Vol. 49, No. 3, Summer 1989

BRIEF REPORT

167

Dental Caries Assessment of Mississippi Head Start Children

Aaron Trubman, DDS, MPH Stephen L. Silberman, DMD, DrPH Edward F. Meydrech, PhD Department of Diagnostic Sciences School of Dentistry University of Mississippi 2500 North State Street Jackson. MS 39216

Abstract This study assessed the dental caries status and

treatment needs of Mississippi Head Start children dur- ing the 1987-88 school year. The 2,393 children exam- ined, representing a 10 percent random sample of all Mississippi Head Start children, were three to six years old with a majority being four to five years old. The mean deft ranged from 1.34 for three-year-olds to 4.32 for six-year-olds; the mean defs ranged from 2.33 to 9.99. More than 50 percent of primary teeth of three- year-olds with dental caries experience required treat- ment, whereas less than one-quarter of similarly affect- ed teeth of six-year-olds were in need of treatment.

Key Words: dental caries, primary teeth, Head Start, preschool children, treatment needs

Operation Head Start is a federally sponsored, locally administered program for preschool children from low- income families. Head Start contains four important dental components: screening, health education, treat- ment, and prevention. A national survey (1) indicated that children one to five years of age had an average of one primary tooth with caries experience (deft). How- ever, combining and averaging age groups provided data that do not allow age-specific comparisons. Stud- ies of Head Start populations in other states provide data that are somewhat confusing and of questionable value to Mississippi populations. Tong and Leske (2) found a mean deft of 3.56 among children four to six years of age. Racial differences were not noted. Mur- phy et al. (3) studied children living on the Gulf Coast of Alabama, Mississippi, and Louisiana. Their data in- dicated a range of 5.33-7.93 deft per child for four- to five-year-olds with no apparent racial differences.

Trubman (4) examined 408 white children at three nonfluoridated sites. His data indicate a deft of 1.47, 2.73, and 3.99 for three-, four-, and five-year-old chil-

Partial funding for this study was provided by the US Department of Health and Human Services, contract #R4-0932-PHS-86. This article is based on a roundtable presentation at the 115th Annual Meeting of the American Public Health Association, October 1987, New Orleans, Louisiana. Manuscript received: 6/24/88; returned to author for revi- sions: 7/28/88; accepted for publication: 11/10/88.

dren, respectively. Pugnier and Irgens (5) examined 1,049 children ages three to sixyears old and reported a deft of 2.8 per child. However, the primary central and lateral incisors were not included in the study. Barton and Saunders (6) examined 908 children and found a deft of 5.3 per child in their two-year study of four- to five-year-olds. More recently, Parker and Fultz (7) re- ported defts ranging from 1.0 to 4.26 among 276 Head Start children, and Johnson et al. (8) reported defts ranging from 2.0 to 2.8 among urban and rural, fuori- dated and nonfluoridated communities.

This study was conducted to provide the necessary baseline data for reliably estimating treatment costs and evaluating dental health education, prevention, and treatment activities.

Methods The population for this study consisted of all children

enrolled in Mississippi Head Start programs. To obtain a representative sample for the state, a random cluster design was employed in which each Head Start class- room within each center was designated as a cluster. A 10 percent sample was selected. The resultant sample of 2,393 children was located in 31 of 313 centers throughout the state. Prior to the start of the study, the examination procedure was standardized, and the ex- aminers were calibrated on a group of nonparticipating Head Start children. All examinations were performed by the same two examiners. Permission for the dental examination was obtained prior to visiting the centers. All children present in the classroom were examined while in a supine position on an examination table. A visual examination (Type 3) was performed with a den- tal mirror, no. 23 explorer, and a portable dental lamp to determine the def and DMF indices (9). Trained as- sistants recorded findings on a form developed for the study.

Histories of exposure to fluorides in drinking water were not obtained. However, discussions with Head Start officials confirmed that an overwhelming majority of children were life-long residents in the community where the centers are located. In addition, unpublished data available at the Mississippi State Department of Health confirmed that the proportion of children going to Head Start centers in fluoride-adequate sites was similar to the proportion of persons exposed to ade-

168 Journal of Public Health Dentistry

TABLE 1 Children Examined, by Age and Sex

Age Male Female Total

3 119 91 210 4 481 522 1,003 5 471 479 950 6 118 112 230 Total 1,189 1,204 2,392

TABLE 2 Mean deft and defs Components, by Age

Teeth Surfaces

Age Component Mean (SD) Mean (SD)

Decayed Filled Extracted Extraction

Total def Decayed Filled Extracted Extraction

Total def Decayed Filled Extracted Extraction

Total def Decayed Filled Extracted Extraction

Total def

indicated

indicated

indicated

indicated

0.74 0.56 0.03 0.00

1.34

1.13 0.12 0.04

2.58 1.45 1.87 0.14 0.06

3.53 1 .oo 3.03 0.26 0.03

4.32

1.30

(1.53) (1.71) (0.20) (0.00)

(2.52) (2.28) (2.17) (0.60) (0.40)

(3.41) (2.30) (2.67) (0.79) (0.42)

(3.80) (1.92) (3.12) (1.18) (0.22)

(3.94)

1.07 (2.62) 1.10 (3.50) 0.00 (0.00) 0.17 (1.02)

2.33 (5.07) 2.03 (4.25) 2.09 (4.68)

0.58 (2.99) 0.21 (2.00)

4.91 (8.20) 2.49 (4.75) 3.85 (6.50) 0.31 (2.12) 0.68 (3.97)

7.33 (10.70) 1.96 (4.55) 6.60 (9.15) 0.15 (1.09) 1.28 (5.89)

9.99 (12.61)

quate fluorides in the state at large (approximately 50%).

Results The number of children examined, by age and sex

distribution, can be seen in Table 1. The numbers of four-and five-year-olds were greater than for the other two age groupings. The average numbers of primary teeth and surfaces affected by dental caries can be seen in Table 2. Differences according to sex were insignifi- cant and thus are not included. As the Mississippi Head Start population contained more than 95 percent black children, racial differences are not included. As expected, dental caries experience increased with age. For example, deft increased from 1.34 at age three to

TABLE 3 Percent Primary Teeth with Dental Caries Experience, by

Tooth Type and Age

First Second Age Central Lateral Cuspid Molar Molar

3 12.9 5.7 2.9 17.1 25.7 4 21.8 11.9 9.3 30.7 44.3 5 25.1 15.7 13.5 41.3 58.0 6 21.3 18.3 11.7 50.9 65.7

4.32 at age six, and defs increased from 2.33 at age three to 9.99 at age six. Treatment received (filled plus ex- tracted) also increased with age. For example, by age six more than 75 percent of caries-affected primary teeth had received treatment. By age five, treatment received exceeded treatment needed (decayed plus ex- tracted), and by age six, the treated primary teeth were three times greater than those requiring treatment.

The percent of each primary tooth type affected by dental caries for each age can be seen in Table 3. Since the policy of Head Start is to use funds to restore only primary canines and molars and permanent teeth, these data provide a perspective on treatment needs. Primary teeth affected by caries in decreasing order were: second molar, first molar, central incisor, lateral incisor, and canine. Medicaid-eligible children received treatment as determined by the State Medicaid Com- mission. The treatment available (to a maximum of $250) includes restoration of carious lesions in any tooth, prophylaxis, and fluoride treatment.

Discussion From the authors’ experience with Head Start pro-

grams in Mississippi, it appears that the vast majority of children enroll in the program at three to four years of age and continue until eligible for grammar school. As expected, the mean deft and defs increased from age three to age six for males and females. In addition, more than 50 percent of three-year-olds’ primary teeth with canes experience required treatment; however, fewer than one-quarter of caries-affected teeth of six- year-olds required treatment. These data suggest that the treatment received increased as the children re- mained in the program, increasing from less than 50 percent of affected lesions at age three to more than 75 percent by age six.

These data were collected from a random sample of Head Start children. The similarity of demographic characteristics between the study sample and the Head Start population, and between the percent of fluoridat- ed and nonfluoridated areas, indicates that these data may be considered as representative of Mississippi Head Start’s dental caries experience of primary teeth. Since premature loss of primary molars and canines may lead to serious malocclusion problems, and con- sidering the funding limitations, the policy of Head Start regarding restorative treatment appears to be appropriate.

Vol. 49, No. 3 , Summer 1989 I69

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