122

Dental Journal
(Majalah Kedokteran Gigi)
2020 September; 53(3): 122–125
Research Report

The correlation analysis of dental caries, general health conditions

and daily performance in children aged 2–5 years

Darmawan Setijanto,1 Taufan Bramantoro,1 Nanissa Dyah Anggraini,2 Ardhyana Dea Maharani,2 Dwita Angesti,2 Dani Susanto Hidayat3 and Aulia
Ramadhani1
1
Department of Dental Public Health,
2
Dental Profession Program,
3
Postgraduate Program,
Faculty of Dental Medicine, Universitas Airlangga,
Surabaya – Indonesia

ABSTRACT
Background: Oral health is important for general health and quality of life. One of the oral diseases with a high prevalence in Indonesia
is dental caries. Dental caries can cause limiting disturbances of daily activities such as biting, chewing, smiling and talking, and of
psychosocial well-being, including development and general health of children. Purpose: This study aims to analyse the correlation
of dental caries incidence rate with general health conditions and daily performance of children aged 2–5 years. Methods: This was
an analytical observational cross-sectional study. The study sample was 103 pairs of children and their mothers, selected using cluster
random sampling technique. Intra-oral examination was conducted on the children to obtain decay, missing, filled-teeth (DMF-T) index
score. Information about oral impacts on daily performance (OIDP) of the children was collected through a questionnaire distributed
to the mothers. The data obtained were statistically analysed with a regression test (p < 0.05). Results: It was found that dental caries
had a significant correlation with general health (p = 0.00) and daily performance, including chewing function disorder (p = 0.00),
difficulties in maintaining oral health (p = 0.039), sleep disorders (p = 0.00), and emotional instability (p = 0.00). Conclusion: The
incidence rate of dental caries has a significant effect on the general health conditions and daily performance of children aged 2–5
years.

Keywords: child health; daily performance; dental caries; oral impact on daily performance

Correspondence: Taufan Bramantoro, Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga,
Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya 60132, Indonesia. Email: taufan-b@fkg.unair.ac.id

INTRODUCTION eat, and socialise without experiencing pain, discomfort,

or embarrassment.3 However, without adequate care,
Oral and dental health is important for general health. dental caries may occur and eventually lead to tooth decay.
Unfortunately, children seem to be vulnerable to oral and Dental caries is the main cause of toothache and tooth
dental diseases because they generally have poor oral and loss. Everyone is susceptible to dental caries throughout
dental care habits. Eating sweet food and drinking sweet their lives.4 Nonetheless, dental caries is one of the many
drinks are some examples of their bad habits.1 Based on the childhood diseases that can be prevented.
2018 Basic Health Research data, dental caries prevalence Dental caries can also interfere with the chewing system
in Indonesia was 81.5% in children aged 3–4 years and as in general or become a focal infection, thus affecting the
high as 92.6% in those aged 5–9 years. Indonesia’s decay, health and development of children.5 For instance, dental
missing, filled-teeth (DMF-T) index in 2018 was 7.1, an caries greatly affects the quality of life of children in
increase of 54% from RISKESDAS 2018.2 America, Canada and England. In Aboriginal children in
Oral health is also considered fundamental to public Western Australia, dental caries is the fifth most common
health since a healthy mouth allows individuals to talk, disease causing preschool children to be hospitalised (ages

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017.
Open access under CC-BY-SA license. Available at http://e-journal.unair.ac.id/index.php/MKG
DOI: 10.20473/j.djmkg.v53.i3.p122–125
Setijanto et al./Dent. J. (Majalah Kedokteran Gigi) 2020 September; 53(3): 122–125 123

1–4 years).6 Toothache caused by dental caries causes a of the children collected through questionnaires distributed
loss of 50 million school hours per year, affecting school to their mothers.
attendance and future adult life. The questionnaire used in this study was concerned
In Indonesia, toothache has caused 62.4% of the with oral impact on daily performance (OIDP) of the
population to experience discomfort at work/in school children involving a) eating and enjoying food, b) talking
for an average of 3.86 days per year. This condition and pronouncing clearly, c) cleaning teeth, d) sleeping
indicates that dental disease, although not fatal, reduces and relaxing, e) smiling, laughing and showing teeth
work productivity. A research in Medan even reveals without embarrassment, f) keeping emotions so as not
the impact of dental caries on four dimensions of quality to be easily offended, g) performing main work or social
of life, namely, limited function, pain, psychological roles, and h) being able to understand conversations with
discomfort and physical disability. In addition, Sheiham7 people around them. In addition, a question instrument
highlights three effects of untreated dental caries on the was added to analyse the general health conditions of the
growth and development of preschool children. First, participants. The data obtained were statistically analysed
pain caused by dental caries can interfere with children’s using a regression test with the Statistical Package for Social
food intake. Second, pain caused by dental caries can Science (SPSS, IBM corporation, Illinois, US) software
trigger sleep disturbances and subsequently leads to version 22, with a p-value of 0.05%.
glucocorticoid production and growth disturbances. Third,
chronic inflammation caused by dental caries can suppress
haemoglobin and lead to anaemia, since the production RESULTS
of erythrocytes in the bone marrow is reduced. Thus, it
is essential to treat dental caries in preschool children to This research was conducted in pre-kindergarten and
improve not only their growth and development but also kindergarten schools in Surabaya on 103 pairs of children
their quality of life.8–10 aged 2–5 years and their mothers. The dependent variable
A preliminary survey of 30 respondents conducted in in this study is caries, while the independent variable is
pre-kindegarten schools in Kenjeran Health Center working the general health conditions of children aged 2–5 years.
area found a 50% incidence rate of caries severity. For the The data were statistically analysed with a regression test
problems outlined earlier, this study is focused on the dental to find correlation between these variables. The regression
caries incidence rate and the general health conditions of test results showed a significant correlation between the
children aged 2–5 years in some pre-kindergarten and incidence rate of dental caries and the general health
kindergarten schools around the Kenjeran Health Center, conditions of those children. The distribution of respondents
Surabaya City. This study aims to analyse the correlation in this study can be seen in Table 1.
of the dental caries incidence rate with the general health Based on Table 1, the results show that 53.4% of the
conditions and the daily performance of children aged respondents had a high caries index of >6.6. Similarly, the
2–5 years. data of the children’s general health conditions indicate that
72.8% of the respondents had experienced illness in the
last two months. The correlation of dental caries incidence
MATERIALS AND METHODS rate with the children’s daily performance was statistically
analysed using the results of the OIDP questionnaire. The
This was an analytical observational cross-sectional study. results of this analysis can be seen in Table 2. Table 2
The DMF-T index of children aged 2–5 years was collected also shows the correlation of the incidence rate of dental
along with questionnaire results distributed to their mothers. caries with OIDP of each respondent. The table also
The study sample was 103 pairs of pre-kindergarten and illustrates that there was a significant correlation between
kindergarten school children and their mothers, around the incidence rate of dental caries and chewing function
Kenjeran Health Center, Surabaya, selected using the disorders, with a p-value of 0.000 (p < 0.05). However,
cluster random sampling method. This research has received there was no significant correlation between the incidence
a certificate (628/HRECC.FODM/X/2019) from the Ethics rate of dental caries and speech difficulties, with a p-value
Commission of the Faculty of Dental Medicine, Universitas of 0.195 (p > 0.05).
Airlangga. Each respondent’s parent was asked to provide The OIDP index scores indicate a significant correlation
informed consent before participating in this study. between the incidence rate of dental caries and difficulties
The severity of children’s caries was observed through in maintaining oral hygiene, with a p-value of 0.039 (p <
direct primary tooth examination (intra oral). Next, DMF-T 0.05). There was also a significant correlation between the
index measurement was conducted to observe the dental incidence rate of dental caries and sleep disorders due to
health conditions of children by observing cavities (decay), oral and dental health problems, with a p-value of 0.000(p
teeth lost due to caries (missed), and teeth that had been < 0.05). There was a significant correlation between the
filled. Based on the data collected, the DMF-T score was incidence rate of dental caries and emotional instability,
obtained and analysed statistically to find any correlation with a p-value of 0.000 (p < 0.05). There was no significant
with the general health conditions and the daily performance correlation between the incidence rate of dental caries and

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017.
Open access under CC-BY-SA license. Available at http://e-journal.unair.ac.id/index.php/MKG
DOI: 10.20473/j.djmkg.v53.i3.p122–125
124 Setijanto et al./Dent. J. (Majalah Kedokteran Gigi) 2020 September; 53(3): 122–125

difficulties in smiling due to oral health problems, with a DISCUSSION

p-value of 0.078 (p > 0.05).
In other words, the incidence rate of dental caries had This study shows a significant correlation between the
a significant correlation with the general health conditions incidence rate of dental caries and the general health
of children aged 2–5 years, related to chewing function conditions of children aged 2–5 years. This may be due to
disorders, difficulties in maintaining oral hygiene, sleep several factors that can increase the severity of dental caries,
disorders due to oral and dental health problems, and such as education level; thus, the higher the education
emotional instability due to oral and dental health problems. level, the higher the awareness of maintaining one’s own
However, the incidence rate of dental caries had no general health.5 In addition, it can also be assessed from
significant correlation with speech difficulties, avoiding how dental and oral health is maintained, such as not
meeting people, and difficulties in smiling. However, eating carcinogenic foods, use of toothbrushes, brushing
the statistical test using a regression test shows that the teeth frequently, and using proper brushing technique.11
incidence rate of dental caries has a significant effect on Similarly, Wening et al.8 argue that although there is no
the general health conditions of children aged <5 years, significant correlation between the severity of dental caries
with a p-value of 0.000 (p < 0.05). and the nutritional status of children, a decrease in desire

Table 1. Distribution of respondents

Variables N* Percentage (%)

Male 49 47.6%
Sex
Female 54 52.4%
2–3 years old 18 17.5%
Age
4–5 years old 85 82.5 %
Low (0-6.6) 48 46.6%
Caries severity
High (>6.6) 55 53.4%
Never experienced 53 51.5%
Toothache
Had experience 50 48.5%
1x a day 17 16.5%
Daily brushing habit 2x a day 79 76.7%
3x a day 7 68%
Never sick 28 27.2%
General health conditions in the last two months
Ever sick 75 72.8%
Often 62 60.2%
Having toothache
Never 41 39.8%
No 38 36.9%
Chewing function disorders
Yes 65 63.1%
No 71 68.9%
Sleep disorders
Yes 32 31.1%
No 71 68.9%
Difficulties in maintaining oral hygiene
Yes 32 31.1%
No 93 90.3%
Avoid meeting people due to oral and dental health problems
Yes 10 9.7%
No 80 77.7%
Emotional instability due to oral and dental health problems
Yes 23 22.3%
No 93 90.3%
Difficulties in smiling due to oral and dental health problems
Yes 10 9.7%
* number of respondents

Table 2. Regression test results on the correlation of the dental caries incidence rate with the children’s daily performance using the
oral impact on daily performance (OIDP) questionnaire

Risk Factor N Sig.

Chewing function disorders 103 *0.000
Speech difficulties 103 0.195
Difficulties in maintaining of oral hygiene 103 *0.039
Avoiding meeting people due to oral and dental health problems 103 0.077
Sleep disorders due to oral and dental health problems 103 *0.000
Difficulties in smiling due to oral and dental health problems 103 0.078
Emotional instability due to oral and dental health problems 103 *0.000
* significant at p-value <0.05

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017.
Open access under CC-BY-SA license. Available at http://e-journal.unair.ac.id/index.php/MKG
DOI: 10.20473/j.djmkg.v53.i3.p122–125
Setijanto et al./Dent. J. (Majalah Kedokteran Gigi) 2020 September; 53(3): 122–125 125

to eat still can be triggered by discomfort felt when eating While the OIDP focuses on ten basic daily activities,
when having a toothache. Decreased appetite can also have it does not mean that all of those ten basic daily activities
an impact on children’s general health as nutrient intake necessarily affect dental caries in children.17–19 Finally, it
decreases and causes decreased endurance. Ramayani et al.9 can be concluded that the incidence rate of dental caries has
state that children suffering from dental caries are lighter in a significant effect on the general health conditions and the
weight than those without dental caries. The findings of the daily performance of children aged 2–5 years.
previous studies strengthen the results of this study, which
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Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017.
Open access under CC-BY-SA license. Available at http://e-journal.unair.ac.id/index.php/MKG
DOI: 10.20473/j.djmkg.v53.i3.p122–125