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Byline: Urooj Saleem, Saeeda Bibi, Brekhna Jamil and Atif Riaz


Objective: To find the frequency/pattern of Early Childhood caries (ECC) and to find out the relationship of different risk factors with ECC.

Methodology: A cross sectional survey was conducted in both pediatric departments present in the dental hospitals of Peshawar, Pakistan from August 2013 to January 2014 . All children with age range of 36 years that visited pediatric department were selected. The diagnosis of ECC was solely based on clinical assessment. A parent or a caregiver was asked to complete a questionnaire regarding information about the child, their oral hygiene, demographics and feeding practices. The data was arranged categorically and analyzed using Statistical Package of Social Sciences (SPSS 16). Chi Square test was used to calculate statistical significance set at less than 0.05

Results: A total number of 320 children were selected. The Mean age of our sample was 4.2 +1.14 years Majority of children were males (n=184, 57.5%) while females were (n=136, 42.5%) The frequency of Early Childhood Caries was 85 %(272). Anterior teeth had more caries (n=139, 43.4%) than posterior and upper jaw teeth had more caries (n=171, 53.4%) than lower jaw. Feeding habits, Age, mother's age, adult supervision, and knowledge of parent were found to be significantly related with Early Childhood Caries (pless than .005), while the gender and who applies the tooth paste were found not significant

Conclusion: There is a high occurrence of early child hood caries among children visiting dental hospitals in Peshawar. Anterior upper teeth are more prone to caries.

Key Words: Early Childhood Caries, Occurrence, Pattern, Risk Factors


The Incidence of Early Childhood Caries (ECC) varies in different countries, this is dependent on the diagnostic criteria, while on the other hand in more developed or advanced countries which have more advanced oral health programs and protection techniques, the Incidence of early childhood caries is around 5%,1-5. While in southern Europe the commonness of this disease is higher around 20% in (Bosnia) apart from that in (Macedonia) it is 14%6,7. The higher prevalence of this disease is in places,5 Alaska (66.8%) and Iran (59%)8. In the United States of America the occurrence of this disease in Indian children is 41.8%8.

Likewise in North American population, the commonness of this disease ranges from 11-72% in children9. In America, its occurrence is more than asthma and seven times more than allergic rhinitis10. In India the dental caries is reported to be 51-54.1% in different researches.

In a study from Karachi, Pakistan, a research conducted reported it to be 29.1% 11. According to another study conducted in Fatima Jinnah dental college and hospital Karachi the experience of early childhood caries was 50.1%12. Caries prevalence was 51% in another study conducted in Saddar Karachi13; while a research by Sufia et al, calculated the dental carries prevalence about 40.1% among the children of 3-5 years age14.

This study is therefore planned to collect the relevant data related to early childhood caries and raise awareness in parents about it. This will provide an idea to a dentist about the link of ECC with different variables. It is important to treat early child hood caries because they affect permanent dentition. The study may also serve as a base for other researches in the same field in the future.


This cross sectional study was conducted in pediatric Department of Khyber College of Dentistry and Sardar Begum Dental College and Hospital, Peshawar. The time required to complete the study was 6 months August 2013-January 2014 after the approval by the Institutional Review Board of Khyber medical university". Ethical permission was taken from the principals of both the hospitals. Children having missing teeth due to caries and healthy children with no systematic diseases were included in our study while children with missing and decayed tooth due to trauma or some other reasons and not due to caries, congenitally missing and supernumerary teeth, un-erupted teeth were excluded

The sample size for this particular study with 95% interval, expected prevalence of ECC as 29% and 5% absolute precision was 320 which was calculated using sample size formula by WHO.


Convenient Sampling technique was selected for the collection of the relevant data required for the analysis of the study on a semi structured proforma. After obtaining consent from the patient, the children were examined in Pediatric Departments of two hospitals Khyber College of Dentistry (KCD) and Sardar Begum And Dental College (SBDC) using decayed, missing, filled teeth (dmft) indices.

Frequency and pattern were analyzed using SPSS version 16 in the form of frequencies (%).Chi Square test was applied to determine the association between Early Childhood Caries and other variables like feeding habits, child's age, child's gender ,mother's age, adult supervision while tooth brushing, who helps in applying toothpaste, parent's knowledge that sweet cause caries. Pattern was defined as something that happens in a regular and repeated way31


The Mean age of our sample was 4.2 +1.14 years. Majority of children were males (n=184, 57.5%) while females were (n=136, 42.5%). The frequency of ECC was 85%. Number of children who were breast fed less than 12 months was (n=176, 55%) and those who were on bottle fed greater than 18 months (n=115, 35.8) {Table 1].

Caries were found more in anterior teeth (n=139, 43.4%) and in upper jaw (n=171, 53.4%) as shown in Table 2.

The comparative analysis showed that feeding, child's age, mother's age, general beliefs, parents knowledge that sweet cause caries ,using tooth brush under adult supervision showed significance with early childhood caries while the variables gender and who applies tooth paste does not shows any significance with early childhood caries.

Table 1: Feeding Habits

###Feeding habits###Frequency###Percentage


###Not at all###89###27.9%

###Breast feeding###For less than 12 months###176###55%

###For greater than 12 months###55###17.1%

###Not at all###127###39.6%

###Bottle feeding###For less than 18 months###78###24.6%

###For greater than 18 months###115###35.8%

Table 2: Pattern of ECC

###Caries pattern###Frequen-###Percentage









Our study stated that occurrence of ECC was 85% compared to the studies conducted at Karachi, which showed occurrence of 29% and 50% respectively.11,12

In our study it was found that majority of the caries were in anterior teeth and upper jaw as compared to posterior and lower jaw. According to the studies by Berkowitz et al and VanHoute J et al that upper anterior are more prone to caries as compare to lower jaw teeth8,15. This may be due to the fact that nipple block entry of saliva to the upper anteriors and hence make them more prone to develop caries15.

There was a significant relationship of feeding and ECC as shown in other studies8,12,15,16. It is worth mentioning that study conducted in United States showed that children who were not breastfed had twice the risk of ECC if compared to their siblings who were breastfed17. According to WHO breast feeding should be encouraged but special instructions should be kept in mind for oral hygiene,8,15,16, . Only three factors are linked to breastfeeding i.e. duration, frequency and breastfeeding at night and three to breastfeeding and/ or bottle-feeding i.e. when used to feed or to stop the infant from crying at night, to put him/her to sleep and duration of breastfeeding longer than 18 months.17

In our study there was a significant association between age of children and ECC which was against the results obtained by a study conducted in Karachi where there was no significant association.11 however the studies conducted in Fatima Jinnah hospital Karachi, Kosovo and Brazil showed that age has the significant association with ECC12,16,17.

At the same time our study showed no significant relationship among ECC and gender of children, which supports the analysis of the researches conducted in Karachi11,12.

The result of our study showed that there was a significant association with mother's age and the occurrence of ECC. It was observed that younger the mother have less chances of occurrence of ECC this is supported by another research which was conducted in Australia. The reason might be that mothers greater than 25 years has less immunity and their oral hygiene is compromised as compared to young mothers and the other reason is that younger are more energetic than older mothers so they can supervise their children more efficiently18.

A study conducted in Karachi showed that there was a significant relationship between caries and adult supervision and who applies the tooth paste whether parent or child12. Our study showed that adult supervision was significant but it was not significant whether who applies the tooth paste on brush.

Our study revealed the fact that parent's know that sweet cause caries is significant tom ECC almost similar to the research conducted in Australia and Ireland18,19.


Recommended increasing parent's information of proper feeding habits and oral health practices Dental caries can be prevented by knowing the factors that cause the disease and then educating the people about the activities to be planned to restrict the prevalence of this disease.. To know the estimated occurrence of dental caries among the young children in Pakistan will help to employ control over it and also possible preventives measures to be taken at the early age of child.


The authors are most grateful to the children and their attendants for participating in this study and to the staff of the Sardar Begum Dental College and Hospital and Khyber College of Dentistry We are highly obliged to Dr. Hamid Hussain, Dr. Saira Afridi, Dr Fozia Bari, Dr Jamal, Dr Fahad Qiam and Dr Atif Riaz for their help in this research project


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Publication:Journal of Postgraduate Medical Institute
Article Type:Report
Geographic Code:9PAKI
Date:Mar 31, 2015

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