Singh et al.

BMC Oral Health (2020) 20:320

https://doi.org/10.1186/s12903-020-01312-2

RESEARCH ARTICLE Open Access

Assessment of oral health status

and treatment needs among people of Foklyan
area, Dharan, Nepal
A. Singh1* , A. Shrestha2 , T. K. Bhagat2 and D. D. Baral3

Abstract
Background: Oral diseases are a major public health problem globally due to high prevalence and significant social
impact. Foklyan is a peri urban area with people belonging to indigenous population of low socioeconomic status.
This study was conducted to assess the oral health status and treatment needs among the people of Foklyan area,
Dharan.
Methods: Cross-sectional house to house survey was conducted on 310 randomly selected participants. The partici-
pants were stratified into five age groups as per WHO Basic Oral Health Survey Methods 1997 and further categorized
by gender. WHO Oral Health Assessment form 1997, WHO oral health assessment questionnaire for adult/children
2013 and questionnaire for oral hygiene practice and cost as a treatment barrier were used. The examinations were
done as per WHO standard guidelines.
Results: Most of the participants were from low socioeconomic background (71.3%). About 40% of the participants
deferred dental visit due to financial burden. Although 99% of the participants brushed their teeth, there was high
caries experience (DMFT: 3.18 ± 5.85; dft: 2.40 ± 2.65). Mean sextant score for bleeding was 5.58 in 35–44 years age
group and 5.61 in 65–74 years age group. Tobacco consumption was seen in 70.9% of the adults. Prevalence of alco-
hol consumption was 58.8% among adult age groups.
Conclusion: The prevalence of dental caries, periodontal diseases, and prosthetic needs were more compared to
national data. There is a need for oral health promotion in this area.
Keywords: Sub-urban population, Nepal, Oral diseases, Oral health assessment, WHO oral health survey

Background and the lost capacity to undertake school, social and eco-
Oral health is a standard of the oral and related tissues nomic activities.
which enables an individual to eat, speak, and socialize In Nepal, ever since the commencement of National
without active disease, discomfort, or embarrassment Oral Health policy in year 2004 A.D. there has been sig-
and which contributes to general wellbeing [1]. Oral nificant amount of dental problems identified but still
health is a critical but overlooked component of overall at present the prevention and treatment of oral diseases
health and wellbeing among children and adults. Oral is virtually unavailable to the rural and underprivileged
diseases have a significant impact on the health and well- population due to various educational, cultural and
being of an individual through pain, morbidity, mortality, socioeconomic burdens [2]. The burden of oral disease
due to associated pain and discomfort may result in loss
of teeth, difficulty in eating, poor diet and consequently
*Correspondence: [email protected]
1
Narayani Hospital, Birgunj, Parsa, Nepal affect one’s appearance, self-esteem, and quality of life.
Full list of author information is available at the end of the article There is a greatly increased risk of the development of

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Singh et al. BMC Oral Health (2020) 20:320 Page 2 of 8

life-threatening sequelae to dental infections due to poor Thirty-one male and thirty-one females, for each age
nutrition, chronic diseases and the lack of availability of group, were randomly selected via lottery method from
oral health care. Socioeconomic status, occupation, and the 410 households in Foklyan. (Fig. 1).
education are playing a major role in the maintenance of This study considered (95% CI) to estimate the sample
good oral health. The maximum burden of all diseases size. For this purpose, 60.3% prevalence of dental caries
rests with the disadvantaged and socially marginalized in eastern Nepal (p) was considered, and the calculated
[3]. sample size was 256 [8]. To increase the sensitivity and
Dental caries is considered a major public health validity, and considering 15% non-response and also to fit
problem globally due to its high prevalence and signifi- the study design sample size was increased to 310. The
cant social impact. World Health Organization reports study included people above 5 years of age regardless of
60–90% of schoolchildren worldwide have experienced their medical condition (except psychiatric illness), and
caries, with the disease being most prevalent in Asian those not willing to take part in the study were excluded.
and Latin American countries [4]. In Nepal, the car-
ies prevalence is found to be 64% in urban area and 78% Survey instruments
in rural population whereas approximately 31% of age
group 35–44 years have a deep periodontal pocket [2]. a WHO Oral Health Assessment form 1997: It is uni-
The WHO oral health assessment form 1997 is univer- versally accepted and used recording methodology
sally accepted for collection of all the information needed for oral health surveys. The form includes many sec-
for planning oral care services and thorough monitoring tions, like, survey identification information, general
and re-planning of existing care services. information, extra-oral examination, TMJ assess-
Little is known about oral health attitudes and behav- ment, oral mucosa, enamel opacities/hypoplasia,
iors of people from developing countries as compared dental fluorosis, community periodontal index, loss
with developed countries [5]. There are few pieces of of attachment, dentition ststus and treatment needs,
literatures conducted on the assessment of oral health prosthetic status/need, dentofacial anomalies, need
status, oral health behavior among such underprivi- for immediate care and referral [9].
leged population in Nepal. Dental caries, gingivitis and b Questionnaire for oral hygiene practice and cost as a
periodontitis are very common oral health problems of treatment barrier: These questions were formulated
Nepalese population, and the severity is more in case of by the authors referring to various published litera-
underprivileged indigenous population groups [2]. Nepal tures.
is a poor underdeveloped country in terms of availability c WHO oral health questionnaire for children/ adult
and accessibility of resources. Foklyan is a peri urban area 2013: These questionnaires provide reliable informa-
of Dharan Sub-metropolitan city with most of the people tion about oral health status and risk to oral health.
belonging to the indigenous population of low socioeco- There are separate sets of questionnaires for adult
nomic status [6]. Studies have shown that the oral health and children. Both questionnaires have been pilot-
of such population is poor and their attitude and prac- tested in range of countries across the world [10].
tice towards oral health hygiene is often neglected [4, 7]. d Socioeconomic status: The Kuppuswamy’s Socioeco-
Hence, this study was conducted to assess the oral health nomic Status scale includes education, occupation
status and treatment needs among the people of Foklyan
area, Dharan.

5 strata (WHO basic Oral Health survey age groups 5 years, 12 years, 15
Methods
years, 35-44 years, and 65-74 years) were taken
Study design and participants
It was a community-based cross-sectional study. The
study was conducted from January 2017 to December
2017 among people of Foklyan area, Dharan, Nepal. Ethi- Male (31 randomly selected Female (31 randomly selected
cal approval was obtained from the Institutional Review from each age group): from each age group):
Committee, BPKIHS, Dharan (Ref. No.: 300/074/074- 31×5= 155 31×5= 155
IRC). Three hundred ten people were randomly selected.
A stratified random sampling technique was used. The
participants were stratified into five age groups as per Total: 155+155
WHO Basic Oral Health Survey Methods 1997 and fur- = 310
ther categorized by gender. Social mapping was done
Fig. 1 Flow diagram of the participants
to select the houses fitting as per the sampling design.
Singh et al. BMC Oral Health (2020) 20:320 Page 3 of 8

of head of the family and income per month from all statistics including the mean and standard deviations
sources. It is categorized as upper class, upper mid- were computed for DMFT/dmft. Frequency distribution
dle class, lower middle class, upper lower class, and among the study population was calculated. Frequency of
lower class. Kuppuswamy’s Socioeconomic Status oral lesions, prosthetic status and prosthetic needs, com-
scale was calculated and classified as per the modifi- munity periodontal index and loss of attachment, denti-
cations done in the year 2009 using the current con- tion status and treatment needs, dental aesthetic index
sumer price index for the year 2017 [11, 12]. Educa- were assessed. Mann–Whitney test was used to compare
tion and Occupation does not change as per time but the mean DMFT/dft. A p value < 0.05 was considered sta-
the income varies with time. So, during modification tistically significant.
of Kupuswamy Scale, the income was re-categorized
based on current consumer price index of year 2017. Results
To re-categorize the income, the current consumer The majority of the participants belonged to Dalit and
price index was obtained online from Nepal Rastra Janajati category and about 12.3% belonged to Brahmin–
Bank website [12] and the conversion factor was cal- Chhetri category as classified by Nepal Demographic and
culated (Conversion factor = Consumer Price Index Health Survey [13]. Most of the people belonged to the
2017 divided by Consumer Price Index 1976). The lower class (71.3%) followed by the middle class (1.6%)
computed conversion factor was 26.7 (144.8/4.3). For and about 27.1% did not respond to socioeconomic sta-
simplicity, the classes were re-categorized as upper tus. Majority (82.3%) of the participants’ self-perception
class, middle class and lower class [11]. regarding oral health status was good to average.
It was seen that 99% of the participants brushed their
teeth. Most of the participants brushed once a day or 2–6
Survey procedure and outcome variables times a week and it was seen that majority of the partici-
Interview of the participants were conducted during pants brushed for 3–5 min. Most of them were found to
the home visits. In case of children, either of the par- be brushing with their tooth brush (85.8%), followed by
ents gave the interview. Time taken for each interview chewing stick (23.8%). Very few were seen using thread
was 15–20 min. All the participants were examined at and wooden toothpicks for cleaning (0.9%). One partici-
their houses by a single trained and calibrated exam- pant was found using salt for cleaning teeth. Out of 99%
iner, under natural light using plane mouth mirror and who brushed their teeth, 89.1% used toothpaste. Table 1
WHO periodontal probe. Time taken for each examina- (oral hygiene practices).
tion was 5–10 min. The examinations were done as per More than 60.0% of the males and females were hav-
WHO standard guidelines. Duplicate examinations were ing toothache/discomfort in the past 12 months but only
performed among 25 participants during the study to 27.7% of males and 40.6% of females had a dental visit in
test the intra-examiner reliability. A pilot study was also their lifetime. Among the ones who had a dental visit,
conducted prior to the main study among 25 partici- pain in the teeth was the main reason for the visit. Nearly
pants of similar community for training and calibration 40% deferred dental visit due to financial problems. Out
of the examiner along with the feasibility assessment of of those who visited the dentist, 60.6% of the participants
the study. Intra-examiner reproducibility was evaluated were not able to afford the treatment and had to defer.
using Cohen Kappa statistics which showed excellent Restorative treatments were deferred most. Table 2 (Den-
agreement (K = 0.912). tal problems and financial burden).
The primary outcomes measured were prevalence of The tobacco exposure was high in the adult age groups.
dental caries, periodontal status and oral lesions along More than 70% belonging to the age group 35–44 years
with oral hygiene behavior and cost as a barrier of partic- and 65–74 years were consuming tobacco in either form
ipants. Data on socioeconomic status, enamel opacities, (smokeless or smoke form). The participants in 15 years
prosthetic needs, temporomandibular joint disorders, age group were also consuming tobacco (43.5%). The
dentofacial anomalies and dental aesthetic index were alcohol consumption in adults belonging to the age group
also obtained. Dietary habits, tobacco consumption, 65–74 years was 54.8%.
alcohol consumption, pain and discomfort were also The extra-oral status of all the participants was found
accessed. normal. Overall, only six participants were having tem-
poromandibular joint (TMJ) symptoms and on exami-
Data management and statistical measures nation it was seen that 17 (0.5%) had clicking. On
Data obtained were entered in Microsoft Excel Sheet examination for oral mucosal lesions, five of the partici-
2007 and statistical analysis was done in SPSS version pants had abscess, six had tobacco pouch keratosis, one
11.5 (SPSS, Inc., Chicago, IL, USA) software. Descriptive had leukoplakia, and six had ulceration. The lesions were
Singh et al. BMC Oral Health (2020) 20:320 Page 4 of 8

Table 1 Oral hygiene practices

5 years 12 years 15 years 35–44 years 65–74 years Total (%)

Brushing status
Male
  Yes 25 30 31 29 23 138 (98.9)
Female
  Yes 25 28 31 31 26 141 (99.1)
Duration of tooth brushing
1–2 min 17 11 8 5 11 52 (18.6)
2–3 min 8 20 20 11 10 69 (24.7)
More than 3 min 25 27 34 44 28 158 (56.7)
Frequency of tooth brushing
Never 14 10 5 2 12 43 (13.8)
Once a day 1 1 3 31 16 52 (16.7)
Twice a day 0 0 0 5 3 8 (2.5)
1–3 times/week 47 50 54 22 27 200 (64.6)
1–3 times/month 0 1 0 2 4 7 (2.4)
Rinse of mouth after each meal
Always 12 35 37 20 27 131 (42.4)
Sometimes 44 25 25 42 35 171 (54.9)
Never 6 2 0 0 0 8 (2.7)
Material used for tooth brushing
Toothbrush 48 52 58 60 48 266 (85.8)
Chewing stick 1 3 9 26 35 74 (23.8)
Toothpick 0 0 0 1 1 2 (0.6)
Others 0 0 0 1 0 1 (0.3)

seen in lips, sulci, buccal mucosa, floor of the mouth, and (43.6%). Loss of attachment of 6–8 mm was seen in
alveolar ridges. 30.9% of the 65–74 years age group where as it was only
Enamel hypoplasia with diffuse opacity was found in 6.4% in 35–44 years age group. Loss of attachment of
in only one participant of 11 years of age, whereas very 9–11 mm was also seen in six participants in both age
mild dental fluorosis was seen in 4 (1.3%) participants. groups. (Table 3).
When examined for prosthetic status, one had a bridge Tooth decay was seen in 57.5% of people with perma-
on the upper arch, and three participants had full remov- nent dentition, 28.4% of people with mixed dentition,
able denture on both upper and lower arches. Prosthetic and 65.1% of people with primary dentition. Missing
needs were present in 23.6% for the upper arch and 21.7% due to caries was also more prevalent (34.4%) in people
for the lower arch. Pain and infection were seen in three with permanent dentition followed by missing due to any
participants and immediate referral was needed for one other reason. Most of the participants had unexposed
participant for abscess management. While assessing for roots (71.5%) in permanent dentition.
Dental Aesthetic Index, elective treatment was indicated One surface filling was required for 35.5% of the par-
in 9.6% (category 2), highly desirable in 1.3% (category 3) ticipants with permanent dentition, followed by 44.1%
and mandatory in 5.8% of the participants. with primary dentition and 26.6% with mixed dentition.
The periodontal status was assessed using the Commu- Extraction was indicated in 30.6% of the participants
nity Periodontal Index (CPI) in adult age groups. Sextant with permanent dentition, followed by 11.6% with pri-
with pocket depth 4–5 mm was seen in 11.1% partici- mary dentition. Pulp care was needed mostly for partici-
pants of age group 35–44 years and 24.5% of age group pants with primary dentition (27.9%) followed by 12.3%
65–74 years. Mean sextant was more for calculus and of permanent dentition. (Table 4).
was most prevalent, with 82.3% in 35–44 years age group Mean DMFT among males was 3.14 ± 9.59, and that
and 74.5% in 65–74 years age group. Loss of attachment among females was 3.23 ± 5.76. The difference was
of 0–3 mm was more commonly observed in 35–44 years not statistically significant (p = 0.720). Also, mean dft
age groups (66.1%) and 4–5 mm in 65–74 years age group among males and females was not statistically significant
Singh et al. BMC Oral Health (2020) 20:320 Page 5 of 8

Table 2 Dental problems and financial burden

5 years 12 years 15 years 35–44 years 65–74 years Total (%)

Toothache/discomfort of participants in past 12 months

Male
  Yes 20 17 16 15 26 94 (60.7)
  No 8 11 10 7 4 40 (25.8)
  Don’t know 3 3 5 9 1 21 (13.5)
Female
  Yes 13 17 19 24 25 98 (63.4)
  No 13 9 10 6 2 40 (25.7)
  Don’t know 5 5 2 1 4 17 (10.9)
Dental visit of participants in their lifetime
Male
  Yes 1 8 13 12 9 43 (22.7)
Female
  Yes 7 10 18 14 14 63 (40.6)
Reason for dental visit
Pain 4 14 23 14 16 71 (66.9)
Treatment 0 2 1 10 4 17 (16.0)
Routine checkup 4 2 7 2 3 18 (16.1)
Deferred dental visit due to financial burden
Male 11 10 13 14 9 57 (46.7)
Female 8 13 13 13 18 65 (53.3)
Deferred dental treatment due to financial burden
Male 1 6 9 10 7 33 (43.4)
Female 3 6 12 10 10 41 (56.6)
Types of treatment deferred
Restorative 4 12 16 15 11 58 (80.6)
Prosthesis 0 0 0 0 7 7 (9.6)
Extraction 0 0 0 0 1 1 (1.4)
Scaling 0 0 1 5 0 6 (8.3)

(p = 0.400), the value being 2.64 ± 2.86 and 2.17 ± 2.416, The findings were similar to the findings by Handa et al.
respectively. [15] and Ghambhir et al. [16].
Toothache/discomfort was reported by more than
60% of the study population, but only 34.1% were found
Discussion visiting the dentist for the problem. This can be well
This study assessed the oral health status and treatment understood by the fact that most of the study popula-
needs of Foklyan area, Dharan, Nepal. The study showed tion belonged to a lower socioeconomic class. Among the
that more than 90% of the study participants cleaned ones who visited, most were seen to visit due to pain in
their teeth. Use of tooth brush was found in 85.8% of the their teeth. Pain is the most common presentation of the
study population which is similar to the study conducted dental patient visiting the dentist as reported in various
by Thapa et al. [14]. studies [17, 18]. Nepal is a poor country with most of the
The impact of oral diseases, especially in an under population belonging to the low socioeconomic status
privileged indigenous population, affects their lives influ- mostly indigenous population [13]. The dental visit was
encing eating, sleeping, and working along with social deferred by 39.3% of the study population due to financial
responsibilities. It was seen that majority of the study burden.
population perceived their oral health as good to average Use of the tobacco products was seen in 43.5% of the
despite a high prevalence of plaque, calculus, and dental 15 years age group (smokeless or smoke form) where as
caries. This might be due to the poor knowledge regard- in adult age groups more than 70.6% were found consum-
ing the understanding of oral conditions and diseases. ing tobacco products. Almost 60.0% of the adults in the
Singh et al. BMC Oral Health (2020) 20:320 Page 6 of 8

Table 3 Periodontal status (CPI)

Distribution of study population based on the specific CPI scores (as per highest scores obtained)
Age group Healthy (H) Bleeding (B) Calculus (C) Pocket 4–5 mm (­ P1)

35–44 years (n = 62) 2 (3.3%) 2 (3.3%) 51 (82.3%) 7 (11.1%)

65–74 years (n = 55) 0 0 41 (74.5%) 14 (24.5%)
Distribution of mean sextant CPI scores in each age group
Age group Healthy (0) Bleeding (1) Calculus (1 + 2 + 3 + 4) Pocket 4–5 mm Excluded
(2 + 3 + 4) sextant
(X)

35–44 years (n = 62) 0.4 (25) 5.58 (346) 5.40 (335) 0.22 (14) 0.01 (1)
65–74 years (n = 55) 0.05 (3) 5.61 (309) 5.5 (307) 0.34 (19) 0.23 (14)
Distribution of study population based on loss of attachments (as per highest scores obtained)
Age group LOA 0–3 mm (0) LOA 4–5 mm (1) LOA 6–8 mm (2) LOA 9-11 mm (3)

35–44 years (n = 62) 41 (66.1%) 14 (22.5%) 4 (6.4%) 3 (4.8%)

65–74 years (n = 55) 11 (20.0%) 24 (43.6%) 17 (30.9%) 3 (5.4%)
Distribution of mean sextant loss of attachments in each age group
Age group LOA LOA LOA LOA Excluded
0–3 mm (0) 4–5 mm (1) 6–8 mm (2) 9–11 mm (3) sextant
(X)

35–44 years (n = 62) 5.25 (326) 0.45 (28) 0.23 (14) 0.07(4) –
65–74 years (n = 55) 3.49 (192) 1.05 (58) 0.98 (54) 0.22 (12) 0.26 (14)

Table 4 Dentition status and treatment needs

Dentition status Treatment needs
Code Crown status Root status Scoresb Primary Mixed Permanent
and ­criteriaa dentition dentition dentition
Primary Mixed Permanent Mixed Permanent
dentition dentition dentition dentition dentition

0 14 (32.5%) 2 (2.5%) 4 (2.2%) 22 (27.2%) 185 (99.0%) 0 14 (32.5%) 7 (8.6%) 42 (22.6%)

1 28 (65.1%) 23 (28.4%) 107 (57.5%) 49 (60.5%) 2 (1.1%) 1 19 (44.1%) 20 (26.6%) 66 (35.5%)
2 7 (16.2%) – – 7 (8.6%) – 2 17 (39.3%) – 17 (9.1%)
3 – – 6 (3.2%) – – 3 – – 3 (1.6%)
4 – – 64 (34.4%) 2 (2.5%) – 4 – – –
5 2 (4.6%) 1 (1.2%) 46 (24.7%) 7 (8.7%) – 5 12 (27.9%) 4 (4.9%) 21 (12.3%)
6 – – – 4 (4.9%) – 6 5 (11.6%) 1 (1.2%) 57 (30.6%)
7 – – 1 (0.5%) – – 7 – – 62 (33.3%)
8 – 74 (91.4%) 133 (71.5%) – – 8 – 3 (3.7%) 105 (56.5%)
9 41 (95.3%) 42 (51.9%) 143 (76.9%) 61 (73.3%) 1 (0.5%) 9 – 2 (2.4%) 4 (2.1%)
a
Code and criteria: 0: sound; 1: decay; 2: filled with decay; 3: filled with no decay; 4: missing due to caries; 5: missing due to other reason; 6: fissure sealant; 7: Bridge
abutment, special crown; 8: unerupted tooth/crown, unexposed root; 9: not recorded
b
Scores: 0: no treatment; 1: one surface filling; 2: two or more surface filling; 3: crown of any reasons; 4: veener and laminate; 5: pulp care and restoration; 6:
extraction; 7: prosthesis; 8: oral prophylaxis; 9: not recorded

age group 35–44 years and 65–74 years were seen con- Janajatis in Nepal. Population groups who do not belong
suming alcohol, where most were consuming at least 2 to this ethnicity also have been found to be increasingly
drinks each time of consumption. Most part of Nepal has consuming alcohol [14].
cold climatic condition. Alcohol has been socially and The lesions observed on examination were very few
culturally accepted among many ethnic groups such as cases of abscess, tobacco pouch keratosis, ulceration, and
Singh et al. BMC Oral Health (2020) 20:320 Page 7 of 8

leukoplakia seen on the sulci, buccal mucosa, and floor of Survey 2004 where dental caries prevalence was reported
the mouth, and alveolar ridges. The most common lesion as 58.0%. The National Oral Health Pathfinder Survey
was tobacco pouch keratosis reflecting the high use of was conducted more than a decade ago with an inclu-
tobacco (70.0%) among the study population. These find- sive population of different ethnic communities whereas;
ings were in accordance with the study done by Bansal these study participants mostly belonged to the under-
et al. [19]. Oral mucosal lesions could be due to infection, privileged indigenous community. The neglected behav-
local trauma, or irritation (keratosis, fibroma etc.), sys- ior of such a population towards oral health, irregular
temic diseases or related to lifestyle factors such as use of brushing and improper brushing technique leads to high
tobacco, areca nut or alcohol. caries and periodontal disease [27].
Teeth in good condition are fundamental for a healthy This study had some limitations. Since questions were
oral environment and the body as a whole. Missing teeth asked about socioeconomic status, oral hygiene practice,
lead to compromised mastication, speech, and facial discomfort/problems, probable chances of recall bias
appearance that affect the overall physical and physi- may have occurred because of the long time frame. Some
ological status of an individual. It was seen that only four of the respondents (27.1%) were reluctant to give their
participants had prosthesis whereas about 25% needed income status so no responses were obtained even after
prosthesis in the upper arch and 30% needed prosthesis multiple attempts. The study was conducted in Foklyan
in the lower arch. Less use of prosthesis among the eden- area and the finding cannot be generalized to the popula-
tulous might be due to a lack of knowledge regarding tion of other areas. A larger survey is needed to explore
the importance of the prosthesis and the poor socioeco- further but this study can be considered as a reference for
nomic status of the individuals. Similar kinds of findings planning oral health programs for similar population.
were reported by the various studies [20–22].
About 3% of the participants in the 35–44 years age
group had healthy sextant. Sextant with pocket depth Conclusion
4–5 mm was seen in 11.1% participants of age group This study concluded that most of the people of Foklyan
35–44 years and 24.5% of age group 65–74 years. Despite area brush their teeth but not on a regular daily basis.
the high prevalence of brushing, sextant with calcu- There is a need for oral health promotion in this area that
lus was most prevalent, with 82.3% in 35–44 years age will enable them to better understand the importance
group and 74.5% in 65–74 years age group. This might of oral health. High prevalence of tobacco consumption
be due to irregular brushing practice and improper tech- among adult population and even half of the adolescent
nique of brushing [23]. About 40% of the study popula- population already consuming tobacco products is an
tions were seen to be brushing 2–6 times per week. Loss alarming issue. Appropriate tobacco control measure is
of attachment of 4–5 mm was observed in 35–44 years must to control rampant tobacco use. Most of the study
age groups (22.5%) and 4–5 mm in 65–74 years age population belonged to the poor socioeconomic status;
group (43.6%) suggestive of periodontitis. The results hence the financial burden of the oral diseases has added
were in accordance with the finding of the National Oral a detrimental effect on the individuals’ health. This is the
Health Pathfinder Survey where it was seen that 31% of first study of its kind done to explore the oral health sta-
the population belonging to the age group 35–44 years tus targeting the under privileged indigenous commu-
were having periodontitis [2]. Similar findings were also nity. Hence, this study gives an idea to the policy makers
seen in the studies conducted by Goel et al. [24] and Var- to focus on the preventive aspects to minimize the oral
enne et al. [25]. The high tobacco consumption (70.6%) health burden of the marginalized.
in adult study participants might be the contributing to
high prevalence of periodontal diseases among that study Abbreviations
participants [26]. BPKIHS: B. P. Koirala Institute of Health Sciences; WHO: World Health Organiza-
tion; DMFT: Decayed missing filled teeth; IRC: Institutional Review Committee;
The study showed that 65.1% had decay in their pri- CI: Confidence interval; TMJ: Temporomandibular joint; CPI: Community peri-
mary dentition, 28.4% of decay was seen in mixed den- odontal index; LOA: Loss of attachment.
tition, and 57.5% of tooth decay in permanent dentition,
Acknowledgements
while recording for crown status. The prevalence of den- We thank Dr. Santosh Kumari Agrawal, Dr. Ujwal Gautam and Mr. Raj Kumar
tal caries (dft) in primary dentition was 65.1%, which was Subedi for their help in formatting and editing the manuscript.
similar to the finding by Bhagat et al. [8], and the preva-
Authors’ contributions
lence of dental caries in participants with permanent AS*, AS, and TKB conceived, conceptualized and designed the study. AS*
dentition (DMFT) was 75.2%. The mean dft was 2.40 and collected and analyzed the data. DDB helped in analyzing the data. AS*
the mean DMFT was 3.18. The prevalence of dental car- drafted the manuscript and all co-authors read and contributed to the final
manuscript, and agreed to its publication. (*Principal author). All authors read
ies was different than the National Oral Health Pathfinder and approved the final manuscript.
Singh et al. BMC Oral Health (2020) 20:320 Page 8 of 8

Funding 10. World Health Organization. Oral health surveys: basic methods. Geneva:
None. World Health Organization; 2013.
11. Ghosh A, Ghosh T. Modification of Kuppuswamy’s socioeconomic status
Availability of data and materials scale in context to Nepal. Indian Pediatr. 2009;46(12):1104–5.
The data supporting the findings of this article are available from the cor- 12. Nepal Rastra Bank. Recent Macroeconomic and financial Situation.
responding author. Research department, Statistics Division, Kathmandu, Nepal. https​://nrb.
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Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal (Committee’s in Nepal: further analysis of the 2006 Demographic and Health Surveys.
Ref. No: 300/074/074-IRC). The written informed consent was taken from the Calverton: Macro International Inc.; 2008.
participants of 16 years or older and proxy consent was taken for individuals 14. Thapa P, Aryal KK, Mehata S, Vaidya A, Jha BK, Dhimal M, Pradhan S,
under 16 years. As the people under 16 years could not give written informed Dhakal P, Pandit A, Pandey AR, Bista B. Oral hygiene practices and their
consent, it was mandatory for them to be accompanied by parents/guardians socio-demographic correlates among Nepalese adult: evidence from non
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for participants under 16 years. Health. 2016;16(1):105.
15. Handa S, Prasad S, Rajashekharappa CB, Garg A, Ryana HK, Khurana C.
Consent for publication Oral health status of rural and urban population of Gurgaon block, Gur-
Data collection was anonymous. No images or other personal details of gaon district using WHO assessment form through multistage sampling
participants are presented here. The patients were informed about the details technique. J Clin Diagn Res. 2016;10(5):ZC43.
collected from them and consent was taken for the use of their details in a 16. Gambhir RS, Sogi GM, Veeresha KL, Sohi RK, Randhawa A, Kakar H. Dental
scientific publication. health status and treatment needs of transport workers of a northern
Indian city: A cross-sectional study. J Nat Sci Biol Med. 2013;4(2):451.
Competing interests 17. Nimako-Boateng J, Owusu-Antwi M, Nortey P. Factors affecting dental
The authors declare that they have no competing interests. diseases presenting at the University of Ghana Hospital. SpringerPlus.
2016;5(1):1709.
Author details 18. Omitola OG, Arigbede AO. Prevalence and pattern of pain presentation
1
Narayani Hospital, Birgunj, Parsa, Nepal. 2 Department of Public Health Den- among patients attending a tertiary dental center in a southern region of
tistry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. 3 School of Public Nigeria. J Dent Res Dent Clin Dent Prospects. 2010;4(2):42.
Health and Community Medicine, B. P. Koirala Institute of Health Sciences, 19. Bansal V, Sogi GM, Veeresha KL, Kumar A, Bansal S. Dentition status and
Dharan, Nepal. treatment needs of prisoners of Haryana state, India. Int J Prison Health.
2012;8(1):27–34.
Received: 30 July 2020 Accepted: 4 November 2020 20. Tramini P, Montal S, Valcarcel J. Tooth loss and associated fac-
tors in long-term institutionalised elderly patients. Gerodontology.
2007;24(4):196–203.
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