CHRISMED Journal of Health and Research

: 2016  |  Volume : 3  |  Issue : 2  |  Page : 119--122

Oral health of Anganwadi children in Tumkur city: A field study

Mythri Halappa, JV Bharateesh, Herbert Kristen Liveiro, P Rameeza, Sameeha Mohammad Basheer, Linta Teresa James 
 Department of Public Health Dentistry, Sri Siddhartha Dental College, Tumkur, Karnataka, India

Correspondence Address:
Mythri Halappa
Department of Public Health Dentistry, Sri Siddhartha Dental College, Tumkur, Karnataka


Objective: In India, due to illiteracy and poor socioeconomic conditions, along with harmful oral habits, the prevalence of oro-dental diseases is widespread. Primary health care approach is the strategy to attain health for all. Hence, the objective was to assess oral health of Anganwadi children. Methodology: A descriptive cross-sectional study was designed to include 316 children from Anganwadi present in the vicinity of a field area of the dental institute, Tumkur. Results: The prevalence of dental caries was 41.77%, mean decayed, extracted, filled tooth being 2. Conclusion: The prevalence of dental caries in Anganwadi children was high indicating the need for both preventive and curative methods. The comprehensive treatment along with oral hygiene instructions was provided.

How to cite this article:
Halappa M, Bharateesh J V, Liveiro HK, Rameeza P, Basheer SM, James LT. Oral health of Anganwadi children in Tumkur city: A field study.CHRISMED J Health Res 2016;3:119-122

How to cite this URL:
Halappa M, Bharateesh J V, Liveiro HK, Rameeza P, Basheer SM, James LT. Oral health of Anganwadi children in Tumkur city: A field study. CHRISMED J Health Res [serial online] 2016 [cited 2021 Jan 16 ];3:119-122
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Full Text


Primary health care approach has been the strategy to attain health for all. One such effort is done by Integrated Child Development Services (ICDS) scheme which was established on October 2, 1975.[1] The administrative units are as follows:

Community Development Block for rural areaTribal development blocks in tribal areas and a group of slums in an urban area.

The in-charge officer will be a Child Development Project Officer. Hence, the first contact point in ICDS project is Anganwadi. Anganwadi means courtyard. It covers a population of 1000 in urban and 700 in tribal areas.[1] This runs by Anganwadi worker. Most of the children going to Anganwadis are from very poor families. Generally, marginal farmers, laborers, agricultural laborers, construction workers, and those living below poverty line send their children to Anganwadis. Ninety-five percent of the children do not even wear slippers or shoes. As children have poor immunity, many children suffer from fever, cough, dysentery, stomach ache, worms, and other gastrointestinal diseases. Major problems with health are stomach infections and diarrhea due to lack of sanitation. Hence, Anganwadi workers are selected from the same area and trained for 4 months in health, nutrition, and development. Services rendered are health checkup, immunization, supplementary nutrition, health education, nonformal school education, and referral services. Payment of Rs. 1500/month is offered for them, and they are supervised by Mukhya Sevikas.[1]

Early childhood caries (ECC) is a serious dental problem which affects infants and preschool children. The American Dental Association defines ECC as “the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age.”[2] Generally, dental problems in preschool children are neglected by their parents as the deciduous teeth are going to shed off and considered to be of no importance and an economic burden if attended to them.[3],[4] However, if it is left untreated, it can lead to pain, infections, and speech problems which in turn affect their growth and maturation of the permanent dentition. In fact, decay in the primary dentition is the best predictor for decay in the secondary dentition.

Since an Anganwadi worker forms the first point of contact between the mass and the health system, they can help in propagating the importance of oral health.[5] There are studies [6],[7],[8] which show the knowledge and attitude of Anganwadi workers toward oral health but need based assessment are scarce. Hence, a study was taken to assess the oral health status of Anganwadi children in Tumkur city.


There are 4081 Anganwadis in the district and 81,292 children in 0–3 years age group and 61,060 children in the 3–6 age group are served by Anganwadi in the district. In Tumkur city, 177 Anganwadis are present in which 49 run in government buildings and 128 in private buildings.[9]

A cross-sectional study was conducted, and 11 Anganwadis present in the field area (Heggere, Agalkote, and Bheemsandra) of a dental institution were included. All the Anganwadi children aged between 3 and 6 years were included for screening. The study was carried out during the period of September 2014–January 2015. For collection of data, the Anganwadis were visited, and Anganwadi workers were explained about the nature and purpose of the study. Clinical examination was carried out at Anganwadi centers by a single calibrated examiner using mouth mirror and explorer under natural light, on an ordinary chair. Caries was recorded based on decayed, extracted, filled tooth (deft) index using codes and criteria as described by Grubbel (1944).[10] According to that decayed (noncavitated or cavitated lesion), missing (due to caries), or filled tooth surfaces in any primary tooth are included in the index.

Gingival color or consistency (red, soft, and edematous) changes along with the presence of plaque and calculus are considered as gingivitis present or else the gingiva was healthy.

Prior permission was obtained from the Anganwadi worker for the convenient date and time, and Type IV examination was carried out to check the oral health of the children. Parents of the children were informed about the study and consent was obtained. Ethical clearance was obtained from the Institutional Ethical Committee.

Inclusion criteria

Children who were present on the day of examination and aged between 3 and 6 years.

Exclusion criteria

Mentally challenged children.

Descriptive statistics was done by using mean and percentages.


A total number of students in 11 Anganwadis with an age ranged between 3 and 6 years was 316. Demographic data were collected which shows that male to female ratio was 47.4:52.5 (150: 166), respectively.

Observed oral problems

Dental caries and simple gingivitis due to poor oral hygiene [Table 1]{Table 1}[Table 2] shows that there was no gender wise difference in distribution of oral health problems among the children{Table 2}[Table 3] shows age-wise distribution which increases as the age increased and overall mean deft among the children to be 2{Table 3}Teeth most commonly affected were mandibular molarsThere were no cases of filled teeth observed in any of the children examined.


The present study showed the prevalence of dental caries was 41.77% which was comparable with studies conducted in Udupi,[4] Mangalore,[11] Bengaluru,[10] and Chandigarh [12] but comparatively high to the study conducted in Davangere.[13] The National Oral Health Survey conducted in 2004 in India has shown prevalence of dental caries as 50.0% in 5-year-old children.[14] According to a systematic review, the prevalence varies from 2.1% to 85.5% worldwide.[4] However, a study in Kerala showed a caries prevalence of 44% among 8–48-month-old children.[15] This may be due to the differences in case definitions and criteria's. Gruebbel's index was used to record both cavitated and incipient carious lesions as studies have reported a fairly high percentage of noncavitated carious lesions in primary dentition.[10],[16]

The present study showed that the mean decayed, missing, and filled teeth (dmft) score of children was 2, with decay component as a major contributor. In India, a study by Jose and King on ECC lesions in children below 4 years in Kerala showed that the mean dmft was 2.87.[15] According to the National Oral Health Survey 2004, mean dmft in 5-year-old children was 1.9 which was similar to the present study results.[14]

The important point is that there was not a single tooth with filling and all deft was due to untreated decayed tooth. This was similar to study conducted in Bengaluru where the prevalence was 37.3%.[10] Very few studies in India has shown prevalence of caries below 40%. This indicates lack of awareness, lack of affordability, and underutilization of the dental care as the Anganwadi was selected from the field area of a dental college. The present study showed increase in prevalence as the age increases which was similar to some caries prevalence studies.[4],[10],[17] Many studies have shown a higher prevalence of ECC among girls than boys,[4],[17] which has not been significant but the present study showed dental caries more in boys than girls but was not significant. About 79.49% of the study participant's gingiva was healthy, only 20.51% showed signs of gingivitis. This was similar to a study conducted by Sonika R et al., in Chandigarh.[12]

Mandibular molars were most commonly affected in the present study similar to other studies;[12],[17] the reason could be morphological variation of posterior teeth and inaccessibility of toothbrush in the posteriors.


Prevalence of dental caries was more among the Anganwadi children in the field area indicating the high treatment need, lack of awareness, and underutilization of oral health services. Since Anganwadi center is a focal point for activities of ICDS program, it is always emphasized to use the convergence and integrity of services provided. Hence,

Comprehensive treatment was provided, and an education program was conducted which comprised lecture, power point presentation, demonstration on brushing using modelsThe Anganwadi workers will be trained to diagnose common oral health problems, so that they can motivate the mass on importance of oral health and refer them for oral health care.


As the many knowledge, attitudes, and practice studies [5],[6],[8] conducted on Anganwadi workers showed that the Anganwadi workers have low knowledge about oral health further studies can be taken up to:

Assess in detail the oral health status among Anganwadi studentsTrain the Anganwadi workers and to check the efficacy of such training program as they are the frontiers in achieving the goal of primary health care.


The authors would like to acknowledge all the Anganwadi workers, Dr. K. R. Kashinath, Principal, and all the staff members of Department of Public Health Dentistry, Sri Siddhartha Dental College, Tumkur, for supporting throughout the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Shashidhara R, Maiya AS, Ramakrishna BV. India's integrated child development scheme and its implementation: Performance of Anganwadi and analysis. OIDA Int J Sustain Dev 2012;5:29-38.
2ADA (American Dental Association) Statement on Early Childhood Caries. Available from: [Last cited on 2015 July 14].
3World Health Organization. Oral Health Surveys Basics Methods. 4th ed. Geneva: WHO; 1997. Available from: [Last cited on 2015 Jul 15].
4Chandramohan S. A study on prevalence of early childhood caries among children attending Anganwadi center in Udupi taluk, Karnataka. Online Int Interdisci Res J 2014;4:248-52.
5Gangwar C, Kumar M, Nagesh L. KAP toward oral health, oral hygiene and dental caries status among Anganwadi workers in Bareilly city, Uttar Pradesh: A cross-sectional survey. J Dent Sci Oral Rehabil 2014;5:53-7.
6Bhambal A, Gupta M, Shanthi G, Saxena S, Bhambal A. Oral health knowledge, attitudes and practices of Anganwadi workers of Bhopal city, India. Int J Med Health Sci 2015;4:108-15.
7Raj S, Goel S, Sharma VL, Goel NK. Screening for caries activity among preschool children of anganwadi centers in a north Indian city. SRM Univ J Dent Sci 2015;6:1-4.
8Sequeira P, Anup N, Srinivas P. A KAP Study on dental health in Anganwadi workers. Indian J Community Med 2009;34:249-51.
9Anganwadi children, Teachers Face Hardship without Toilets. The Hindu; 2012. Available from: [Last cited on 2015 Jul 15].
10Priyadarshini HR, Hiremath SS, Puranik M, Rudresh SM, Nagaratnamma T. Prevalence of early childhood caries among preschool children of low socioeconomic status in Bangalore city, India. J Int Soc Prev Community Dent 2011;1:27-30.
11Shenoy R, Sequeira P, Rao A, Rao A, Pai D. Dental caries experience of preschool children in Mangalore, India. J Nepal Dent Assoc 2009;10:25-30.
12Sonika R, Goel S, Vijaylakshmi S, Goel NK. Prevalence of dental caries and its association with Snyder test among preschool children in anganwadis of a north Indian city. Int J Pub Health Dent 2012;3:1-10.
13Tyagi R. The prevalence of nursing caries in Davangere preschool & its relationship with feeding practices & socioeconomic status of the family. J Indian Soc Dent 2008;26:153-7.
14National Oral Health Survey and Flouride Mapping, 2002-2003. Vol. 32. New Delhi: Dental Council of India, Ministry of Health and Family Welfare, Govt. of India, 2004. p. 67-78.
15Jose B, King NM. Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent 2003;25:594-600.
16Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the national institute of dental and craniofacial research, the health resources and services administration, and the health care financing administration. J Public Health Dent 1999;59:192-7.
17Rosenblatt A, Zarzar P. The prevalence of early childhood caries in 12- to 36-month-old children in Recife, Brazil. ASDC J Dent Child 2002;69:319-24, 236.