Oral Health Status of Middle School Students in Jeddah: A Learning Experience Outside the Classroom : Dentistry and Medical Research

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Oral Health Status of Middle School Students in Jeddah

A Learning Experience Outside the Classroom

Abdelrasoul, Mohamed R.; Hassan, Ahmed Fouad; Pullishery, Fawaz1,

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Dentistry and Medical Research 10(1):p 29-34, Jan–Jun 2022. | DOI: 10.4103/dmr.dmr_8_22
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Community service as an educational tool is not a new phenomenon in the field of higher education.[1] The first step in adult education for community development is to gain an understanding of exactly what are the needs of the community.[2] However, there is still a lack of continuity between classrooms and residential communities.[3] Community participation is based on the belief that health development can best be achieved through combining the efforts of both the government and all concerned parties. As the community's demand for health continues to grow and change, this cooperation is essential.[34] The term need can also be defined as the service that is required to effect change. It is important to recognize what the needs are in order to address the problem and find a solution.[3] Community service is an important component of educational process and is also being encouraged as of the goals of the participating authors' institution.

The most common oral disease is dental caries, and the diseases that affect the periodontium. The treatment of dental diseases and problems poses a significant economic problem in many high-income countries, as it accounts for 5%–10% of the overall health expenditures.[5] Dental caries is a major oral health problem affecting 2.43 billion people (35.3% of the population) worldwide in the year 2010.[6] A high burden of dental caries was evident among children in Saudi Arabia with an estimated prevalence of approximately 80%.[5] The burden of dental caries is high in Saudi Arabia, with eight out of ten primary schoolchildren aged 6–8 years suffering from this preventable condition.[7]

Children are predominantly susceptible to dental caries and gingival diseases due to changing dietary habits with increased consumption of refined carbohydrates and less focus on oral hygiene maintenance.[8]

Saudi Arabia is a country with a serious early childhood oral health problem. While research on this problem has focused mainly on the issue of dental caries, there have been a few studies that have looked at the problem from the perspective of oral hygiene.[9] Gingival inflammation is a reversible condition that mostly in childhood and adolescence,[1011] with the prevalence decreasing as adulthood is reached.[12] Gingivitis is a risk factor for periodontitis,[1314] which, in turn, is associated with several systemic disorders of public health importance including coronary heart diseases,[15] atherosclerosis, and diabetes.[16] Adolescence is an age where individuals adopt habits that may be carried forward well into adulthood including toothbrushing,[12] smoking,[17] and dietary habits.[18] Diseases that begin at this stage in life and continue uncontrolled may start cumulative destruction that becomes difficult to tackle later.[19] In Saudi Arabia, marked changes in lifestyle are taking place, and they have public health implications because of their association with several diseases including those of the oral cavity. For example, reports indicate an increase in the consumption of sweetened beverages such as soft drinks and fruit juices, in addition to a low prevalence of regular toothbrushing and increased prevalence of smoking among young Saudi Arabians.[20]

Previous research on the effects of service programs generally supports the presumption that community service is beneficial for adolescents. In particular, evidence has been provided regarding students' personality (e.g., self-concept, self-efficacy, and self-esteem), social attitudes (e.g., social responsibility, civic engagement, reducing stereotypes), and learning (e.g., outcomes, course grades, and attitudes).[2] The aim of our study was to engage our students in a learning experience outside the classroom with a hands-on practice about dealing with the two most common oral diseases and to assess and compare the community indices of these diseases among middle school males and females.


This study was conducted during an oral health education program for middle schoolchildren in Jeddah. The study was conducted during January–March 2019. The study population included 11–16 year of schoolchildren of both genders. Parents were informed about the study's purpose and benefits, and those who gave consent for participation were only included. The oral health assessment was done using Ramfjord's calculus index,[21] decayed, missing, and filled teeth (DMFT) index,[22] simplified-debris index,[23] and modified gingival index.[24] Two calibrated examiners (dentists) were in charge of recording the oral health status [Figure 1]. The interexaminer and intraexaminer reliability was assessed before examining the children that showed a very good intraclass correlation for Ramfjord's calculus index (ICC = 0.879), DMFT index (ICC = 0.913), debris index (ICC = 0.861), and modified gingival index (ICC = 0.798).

Figure 1:
Oral health status assessment

Each student was allotted a separate sheet that recorded the sociodemographic details and indices' score. All the data obtained were tabulated accordingly subjected to statistical analysis. Frequencies and percentages were used to represent categorical variables. The data normality check showed that some continuous variables did not follow a normal distribution (Shapiro–Wilk test, P < 0.05). Comparison of continuous variables was performed using Student's t-test and Mann–Whitney U test. A significance value (P value) less than 0.05 was considered statistically significant.


The study included 410 schoolchildren that had 62.9% (n = 258) of male and female 37.1% (n = 152) students. The comparison of gingival status showed that male students had comparatively more scores for debris index, calculus index, and gingival index than female students, which showed a statistically significant difference (P < 0.001). Similarly, each component of DMFT index except “missed” component showed statistically significant difference between male and female students (P < 0.001) [Table 1]. The correlation of the scores of all applied dental indices based on the gender of the schoolchildren is given in Figures 2 and 3.

Table 1:
Oral hygiene status of the participants (n=410)
Figure 2:
Correlation of scores of all dental indices
Figure 3:
Correlation of scores of all dental indices without D component of decayed, missing, and filled teeth index


Dental decay is the most common oral disease in childhood from the first through the 12th year of life. In this crucial period, the primary teeth are exfoliated, and the permanent teeth, exclusive of third molars, are formed and erupt into a functional pattern.[25] A considerable number of surveys have been done on dental caries' experience in permanent dentition. These studies are in general agreement with the fact that approximately 20% of the children at the age of 6 years have experienced tooth decay in their permanent teeth. From there, a rapid increase follows, and at the age of 8 years and 10 years, 60% and 85% of the children are affected by dental caries, respectively. At the age of 12 years, when most of the permanent dentition has erupted, over 90% of the schoolchildren have experienced dental caries.[8] In the present study, the point prevalence of dental caries was 75.6%, where male students showed a prevalence of 72.1%, and for female students, it was 78.5%. The prevalence of dental caries was higher when compared with the other survey findings that had reported prevalence of 53%,[26] 65.88%,[27] 68.8%,[28] and 65.3%,[29] respectively. Furthermore, our results matched with the findings of the study conducted in the Hail region (78.9%),[30] Al-Khobar,[31] and Makkah,[32] but were in contrast with the findings from the central province of KSA.[33] This collective evidence signifies the endemic nature of dental caries and the economic burden on the country.

Our results were consistent with the study results conducted in Riyadh[7] with caries prevalence among 8-year-old schoolchildren of 83% and a recent meta-analysis of various dental caries studies in different regions of Saudi Arabia that determined the prevalence to be 80%.[5] Furthermore, our findings were similar to previous studies conducted in Dammam, Tabuk, Riyadh, and Jeddah, with a caries prevalence of 73%, 77%, 80%, and 78%, respectively.[34]

The results of our study showed that the mean DMFT index value was 1.07 ± 1.5 for 13–15-year-old school students male and females, which is lesser than with AlDosari etal., 2010,[35] who have shown that the mean DMFT index value was 3.12 (2.24–7.35) for 15–18-year-old adolescents in a study of 11 regions in KSA. A higher mean DMFT value of 4.66 for 16-year-old adolescents was reported by Outub in the Makkah region.[9] Likewise, Hassan etal., 2005,[36] reported that the DMFT was 4.31 for 16–18-year-old adolescents in Jeddah city. In addition, Magbool, 1992,[31] reported that the DMFT was 4.59 for 16–17-year-old adolescents in Al-Khobar. This might be attributed to the use of desalinated water for domestic purposes in Jeddah, Makkah, and Al-Khobar, KSA, which may affect mineral levels in the water.

The lesser value of the DMFT mean in our study was reported to the small sample size of our study and the difference in the age groups between our study and the previous studies mentioned. The value of the mean DMFT index was in accordance with the WHO report in 2003[37] for the Eastern Mediterranean Region DMFT index mean, which is 2 ± 1.3.[38]

Analysis of the DMFT components in this study shows that the decayed teeth index mean value was 2.4, while the DM and DF index mean values were 0.2 and 0.6, respectively, comprising a much lesser of the total DMFT mean value. This might be related to the lack of oral hygiene knowledge and practices or difficulties in accessing dental services.

The results of this study indicated that females showed a significantly higher DMFT mean value than males. The observation of higher caries risk among females might conjointly be connected to fluctuating hormonal levels during puberty.[39] This result is consistent with a study in Jeddah KSA.[36] Moreover, the foreign direct investment previously reported higher caries experience in females due to earlier permanent teeth eruption than in males.[40]

In the present study, the prevalence of gingivitis among school students was 66.8%, which is consistent with the study done by Tantawi and AlAgl 2018[20] in Dammam and Khobar on a sample on Saudi Arabian males aged 13–15 years old that showed a gingivitis prevalence of 73.9% and also was similar to that among Nigerian schoolchildren (71%). Moreover, the prevalence of gingivitis in our study was similar to that reported among 12-year-old males in Medina, Saudi Arabia (71%).[41]

A study done in Jazan measured the plaque index score for 500 adolescents where the mean plaque index value for male and female school students was 0.69 and. 0.66, respectively, which is not too far from our study results that showed plaque index for male and female studied group 1.1 and 0.9, respectively.[34] Another study done by El-Angbawi and Younes, 1982,[42] showed that males had significantly higher debris, calculus deposits, and intense gingivitis counts than females, which is similar to our study findings. We assume that there may be variances in the practices of oral hygiene among the population residing in different sectors of the world and even in the same country, especially attributed to their culture, lifestyles, and last but not least socioeconomic status which affects the outcome and the prevalence of the two most common oral diseases in the world.


The comparison of these community indices leads to our assumption that there may be variances in the practices of oral hygiene among the population residing in different sectors of the world and even in the same country, especially attributed to their culture, lifestyles, and last but not least socioeconomic status which affects the outcome and the prevalence of the two most common oral diseases in the world. We successfully engaged our students in a learning experience outside the classroom and opened to them hands-on practice about most two common oral diseases. Nevertheless, by the positive feedback we received, we concluded that these dental community services have significantly outreached to our targeted age group, and it was beneficial to them in terms of a better understanding and knowledge about oral diseases and applied oral hygiene practice.

Ethical clearance

The study was approved by the Research and Ethics Committee of the authors' institution. Reference No: RES-2021-0017).

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


All the authors would like to express their deep gratitude toward all the parents, the teachers, and administrative staff of the two participating schools.


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Dental caries; dental education; dental health survey; health promotion; preventive dentistry

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