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Year : 2020  |  Volume : 18  |  Issue : 3  |  Page : 204-209

Do social support and social network influence dental caries in 12–14-year-old schoolchildren of Hyderabad City? – A cross-sectional study

Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India

Date of Submission17-Jan-2020
Date of Decision13-Feb-2020
Date of Acceptance30-Sep-2020
Date of Web Publication24-Oct-2020

Correspondence Address:
Vishnu Priya Sadhu
Sri Sai College of Dental Surgery, Kothrepally, Vikarabad, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_11_20

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Background: Evidence on the influence of psychosocial factors (social support and social network) on dental caries is scarce in the Indian literature. This assessment is even more important in children, owing to the serious complications of caries that could make their daily activities painful. Aim: We aimed to study if social support and social network influence dental caries among 12–14-year-old schoolchildren of Hyderabad city. Methodology: A cross-sectional questionnaire study was conducted on a sample of 1015 students, and information about social support (using the Multidimensional Scale of Perceived Social Support) and social network (2 questions on number of friends and family members) was recorded. Caries was assessed through the “WHO Dentition Status and Treatment Needs 1997 pro forma” and Decayed, Missed, and Filled Teeth (DMFT) (caries experience) was calculated. Correlation between psychosocial and outcome (D and DMFT) variables followed by binary logistic regression with D and DMFT as the outcome variables in two models were conducted using SPSS 24 with a significance level set at P < 0.05. Results: The mean social support score was 4.10. Almost half of them had a good network of friends and family members. A significant negative correlation was found between “social network family” and both the outcome variables. None of the psychosocial variables predicted caries in the regression. Conclusion: Although psychosocial variables could not predict caries, teaching children about their importance in life and influence on oral health would not only minimize caries but make them healthy and happy.

Keywords: Dental caries, Decayed, Missed, and Filled Teeth, social network, social support

How to cite this article:
Sadhu VP, Anjum M D, Divya V, Tenali V, Sravya T, Jyothi M. Do social support and social network influence dental caries in 12–14-year-old schoolchildren of Hyderabad City? – A cross-sectional study. J Indian Assoc Public Health Dent 2020;18:204-9

How to cite this URL:
Sadhu VP, Anjum M D, Divya V, Tenali V, Sravya T, Jyothi M. Do social support and social network influence dental caries in 12–14-year-old schoolchildren of Hyderabad City? – A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2022 Dec 3];18:204-9. Available from: https://www.jiaphd.org/text.asp?2020/18/3/204/298993

  Introduction Top

Oral health plays a very pivotal role in shaping the general health of a person,[1] and among the various problems associated with the oral health, dental caries occupies the first place. Of late, there is evidence that suggests that dental caries develops by a complex interaction of sociodemographic, behavioral,[2] and environmental factors.[3] This multifactorial nature of dental caries makes it highly prevalent in many parts of the world despite the advanced caries detection tools and treatment techniques. The inability to articulate the complex social processes and network of pathways between social structure and oral health has made researches analyzing the social determinants of oral health incomplete.[4] The literature also has demonstrated well-established health benefits associated with social integration through life course challenges.[5]

The WHO commission gave a conceptual framework,[6] grouping the social determinants of health into structural and intermediary factors. Social support and social network were grouped under the intermediary psychosocial factors. Shumaker and Brownell defined social support as “an exchange of resources between at least two individuals perceived by the provider or the recipient to be intended to enhance the well-being of the recipient.”[7] Social network is defined as a vehicle through which social support is provided. While social network is the structural aspect, social support forms the functional measure that could be “perceived” or “received.” It is necessary to assess both the structural and functional measures, as research supports that a mere count of people does not depict the true support, but the receiver's perception (perceived support) matters.[8]

The target population for most studies that evaluated the role of social support and social network was adults,[9] especially the sick,[10] the psychologically disturbed,[11] and those under stress.[12] Studies on adolescents are sparse with mixed study results.[13],[14] There is a need for research work to be directed toward learning about social support in adolescents because children evolve in their thought process in adolescence and the slightest motivation about oral hygiene and its connection to psychosocial factors could minimize caries. Therefore, the present study was undertaken with the objective to study the influence of social support and network on dental caries among 12–14-year-old schoolchildren of Hyderabad city. Our null hypothesis was that social support and social network do not influence the dental caries.

  Methodology Top

A cross-sectional questionnaire study was conducted on the school students of Hyderabad to investigate the influence of social support and social network on caries. The sample size was calculated as 970 taking a 35% prevalence (calculated from the pilot study), 5% error, and 95% confidence interval, using the formula – z2 pq/d2 (z = standard normal variate at 5% type 1 error, P = proportion in population based on pilot study, q = 1 − p, and d = absolute error). However, a sample of 1015 was taken to avoid problems with missing data in the questionnaires. Students were selected using a three-stage random sampling as depicted in [Flowchart 1] where initially schools were randomly selected from the 5 zones of Hyderabad – north, south, east, west, and central. In the second stage, classes 7th, 8th, and 9th were selected where the probability of finding the required age group is greater. The students were then recruited in the 3r d stage. An official letter was sent to the children's parents informing them about the need and details of the study and informed consent taken. Ethical clearance was obtained from the institutional review board (No. 557/6/COMD/SSCDS/IRB-E/2015). Schoolchildren within the age group of 12–14 years, willing to participate, and capable of understanding English or Telugu were included. Those who could not co-operate due to restricted mouth opening or students having problems in filling the questionnaire despite helping them were excluded. This was done to prevent the subjective assessment from being influenced (as the perceived social support was measured).

The questionnaire to be answered by the students was developed in English and Telugu for recording a few structural (socioeconomic status and demographics) and intermediary determinants (oral health behavior, psychosocial factors, and dental health system) under the WHO framework. Socioeconomic status was partially assessed through the type of school; demographics including gender and religion, oral health behavior through brushing frequency and sweet consumption in the previous week, psychosocial factors through social support and social network, and dental health system through the presence of previous dental treatment within school and time since the last dental visit were assessed. Social support was measured using “The Multidimensional Scale of Perceived Social Support”[15] that was validated in the present study for content and face validity, and internal consistency was found to be 0.78 (Cronbach's α). The options for the 12 questions were rated on a 5-point Likert scale, ranging from “strongly disagree” (score = 0) to “strongly agree” (score = 5). Information about social network was ascertained through two questions on the number of family members and friends available to support them. Caries “D” was recorded using “The Dentition Status and Treatment Needs pro forma 1997” and Decayed, Missed, and Filled Teeth(DMFT) (caries experience) also was calculated.

The data were subjected to statistical analysis using the Statistical Package for the Social Sciences version 24 (IBM SPSS Statistics for Windows, version 24.0 Armonk NY: IBM Corp.). The distribution of the outcome (D and DMFT) and psychosocial variables across all the demographics was analyzed using Z-test for continuous variables within two-group (for gender and type of school) and ANOVA for three-group (religion) comparisons followed by post hoc. Kruskal–Wallis was used for ordinal variables compared among three groups. Spearman's correlation between psychosocial factors and outcome variables and a regression analysis to predict the influence of all the independent variables on the two outcome variables (D and DMFT in two separate models) also were conducted.

  Results Top

Family was the major source of support among the three sources assessed in the study, and the mean social support score was 4.10. It was found to vary significantly across different religions, with the Christian students having a greater score than the Hindu religion students.

The “social network of family” score varied significantly across gender (boys > girls) and the type of school (private school students > government school students). The “social network of friends” was significantly higher in boys and Hindu students. Almost half of the students had a good network of family and friends.

Both the outcome variables D and DMFT varied across religion and type of school, with Muslim and government school students having a higher number of carious teeth and caries experience. The mean D was 0.57 for the sample and mean DMFT 0.58 [Table 1].
Table 1: Variation of psychosocial and outcome variables across the demographics

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Correlation between psychosocial factors and outcome variables. A significant correlation was found only between “social network of friends” and both the outcome variables [Table 2].
Table 2: Correlation between psychosocial and outcome variables

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We dichotomized D (D = 0; D ≥ 1) and DMFT (DMFT = 0; DMFT ≥1) and conducted binary logistic regression in two separate models. Only “religion” and “sweet consumption in the previous week” predicted the outcome in both the models. Muslim students had 1.9 times greater odds of D ≥1 and 1.82 times greater odds of DMFT ≥1 than Hindu students. The odds of D ≥1 and DMFT ≥1 for students who ate sweets on all days in the previous week was 2.28 and 2.17 times, respectively, than those who did not consume sweets at all [Table 3] and [Table 4].
Table 3: Binary logistic regression with variables predicting D ≥1

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Table 4: Binary logistic regression with variables predicting Decayed, Missing, and Filled Teeth ≥1

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None of the social factors predicted the outcome in either of the models. Although insignificant, students who did not brush regularly and who did not have a previous dental treatment at school had greater odds of caries and caries experience. Surprisingly, students who never visited a dentist had lesser odds of caries than those who had one.

  Discussion Top

Dental caries is influenced by a multitude of factors among which we set out to determine the influence of social support and social network among 12–14-year-old schoolchildren.

Support from family (mean score = 4.31) was greatest in this study, contradictory to the study results of Bernabé et al., on Brazilian adolescents [13] where the main source of support was obtained from “significant others,” possibly because of the cultural differences. The adolescents in Western countries are independent right from teenage, and most of them engage in relationships, thus deriving their support from this “significant other.” In contrast, teenagers in India are totally dependent on their parents until they start their livelihood, and hence, family is their strength.

Social support varied across religion, attributed to the growing connections between religion and culture evident in the society where cultural differences rooted in different cultural ideas about social groups exist.[16]

The social network of both friends and family was significantly greater in boys than girls because during childhood, boys tend to gang together in larger groups although girls tend to develop more intimate interpersonal relationship than boys.[17] Taylor et al. in their review on social support suggested that differences in social support and network exist across gender, owing to the biological differences between them in how they respond to stress.[18]

The D and DMFT values, though not significant, were higher among girls. The caries risk factors for females include a different salivary composition and flow rate, hormonal fluctuations, dietary habits, genetic variations, and particular social roles among their family. Systemic diseases associated with caries have also been found to have an association with the female gender.[19] A study by Sogi and Bhaskar showed higher caries experience in females, which was linked to earlier tooth eruption in females.[20]

A greater percentage of students had a DMFT score of ≥1 in government schools than those in private schools that could be due to the poor socioeconomic status of government school students leading to difficulty in seeking the required dental care and negligence toward oral health. The results were alike in studies by Moses et al.[21] where the caries pattern was linked to the poor oral hygiene practices in children of lower socioeconomic status.

A correlation analysis was initially done between the psychosocial factors and caries outcome followed by logistic regression with D and DMFT as the dependent variables in two models. Social network of friends was negatively correlated to both D and DMFT similar to a study by Bernabé et al., explained by the influence of social factors on caries through health-related behaviors, stress, and the emotional status of the individuals.[13] None of the other social variables were found to be linked to caries in the regression analysis. This is in resemblance to the study results of Pattussi et al. in which they asserted that the other demographics and oral health behavioral variables could have confounded the results.[14]

In both the regression models, only the religion and frequency of sweet consumption predicted the outcome. Children belonging to the Muslim religion had higher odds of caries and caries experience. For generations, India has a prevailing tradition of joint family system, which is still predominant among Muslims. Children in such families have numerous options apart from parents, to satisfy their taste buds. Moreover, the tendency to celebrate every small occasion is more likely with a bigger network of people around, thus contributing to caries due to frequent snacking.

People who consumed sweets in the previous week were at 1.28 times greater odds of having caries compared to those who did not consume sweets in the previous week. This is in the expected direction because sugar is a known etiological factor of dental caries, also supported by Antunes et al., whose study showed that children consuming sweets for at least once a day had greater odds of caries than those who did not or consumed sweets for less than once a day.[22] Peres et al.[23] and Nurelhuda et al.[24] also reported that 12-year-old children who consumed sugary snacks more than 3 times per week were more likely to experience oral health impacts compared to their counterparts.

The finding of caries odds being greater in people with lesser brushing frequency is comparable to a study by Guptha et al. on 1600 schoolchildren in Jaipur,[25] but Mahalakshmi et al.[26] and Boka et al.[27] could not find such relation, suggesting that proper brushing technique is equally important to achieve total deplaquing. The odds of caries was greater in children who had a previous dental visit compared to those who did not. A study by Beil et al. found children with earlier visits having higher DMFT than those who visited at later ages stressing that children who needed care because of known disease or pain were more likely to see a dentist early.[28] The current study did not consider the reason for dental visit.

This study has a few limitations like the socioeconomic status not being completely addressed owing to the possibility of children providing incomplete data. This was, however, addressed partially by considering the type of school. There is also scope for information bias about children's memory about their frequency of consuming sweets in the past week or the duration since the last dental visit. Despite these limitations, our study has added valuable evidence on social support in the Indian context and setting. We recommend additional studies on similar lines that would better account for generalizability.

  Conclusion Top

Although the influence of social variables on caries failed to be seen in this study, it is important to consider them because of the various direct and indirect pathways through which they are established to influence the oral health.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]


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