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Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 44-48

Assessment of dental caries and interrelationship with sugar exposure in rural population visiting a dental college

Department of Public Health Dentistry, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India

Date of Submission28-Oct-2021
Date of Acceptance19-Dec-2021
Date of Web Publication06-Apr-2022

Correspondence Address:
Avijit Avasthi
Department of Public Health Dentistry, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh - 173 205
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_170_21

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Objective: The observational study intended to estimate dental caries and check the interrelationship of sugar exposure with dental caries in people seeking dental treatment in a Dental College. Materials and Methods: Subjects were clinically assessed for dental caries and a semi-structured close-ended questionnaire was used in recording sugar consumption among the participants. Descriptive statistics was generated in frequency and percentage. Comparison of sugar consumption in relation to age, gender, and marital status was done using Unpaired T-test and Analysis of Variance (ANOVA). Correlation was explored between sugar consumption and dental caries by applying one-way ANOVA. Results: Total mean decay-missing-filled (DMF) was 3.82 ± 4.53 interquartile range (2–4). 76.6% had decayed teeth, followed by 38.1% having missing teeth and scantly quarter (21%) of subjects had undergone restorative treatment. Females had a high mean DMF score in comparison to males with nonsignificant difference. Tooth morbidity was more predominately confined to first molars and second molars. Married subjects fared poor in mean DMF with statistically significant (P < 0.002) effect in comparison to unmarried subjects. Edentulism advanced with age and the frequent intake of sugar in between meals worsened the total mean DMF.

Keywords: Dental caries, dietary sugars, epidemiology and questionnaire

How to cite this article:
Avasthi A. Assessment of dental caries and interrelationship with sugar exposure in rural population visiting a dental college. J Dent Res Rev 2022;9:44-8

How to cite this URL:
Avasthi A. Assessment of dental caries and interrelationship with sugar exposure in rural population visiting a dental college. J Dent Res Rev [serial online] 2022 [cited 2022 Dec 3];9:44-8. Available from: https://www.jdrr.org/text.asp?2022/9/1/44/342703

  Introduction Top

More than 80% of world population is affected with dental caries and ingestion of dietary sugar is primarily a risk factor for dental caries.[1] Trends show that the consumption of sugar has decreased over the period but, there are other dietary sources that contribute to increase incidence of dental caries like sugar-sweetened beverages (SSB's),[2] fruit juices, and sugar-laden items. A sticky diet rich in sugar retains on pit and fissures and as a consequence dietary clearance time gets prolonged. SSBs and fruit juices when consumed produce a sudden surge in acidic content altering the oral pH which accelerates tooth decay.[3] It is crucial to highlight that dental caries increases out-of-pocket expenditure and is rated fourth high-priced disease for treatment.[1] Similarly, an average Indian losses 117 rupees because of burden of dental disease which indicates that out-of-pocket purchase expense borne on Oral Health is less when compared to Western countries and there is less priority in maintaining Oral Health.[4]

Substantial evidence points the association of dental caries with sugar consumption. Dental caries is having multifactorial causation. The increased availability of sugar coupled with frequent intake of sugar hastens demineralization resulting in decayed teeth (DT). In India there is disproportionate distribution of oral health services for rural population since 40%–50% of rural population are inflicted with pain and discomfort because of dental caries when compared to urban population attributing to poverty, illiteracy, poor accessibility, and lack of manpower.[5]

Although there is a proposal to upgrade the existing Sub Health Centre, Primary Health Centre, and Urban Primary Health Centre into Health and Wellness Centre with the objective to deliver Oral Health Care amalgamated with Comprehensive Primary Health Care but it will take a long time to full fill the gap in oral health services[6] Previous research on dental caries is focused primarily on estimating lifetime caries experience and there is limited research focusing upon association of sugar consumption and dental caries in rural population.[7],[8],[9],[10] There has also been limited research exploring upon the burden of dental caries and tooth loss ascribing to sugar exposure.

Thus the above study intended to explore the dental caries status among rural residents and observe the association of sugar exposure with dental caries.

  Materials and Methods Top

Ethical clearance was obtained from Institutional Ethical Committee (BDC/BHUD/6175) dated July 05, 2021 before conducting the study and the study commenced for 3 months from July 2021 to September 2021 on participants reporting to dental outpatient department (OPD) in rural belt of North India. Sample size estimation was done by employing online sample size calculator Raosoft.[11] Considering population of 29,911 keeping margin of error at 5%, expected response distribution at 70% and confidence level at 95% the above sample estimated was 320. The subjects who visited dental OPD were first screened for inclusion and then explained the objective of the study. Written consent was obtained from those who were agreed for participation and clinical examination. Participants in the age range of 18–70 years were enrolled using purposive sampling and were interviewed face-to-face using semi-structured close-ended questionnaire seeking details of sugar consumption. Clinically dental caries was evaluated using decayed, missing and filled teeth (DMFT) index[12] to estimate life-time dental caries experience. The semi-structured close-ended questionnaire was also translated in Hindi language to maximize the responses. Before clinically evaluating dental caries, tooth surfaces were dried with cotton rolls to improve visual detection of dental caries. The severity of dental caries was assessed by segregating and recording the DT, missing teeth (MT) and filled teeth (FT). The subjects were interviewed for intake of sugar consumption in solid and liquid form. Demographic information was also additionally obtained.

Statistical analysis

The data obtained were subjected to statistical analysis. Descriptive statistics were computed for demographic variables and sugar consumption. Comparison of sugar consumption in relation to age, gender, and marital status was done using Unpaired T-test and Analysis of Variance (ANOVA). The independent variables were age, gender, and marital status and dependent variable was mean decay missing filled (DMF). Correlation was explored between sugar consumption and dental caries by applying one-way ANOVA.

  Results Top

The mean age of subjects was 35.13 ± 11.40 years out of which 60% (192) were males and 40% (128) were females. The prevalence of DT was 76.6% and the mean DMF score was 3.82 ± 4.53 interquartile range (2–4). Clinically 38.1% had MT and only 21.2% had FT. As shown in [Table 1] there was no significant difference in mean DMF index in relation to gender however, the total mean DMF score in females was more when compared to males. First molars and Second Molars were the most affected DT (83.5%) in mandibular arch as opposed to DT (51.5%) in maxillary arch. In the posterior region, mandibular arch had more MT (47.4%) when compared to maxillary arch (28.7%) [Table 2]. One-fifth had (20.1%) permanent restorations in posterior mandibular region in contrast to 15.4% of permanent restorations seen in maxillary posterior region and restorations were predominantly confined to 1st molar and 2nd molars. The proportion of DT in 18–45 year age group was 84.7% and 15.3% had DT in 44–70 years of age group. Comparing total mean DMF score in relation to marital status was high in married subjects and was statistically significant (P < 0.002) in comparison to mean DMF of those who were unmarried [Table 3]. With advancing age mean number of MT increased and total mean DMF deteriorated with a significant difference (P < 0.00) [Table 4]. Correlation was explored between consumption of sugar and dental caries with total mean DMF accelerating alongside increased intake of sugar depicted in [Table 5]. Correlation of sugar consumed in solid form with DMF was also observed and frequent intake of sugar in between meals worsened the total mean DMF [Table 6].
Table 1: Comparing mean decayed missing filled score in relation to gender

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Table 2: Decayed missing and filled teeth (prevalence) arch-wise

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Table 3: Comparing mean decayed missing and filled score in relation to marital status

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Table 4: Age-group comparison of mean decayed missing and filled

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Table 5: Comparing mean decayed missing filled score with sugar consumption in liquid form using one-way ANOVA test

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Table 6: Comparing mean decayed missing filled score with sugar consumption in solid form using one-way ANOVA test

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  Discussion Top

Most of the epidemiological research on dental caries in India is confined to WHO index age-groups of 5 years, 12 years, 15 years, and 35–44 years. There is a paucity of data to uncover dental caries status of subjects within the age group of 18–70 years. The overall mean DMFT in the present study was 3.82 ± 4.53 being reportedly high when compared to previous research from Shah et al. from North India[2] and a similar research by Raisidi M from South India[13] but there was discordance with previous research.[5],[10],[12] The overall prevalence of DT was markedly high which synced with similar studies[9],[14] The mean DMF score observed clinically in 45–70 years of age bracket was less in comparison to study findings from Southeast Europe.[9] The total proportion of edentulism was clinically 38.1% and scantly 14.1% had at least one missing tooth corroborating with earlier research.[10] High mean DMF in rural dwellers was conspicuous which traced to change in dietary and lifestyle practices.[5],[11] Semblance of gender with dental caries was observed insignificant however there was exception with high DT score seen in males unlike in previous findings.[8],[15] Less than quarter of subjects had undergone permanent restorations and this ponders upon addressing the knowledge gap to improve overall restorative care.[2] Less than one-fifth of the middle-aged and geriatric subjects had DT and this trend differed in contrast to previous research from India and western world.[5],[9] The frequent exposure to sugar in between meals worsened the mean DMFT score and equated with past research too.[14] Although sugar consumption in between meals was the arch-criminal for dental caries however exception was reported from a study where daily sugar intake had no significant effect on dental caries.[16] Local salivary factors and daily exposure to fluoride through the use of fluoridated toothpaste could also be attributed to nonsignificant association of dental caries and sugar exposure.[16] Investigation of DMFT component revealed that the DT score was major factor to be taken into consideration to necessitate the use of intraoral preventive agents which would help in reducing the burden of restorative care. Hence, our study made an attempt to study dose-response association of sugar frequency with dental caries.


Some of the participants may have modified their behavior while reporting sugar consumption since they were being observed for dietary practices corresponding to “Hawthorne Effect.”[14] Thus there was a possibility of underreporting sugar intake among study subjects.


From the above observational research, it is evident that there is high prevalence of dental mortality and measures should be incorporated in achieving the target of reducing dental morbidity and mortality by 15% by 2030. Promoting awareness for timely prompt restorative care should be propagated through Community Based Oral Health Campaigns.[17] Common-risk factor approach should also be channelized to lessen the load of dental caries. Media advocacy campaigns propagating takeaway messages restricting frequent intake of sugar-rich confectionaries in between meals and explaining the consequences of frequent sugar exposure associated with general health and oral health should be promoted. Regulating advertising of sugar-rich laden foods and SSBs should be strictly curbed. Imposing tax on SSB's, fruit juices, and free-sugar items should also be considered in near future which may drastically reduce the intake of sugars.[18]

  Conclusion Top

Thus, the need of hour is to address the challenge of sugar consumption, frequency, and unhealthy eating practices which contribute dental disease burden. We need to stress on the relationship of cariogenic diet and dental caries.

Ethical clearance

BDC/BHUD/6175 (dated July 05, 2021).

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Paula M. Sugars and dental caries: Evidence for setting a recommended threshold for intake. Adv Nutr 2016;7:149-56.  Back to cited text no. 1
Shah N, Mathur VP, Kant S, Gupta A, Kathuria V, Haldar P, et al. Prevalence of dental caries and periodontal disease in a rural area of Faridabad District, Haryana, India. Indian J Dent Res 2017;28:242-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
Lendrawati L, Pintauli S, Rahardjo A, Bachtiar A, Maharani DA. Risk factors of dental caries: Consumption of sugary snacks among Indonesian adolescents. Pesqui Bras Odontopediatr Clín Integr 2019;19:e4488.  Back to cited text no. 3
Balaji SM. Economic impact of dental caries in India. Indian J Dent Res 2018;29:132.  Back to cited text no. 4
[PUBMED]  [Full text]  
Patro BK, Ravi Kumar B, Goswami A, Mathur VP, Nongkynrih P. Prevalence of dental caries among adults and elderly in an urban resettlement colony of New Delhi. Indian J Dent Res 2019;19:95-8.  Back to cited text no. 5
Operational Guidelines for Oral Health Care at Health and Wellness Centre; 2018. Available from: https://ab-hwc.nhp.gov.in'download'document. [Last accessed on 2021 Apr 27].  Back to cited text no. 6
Shah N, Pandey RM, Duggal R, Mathur VP, Ranajn K, editors. Oral Health in India a Report of the Multi centric Study. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India and World Health Organization Collaborative Program; 2007. Pdf. Available from: https://arogya.maharashtra.gov.in/. [Last accessed on 2021 Apr 27].  Back to cited text no. 7
Bhardwa JV. Dental caries prevalence in individual tooth in primary and permanent dentition among 6-12 year old school children in Shimla, H.P. Int J Health Allied Sci 2014;3:125-8.  Back to cited text no. 8
Kamberi B, Koçani F, Begzati A, Kelmendi J, Ilijazi D, Berisha N, et al. Prevalence of dental caries in Kosovar adult population. Int J Dent 2016;2016:4290291.  Back to cited text no. 9
Varghese CM, Jesija JS, Prasad JH, Pricilla RA. Prevalence of oral diseases and risks to oral health in an urban community aged above 14 years. Indian J Dent Res 2019;30:844-50.  Back to cited text no. 10
[PUBMED]  [Full text]  
Sample Size Calculator by Raosoft, Inc. Available from: http://www.raosoft.com'Samplesize. [Last accessed on 2021 Jan 04].  Back to cited text no. 11
Soben P. Indices used in dental epidemiology. In: Essentials of Public Health Dentistry. 1st ed. New Delhi: Arya (Medi) Publishing House; 1999. p. 456-552.  Back to cited text no. 12
Rasidi MQ, Gheena S. The prevalence of dental caries in 18 to 30 years individual associated with socio-economic status in an outpatient population visiting a hospital in Chennai. Biomed Pharmacol J 2018;11:1295-300.  Back to cited text no. 13
Pitchika V, Standl M, Harris C, Thiering E, Hickel R, Heinrich J, et al. Association of sugar-sweetened drinks with caries in 10- and 15-year-olds. BMC Oral Health 2020;20:81.  Back to cited text no. 14
Ferraro M, Vieira AR. Explaining gender differences in caries: A multifactorial approach to a multifactorial disease. Int J Dent 2010;2010:649643.  Back to cited text no. 15
Gupta P, Gupta N, Singh HP. Prevalence of dental caries in relation to body mass index, daily sugar intake, and oral hygiene status in 12-year-old school children in Mathura city: A pilot study. Int J Pediatr 2014;2014:921823.  Back to cited text no. 16
National Oral Health Policy. Available from: https://main.mohfw.gov.in.>sites>default>files. [Last accessed on 2021 Oct 25].  Back to cited text no. 17
Sugars and Dental Caries-WHO | World Health Organization. Available from: https://www.who.int>.>Detail. [Last accessed on 2021 Dec 05].  Back to cited text no. 18


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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