Czytelnia Medyczna » Nowa Stomatologia » 2/2003 » Dental caries and oral health practices in 12-year-old children in Lodz*

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Patrycja Proc, Jacek L. Pypeć

Dental caries and oral health practices in 12-year-old children in Lodz*

Department of Paediatric Dentistry, Medical University in Lodz
Head of Department: Prof. dr hab. n. med. Magdalena Wochna-Sobańska

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INTRODUCTION

Dental caries is considered to be a complex disease. Caries prevalence is related not only to individual genetic factors, but also to social ones. Up to now science has been unable to find a remedy for susceptibility caused by inheritance, but a favourable environment for good oral health can be created. Many authors state that nutritional habits and oral health practices are of paramount importance in the control and reduction of this disease (1-4). The relationship between external factors and caries prevalence is especially relevant in childhood. Until 1989 Poland formed part of the East Communist bloc, but political and economic changes since then have created new opportunities for health promotion and effective co-operation between the authorities and the professionals. The process of opening up to the West caused not only economic changes but influenced social behaviour, including nutrition and oral health practices, especially among younger Poles. Strident TV promotion of dental products by western companies, and easy access to these new brands, has improved the quality of hygiene procedures. On the other hand, an explosive increase in the consumption of sweet confectionery, and the collapse of oral health care previously provided in grammar schools, might increased the incidence of caries among 12-year-olds. Poland is one of the East European countries where caries incidence is considered to be moderate to high. The state of dental health among 12-year-olds in Lodz has been assessed several times. In 1993 dental decay incidence in 12-year-olds measured by the DMFT index was 4.8 (5), and in 1995 the index reached a value of 4.26 (6), which compares with the results from 1998 where the value was estimated as 4.0 (7).

The aim of our study was to assess the state of oral health and the extent of preventive practices among 12-year-old children in Lodz.

MATERIALS AND METHODS

The study took place from April to May 2000 in the city of Lodz. A sample of 263 12-year-old children, 142 boys and 121 girls, was selected from grammar schools in Lodz. Schools were randomly selected from the total number of grammar schools in the city. Each school was visited before the survey to deliver the questionnaires, and teachers were asked to distribute and collect papers. Consent to a dental examination was obtained from both the participants and their parents. The questionnaire used for the interviews was designed by the authors. The following information was collected:

1.children´s personal data (sex, age),

2.oral health practices (frequency of toothbrushing, using other cleaning aids, frequency of dental visits),

3.nutritional habits (frequency of eating sweets or snacks between meals),

4.awareness of dental health advice,

5.attitude towards dental care.

All children were seen by one examiner (JLP) who had received training in clinical methodology, and had wide experience in the clinical diagnosis of caries lesions. Children were seated in a chair and natural light was used. Dental examination was made by using a dental mirror and sometimes a probe to inspect the extent of dental plaque (DI-S), or to check doubtful diagnoses. No radiographs were used. The WHO caries diagnostic criteria (8) were used to assess the dental state of the children, and the Simplified Debris Index to measure the level of oral health. Following the recommendations of Green and Vermillion, 1964 (9) all six surfaces of the teeth were inspected. In the posterior area of the mouth: the buccal part of the upper and lingual surfaces of the lower selected molars, and in the anterior area: the labial surface of the upper right and the lower left central incisors. The maximum score per tooth was 3, and for a person 18. An individual index was obtained by dividing the total score by 6. Children were divided into three groups: 0-group with DI-S = 0 and a very good state of hygiene, 1-group with DI-S = 1 and a good state of hygiene, 2-group with DI-S = 2 and a poor state of hygiene, and 3-group with DI-S = 3 and a very poor state of hygiene.

Data were recorded on specially designed cards and then entered into the computer.

For the statistical inference of the accumulated material, mean values were adopted for measurable readings, with standard deviation and 95% reliability of the arithmetical means. The nature of decay in the examined cases was subjected to the Shapiro-Wilk test. To establish differences between the mean values in the groups, Kruskal-Wallis and Mann-Whitney tests were used. Results were obtained using the STATGRAPHICS Plus V.5. computer program.

RESULTS

The overall mean DMFT score of the surveyed children was 3.07 ± 2.79. The mean DMFT for boys was 3.38 ± 3.03, and lower for girls at 2.63 ± 2.31. Nineteen percentage of children were free of caries, 18% of boys and 21% of girls. Almost 47.8% of the overall mean DMFT score was contributed by decayed teeth (DT), and 50.2% by filled teeth (FT), so only 2% of teeth were extracted because of caries (tab. 1). Boys had more teeth with active caries lesions, the mean score for DT in boys was 1.84 ± 2.49 compared to 0.88 ± 1.43 in girls (p <0.01). The mean score for FT in boys was 1.44 ± 1.62 and in girls 1.70 ± 1.85. Thus the mean value of the care index (FT/DMFT) was lower for boys (42.6%) than for girls (64.6%). In the examined sample the children´s oral health was found to be very good in 36.5% (group 0), in good 15.7% (group 1), in poor 40.9% (group 2) and very poor in 6.9% (group 3). The mean DMFT scores in groups 0, 1, 2 and 3 were 1.47 ± 1.53, 3.30 ± 2.61, 3.86 ± 1.88 and 9.10 ± 7.83 respectively, which is statistically significant (p <0.05) (tab. 2). There was also a significant difference in the oral health levels between the genders. The boys´ mean DI-S was 0.96 ± 0.79, compared to 0.59 ± 0.78 for the girls (p <0.001).

It was also found that children´s dental health was related to some of their oral health practices (tab. 3). Children who brush their teeth twice daily had a lower DMFT score than children who brush their teeth less than once daily. In the investigated group, 73% of girls and only 44% of boys brush their teeth at least twice a day, and 27% of girls and 45% boys brush their teeth only once daily. Almost 11% of boys brush their teeth less than once a day, but no girl in this group brushes her teeth so seldom.

Table 1. DMFT, DT, FT indices of 12-year-old children from Lodz, 2000.

Gender	N (%)	DMFT	DMFT = 0	DT	DT/DMFT	FT	FT/DMFT
Boys	142 (54%)	3.38 ? 3.03	26 (18%)	1.84 ? 2.49*	54.4%	1.44 ? 1.62	42.6%
Girls	121 (46%)	2.63 ? 2.31	25 (21%)	0.88 ? 1.43*	33.4%	1.70 ? 1.85	64.6%
Total	263 (100%)	3.07 ? 2.79	51 (19%)	1.47 ? 2.19	47.8%	1.54 ? 1.71	50.2%

* statistically significant, p <0.01

Table 2. Distribution of DI-S index scores and DMFt index in each group.

Group	DI-S index	Boys N (%)	Girls N (%)	Total N (%)	Mean DMFT	Significance
0	0	38 (27%)	64 (53%)	94 (36%)	1.47 ? 1.53*	p < 0.05
1	Ł 1	52 (37%)	30 (25%)	87 (33%)	3.30 ? 2.61
2	Ł 2	42 (29%)	22 (18%)	66 (25%)	3.86 ? 1.88
3	Ł 3	10 (7%)	5 (4%)	16 (6%)	9.10 ? 7.83*

Table 3. Incidence of dental caries according to some oral health practices and the consumption of sweets.

	Group	N (%)	Mean DMFT	Significance
Toothbrushing	Twice daily	150 (57%)	2.78 ? 2.78*	p < 0.05
	Once daily	97 (37%)	3.47 ? 3.02
	Less than once daily	16 (6%)	4.85 ? 3.23*
Use of dental floss	Yes	97 (37%)	2.79 ? 2.81
Use of dental floss	No	166 (63%)	3.62 ? 2.59
Dental visit pattern	Every 6 months	179 (68%)	3.35 ? 4.34
	Once a year	29 (11%)	2.69 ? 1.84
	Less than once a year	55 (21%)	3.04 ? 2.56
Eating sweets	More than once daily	50 (19%)	3.94 ? 2.93*	p < 0.05
	Once daily	95 (36%)	3.34 ? 2.59
	Less than once daily	118 (45%)	1.72 ? 1.75*

* statistically significant

The examination revealed that girls and boys who eat sweets less than once a day are less prone to dental caries than those who eat sweets daily, whilst children who eat sweets more frequently had the highest mean DMFT score. Children who use other cleaning aids had a lower DMFT score than those who don´t, but this was not statistically significant. There was no correlation between frequency of dental visits and incidence of caries. Children who had the highest DMFT scores visit their dentist as often as children with the lowest ones. The questionnaire revealed that 70% of children change their toothbrush every 3 months, 84% know what fluoride is, 82% find brushing very useful, and 13% never eat snacks between meals "so as not to contaminate” their teeth. Asked about the source of dental information, 64% of children indicated parents, 56% dentist, 29% school, 23% TV health information programmes, and 15% TV advertisements. Only 4% of the sample gained the information from professional articles or books. Over 40% of investigated children complained of not getting enough proper information from their dentists.

Discussion

The findings of are in agreement with the downward trend of caries prevalence among Polish children noticed by other Polish authors (10). In 1993, during the national epidemiological survey, it was estimated that 92% of 12-year-old Polish children had prevalenced caries, and the mean overall DMFT index for them was 4.4. In 1997 the number of children affected fell to 87% and the DMFT index to 4.0, compared with the results of this study in which 81% of children were affected by caries and the mean DMFT for them was 3.07 (10). In Lithuania, a country of a similar culture and economy to Poland, in 1995 the overall mean DMFT among 12-year-olds ranged from 3.3 to 4.9, and a previous study in 1988 revealed that the DMFT index was 3.5 (11, 12). The conclusion must be that the incidence of caries in Lithuania is not declining (11). In many industrialised countries, such as England, the fall in caries cases has slowed down, but the values of the mean DMFT index among 12-year-olds in these places are significantly lower than in Poland (13). Our study results showed a higher level of caries in boys than in girls, which is in contrast with the findings of most authors, but in agreement with the results of previous surveys in Łódź (7). In line with the findings of other authors (13, 14, 15), the Care Index value in our sample was slightly higher for girls than for boys, but in contrast with the results of these studies the level of active caries (DT) was much higher among Polish boys than girls (p <0.01). In the present study we also found that the level of oral cleanliness was strictly associated with gender (p <0.001). Chesters et al, 1992 (16), also observed differences in oral habits between the sexes: in his survey, 73% of girls and only 44% of boys brushed their teeth twice a day. His results are very similar to ours; in this survey more girls brush their teeth twice a day, and girls had a better hygiene level and lower DMFT indices than boys. Our study results support the previous study by other authors (17), which showed that girls brushed their teeth more frequently than boys, and had better hygiene levels and caries scores, due to better protection provided by fluoride in their toothpaste. The correlation between the frequency of toothbrushing and caries incidence is also reported in recent studies by other authors (1, 2, 16, 17, 18).

Compared with the results gained by other authors (2, 19, 20), the extremely high percentage of children in our survey using dental floss is probably an over-estimate. Children knew the correct answer and tried to do their best. A problem with the reliability of the children´s answers has also been noticed by other authors (21), who found that respondents often gave socially desirable answers.

The finding of our survey, that there is no straight correlation between the frequency of dental visits and caries, is in agreement with previous studies (4, 21), but many authors (2, 21) have found that dental visits are a very important source of dental health information. Parents, dentists and teachers were the main sources of dental awareness in 12-year-old children from Kuwait (21) and this was confirmed by Polish pupils in our survey. Professional information from a dentist was also felt to be the most desirable and trustworthy source by the 12-year-olds.

CONCLUSIONS

We found that the oral health state of children is in strict correlation with oral preventive practices. Although parents should be the primary source of dental information, the heaviest responsibility in imparting it must lie with the professionals. This must become a top priority for dentists in their day-to-day practice.

* Praca finansowana przez Uniwersytet Medyczny w Łodzi z pracy własnej nr 502-12-718.

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Piśmiennictwo

1. Ashley P.F. et al.: Toothbrushing Habits and Caries Prevalence. Caries Res. 1999, 33:401-402. 2. Chu C.H. et al.: Dental caries status of preschool children in Hong Kong. Br. Dent. J. 1999, 187:616-620. 3. Gibson S., Williams S.: Dental Caries in Pre-School Children. Association with Social Class, Toothbrushing Habit and Consumption of Sugars and Sugar-Containing Foods. Caries Res. 1999, 33:101-113. 4. Rodrigues C.S., Sheiham A.: The relationship between dietary guidelines, sugar intake and caries in primary teeth in low income Brazilian 3-year-olds: a longitudinal study. Int. J. Paed. Dent. 2000, 10:47-555. 5. Wochna-Sobańska M. et al.: Assessment of the condition of teeth and dental health needs in children aged 12 years from Łódź and Piotrków province. Czas. Stomat. 1993, 11-12:740-743. 6. Wochna-Sobańska M. i wsp.: Próchnica zębów u dzieci w wieku 6, 7, 12 i 18 lat zamieszkałych w Łodzi oraz małym miasteczku i wsiach województwa łódzkiego. Przegl. Stom. Wieku Rozw. 1995, 3-4:28-30. 7. Szczepańska J.: The analysis of prognostic factors in the course of dental caries, in 12-year-old children living in Łódź. Przegl. Stom. Wieku Rozw. 1998, 24(4):33-36. 8. Oral Health Organization. Oral Health Surveys, Basic Methods. Geneva: WHO, 1987. 9. Green J., Vermillion J.: The simplified oral hygiene index. J. Am. Dent. Assoc. 1964, 68:7-13. 10. Wierzbicka M. et al.: Impact of school programmes on dental health: a report from Poland (Abstract). Intern. J. Paed. Dent. 1999, 9 (Suppl. 1):12. 11. Machiulskiene V. et al.: Prevalence and Severity of Dental Caries in 12-year-old Children in Kaunas. Lithuania 1995, Caries Res. 1998, 32:175-180. 12. Aleksejuniene J. et al.: Caries prevalence in Lithuanian children and adolescents. Acta Odont. Scand. 1996, 54:75-80. 13. Whittle K.W., Whittle J.G.: Dental caries in 12-year-old children and the effectiveness of dental services in Salford UK in 1960, 1988 and 1997. Br. Dent. J. 1998, 184:394-396. 14. Okada M. et al.: Relationship between gingival health and dental caries in children aged 7-12 years. J. Oral Sc. 2000, 42(3):151-155. 15. Ratka-Kruger P. et al.: Relations between oral hygiene, caries and gingivitis in 4- and 5-year-old children in Frankfurt//Main area. Oralprophylaxe 1989, 11:58-64. 16. Chesters R.K. et al.: Effect of oral care habits on caries in adolescents. Caries Res. 1992, 26:299-304. 17. Dummer P.M.H. et al.: The effect of social class on the prevalence of caries, plaque, gingivitis and pocketing in 11-12-year-old children in South Wales. Intern. Dent. J. 1987, 15:185-190. 18. Sjogren K., Birkhed D.: Factors related to fluoride retention after toothbrushing and possible connection to caries activity. Caries Res. 1993, 27:474-477. 19. Honkala E. et al.: Oral health habits of schoolchildren in 11 European countries. Intern. Dent. J. 1990, 40:211-217. 20. Al-Banyan R.A. et al.: Oral health survey of 5-12-year-old children of National Guard employees in Riyadh, Saudi Arabia. Intern. J. Paed. Dent. 2000, 10:39-45. 21. Vigild M. et al.: Oral health behaviour of 12-year-old children in Kuwait. Intern. J. Paed. Dent. 1999, 9:23-29.

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