RAJIV GANDHI COLLEGE OF NURSING IIT CAMPUS, OPP. MEENAKSHI TEMPLE

BANGALORE -560 076RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OFSUBJECT FOR DISSERTATION.

1 NAME OF THE CANDIDATE

AND ADDRESS.

Mr.YOGESH KUMAR M,

I YEAR M.Sc. NURSING,

RAJIV GANDHI COLLEGE OF

NURSING BANGALORE.

2 NAME OF THE

INSTITUTION.

RAJIV GANDHI COLLEGE OF

NURSING BANGALORE.

3 COURSE OF STUDY &

SUBJECT

I YEAR M.Sc. NURSING,

PAEDIATRIC NURSING.

4 DATE OF ADMISSION 15/10/2011.

5. TITLE OF THE TOPIC

“A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON

PREVENTION OF DENTAL CARIES

AMONG SCHOOL CHILDREN AT

SELECTED URBAN SCHOOL OF

BANGALORE, WITH A VIEW TO

DEVELOP AN INFORMATION

BOOKLET”.

1

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION;-

“For thou must know, Sancho, that a mouth without teeth is like a mill without a stone, and that a diamond is not so precious as tooth”.

-Cervantes Saavedra.

Dental care is an important care of personal hygiene. School going children are not much

aware of its need and complications. Dental caries is a common childhood disease; As many as

19% of children aged 2-5 years and 52% of children aged 5-9 years have experienced dental

caries. Health has been declared a fundamental human right. This implies that state has

responsibility for the health of its people. Oral health is an integral part of general health, rather

oral cavity can rightly be called gateway of the body.1 the dental caries experience is more in

urban people (55.5%) than rural population (44.5%).

WHO reports dental caries prevalence in school age children, in the majority of countries

was 60-90%.So few countries are united states and Canada are high levels of this disease. A

study conducted in August 2005 reveal high Prevalence of dental caries in children reveals that,

27% of preschoolers, 42% of school-age children, and 91% of adults having caries experience.2

Fluoride is a chemical that is found naturally in water in very low concentrations. It helps

to protect teeth against caries. Some areas have fluoride added to the water supply. This has

greatly reduced tooth decay in those areas. And a dental checkup is worth getting your child used

to dental check-ups from an early age. A check up every 6-12 months is best. In some areas,

particularly where there is no fluoride in the water supply, a ‘sealant’ can be placed in the

crevices at the back of the teeth by a dentist. This helps protect the teeth from caries and tooth

decay. It is 6-7 year olds who may benefit most. Fluoride varnish is an effective tool that has

been proven to prevent dental caries both in primary and permanent dentition. 3

As per the study conducted in Chandigarh 2007, the prevalence of dental caries in 6, 9,

12, and 15 years school children selected on a randomized basis to evaluate the risk factors of

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dental caries. The high prevalence of dental caries in the children was attributed to the lack of

use of fluoride tooth paste (80% children). And lack of knowledge about etiology of dental caries

98% (children) and frequency of sugar exposure more than 5-times per day (30%).4

Despite great improvements in the oral health of populations across the world, problems

still persist particularly among poor and disadvantaged groups in both developed and developing

countries. According to the World Oral Health Report, dental caries remains a major public

health problem in most industrialized countries, affecting 60-90% of schoolchildren. Research on

the oral health effects of fluoride started around 100 years ago; the focus has been on the link

between water and fluorides and dental caries and fluorosis, topical fluoride applications,

fluoride toothpastes and salt and milk fluoridation. Most recently, efforts have been made to

summarize the extensive database through systematic reviews. Such reviews concluded that

water fluoridation and use of fluoride toothpastes and mouth rinses significantly reduce the

prevalence of dental caries. WHO recommends for public health that every effort must be made

to develop affordable fluoridated toothpastes for use in developing countries. Water fluoridation,

where technically feasible and culturally acceptable, has substantial advantages in public health;

alternatively, fluoridation of salt and milk fluoridation schemes may be considered for

prevention of dental caries.5

Caries preventive measures should include diet analysis and modification of the diet by

reducing the amount and frequency of sucrose consumption. Sealing all caries-free pits and

fissures, Professional topical fluoride treatments every 3-months (treatment intervals should be

changed to every 6 months when the child remains caries free for a 2-year period). Daily home

use of a 0.05% sodium fluoride. Mouth rinse by children 6-years. And use of suboptimal

concentration of fluoride in the drinking water. Oral hygiene instruction to the child and parents.

6.1 NEED FOR THE STUDY;-

The study is to assess the oral health knowledge and oral hygiene practices among school

children. A researcher administered questionnaire to determine the oral health knowledge and

practices in a random sample of 401 students in the period March to June 2002 reveals, 92% of

the students claimed they brushed their teeth. About 48% brushed at least twice daily. More

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students (59.1%) reported using the chewing stick compared to those using commercial

toothbrushes, Female students brushed more frequently than their male counterparts. 39.9% of

the students knew the cause of tooth decay, 48.2% could state at least one method of prevention,

while 16.5% knew the importance of teeth. Use of toothpaste was reported by 38.9% of the

students. Less than half of the students knew the causes of tooth decay. This would hopefully

lead to improvement on the oral hygiene practices.6

A study was conducted on 1587 government school children of Udaipur district in the age

group of 5-14 years for recording the prevalence of dental caries and treatment needs. Dental

caries was found in 46.75% children, and 76.87% children required some kind of dental

treatment.7

A study was conducted to assess the pattern of prevalence of dental caries in the primary

dentition among 5 year old children. The area of study was urban Pondicherry and the study

population consisted of 1009 school children of both sexes (527 boys and 482 girls). A simple

random sampling method was used to select the schools. Dental caries was assessed by the

Dental status and Treatment Need (WHO 1997). Statistical analysis was done using the

Proportion test. The prevalence of caries was 44.4% among the study population, being higher in

the boys (P < 0.05); In Mandibular arch in both the sexes (boys P < 0.05, girls P < 0.01); in

posterior teeth (both sex wise & arch wise). Comparison of caries among anterior teeth (Boys vs

Girls) [corrected] and posterior teeth (upper vs. lower) revealed higher caries prevalence in

Maxillary anterior teeth (P < 0.001) and Mandibular posterior teeth (P < 0.001). In both the sexes

and arches, primary second molars showed higher caries prevalence.8

A study was carried out with the purpose of evaluating the prevalence of dental caries, in

semi urban school children. The sample comprised of 415 school going children. The entire

sample showed a dental caries prevalence of 58.1%. It was noted that the children brushed once a

day with toothpaste and toothbrush. Complete oral rehabilitation was undertaken through an

incremental school health care programme.9

The study was to assess the prevalence of dental caries and treatment needs among 5 and

12 years old school children of urban Pondicherry. The study population consisted of 2022

school children of both the sexes, (1009, 5-year-old children) and (1013, 12-year-old children).

4

A simple random sampling method was used to select the schools. Dental caries was assessed by

Dentition Status and Treatment Needs described by WHO. The prevalence of dental caries was

44.4% in 5 years age group with 47.4% for males and 41.1% for females. In 12 years age group

the prevalence of dental caries was 22.3% with 20.6% for males and 24.1% for females. It may

be concluded that FDI/WHO Oral Health Goals for the year 2000 have been achieved for the

ages 5-6 and 12 years in Pondicherry.10

The above studies prove that school children do not practice dental hygiene, due to the

neglected dental care 60% of children suffering from dental caries and periodontal disease.

School health committee, an annual dental checkup mandatory as part of school health

examination, in spite of all the section there is prevalence of dental disease among children. This

proves that there is an urgent need to educate the children among dental hygiene and care.

Hence the researcher felt need to assess the knowledge of school children about dental

hygiene and import educate to promote dental health.

5

6.2 REVIEW OF LITERATURE:-Review of literature helps to get an in-depth knowledge of the subject matter. For better

understanding the topic is categorized as following.

1. Brief description of dental hygiene and diseases.

2. Prevention and management.

3. Related studies on dental caries among school children.

4. Related studies on effects of structured teaching program on dental caries.

1. Brief description of dental hygiene and diseases :-

Children are the wealth of tomorrow.

Dental caries, also known as tooth decay or a cavity, is an infection usually bacterial in

origin that causes demineralization of the hard tissue (enamel, dentin and cementum) and

destruction of the organic matter of the tooth, usually by production of acid by hydrolysis the

food debris accumulated on the tooth surface.

The two bacteria most commonly responsible for dental cavities are

1. Streptococcus mutans.

2. Lactobacillus.

Today, caries remain one of the most common diseases throughout the world.11

Undoubtedly tooth brushing is the most widely used and socially accepted form of oral

hygiene. Most children spend less than 1minute tooth brushing and failed to brush 38% of the

tooth surface especially the lingual. Tooth decay disease is caused by specific types of bacteria

that produce acid in the presence of fermentable carbohydrates such as sucrose, fructose, and

glucose. The mineral content of teeth is sensitive to increases in acidity from the production of

lactic acid. people with little saliva, especially due to radiation therapies that may destroy the

salivary glands, there also exists remineralization gel Most foods are in this acidic range and

without remineralization, this results in the ensuring decay. Depending on the extent of tooth

destruction, dental health organizations advocate preventive and prophylactic measures, such as

regular oral hygiene and dietary modifications, to avoid dental caries.

6

A study was conducted in Rohtak(Haryana) India 2007, In order to maintain good

hygiene and status of dental caries in 9-12years of school children. 2304 children (1290 male

children and 1014 female children) were included in the study during preventive and community

dentistry school program by dental college. The children were examined in the class room with

sufficient natural day light. The data regarding on oral health status, oral hygiene status, and

general information. 12

A tooth has 3 layers namely enamel, dentine and pulp. When bacteria inside the plaque

metabolizes, they will release acid which will cause demineralization of tooth enamel causing

tooth cavity. Children’s teeth are thinner. So they are more susceptible to dental caries. Baby

bottle tooth decay or early childhood caries refers to severe tooth decay in a child. The symptoms

includes, the child may complain of pain or discomfort while chewing and drinking cold or hot.

The tooth surfaces turning brownish or blackish. Tooth cavities get spotted as food gets stuck.

Sinus (pin point pus discharge over gum) noted near to decayed teeth. Gum swelling with pus

pooling. Fever due to dental infection. Facial swelling cum redness if infection. Low appetite,

emotionally stressed.

Factors increasing risk of developing caries also may include, high cariogenic bacteria, poor oral hygiene, prolonged nursing (bottle or breast), poor family dental health, developmental or acquired enamel defects, genetic abnormality of teeth, chemotherapy or radiation therapy, eating disorders, drug or alcohol abuse, irregular dental care, cariogenic diet, presence of exposed root surfaces, restoration overhangs and open margins, and physical or mental disability with inability or unavailability of performing proper oral health care. Prevention includes teeth cleaning. Application of dental sealant to protect teeth from decay, fluoride treatment, metal free filling, interceptive orthodontics, cosmetic dental bonding. Advice to parents, dental hygiene requires both personal and professional care and it begins in infancy. 13

7

A brown spot that is dull in appearance is probably a sign of active caries. As the enamel

and dentin are destroyed, the cavity becomes more noticeable. The affected areas of the tooth

change color and become soft to the touch. Once the decay passes through enamel, the dentinal

tubules, which have passages to the nerve of the tooth, become exposed and causes a toothache.

The pain may worsen with exposure to heat, cold, or sweet foods and drinks. Dental caries can

also cause bad breath and foul tastes. In highly progressed cases, infection can spread from the

tooth to the surrounding soft tissues. Complications such as cavernous sinus thrombosis and

Ludwig's angina can be life-threatening.14

2. Prevention and management:-

Good oral hygiene is thought to be important for oral health. This review is to determine

the effectiveness of flushing in addition to tooth brushing for preventive gum disease and dental

caries in children.

Preventive measures include dietary modification by reducing carbohydrate rich food

intake and avoiding oral retaining, Use of fluoride toothpaste, avoiding chewing gum, chocolate,

bottle feeding, Good oral and dental hygiene with correct technique of tooth brushing, Regular

dental checkup for early detection of problems and necessary advice. Avoid sweetened liquid or

food. Substitute sugar with honey as honey is not cariogenic (promotes dental caries).  Start

teaching brushing when the child is old enough to hold a toothbrush properly, usually at 2 years

of age.

A study to assess the prevention and correlates of self reported states of teeth in 12-years

old children in Kerala, India 2006. The sample consists of 838 school children. Data was

collected for clinical examination. The clinical oral health status was recorded using decayed,

missing, and filling teeth.23% of school children reported the state of teeth as bad. The self

reported bad teeth was associated with poor school performance having bad breath and food

infection, being dissatisfied with teeth appearance and having caries experiencing information

from self report of children might help in planning effective strategies to promote health. 15

8

Brush teeth twice a day using toothpaste containing fluoride. ensure that all accessible

surfaces of teeth are cleaned, find out the toothpaste and avoid rinsing out with water. Chewing

gums containing xylitol and sorbitol have anti-caries properties through salivary stimulation.

Xylitol is more effective than sorbitol in caries reduction, as it also has antibacterial properties.

In children up to seven years of age the report recommends the use of only a smear or small pea-

sized quantity of toothpaste and encourages children to spit out toothpaste after brushing.

Swallowing toothpaste is discouraged, as is active rinsing out after brushing.

A study was conducted in Chandigarh, India evaluated the professional application of

2% NaF solution, 1.23% acidulated phosphate fluoride solution (APF), 2.26% F Duraphat at six-

monthly intervals for 30 months in children aged 6-12 years. The largest reduction in caries

increment was seen with Duraphat. However, the authors of this study highlighted the socio-

cultural differences between Chandigarh and the West, and some caution may therefore be

needed in extrapolating the results of this study to the population.

A study was conducted in Finland found no significant difference in three year caries

increments in children (aged 12-13 years) who received six monthly applications of either 2.26%

F Duraphat varnish or 1.23% APF gel. Applying fluoride varnishes more frequently than twice a

year does not provide additional caries protection in a population with relatively low caries

activity. A study in Finnish children aged 9-13 years found no statistically significant difference

in caries increments between two or four applications of Duraphat per year.16

3. Related studies on dental caries among school children:-

A study was conducted to estimate the caries-preventive effects of a school-based weekly

fluoride mouth rinse (FMR) program and to determine whether its effectiveness varied by

school-level caries risk. We used clinical and parent-reported data for 1,363 children in North

Carolina (NC) schoolchildren. We found a trend toward a larger caries-preventive benefit among

children in high-risk schools compared with those in low-risk schools (i.e., 55% vs. 10% caries

reduction for 5 to 6 yrs of FMR participation), may experience substantial caries-preventive

benefits from long-term FMR participation.17

9

A study to assess the effectiveness of a dental caries prevention programme on the

permanent dentition of Chilean rural schoolchildren using fluoridated powdered milk and milk

derivatives. The fluoridated products were delivered to 35,000 schoolchildren in the rural areas

of the Ninth Region in Chile using the standard School Feeding Programme (PAE). The daily

fluoride dose from milk fluoridated products was estimated at 0.65 mg/day, during

approximately 200 schooldays/year. Cross-sectional samples of schoolchildren aged 6, 9 and 12

years from study communities were compared to those obtained after 36 months of receiving

fluoridated milk products Considering the relative costs and technical difficulties involved in

both caries preventive programmes and fluoridation of powdered milk and its derivatives is an

effective alternative caries prevention programme in areas where either water fluoridation or

other community delivered programmes are difficult to apply.18

4. Related studies on effects of structured teaching program on dental

caries:-

A Study conducted by Annamalai University, Chidambaram in 2008, children studying in

6 primary school of 6 villages in field practice area of rural health center of faculty of medicine,

525 school children (255 boys and 270 girls) were surveyed. The overall dental fluorosis

prevalence was found to be 31.4% in our study sample, where as gender differences was not

statistically significant.19

A total of 2000 children (1-14 year age group) attending pediatric OPD, school clinic &

well body clinic of Dr. R.N. Cooper Municipal Hospital & K.E.M Hospital, Mumbai were

examined for caries prevalence and 35.6% had dental caries. particularly maternal literacy was

shown to influence caries prevalence in children. The prevalence was low in well-nourished

children and in those taking vegetarian type of diet. Frequency of sweet consumption was shown

to be associated with prevalence of dental caries. In 1-4 year age group it was noted that bottle

fed children were more affected by dental caries. Caries prevalence was low in those children

using tooth brush than in those using tooth powder. Those children who were using Neem datun

were found to be less affected with dental caries. Dental caries was also found to be low in those

who rinsed their mouth with water after food.20

10

In the present study mean DMFT for 12 years, 15 years age group population in urban

areas was 1.33, 1.55 . The corresponding values in rural area was 1.12,and 1.23. This finding is

similar to a previous study conducted in Madagascar where mean number of DMFT in 12 year

olds of urban area was 3.1 and that of rural 2.9, in 15 year olds of urban area was 5.8 and that of

rural 5.0. This higher level of caries was attributed to frequent consumption of sugar.21

A study was conducted to describe the dental health status of 12-year-old school children

in Thiruvananthapuram, Kerala, India, and to identify sociodemographic factors, oral health

behaviours, attitudes and knowledge related to dental caries experience. The study carried a

cross-sectional survey of 838 children in upper primary schools. Dental caries was measured

using World Health Organization criteria. Sociodemographic factors, oral health behaviours,

Attitudes and knowledge were assessed by a self-administered questionnaire. The prevalence of

dental caries in the permanent dentition was 27%. The decayed component (D) constituted 91%

of the total number of decayed, missing and filled teeth (DMFT). Multiple logistic regression

analysis showed that children had a higher risk of having dental caries. The present study

indicated that urban living conditions were associated with more dental caries. Since

urbanization is rapid in India, oral health promotion at the present time would be valuable to

prevent increased caries prevalence.22

6.3 STATEMENT OF THE PROBLEM“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON PREVENTION OF DENTAL CARIES AMONG SCHOOL

CHILDREN AT SELECTED URBAN SCHOOL OF BANGALORE, WITH A VIEW TO

DEVELOP AN INFORMATION BOOKLET”.

6.4 OBJECTIVES OF THE STUDY;- To collect the demographic data among the school children at selected urban schools of

Bangalore.

To assess the pre-test knowledge of school children on management and prevention of

dental caries.

To correlate pre-test knowledge with selected demographic variables.

11

To assess the post test knowledge of school children on management and prevention of

dental caries.

To find out the effectiveness of structured teaching programme regarding knowledge on

management and prevention of dental caries among school children.

6.5 HYPOTHESIS;- H1. The post-test knowledge score will be significantly higher than the pre-test knowledge

score.

H2. There is a significant association between pre-test knowledge scores with selected

demographic variables.

6.6 OPERATIONAL DEFINITIONS;-

6.6.1 Effectiveness: Refers to gain in knowledge as determined by the significant differences

between Pre-test & Post-test knowledge scores.

6.6.2 Structured teaching programme: refers to a planned and organized teaching Programme

on Dental caries and its management and prevention with the use of AV aids.

6.6.3 Knowledge: Refers to information regarding Dental caries and its management and

prevention among school going children.

6.6.4 Dental caries: Dental caries, also known as tooth decay or a cavity, is an infection usually

bacterial in origin that causes demineralization of the hard tissue. The two bacteria most

commonly responsible for dental cavities are Streptococcus mutans, Lactobacillus.

6.6.5 Management: proper hygiene and dental care under taken by Good oral and dental

hygiene with correct technique of tooth brushing.

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6.6.6 Prevention: Refers to the measures taken to decrease the incidence and limit the

Progression of dental caries.

6.6.7 School children: Refers to School going children among age group of 6 to 9

years. In urban school of Bangalore.

6 MATERIALS AND METHODS:-

7.1 SOURCE OF DATA : Data will be collecting from School

Children in selected urban school Bangalore.

7.2 METHOD OF COLLECTION : The data will be collecting using

OF DATA structured knowledge questionnaire.

7.2.1 SAMPLE : Children both age group of 6-9 year in

selected school of Bangalore.

7.2.2

a) INCLUSION CRITERIA : 1. Children at the age group of 6-9years.

2. Children studies in urban schools.

3. Willing to participate.

4. Present at the time of data collection.

b) EXCLUSION CRITERIA : 1. Children who are below 6 years and

Above 9 years.

2. Children who are studying other than

Urban schools.

3. Children who are not willing to

Participate.

4. Children who are not present at the

Time of data collection.

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7.2.3 RESEARCH DESIGN : One group pre-test and post-test design.

7.2.4 SETTING : Selected urban schools of Bangalore.

7.2.5 SAMPLING TECHNIQUE : Convenient Sampling techniques.

7.2.6 SAMPLE SIZE : 50 school children.

7.2.7 TOOL OF THE RESERCH : Structured questionnaire will be

Constructed into two parts:

Part – A consist of Demographic data.

Part-B Knowledge questionarrie

regarding prevention of dental caries

infection.

7.2.8 COLLECTION OF DATA : Data will be collected from the

samples by using structured and validated

questionnaire.

7.2.9 METHOD OF DATA : 1. The investigation will be done using

ANALYSIS AND analysis of the data. Descriptive statistics

PRESENTATION like mean, median, standard deviation,

mean Percentage and inferential statistics

namely paired t-test to analyze the data.

2. The analyzed data will be presented

in the form of tables and graphs

where ever necessary.

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7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS ? IF SO PEASE DESCRIBE BRIEFLY. Yes, the study will be conducted among school children regarding prevention of dental carries.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION CASE OF 7.3?1. Yes, ethical clearance has been obtained from the concerned authority of the institution.

2. Informed consent will be obtained from the participants prior to the study.

3. Privacy, confidentially and anonymity will be guarded.

4. Permission will be obtained from the research committee of the Rajiv Gandhi College of

nursing.

15

7.5 LIST OF REFERANCE:

1. Park K Park’s textbook of preventive and social-medicine. 17th Ed Banarasidas Bhanot. 2002; 632-633.

2. www.biomedcentral.com/1472-6831/6 .

3. Mott children’s health center, flint. Fluoride varnish: a primary prevention tool for dental caries. J Mich dent assoc. 2008 jan; 90(1); 44-7.

4. Goyal A. Gauba K. Chanta HS. Kapur A. Epidemiology of dental caries in Chandigarh

school children. J Indian sec pediod prev Dent, 2007 Jul-sep;25(3):155-8

5. Petersen PE, Lennon MA. Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach. Community Dent Oral Epidemiol. 2004 Oct;32(5):319-21.

6. Okemwa KA, Gatongi PM, Rotich JK. The oral health knowledge and oral hygiene practices among primary school children age 5-17 years in a rural area of Uasin Gishu district, Kenya. East Afr J Public Health. 2010 Jun;7(2):187-90.

7. Dhar V, Jain A, Van Dyke TE, Kohli A. Prevalence of dental caries and treatment needs in the school-going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent. 2007 Jul-Sep;25(3):119-21.

8. Saravanan S, Madivanan I, Subashini B, Felix JW. Prevalence pattern of dental caries in the primary dentition among school children.Indian J Dent Res. 2005 Oct-Dec;16(4):140-6.

9. Gopinath VK, Barathi VK, Kannan A. Assessment and treatment of dental caries in semi-urban school children of Tamilnadu (India). J Indian Soc Pedod Prev Dent. 1999 Mar;17(1):9-12.

10. Saravanan S, Anuradha KP, Bhaskar DJ.Prevalence of dental caries and treatment needs among school going children ofPondicherry, India. J Indian Soc Pedod Prev Dent. 2003 Mar;21(1):1-12.

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11. Parul Datta, EYE,ENT,and Oral-dental problem in india. Paediatric nursing, Second edition, 2009, Pageno. 433-448.

12. B Ravi,R Jain, SC Anand: Dental caries and oral hygiene status of 8-12 year school

children of Rohtak(Haryana): A Brief report, The internal journal of dental health 2007.

13. Blessy Varghese, children and dental health, J health action. February 2012 page 30-33

14. Oral Health Topics: Cleaning your teeth and gums . Hosted on the American Dental Association website. Page accessed August 15, 2006.

15. Harsh AA, Harren JJ, Levy SM, Broffitt B, Oral health behaviors of children in low and

high socio economical status of the family. Pediatric Dent 2006, 28(4); 310-315.

16. Scottish Intercollegiate Guidelines Network, Elliott House, 8-10 Hillside Crescent, Edinburgh EH7 5EA Web contact duncan.service@nhs.net Last modified 27/02/12.

17. Divaris K, Rozier RG, King RS. Effectiveness of a school-based fluoride mouthrinse

program. J Dent Res. 2012 Mar;91(3):282-7. Epub 2011 Dec 27.

18. Weitz A, Mariñanco MI, Villa A. Reduction of caries in rural school-children exposed to fluoride through a milk-fluoridation programme in Araucania, Chile. Community Dent Health. 2007 Sep;24(3):186-91.

19. S Saravanan, C Kalyani, MP Vijayarani, P Jyakodi, S Nagarajan. Prevalence of dental

Fluorosis among primary school children in rural area Chidambaram, Tamilnadu. Indian

Journal of community medicine 2008. Volume 33 Page 146-150.

20. Venugopal T, Kulkarni VS, Nerurker RA, Damle SG, Patnekar PN, Epidemiological study of dental caries. Indian J pediatr. 1998 nov-dec;65(6);883-9.

21. Kevin S. Hardwick, David B. Jones, Kathy R. Phipps. The Oral Health Status Among

Residents of the Magadan Oblast, Russian Far East. J Public Health Dent ; 53(2) 101-

108.

22. David J. Wang NJ, Astrom AN, Kuriakose S. Dental caries and associated factors in 12- year old school children in Thiruvananthapuram, Kerala, India. Int J Paediatr Dent. 2005 Nov;15(6);422-8.

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8. SIGNATURE OF THE

CANDIDATE

9 REMARKS OF THE GUIDE This Study is feasible and helps to prevent

dental caries.

10 NAME AND DESIGNATION Mrs. JASMINE MARY MSC

N,PGDFWCD,PGDNA,ASSOCIATE

PROFESSOR

10.1 GUIDE Mrs. JASMIN MARY

10.2 SIGNATURE

10.3 HEAD OF THE DEPARTMENT Mrs. JASMIN MARY

10.4 SIGNATURE

11 REMARKS OF THE

PRINCIPAL

Study can be Proceeded

12. SIGNATURE OF THE PRINCIPAL

18