Survey of Caries and Fluorosis in Six- and 12-Year-Old Children in Malawi

An increase in the prevalence of caries has been reported in many low- and middle-income countries. However, limited data are available in Sub-Saharan Africa. Aims: The aims were to conduct a national oral health survey in six- and 12-year-old schoolchildren in Malawi, to determine the burden of disease and any history of toothache, and to collect behavioural information from the children, together with current health promoting practices within schools. Methods: Ethical approval was granted by Malawi’s National Health Sciences Research Committee. The survey was undertaken by nine Malawian dental therapists and three UK dentists, in 24 schools. Stratified cluster sampling ensured that the children were representative of Malawi’s three regions. Dental caries (into dentine), fluorosis, oral hygiene and PUFA index data were collected via a dental examination. The WHO pathfinder methodology and BASCD criteria were followed for caries. Questionnaires were completed by each child with support when needed, and by the Head Teacher from each school. Results: A total of 1,330 six-year-old and 1,611 12-year-old children were examined, evenly split between the sexes. Dental caries was identified in 629 (47%) of six-year-olds and 367 (23%) of 12-year-olds. None of the children examined had filled teeth. The mean dmft/DMFT for children with caries experience was 3.0 for six-year-olds and 1.8 for 12-year-olds. Dental fluorosis was recorded for 37 (3%) six-year-olds and 109 (7%) for 12-year-olds. A history of toothache was reported by 391 (29%) of six-year-olds and 690 (42%) 12-year-olds. A lack of PUFA signs was recorded in 1252 (94%) of six-year-olds and 1570 (97%) of 12-year-olds. Conclusions: In the population studied, the prevalence of caries and absence of signs of past clinical care highlight the need to implement activities identified in Malawi’s National Oral Health Policy around the provision of appropriate preventive and treatment services for children.