Effect of Vitamin D Deficiency on Dental Caries Among School Aged Children of The Local Area of District Mardan

Dental caries and Vitamin D deficiency are a worldwide phenomenon. Therefore the study aims to explore the effect of vitamin D deficiency on dental caries among school aged children of the local area of district Mardan. A total of 800 children between the ages of 4-15 years were studied. A systematic random sampling technique was applied for sample collection. In the current research work, 800 samples were estimated for the exploration of vitamin D deficiency in school-aged children. A high percentage of Vitamin D deficiency was found in males 90(22.5%) while a very low ratio was found in females 50(12.5%). The ratios of insufficiency in the school-aged children were also high in male 110(27.5%) children as compared to female 50(12.5%) students were respectively. Aged-wise exploration of vitamin D deficiency shows that very low frequency was showed in low aged group 4-7 years 40 (10%), similarly in 8-11 years the frequency of vitamin D deficiency was 60(15%) while in the aged group 12-15 years the frequency of Vitamin D deficiency were found very high 80 (20%). Residency-wise results show that the frequency ratio of urban children was high 80(20%) as compared to rural area children 60(15%) respectively. This emerging health problem of Vitamin D deficiency and its connection with the academic career of school-going children has long-term health impacts. The present study highlighted the association between vitamin D deficiency in different age groups, genders, and socioeconomic status-wise exploration of vitamin D deficiency .


INTRODUCTION
Vitamin D deficiency is an important public health problem in both developed and developing countries, with a reported worldwide prevalence of 30-80% in children and adults.The role of vitamin D in bone mineralization is well-documented Calvo et al 2005.Vitamin D [25(OH) D] started to gain importance worldwide for its important role in healthy bone structure and calcium and phosphate metabolism.There are many studies showing 25(OH) D deficiency and insufficiency in children worldwide (Cediel 2018).In the presence of 25(OH) D deficiency and insufficiency, absorbtion of both calcium and phosphorus is impaired resulting in reduced bone mineral density (Adam et al 2010).Low levels of 25(OH) D affects an individual's present and future health status, triggering multiple systemic responses reducing bone density and the level of immune response since there are 25(OH) D receptors in a wide range of tissues, and are related with retarded growth, skeletal deformities and secondary hyperthyroidism in the childhood, whereas hip fracture in the elderly is observed in individuals with impaired bone structure (DeLuca et al 2004).Also, there are increasing data explaining the relationship between low levels of 25(OH) D and different types of non-skeletal diseases including some types of cancer, autoimmune, infectious, cardiovascular and psychiatric diseases (Holick et al 2007).Risk factors for 25(OH)D deficiency in children were defined as obesity, intestinal malabsorbtion syndromes, usage of anticonvulsant agents such as Phenytoin, phenobarbital, and carbamazepine, low levels of sun exposure, clothing habits, climatization and seasonality, nutritional choices, dark skin color (Autier et al 2010).In order to determine an individual's vitamin D status, serum 25 (OH) D levels is measured.There are different threshold points used to determine 25 (OH) D statuses of individuals as suggested by different organizations and in guidelines (Alyahya 2017).Regular measurement of 25(OH) D levels in the childhood and replace the low levels with vitamin D fortification or supplementation is essential and a public health matter in order to acquire healthy generations with robust bone structure.The aim of our study was to assess serum 25(OH)D levels in elementary school children aged between 6-9 years old within a year duration and determine 25(OH)D status between different seasons (Mansbach et al 2009)

Amis of the study
The aims of the study to explore gender and aged wise deficiency of vitamin D and Dental caries among school aged children of the local area of district Mardan

METHODS
This study was undertaken for the Exploration of Dental caries and vitamin D deficiency in school aged children of the local area of District Mardan.We retrospectively studied the records of a total of 800 children of aged between 4-15 June 2023 to December 2023.All patients were subjected to a careful physical examination.Weights were measured using a calibrated digital scale.Height measurements were done intriplicate to the nearest millimeter using a calibrated stadiometer.Body mass index (BMI) were calculated according to the formula [weight (kg)/height (m)2].Patients with a history of a chronic disorder or on any medication that may alter vitamin D metabolism were excluded from the study.Serum calcium (Ca), phosphorus (P), magnesium (Mg), alkaline phosphatase (ALP) and glucose levels were measured using the enzymatic colorimetric method (Roche Integra 800), while serum 25 hydroxy vitamin D

Study Area and Period
The study was conducted in Takht Bhai Mardan, which is located Khyber Pakhtunkhwa.

Study Design
Institutional based cross-sectional study designs were used.

Study Population
All secondary and primary school students (age group wise the source population, whereas sampled or selected students were the study population of this study.

Sample Size Determination
A Total of 800 children between the ages of 4-15 years were studied.A systematic random sampling technique was applied for sample collection.
Lab investigations and Tests: All patients were subjected to: Complete Blood count and reticulocyte count.Patients with microcytosis underwent the following:

• Serum Iron and ferritin
An automatic hematological analyzer and Biochemistry analyzer were used for Clinical Examination Routine blood tests This is done to assess anemia and other vitamin and mineral deficiencies.There may be dehydration, low blood sugar and signs of severe infection as is evident by raised while blood cell counts.

Diagnosis of malnutrition in children
In children weight and height is measured and compared with the charts showing the expected average height and weight for a child of that age.Some children are persistently smaller for age and may be genetically so.

Blood tests in children
Routine blood tests in children include those for blood glucose, blood counts, urine for routine examination.Levels of iron in blood, folic acid and vitamin B 12 are also done.For protein estimation other tests including Normal ranges of ferritin 10 to 150 ng/mL for children 4 th years to14 years.MCV normal range is 80 to 95 for children

ANALYSIS & INTERPRETATION  Analysis and Interpretation of data
Data will analyze and interpret by using M word, Origin8 and Excel.Frequency and Percentage were calculated for all quantitative variables.

Statistical Analysis
Statistical analysis was performed by using Origin8 and MS office word 2010.

RESULTS
In the current research work 800 samples were estimated for the exploration of vitamin D deficiency in school aged children.Out of 800 samples 400 from male students while 400 were taken from the females' student.The high percentage of Vitamin D deficiency were found in male 90(22.5%)while very low ration were found in female 50(12.5%) Figure .1.while the ratios of insufficiency in the school aged children were also high in male 110(27.5%)children as compare to female 50(12.5%)and the prevalence of Dental caries was found 50(6.25%)students were respectively.

Figure.3 Residence wise Vitamin D deficiency in School Children
Our study also reveal that the vitamin D deficiency related with that of socioeconomic status which shows that the high frequency were found in children of high socioeconomic status as compare to that of the children of low socioeconomic status.In conclusion the vitamin D deficiency was found to be dependent on sunlight, diet and the other factors are socioeconomic status, residency of schoolchildren.The results explore that the need for behavior change communiqué on the significance of exposure to sunlight to create appropriate vitamin D in the schoolchildren of the local area of Mardan.This emerging health problem of Vitamin D deficiency and its connection with the academic carrier of school going children long term health consequences.As the present study only highlighted the association between vitamin D deficiency in different aged group, gender and socioeconomic status wise exploration of vitamin D deficiency.

DISCUSSION
In the current research work 800 samples were estimated for the exploration of Dental caries and vitamin D deficiency among school aged children.Out of 800 samples 400 from male students while 400 were taken from the females' student.The high percentage of Vitamin D deficiency were found in male 90(22.5%)while very low ration were found in female 50(12.5%) Figure .1.while the ratios of insufficiency in the school aged children were also high in male 110(27.5%)children as compare to female 50(12.5%)students were respectively.Same study were also conducted by (Zhu et al 2012) a total of 6,008 children aged 1 month to 16 years partaken in this cross-sectional study.All the subjects were divided into subgroups according to their age: 0-1y, 2-5y, 6-11y and 12-16y representative infancy, preschool, school age and adolescence stages respectively.The highest mean level of serum 25(OH)D was found in the 0-1y stage (99 nmol/L) and the lowest one was found in 12-16y stage (52 nmol/L).Accordingly, the prevalence of serum In the current research work the prevalence of Dental caries was 50(6.25%) in vitamin D deficient students in the local area of district Mardan.A study was also conducted by [32] The dental index of decayed, missing and filled teeth (DMFT) in the deficient and insufficient vitamin D groups was significantly higher than in the sufficient vitamin D group (P=0.03).The linear regression model on the effect of age, vitamin D, and calcium on dental indexes showed no significant statistical relationship.However, in the case of the dental index, age, and calcium level affected dental caries (d), but vitamin D did not affect this index.

CONCLUSION
The results explore that the need for behavior change communiqué on the significance of exposure to sunlight to create appropriate vitamin D in the schoolchildren of the local area of Mardan.This emerging health problem of Vitamin D deficiency and Dental caries its connection with the academic carrier of school going children long term health significances.As the present study only highlighted the association between vitamin D deficiency in different aged group, gender and socioeconomic status wise exploration of vitamin D deficiency.


The subjects were briefed about the study. Consent was taken from the subjects after explaining the purpose of study for the collection of data.

Figure. 1 Figure. 2
Figure.1 Gender wise prevalence of Dental caries and Vitamin D deficiency in School Children Aged wise exploration of vitamin D deficiency shows that very low frequency were showed in low aged group 4-7 years 40 (10%), similarly in 8-11 years the frequency of vitamin D deficiency were 60(15%) while in aged group 12-15 years the frequency of Vitamin D deficiency were found very high 80(20%) shown in Figure.2

Figure. 4
Figure.4 Socioeconomic status wise Vitamin D deficiency in School Children

According to WHO formula BMI= weight Hight(M 2 )
25(OH)D levels of < 75 nmol/L and < 50 nmol/L were at the lowest among infants (33.6% and 5.4% respectively) and rose to the highest among adolescents (89.6% and 46.4% respectively).The mean levels of serum 25(OH)D and the prevalence of vitamin D deficiency changed according to seasons.In winter and spring, more than 50% of school age children and adolescents had a 25(OH)D level at < 50 nmol/L.If the threshold is changed to < 75 nmol/L, all of the adolescents (100%) had low 25(OH)D levels in winter and 93.7% school age children as well.