be

taken into account when assessing the need for fluoride

supplementation. This is especially important in young children under

the age of 6 whose teeth are still developing. Excessive intakes of

fluoride may eventually cause a mottling of the teeth known as

"fluorosis".

Tooth brushing with fluoridated toothpaste is thought to be the

most important factor in the observed decline in dental caries in many

countries. Brushing and flossing helps concomitantly to the fluoride

application to remove bacteria from the mouth and reduce the risk of

both caries and periodontal disease.

The regular application of fluoride varnishes by dental

practitioners is an established caries preventive measure in many

countries. This practice is especially suitable for children at high risk of

dental caries.

Regular dental check-ups can help detect and monitor potential

problems. Regular plaque control and removal can help diminish the

incidence of dental caries. If very little plaque is present, the amount of

acid formed is insignificant and decay cannot occur.

Although the decline in tooth decay in many countries has been

largely linked to fluoride exposure and improved dental hygiene,

eating habits still affect the risk of tooth decay.

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For many years the simplified message to prevent tooth decay

was ‘don’t eat too much sugar and sugary foods’. Over the last few

decades sugar intake in many countries has remained constant whilst

caries levels have declined. This suggests that where appropriate oral

hygiene is practiced (i.e. regular tooth brushing using fluoride

toothpaste) the role of sugars in tooth decay is less manifest.

Advice to replace sugar with starchy foods to avoid tooth decay

is of questionable value. It is now known that any food containing

fermentable carbohydrates can contribute to tooth decay. This means

that as well as sweets and confectionery, pasta, rice, potato crisps,

fruits, and even bread can set the scene for demineralisation. For

example, a study testing the acid-producing potential of various

starchy foods including pasta, rice and bread, found that these foods

produced the same amount of acid as a 10% sucrose (table sugar)

solution. Another study found that acid formation in plaque after eating

soft bread or potato chips was greater and lasted longer than after

eating sucrose.

The physical characteristics of a food, particularly how much it

clings to the teeth also influence the tooth decay equation. Foods that

adhere to the teeth increase the risk of tooth decay compared to foods

that clear from the mouth quickly. For example crisps and biscuits stick

to teeth for longer periods than foods such as caramels and jelly

beans. This may be because caramels and jellybeans contain soluble

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sugars that are washed away more quickly by saliva. The longer

carbohydrate-containing foods are around the teeth, the more time

bacteria have to produce acid and the greater the chance of

demineralisation.

There is some debate over the relative importance of the

frequency of consuming carbohydrate foods and its link with dental

caries. As with the relationship between diet and caries, the link

appears to have been weakened with the adoption of good oral

hygiene and fluoride.

Each time we nibble a food or sip a drink containing

carbohydrates, any decay-causing bacteria present on the teeth start

to produce acid and demineralisation commences. This continues for

20 to 30 minutes after eating or drinking, longer if food debris is locally

entrapped or remains in the mouth. In between periods of eating and

drinking saliva works to neutralise the acids and assist in the process

of remineralisation. If food or drink is taken too frequently the tooth

enamel does not have a chance to remineralise completely and caries

can start to occur. This is why nibbling or sipping continuously

throughout the day should be discouraged. The best advice is to limit

the consumption of food and drink containing carbohydrates to no

more than 6 occasions per day and ensure teeth are brushed with

fluoride toothpaste twice a day.

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Baby bottle caries or nursing caries is a condition in which

infants’ teeth are damaged by prolonged frequent exposure to drinks

containing sugars usually via a baby feeding bottle. In particular,

problems arise when infants are put to sleep with a bottle of formula or

juice. The flow of saliva is greatly reduced during sleep and the sweet

liquid pools around the teeth for extended periods of time. This

provides the perfect environment for tooth decay to develop.

Some foods help protect against tooth decay. For example hard

cheese increases the flow of saliva. Cheese also contains calcium,

phosphate and casein, a milk protein, which protects against

demineralisation. Finishing a meal with a piece of cheese helps

counteract acids produced from carbohydrate foods eaten at the same

meal. Milk also contains calcium, phosphate and casein, and the milk

sugar, lactose, is less cariogenic (caries causing) than other sugars.

Nevertheless caries have been found in children breastfed frequently

on demand.

Tooth -friendly products are formulated using sweetening

ingredients that cannot be fermented by the mouth bacteria. Intense

sweeteners such as saccharin, cyclamate, acesulfame-K and

aspartame, and sugar substitutes such as isomalt, sorbitol and xylitol

fall into this category.

Sugar-free chewing gums use these sweeteners. Both the sweet taste

and chewing stimulate salivary flow, which contributes to the

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prevention of caries. Such chewing gums may also contain minerals

such as calcium, phosphate and fluoride to enhance the repair process.

Studies have reported that chewing sugar-free gum after a meal

accelerates the clearance of food debris and reduces the rate of caries

development in children.

Tooth-friendly products have to comply with a specific test

regimen in order to get ‘safe for teeth’ approval.

Tooth erosion is the loss of dental hard tissue from the tooth

surface by chemical processes, usually acid, without involving plaque

bacteria. There are many acidic foods and drinks in our diet and it is

possible that in a susceptible individual in certain circumstances, for

example, a higher frequency of exposure to acidic foods and/or drinks,

erosion may occur. This increased frequency of exposure may override

the natural buffering capacity of the mouth, which varies between

individuals.

It is advised to avoid frequent nibbling and sipping of acidic foods

and drinks throughout the day, restricting their consumption preferably

to main meals, and to clean teeth at least twice per day using fluoride

toothpaste. It has been suggested that cleaning teeth immediately

after consuming an acidic food or drink should be avoided as this can

result in physical wear to the teeth resulting from tooth brushing in the

presence of acid. Chewing sugar free chewing gum to stimulate

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salivary secretion following an acid challenge helps neutralize the acid

effects.

The incidence of dental caries in children and adolescents in

most European countries has been declining for some years. This is

largely attributed to exposure to fluoride, primarily from fluoride

toothpaste, and improved oral hygiene. Over the same period the diet,

including the intake of sugar and other carbohydrates has remained

fairly constant. Where dental caries is largely under control by fluorides

and regular dental care (as in most European countries), moderate

consumption of sugars is not a major risk factor except in individuals

who are highly susceptible to dental caries or do not use fluoride

toothpaste properly.

More than half of all 5 to 7 year-old European children have no

dental caries in their primary (milk) teeth. In general, those who have

dental caries have only one tooth affected. The “DMF-T index” which

refers to the number of Decayed, Missing and Filled Teeth is used to

measure the prevalence of dental caries. In 12 year-old European

children dental caries levels began to fall during the 1980s and

continued to fall during the 1990s reaching the WHO global oral health

goals set for the year 2000. DMF-T figures in this age group range from

1 in Finland and the Netherlands, to 3 in Portugal, although it is higher

in some Eastern European countries. In some countries dental caries is

becoming polarised with 80% of decay being found in just 20% of the

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population. For these high-risk groups targeted intervention strategies

are recommended.

In many countries the reduction in dental caries seen in children

is now extending to adolescents and young adults. Elderly people are

now keeping their teeth longer. The risk of root caries, when gums

recede, can also be controlled by the preventive measures described.

Good oral hygiene and the use of fluoride are now considered the

main factors responsible for preventing tooth decay and promoting

good oral health. The following advice is also important for keeping

teeth caries-free.

Start dental care early, brush baby’s teeth with a fluoride

toothpaste as soon as they appear in the mouth. Do not

habitually allow infants to fall asleep while drinking from a

bottle of milk, formula, juice or sweetened drink. These

sweet liquids pool around the baby’s teeth for long periods

of time and can lead to “baby bottle tooth decay”.

Brush teeth twice a day with fluoride toothpaste. And if

possible, clean between the teeth with dental floss or

toothpicks once a day. Do not eat after cleaning teeth at

bedtime as salivary flow decreases as we sleep.

Visit the dentist about every 6 months for a check-up. And

seek dentist's advice before using aesthetic products (e.g:

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teeth whiteners) that could have a deleterious effect on the

teeth.

Do not nibble food or sip drinks continuously. Allow time

between eating occasions for saliva to neutralise acids and

repair the teeth.

People at high risk from tooth wear and erosion should

take special precautions, such as:

o decrease frequency and contact with acidic foods

and drinks;

o Avoid brushing teeth immediately after consuming

acidic foods, drinks, citrus fruits and juices. This allows

time for remineralisation to occur.

Fluoride mouthwashes and sugar-free chewing gum may be

useful after taking acidic food or drinks as they encourage

remineralisation.

Sugar-free chewing gum is “toothfriendly” as it helps

increase saliva flow and clears food debris from the mouth.

Good dental health is the responsibility of individuals,

communities and governments although their relative importance

varies. For example in some European countries water fluoridation is

not yet publicly acceptable and so responsibility for preventing tooth

decay lies largely with the individual.

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Dental professionals play an essential role in monitoring dental

health and treating or preventing any problems. Access to good dental

care, including regular check-ups is vital. For some people, especially

those from lower socio-economic groups, access to dental

professionals may be limited. These groups are important targets for

dental health education programmes. Schools also play an important

role in educating children on the importance of good oral hygiene and

diet. (Johnson, R. K. (2000). The 2000 Dietary Guidelines for

Americans: foundation of US nutrition policy. British Nutrition

Foundation Bulletin, 25:241-248)

Local Studies

The Philippine Nationwide Oral Health Survey conducted

between November 2005 and February 2006 in the country’s 17

regions found that, of the 4,000 pupils surveyed, 97 per cent of six-

year-olds and 82 per cent of 12-year-olds suffered from tooth decay.

One of the survey findings, however, offered hope, as it showed that

schools are the best place at which to institutionalize healthy habits.

Several pilot studies conducted in the country have shown that

implementing school-based daily fluoride tooth brushing could reduce

new dental caries by 40 per cent and oral infections by 60 per cent

(Zalwiczek, 2009).

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The baby or milk teeth are essential for good growth and

development of the child. Baby teeth allow the child to eat well and

speak clearly. Baby teeth also have the important function of guiding

the growth of the permanent teeth. The first baby or milk teeth to

appear are the lower front teeth, around the age of six to seven

months. By the time, children are two years old , nearly all the full set

of twenty baby teeth would have grown. The baby teeth will not begin

to fall till the age of five or seven years old. Care for baby teeth should

begin as soon as they appear. This includes cleaning the teeth after

meals. Pre-school children can develop tooth decay. It is important to

keep baby teeth healthy until the permanent teeth are ready to grow

which can be as late as eleven to twelve years old. It is especially

useful to bring children to the dentist for an assessment of the growth

of the teeth at ages seven, nine and eleven. At these ages, problems of

crowding or development of the jaws can be anticipated and if need

be, treated early to avoid more complex problems later. All throughout

childhood, the importance of daily hygiene and choice of healthy foods

can be inculcated in the child so that good habits can be formed and

kept for life. (Della Cruz 2002).

Foreign Studies

Often taken for granted, the monotonous task of brushing and

flossing our teeth daily has never been more important in order to

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avoid gum disease and the risks gum disease place on our overall

health. It has been estimated that 75% of Americans have some form

of gum disease, which has been linked to serious health complications

and causes various dental problems that are often avoidable.

Periodontal disease, also called gum disease, is mainly caused by

bacteria from plaque and tartar build up. Other factors that have the

potential to cause gum disease may include: Tobacco use, Clenching or

grinding your teeth, Certain medications and Genetics.

Types of Gum Disease Include: Gingivitis - The beginning stage

of gum disease and is often undetected. This stage of the disease is

reversible and Periodontitis - Untreated gingivitis may lead to this

next stage of gum disease. With many levels of periodontitis, the

common outcome is chronic inflammatory response, a condition when

the body breaks down the bone and tissue in the infected area of the

mouth, ultimately resulting in tooth and bone loss.

Signs of Gum Disease Include: Red, bleeding, and/or swollen

gums; Bad breath ; Mobility of the teeth; Tooth sensitivity caused by

receding gums; Abscessed teeth and Tooth loss.

Recent studies suggest gum disease may contribute to or be

warning signs of potentially life threatening conditions such as:

Heart Disease and Stroke - Studies suggest gingivitis may

increase the risk of heart disease and stroke because of the high levels

of bacteria found in infected areas of the mouth. As the level of

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periodontal disease increases, the risk of cardiovascular disease may

increase with it. Other studies have suggested that the inflammation in

the gums may create a chronic inflammation response in other parts of

the body which has also been implicated in increasing the risk of heart

disease and stroke.

Diabetes - People with diabetes often have some form of gum

disease, likely caused by high blood glucose, according to the CDC.

People with diabetes need to take extra care to ensure proper brushing

and flossing techniques are used to prevent the advancement of the

gum disease. Regular check-ups and cleanings with your dental

hygienist should be followed.

Chronic Kidney Disease - A study, conducted by Case Western

Reserve University, suggests that people without any natural teeth,

known as edentulous, are more likely to have chronic kidney disease

(CDK), than people with natural teeth. CDK affects blood pressure

potentially causing heart disease, contributed to kidney failure, and

affects bone health. (By Shawn Watson, 2010)

According to Shuter (2001) “Dental caries incidence is

affected by host factors that may be related to the structure of dental

enamel, immunologic response to cariogenic bacteria, or the

composition of saliva. Genetic variation of the host factors may

contribute to increased risks for dental caries. This systematic review

examined the literature to address the question, "Is the risk for dental

294

decay related to patterns of genetic inheritance?" Numerous reports

have described a potential genetic contribution to the risk for dental

caries. Studies on twins have provided strong evidence for the role of

inheritance. Establishing a basis for a genetic contribution to dental

caries will provide a foundation for future studies utilizing the human

genome sequence to improve understanding of the disease process.

Inherited disorders of tooth development with altered enamel structure

increase the incidence of dental caries. Specific genetic linkage has not

been determined for all of the syndromes of altered tooth

development. Consequently, genetic screens of large populations for

genes or mutations associated with increased caries susceptibility

have not been done. Altered immune response to the cariogenic

bacteria may also increase the incidence of caries. Association

between specific patterns of HLA genetic inheritance and dental caries

risk is weak and does not provide a predictable basis for predicting

future decay rates. The evidence supporting an inherited susceptibility

to dental caries is limited. Genetic linkage approaches on well-

characterized populations with clearly defined dental caries incidence

will be required to further analyze the relationship between inheritance

and dental caries.”

The following are abstracts of research on dental health surfed

from the Internet accessed March 20, 2010.

304

Why do Women get More Cavities Than Men? Reproduction

pressures and rising fertility explain why women suffered a more rapid

decline in dental health than did men as humans transitioned from

hunter-and-gatherers to farmers and more sedentary pursuits, says a

University of Oregon anthropologist. The conclusion follows a

comprehensive review of records of the frequencies of dental cavities

in both prehistoric and living human populations from research done

around the world. A driving factor was dramatic changes in female-

specific hormones, reports John R Lukacs, a professor of anthropology

who specializes in dental, skeletal and nutritional issues. His

conclusions are outlined in the October issue of Current Anthropology.

The study examined the frequency of dental caries (cavities) by sex to

show that women typically experience poorer dental health than men.

Among research reviewed were studies previously done by Lukacs.

Two clinical dental studies published this year (one done in the

Philippines, the other in Guatemala) and cited in the paper, Lukacs

said, point to the same conclusions and "may provide the mechanism

through which the biological differences are mediated." (University

of Oregon,2008)

Finnish Kids' Dental Health Decaying. The condition of

Finnish children's teeth is going downhill. Only about half of all twelve-

year olds have a healthy smile. Dentists say they have even been

314

forced to remove cavity-filled teeth from some children -- a procedure

quite uncommon in the past. Unhealthy eating is part of the problem.

More children are drinking soda and nibbling on unhealthy snacks than

ever before. But not all the blame can be placed on poor eating habits.

There are cracks in education as well. Schools aren't providing children

with sufficient information on dental hygiene -- mainly because they

lack proper instruction materials. Furthermore less than 40 percent of

boys between the ages of 14 and 18 brush their teeth twice a day. For

girls the number is over 50 percent. From the mid 1970s to the early

1990s, dentists saw a decline in the number of cavities in children's

teeth. Nowadays, Finnish children's teeth rank about average when

compared to other European countries. The condition of Finnish

children's teeth is going downhill. Only about half of all twelve-year

olds have a healthy smile. (Anja Eerola, 2008)

New Research Gives Dental Patients Hope; Stop Cavities

Before They Start. What if your dentist could detect the potential for

a cavity to form before it ever happened? A new testing device called

the CariScreen from an Oregon company, Oral BioTech, now makes

early detection possible. Cavities are caused by a bacterial infection

called dental caries. New research by leading experts worldwide

confirms that this infection while complex, is identifiable and treatable,

no needles or drills necessary. The CariScreen is a hand-held meter

324

that utilizes ATP bioluminescence technology to detect the levels of

acid-producing, decay-causing bacteria residing in an individual's

plaque. Contrary to popular belief, not all plaque is bad plaque. Only

when there has been a shift from the normal healthy micro flora of the

mouth to an unhealthy acidic bacterial population does dental decay

become possible. The CariScreen technology allows dentists to take a

quick, painless swab sample of patients' plaque and using the meter,

get a reading within 15 seconds as to whether there are too many of

these acidic bacteria present. The revolutionary aspect here is that this

shift in bacterial population can now be identified and health restored

before a cavity ever has a chance to form. (Albany, 2008)

Children Enrolled in Medicaid Have More Untreated Tooth

Decay. Children covered under Medicaid receive considerably less

dental care and have more untreated tooth decay than those who are

privately insured, witnesses testified during a recent hearing held by

the House Oversight and Government Reform Domestic Policy

Subcommittee, CQ HealthBeat reports.

According to CQ HealthBeat, a Government Accountability

Office report released last month found that an estimated 6.5 million

children covered by Medicaid had untreated tooth decay in 2005. Alicia

Cackley, acting director of health care at GAO, in written testimony

334

said that children covered by Medicaid between 1999 and 2004 were

almost twice as likely to have untreated tooth decay. She added that

15% of children in Medicaid had difficulty receiving dental care

because the provider did not accept their insurance plan, compared

with 2% of privately insured children.

According to James Crall 2008, director of the National Oral

Health Policy Center at University of California-Los Angeles, said

"chronically low" reimbursement rates discourage many dentists from

participating in the program. He added that increases in provider

reimbursement have increased the rate of children covered by

Medicaid using dental services in several states. He also suggested

streamlining provider enrollment and separating dental benefits from

the rest of the Medicaid program to "allow states to retain greater

control in setting reimbursement rates, and allow for reasonable profits

on the part of the dental benefits managers while eliminating the

incentive to reduce payments to dentists who provide dental services

to Medicaid beneficiaries."

Parents Blamed for State of Children’s Teeth. Bad

parenting is today blamed for the shocking state of children’s teeth in

Wales. A politician launched the astonishing attack on parents as

dentists told the Western Mail it is “not unusual” for children as young

as three in Wales to have their milk teeth filled. Thousands of Welsh

children are undergoing a general anaesthetic in hospital every year to

344

have decayed teeth removed. And other experts have revealed that

some young children in the South Wales Valleys do not know what a

toothbrush is or even recognize the taste of toothpaste.

According to Jonathan Morgan 2008, the Conservatives’

shadow health minister, blamed “parental neglect” for three-year-olds

with bad teeth. He said: “Looking after a child’s teeth is fundamentally

important – not looking after their teeth is as bad as allowing them to

go outdoors without shoes. Why do we tolerate it when parents do not

ensure that their children’s teeth are clean?

Changing Dental Caries and Periodontal Disease Patterns

Among a Cohort Of Ethiopian Immigrants to Israel: 1999-2005.

Dental epidemiology has indicated that immigrants and minority ethnic

groups should be regarded as high risk populations on the verge of oral

health deterioration. The objectives of this study were to measure the

changing pattern of dental caries, periodontal health status and tooth

cleaning behavior among a cohort of Ethiopian immigrants to Israel

between the years 1999-2005. The method used was to identify

increment of dental caries and periodontal health status was recorded

among a cohort of 672 Ethiopian immigrants, utilizing the DMFT and

CPI indices. Data were gathered during 1999-2000 and five years later,

during 2004-2005. Participants were asked about their oral hygiene

habits in Ethiopia and in Israel five years since their immigration.

354

(Yuval Vered, Avi Zini, Alon Livny, Jonathan Mann and Harold

Sgan-Cohen, 2008)

Dental Care Can Reduce Risk of Preterm Birth by Nearly

50 Percent.

According to a study conducted by Aetna and Columbia

University College of Dental Medicine 2003, women who received

dental care before or during their pregnancy had a lower risk of giving

birth to a preterm or low birth weight baby than pregnant women who

didn't seek dental care at all. The study, conducted between January 1,

2003 and September 30, 2006, reviewed medical and dental insurance

data for 29,000 pregnant women who each had medical and dental

coverage with Aetna to determine if there was an association between

dental treatment and the likelihood of experiencing either birth

outcome. "Further studies need to be done but our findings show that

dental treatment had a protective effect on adverse birth outcomes in

women who sought dental treatment," said David A. Albert, DDS, MPH,

Director, Division of Community Health, College of Dental Medicine,

Columbia University.

The Save-A-Tooth system can be used to transport teeth

destined for cryopreservation and stem cell treatment of disease.

Recent research has shown that normally shedding baby teeth and

extracted wisdom teeth can be a source of stem cells that are the

364

equivalent of umbilical cord blood stem cells. The use of umbilical cord

blood as a source of stem cells has been routine for several years.

However, this method has many problems. The window of time for the

retrieval of the cord blood is very short, the hospital staff needs to be

well trained in the technique and it is expensive. Every child loses 20

baby teeth over a period of six to eight years, and 1.4 million wisdom

teeth are extracted each year. Each of these is a rich source of stem

cells In the past, these teeth were thrown in the trash, but now they

can be saved and shipped to a cryo- preservation facility and the stem

cells stored until needed for the many possible future clinical

applications. “This potential source of stem cells from teeth is a

tremendous breakthrough,” said Dr. Paul Krasner, professor of

endodontics at Temple University School of Dentistry. “Four million

baby teeth a year normally fall out, and for a small cost and virtually

no effort, each can have their stem cells stored for future medical use.”

(Michmershuizen, 2009)

The foregoing related literature and studies had given the

researchers, being nursing students, adequate information and insight

into the conduct of their present study; specifically on the identification

of dental diseases, diagnosis, signs, symptoms, prevention and

treatment. Furthermore, the information on the factors contributing to

occurrence of dental diseases and the means of measuring the level of

dental health through the DMFT index are very useful to the

374

researchers’ current study wherein they are tasked to measure

incidence of dental diseases as caries and erosion among school-age

children in five barangays of Pakil, Laguna.

Chapter III

METHODS AND PROCEDURE

This chapter presents the research design, sources of data,

respondents of the study, research setting, data gathering and

statistical treatment of data gathered in the pursuit of the objectives of

the study.

Research Design

The descriptive survey research design was used in this study.

Best (1998), defined descriptive investigation as a method used

in research study which includes all those that present facts

concerning the nature and status of anything, a group of persons, a

number of objects, a set of conditions, a class of events, a system of

thought, or any kind of phenomena which one may wish to study.

Survey research involves researchers asking respondents

questions about a particular topic or issue and can be in a number of

384

ways – face to face, by mail through a questionnaire or by phone

(Fraenkel and Wallen 1994).

In this study, the questionnaire-checklist and interview technique

were used to elicit responses and to obtain the pertinent data needed

by the researchers.

Sources of Data

The data were derived from the responses to the questionnaire-

checklist constructed by the researchers and obtained through

interview of parents of the children-respondents and actual inspection

of the children’s teeth to determine the level of mean DMFT and the

profile and other person-related factors included in this study.

Respondents of the Study

The respondents of this study were consist of parents of school

age children from 6 to 8 years old, residing in the six barangay located

near the town proper of Pakil, Laguna. Table 1 shows the distribution of

respondents by barangay and gender.

Table 1. Distribution of School Age Respondents by Barangay and Gender.Barangay Male Female Total Percentage

1. Baño 10 10 20 19.602. Burgos 10 10 20 19.603. Gonzales 10 10 20 19.604. Rizal 10 10 20 19.605. Tavera 11 11 22 21.60

Total 51 51 102 100.00

394

Research Setting

The study will be conducted in the five (5) barangays within the

town proper of the Municipality of Pakil, Laguna. (Pls.see attached

location map in Appendix_____).

Data Gathering

A questionnaire-checklist survey form was constructed to gather

the pertinent data needed to answer the specific questions outlined in

Chapter 1 using the interview technique. The research instrument was

content-validated by their adviser and some professors of the college.

Revisions was done . Upon approval of the final draft, the researchers

proceeded to the research setting, secured the necessary permission

from the school and local authorities and conducted the study in

pursuit of the objectives of the study. The data gathered were

encoded, organized and were descriptively analyzed using the

statistical tools described in Chapter 3 in consultation with a

statistician. The final draft of the manuscript was prepared for oral

defense on the prescribed schedule.

404

Statistical Treatment of Data

The data gathered were analyzed using the following descriptive

statistical tools:

Analysis Statistical Tools

1. Profile of the respondent-children in terms of age, gender, grade level

2. Common factors that contribute to the development of dental problems among the children

3. Common dental diseases among the children

4. Common dental practices done by the children of the parent-respondents

5. The strategies or recommendations to improve dental health

1. frequency, percentage and rank

2. frequency, percentage and rank

3. frequency, percentage rank, mean or average

.

4. frequency, percentage, rank, mean or average

5. frequency, percentage, rank

Formulas Used:

FrequencyPercentage = ---------------------------- X 100

Total No. of Respondents

Sum of all observationsAverage or Mean = ------------------------------

414

Total No. of Respondents

Chapter IV

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter presents analyses and interprets the data gathered

in determining the incidence of dental-related diseases in five (5)

barangays of Pakil, Laguna.

The findings are presented according to the sequence of the

specific questions outline in Chapter 1.

Problem 1. What is the profile of the children in terms of age, gender

and grade level?

Table 2.1. Distribution of School Age Children According to Age

Age Frequency Percentage Rank

6 29 28.43 2.5

7 44 43.14 1

8 29 28.43 2.5

Total 102 100.00

Table 2.1 describes the distribution of school age children

according to age. The findings revealed that 46.14 percent of the

children were seven (7) years old followed by those with ages six(6)

years and eight(8) years each contributing 28.43 percent to the total

424

respondent children of 102. The average age of the children was

seven(7) years old.

According (Zalwiczek, 2009)One of the survey findings,

however, offered hope, as it showed that schools are the best place at

which to institutionalize healthy habits. Several pilot studies conducted

in the country have shown that implementing school-based daily

fluoride tooth brushing could reduce new dental caries by 40 per cent

and oral infections by 60 percent.

Table 2.2. Distribution of School Age Children According to Gender

Gender Frequency Percentage Rank

Male 51 50 1.5

Female 53 52 1.5

Total 104 102

Table 2.2 shows the distribution of children in terms of gender.

Since the sampling design used was purposive following a 1:1 male to

female ratio; 50 percent of them are male and 50 percent are female.

This was done to have equal representation of male and female

respondent-children.

According to John R. Lukacs reproduction pressures and rising

fertility explain why women suffered a more rapid decline in dental

434

health than did men as humans transitioned from hunter and gatherers

to farmers and more sedentary pursuit.

Table 2.3. Distribution of School Age Children According to Grade Level

Grade Level Frequency Percentage Rank

1 32 31.37 2

2 41 40.20 1

3 29 28.43 3

Total 102 100.00

In terms of grade level, 40.20 percent were Grade 2, 31.37

percent were Grade 2 and 28.43 percent were Grade 3.

The profile of the children involved in this study revealed that most of

the respondents were seven (7) years old and Grade 2 pupils.

According (Zalwiczek, 2009) One of the survey findings,

however, offered hope, as it showed that schools are the best place at

which to institutionalize healthy habits. Several pilot studies conducted

in the country have shown that implementing school-based daily

fluoride tooth brushing could reduce new dental caries by 40 per cent

and oral infections by 60 percent.

444

Problem 2. Common factors that contribute to the development of dental problems among the children

Table 3.1.Common Factors that Contributed to the Development of Dental Problems Among the Children- Visit to the Dentist

Number of Visits to the Dentist Per Year

Frequency Percentage Rank

None/ Never 75 73.53 1

Once 12 11.76 3

Twice 15 14.71 2

Total 102 100.00

It could be gleaned from Table 3.1 that 73.53 percent had not had any

dental checkup or visit for their children. About 14.71 percent had

visited the dentist twice a year and 11.76 percent had a dental

checkup at least once a year. This implies that about three-fourth of

the children had never been attended by the dentist every year.

According to Salwiczek, 2009 regular check-ups can help

detect and monitor potential problems. Regular plaque control and

removal can help diminish the incidence of dental caries. If very little

plaque is present, the amount of acid formed is significant and decay

cannot occur. Although the decline in tooth decay in many countries

has been largely linked to fluoride exposure and improved dental

hygiene, eating habits still affect the risk of tooth decay.

454

Table 3.2.Common Factors that Contributed to the Development of Dental Problems Among the Children- Weekly Diet

Weekly DietNumber of Times Eaten per Week

MinimumMaximu

m Average Rank

Rice 9 21 16.12 1

Vegetables 1 6 2.24 7

Fish 2 9 5.61 2

Meat 1 8 3.06 5

Fruits 1 7 2.46 6

Eggs 1 7 4.35 3

Milk 0 7 0.93 8

Sweets/ soft drinks 0 7 3.21 4

Table 3.2 above reveals the weekly diet of the children and the

number of times each type of food was eaten on a weekly basis.

The data collected showed that rice comprised a bigger share of

the children’s diet where a minimum of nine and a maximum of 21

times rice was eaten; on the average the respondent-children ate rice

16.12 times a week which a little bit more than twice a day. Secondly,

fish was eaten from 2 to 9 times a week or an average of 5.61 times a

week. Thirdly, eggs were part of the diet from one to 7 times a week or

an average of 4.35 times a week. Fourthly, sweets and soft drinks were

eaten or taken 3.21 times a week or every other day. Least-taken was

milk which was taken 0.93 times a week or less than one time a week.

Milk is known to be rich in calcium, vitamins and minerals which help

464

strengthen our bones including our gums and teeth. This particular

food was found wanting in the diet of the respondent-children.

According to Salwiczek, 2009 that longer carbohydrates-

containing foods are around the teeth, the more time bacteria have to

produce acid and the greater the chance of demineralization.

Problem 3. What are the common dental diseases among the

children?

Table 4.1 describes the common dental diseases observed

among the respondent-children which included decayed, missing, and

filled teeth; gingivitis and bad breath.

Table 4.1. Common Dental Diseases Observed Among the Children

Number of

Teeth Affecte

d

Common Dental DiseasesDecayed Missing Filled Gingivitis Bad Breath

Freq

%freq

%Freq

%freq

%Freq

%

None 64 62.75 51 50.00 97 95.10 88 86.27 53 5196

One 12 11.76 14 13.73 4 3.92 14 13.73 49 48.04

Two 18 17.65 14 13.73 1 0.98 0 0.00 0 0.00

Three 7 6.86 15 14.71 0 0.00 0 0.00 0 0.00

Four 1 0.98 8 7.84 0 0.00 0 0.00 0 0. .00

Total 102 100.00 102 100.00 102 100.00 102 100.00 102 100.00

Percent affected

37.25 50.00 4.90 13.73 48.04

Rank 3 1 5 4 2

474

The findings revealed that 50 percent of the children had missing

teeth or tooth loss; 48.04 percent had bad breath which could be

attributed to decayed teeth; 37.25 percent had decayed teeth; 13.73

percent had gingivitis or gum bleeding; and 4.90 percent had

filled teeth which is seldom done at this age of the respondent-

children.

As mentioned in the introduction of Chapter 1, according to the

latest national oral health survey, 97 percent of first-graders in public

schools had tooth decay while in this study, 37.25 percent of the

respondent-children had tooth decay which is 60 percent below the

national survey.

According also to the aforementioned survey, six-year olds

had an average nine decayed teeth while in this study, the average

decayed teeth per respondent-child is 0.72. Thus, this study negated

the findings of the National Oral Health Survey.

484

Problem 4. What are the common dental practices done by the

children as observed by the parents?

Table 5.1 presents the common dental practices done by the

respondent-children as observed by the parents with respect to

brushing of teeth

Table 5.1. Common dental practices done by the children as observed by the parents- Brushing of Teeth

Number of Times of Brushing the Teeth per Day

Frequency Percentage Rank

Once a day 30 29.41 2

Twice a day 41 40.20 1

Three times a day 29 28.43 3

Four times a day 2 1.96 4

Total 102 100.00

It was observed that 40.20 percent of the respondent-children

brushed their teeth twice a day; 29.41 percent brushed their teeth

once a day; 28.43 percent brushed their teeth here times a day; and

1.96 percent brushed their teeth four times a day. The findings imply

that the respondent-respondents had the habit of brushing their teeth

every day not only once but twice or thrice.

According to (Johnson, R. K. (2000).An increase in oral

hygiene including regular brushing and flossing to remove plaque and

494

the use of fluoridated toothpaste, combined with regular dental check-

ups, is thought to be responsible for the improvement.

Table 5.2. Common Oral Hygiene that usually used among children Contributed to the Development of Dental Problems Among the Children- Use of Toothpaste, Rinsing Agent or Mouthwash

Use of Toothpaste, Rinsing Agent or Mouthwash

Frequency Percentage Rank

Toothpaste

Yes 94 92.16 1

No 8 7.84 2

Total 102 100.00

Rinsing Agent

Yes 4 3.92 2

No 98 96.08 1

Total 102 100.00

Salt and Water

Yes 9 8.82 2

No 93 91.18 1

Total 102 100.00

The findings shown in Tables 5.1 and 5.2 may have contributed

to low incidence of tooth decay among the respondent children. Even

though 97 percent of the respondent-children had never visited a

dentist for a dental checkup, they had good dental care practices such

as daily brushing of their teeth with toothpaste had somehow lessened

the incidence of decayed teeth as compared to national figure.

504

Problem 5. What are the strategies or recommendations to improve

dental health?

Based on the findings of this study, the state of oral health

among school age children in Pakil, Laguna is not very alarming as

compared to the national status. However, one-third of the respondent-

children having decayed teeth is not a comfortable figure. As the

saying goes “An ounce of prevention is always better than a pound of

cure.” There is a need to formulate strategies or recommendation to

still lessen or totally eradicate the incidence of tooth decay and dental

problems among school-age children and even adults. Attached in the

appendices is an example of an Oral Health Care program which the

researchers recommend for adoption and implementation of concerned

agencies or organizations: Implementing a Tooth Brushing

Program to Promote Oral Health and Prevent Tooth Decay.

Chapter V

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

514

This chapter presents the summary of findings, the conclusions

arrived at and the recommendations offered by the researchers in the

process of determining the incidence of dental diseases among 102

school age children, 6 to 8 years old, in five barangays of Pakil,

Laguna. Specifically, it sought answers to the following questions:

1. What is the profile of the children of the parent-respondents in

terms of

1.1. age;

1.2. gender; and

1.3. grade level?

2. What are the common factors that contribute to development of

dental problems among the children?

3. What are the common dental diseases observed among the children

of the parent-respondents?

4. What are the common dental practices done by the children as

observed by the respondent-parents?

5. What are the strategies or recommendations to improve dental

health?

Summary of Findings

The following are the summary of findings of the study”

1. The findings revealed that 46.14 percent of the children were

seven (7) years old followed by those with ages six (6) years

524

and eight (8) years each contributing 28.43 percent to the total

respondent children of 102. The average age of the children

was seven (7) years old; 50 percent of them are male and 50

percent are female; 40.20 percent were Grade 2, 31.37 percent

were Grade 2 and 28.43 percent were Grade 3.

2. Seventy three and 53 hundredths (73.53) percent had not had

any dental checkup or visit for their children. About 14.71

percent had visited the dentist twice a year and 11.76 percent

had a dental checkup at least once a year. In terms of weekly

diet, on the average the respondent-children ate rice 16.12

times a week. Secondly, fish was eaten an average of 5.61

times a week. Thirdly, eggs were part of the diet for an

average of 4.35 times a week. Fourthly, sweets and soft drinks

were eaten or taken 3.21 times a week or every other day.

Least-taken was milk at 0.93 times a week or less than one

time a week. Milk is known to be rich in calcium, vitamins and

minerals which help strengthen our bones including our gums

and teeth. This particular food was found wanting in the diet of

the respondent-children.

3. The findings revealed that 50 percent of the children had

missing teeth or tooth loss; 48.04 percent had bad breath

which could be attributed to decayed teeth; 37.25 percent had

decayed teeth; 13.73 percent had gingivitis or gum bleeding;

534

and 4.90 percent had filled teeth which is seldom done at this

age of the respondent-children; 97 percent of first-graders in

public schools had tooth decay while in this study, 37.25

percent of the respondent-children had tooth decay which is 60

percent below the national survey. According also to the

aforementioned survey, six-year olds had an average nine

decayed teeth while in this study, the average decayed teeth

per respondent-child is 0.72. Thus, this study negated the

findings of the National Oral Health Survey.

4. It was observed that 40.20 percent of the respondent-children

brushed their teeth twice a day; 29.41 percent brushed their

teeth once a day; 28.43 percent brushed their teeth three

times a day; and 1.96 percent brushed their teeth four times a

day. The findings imply that the respondent-respondents had

the habit of brushing their teeth every day not only once but

twice or thrice. The findings revealed that 92.16 percent used

toothpaste; 96.08 percent did not use any rinsing agent or

mouth wash; and 8.82 percent used salt and water as a rinsing

agent or mouthwash. Even though 97 percent of the

respondent-children had never visited a dentist for a dental

checkup, they had good dental care practices such as daily

brushing of their teeth with toothpaste had somehow lessened

the incidence of decayed teeth as compared to national figure.

544

5. There is a need to formulate strategies or recommendation to

still lessen or totally eradicate the incidence of tooth decay and

dental problems among school-age children and even adults.

Attached in the appendices is an example of an Oral Health

Care program which the researchers recommend for adoption

and implementation of concerned agencies or organizations:

Implementing a Tooth Brushing Program to Promote

Oral Health and Prevent Tooth Decay.

Conclusions

Based on the findings and objectives of this study, it is concluded

that the state of oral health in the five barangays of Pakil, Laguna is

not as alarming as the national status.

It is further concluded that the respondent-children had a good

dental habit in terms of daily brushing of teeth but need to visit the

dentist at least twice a year for dental check-up and have to improve

their diet to include milk and lessen intake of sweets and soft drinks to

maintain good oral health.

Recommendations

In the light of the conclusions arrived at, it is recommended that

the attached program on Growing Healthy Smiles in the Child Care

Setting which is a Tooth Brushing Program to Promote Oral Health and

Prevent Tooth Decay be considered for implementation in the pre-

school and elementary schools.

554

It is further recommended that parallel studies be undertaken by

other researchers with a wider scope and more variables in order to

affirm or negate the findings of this study.

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Fraenkel, Jack R. and Norman E. Wallen. (1994). How to Design and Evaluate Research in Education. New York: MxGraw Hill, Inc.

Walpole, Ronald E. Introduction to Statistics. 3 rd Edition, Prentice Hall. 1982.

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Changing Dental Caries and Periodontal Disease Patterns Among a Cohort Of Ethiopian Immigrants to Israel: 1999-2005 http://7thspace.com/headlines/294319/changing_dental_caries_and_periodontal_disease_patterns_among_a_cohort_of_ethiopian_immigrants_to_israel_1999_2005.html

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Why do Women get More Cavities Than Men? (University of Oregon,2008)

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APPENDICES

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