Cleaton-Jones, P.

Vickers, A. R.

Vickers, K. R.

English

Wits Institutional Repository on DSPACE

Journal of the Dental Association of South Africa, 38, 539-542
Oral health in kwaZulu. A Pathfinder Survey
P. Cleaton-Jones1, A.R. Vickers2 and K.R. Vickers2
'MRC/University of the Witwatersrand, Dental Research Institute, 2 Dental Division, kwaZulu Department of 
Health.
Keywords: dental caries; epidemiology; community health.
SUMMARY
.4 pathfinder survey o f oral health was undertaken in 
kwaZulu. Cluster samples of 6, 12, 16-18, 30-34 and 
15-44-year-old subjects were examined. Dental caries 
prevalence in the permanent dentition ranged bewteen 56 
and 92 per cent, while the range of mean DMFT was 1,6 
to 8,0, caries was slightly greater in the urban group and 
filled teeth were notable by their absence. The main 
periodontal problem was gingivitis.
OPSOMMING
’n Voorlopige ondersoek na mondgesondheid in kwa­
Zulu is onderneem. Monstergroepe van 6, 12, 16-18, 
30-34 en 35-44 jaar oue persone is ondersoek. Tandka- 
ries-voorkomssyfers in die permanence gebit het tussen 
56 en 92 persent gewissel, terwyl die gemiddelde DMFT 
van 1,6 tot 8,0 gewissel het. Karies het effens meer dik- 
wels in die stadsgroep voorgekom en gestopte tande het 
glad nie voorgekom nie. Die hoof periodontale prob- 
leem was gingivitis.
INTRODUCTION
Dentist to population ratios may vary considerably, for 
example from approximately 1 to 900 in Sweden to 
about 1 to 1 000 000 in some African countries (Barmes 
1981). At the time of the present study, 1980, the ratio 
in kwaZulu was 1 dentist to approximately 640 000 
people, comprising 5 dentists working from 5 larger 
hospitals. The purpose of the present investigation was 
to undertake a pathfinder prevalence survey to obtain 
data for oral health service planning (World Health 
Organization 1977).
MATERIALS AND METHODS
kwaZulu is an African governmental authority, com­
prising some 10 detached land units situated in in the 
Province of Natal, Republic of South Africa, with a total 
population of approximately 3,2-million Black people, 
per cent of whom are Zulu-speaking (Malan and 
Hattingh 1976). Both rural and urban populations 
exist.
Selection of the sample for study presented problems in 
view of the separate land areas and large population. 
Since a pathfinder survey is based mainly on practical 
considerations (WHO 1977) it was decided to base the 
survey in the Pietermaritzburg area, which is the area 
where the examiner (ARV) was active and is similar to 
the one in which Jones (1938, 1940) undertook dental 
investigations. Where necessary, more distant areas 
were visited (Fig. 1). Representative geographical 
areas were determined through discussion with local 
authorities and within these clusters random sampling 
was used to determine samples for examination. These
consisted of school children, hospital outpatients (not 
including dental outpatients) and industrial workers. 
The age groups studied were 6, 12, 16-18, 30-3, 35-44 
years. Individuals were termed rural if they lived in an 
agricultural subsistence area, or worked in a large scale 
commercial farming area. They were termed urban if 
they lived in “ townships” , were employed in industry 
and possessed no subsistence agriculture. Within each 
of the areas sampled all the available individuals of the 
various age groups were examined.
Each person was examined in good natural light by a 
single examiner using plane mouth mirrors, sickle 
shaped probes, and graduated periodontal probes. 
Dental caries was diagnosed if the probe caught in a 
suspicious area, pit or fissure (Staz 1938). Teeth lost 
due to trauma were recorded as healthy, and an at­
tempt was made to determine whether missing teeth 
had been removed either because of dental caries or 
periodontal disease.
Oral hygiene was determined as described by Greene 
and Vermillion (1964) through measurement of oral 
debris and calculus followed by calculation of the sim­
plified oral hygiene index (OHI-S). Periodontal disease 
was assessed using the Periodontal Disease Index 
(PD1) of Ramfjord (1959). The examiner was cali­
brated prior to the study by examining a sample of 36 
trainee nurses, on two occasions, one week apart. On 
attaining 80 per cent reproducibility the survey was 
commenced. Spot checks, during the survey, as recom­
mended by WHO (1977) confirmed the maintenance ot 
the reproducibility level.
Data were recorded on computer forms similar to those
Journal ol the D.A.S.A. — September 1983 
539
P Cleaton-Jones, A R Vickers and K R Vickers
Fig. 1: Map of Natal and kwaZulu showing sampling sites. Rural 
areas - 1. Nongoma. 2. Montibello. 8. Pholela. 9. Ohlangc. 
Urban areas - 3. kwaMaslui. 4. Umbogintwini. 5. 6. Eden- 
dale. 7. Georgetown.
of the World Health Organization (1977). The observa­
tions were transferred directly to computer punch cards 
and processed in an IBM 370/158 computer using 
SPSS (Nie et al, 1975). Only descriptive statistics have 
been used.
RESULTS
A total of 853 individuals, 344 males (40,3 per cent) and 
509 females (59,7 per cent) were examined. The break­
down of numbers by age is shown in Table 1. Because 
the numbers in the groups were low, due to the path­
finder study design, subdivision into males and females 
was not made.
The percentage prevalences of dental caries and clean 
teeth (OHI-S =  0) are shown in Fig. 2. In the primary 
dentition the percentage prevalence of dental caries 
was greater in rural 6-year-olds than in urban 6-year- 
olds. The opposite pattern was present in the perma­
nent dentition of the children and adults examined. In 
the permanent teeth of rural dwellers caries showed a 
gradual linear increase with increasing age. Among 
urban people the rise was more rapid, but after 16 years 
the prevalence remained fairly constant. The percent­
age of individuals with clean teeth was consistently 
higher in the urban group.
Mean dmft and DMFT scores are presented in 1 ig. 3. 
Mean dmft scores were indentical in rural and urban 6- 
year-olds. In the permanent dentition mean DMFT 
scores increased steadily with age and were always 
higher in the urban group. In the lower half of Fig. 3 
the proportions of the components of the mean dmft 
and DMFT can be seen. Filled teeth were conspicuous 
by their absence. Decayed teeth formed the major 
component although missing teeth became more 
common as age increased.
The pattern of D, M and F in the permanent dentition 
from 16 years onwards is shown in Fig. 4. Caries in the 
first permanent molars was less than in the second 
molars at all ages, and in the 35-44 year group, the third 
molar was most frequently carious. In the 30-34 year 
group, the third molar was most frequently carious. In 
the 30-34 and 35-44 year groups there was little differ­
ence in the proportion of missing teeth but in the 35-44
PERCENTAGE PREVALENCE OF DENTAL CARIES & CLEAN TEETH (OHI S=0)
clean 
teeth 0
permanent dentition
12 16-18 30-34  3 5 -4 4
URBAN
clean
+ ca riesO  c a rie s -fre e O
Fig. 2: Percentage prevalence of dental caries and clean teeth.
TydskrifvandieT.V.S. A. — September 1983
year group there were more missing teeth in the urban 
group.
Fig. 5 presents the mean PDI, OHI-S and oral debris 
(DI-S) scores for the rural groups while Fig. 6 shows 
the details for the urban groups. In both rural and 
urban groups mean oral debris was greatest in 6 and 12- 
year-old children. Thereafter the debris was less. Mean 
OHI-S scores showed less fluctuation due to an increas­
ing calculus component. Mean PDI scores increased 
with age, rural scores being consistently higher than 
urban scores. The various components of the PDI 
scores are displayed in Fig. 7. From this it is clear that 
gingivitis (scores 1-3) was the main periodontal prob­
lem encountered.
DISCUSSION
Several studies on the dental health of Zulu-speaking 
people in Natal have been reported in the first half of 
the present century. Suk (1919) recorded his observa­
tions during the years 1913 and 1914, on 1008 Zulu 
people aged from under 4 to 20 years, and compared 
these to findings in White children and adults in 
Prague. He reported that 85-94 per cent of his Zulu
Kdmft—i DM FT
age 6 12
R U R U
16-18 3 0 -3 4  3 5 -4 4
R U R U R U
□  D/DMFT E3M/DMFT ■  F/DMFT D urban
or d/dmft m/dmft f/dmlt
Fig. 3: Mean dmft, DMFT scores and breakdown of components of 
mean scores.
subjects had no dental caries and in those with the 
disease, few teeth were carious.
Authors such as Lennox (1929) and Friel and Middle- 
ton Shaw (1931) mentioned that the teeth of Zulu 
people were excellent, but did not present specific re­
sults. Jones (1938, 1940) presented more detailed re­
sults. He found caries to be present in 78 per cent of 
Zulu children aged between 5 and 20 years who at­
tended schools in the Pietermaritzburg area. No articles 
on dental caries among the Zulu people have been pub­
lished subsequently. However, because of differences 
in methodology, the earlier studies cannot be directly 
compared to the present investigation.
Comparison of dental caries observations in the present 
study to those reported in the Transvaal (Retief, Clea- 
ton Jones and Walker, 1975; Hirschowitz, Rashid and 
Cleaton-Jones, 1981 and Walker et al, 1981) in which 
similar criteria and methodology have been used for the 
diagnosis of dental caries is presented in Table 2. Mean 
caries prevalence and DMFT scores in the 12-year-old 
urban groups are very similar but in both the rural and 
urban areas the 16 to 18-year-old kwaZulu subjects 
have higher values, except for the study by Walker etal 
(1981) which had values closer to those of the present 
kwaZulu subjects.
In a pathfinder survey such as this, only broad trends 
can be shown, but it is clear that a therapeutic and pre-
5 Q C A R IE S  PATTERN BY T O O T H  TYPE
16 " 18yr
□ 0
in e ac h  pair o( b a r s  le ft* r u ra l ,  r ig h t .u rb a n  FT  u
■  f
Fig. 4: Caries pattern by tooth type.
Journal of the D. A.S. A. — September 1983 
541
P* Cleaton-Jones, A R Vickers and K R Vickers
RURAL Z 7 \
o,
Z71
Z7|
Ok*r
471
471
LlJ
LP
471
471
Z7
/ ^ 4 74—f a  ro
471
471oa»
L y
4 7 Z 7 I
0/0 / 35- 44y,
_V  /sa-S*v 
/ * !  \8 ,.
Aj,'
y6yr
Fig. 5: Mean PDI, OHI-S and oral debris (DI-S) scores for the rural 
people.
URBAN
people.
R AM FJO R D ’S PER IO D O N TA L D ISEA SE INDEX
Fig. 7: Breakdown of component of PDI scores.
5 4 6  not s*«r
R*rur*|
U* urban
Table 1: Number of persons examined by environment and age
Age in Years
6
12
16-18
30-34
35-44
Rural Group
71
169
90
59
17
Urban Group
43
41
102
190
71
ventive challenge faces the dental authorities, in rural, 
but perhaps more so in urban areas, where the need ap­
pears to be greater. A solution to the problem is nol 
simple to provide. An increase in manpower may be 
the first priority since at the time of the survey only five 
dentists and no dental therapists were employed in the 
kwaZulu dental department. A suitable dentist (and 
dental therapist) ratio to population will need to be de­
termined bearing in mind that many individuals may 
utilize the services of dentists and dental clinics in 
towns and cities adjoining kwaZulu.
Secondly consideration should be given to the siting of 
dental services to be of greater availability to the 
population at risk. Thirdly, the use of such services will 
have to be encouraged. This study has highlighted the 
pressing need to bring much needed dental services to 
the people of kwaZulu.
REFERENCES
Barmcs, D.E. (1981) Oral health and the World Health Organis­
ation. In Dental Public Health, 2nd cd. Ch 4 pp 77 XS. Bristol: 
John Wright.
Friel, G. & Middleton Shaw, J.C. (1931) Some notes concerning 
dental caries in South African children. British Dental Journal 52, 
309-320.
Greene, J.C. and Vermillion, J.R. (1964) The simplified oral hygiene 
index. Journal o f the American Dental Association, 68, 7-13. 
Hirschowitz, A S., Rashid, S.A.A. and Cleaton-Jones, P. (1981) 
Dental caries, gingival health and malocclusion in 12-year-old 
urban Black schoolchildren from Soweto. Johannesburg. Com­
munity Dentistry anti Oral Epidemiology, 9, 87-90.
Jones, H.A. (1938) A preliminary report on the incidence of dental 
caries among the Bantu in schools in and on the outskirts ol 
Pietermaritzburg. South African Dental Journal 11, 115-121. 
Jones, H.A. (1940) Further observations on the incidence of dental 
caries. South African Dental Journal 14, 226-233.
Lennox, J. (1929) Observations on diet and its relation to dental 
disease. South African Dental Journal 3, 125-135.
Malan, T. & Hattingh, P.S. (1976) Black Homelands in South Africa.
Ch 17, pp 159-173. Pretoria: Africa Institute of South Africa. 
Nie, N.H., Hull. C.H., Jenkins, J.G., Steinbrenncr. K. & Bent. 
D.H. (1975) Statistical Package for the Social Sciences, 2nd ed 
New York: McGraw-Hill.
Ramfjord. S.P. (1959) Indices for prevalence and incidence ol 
periodontal disease. Journal o f Periotlontology. 30, 51. 59. 
Reticf. D H.. Cleaton-Jones. P. and Walker. A R P .  (1975) Dental 
caries and sugar intake in South African pupils of 16 to 17 years in 
four ethnic groups. British Dental Journal 138, 463-469.
Staz, J. (1938) Dental caries in South Africa. South African Journal 
o f Medical Sciences 3 (Supplement), 1-63.
Suk. V. (1919) Eruption and decay of permanent teeth in whites and 
Negroes, with comparative remarks on other races. American 
Journal o f Physical Anthropology 2, 351-388.
Walker, A.R.P., Dison. E., Duvenhagc. A., Walker. B.F.. Fried- 
lander, I. & Aucamp, V. (1981) Dental caries in South African 
Black and White high school pupils in relation to sugar intake and 
snack habits. Community Dentistry and Oral Epidemiology 9, 37- 
43.
World Health Organisation (1977) Oral Health Surveys, BASIC 
Methods. 2nd ed Geneva, W H O.
Table 2: Comparison of den tal caries prevalence and severity between kwaZulu and Transvaal black groups
STUDY AGE RURAL URBAN
Caries Caries
Prevalence Mean DMFT Prevalence Mean DMFT
% c/c
Transvaal
Reticf et al (1975) 16-18 39,7 1,2 67,0 2,1
Hirschowitz et al (1981) 12 65.6 2,3
Walker et al (1981) 16-18 43.4 1.5 87,3 5.2
KwaZulu
Present study 12 1.6 78.0 2.4
16-18 74.0 3,1 93.0 4,9
Tydskrifvan die T.V.S.A. — September 1983
542


Oral health in kwaZulu. A pathfinder survey

http://wiredspace.wits.ac.za/bitstream/10539/19532/1/Oral%20health%20in%20kwaZulu.%20A%20pathfinder%20survey.pdf

Oral health in kwaZulu. A pathfinder survey

Abstract

Similar works

Full text

Available Versions

Wits Institutional Repository on DSPACE