© Borgis - Nowa Stomatologia 3/2017, s. 129-141
*Dorota Olczak-Kowalczyk1, Dariusz Gozdowski2, Urszula Kaczmarek3
Dental caries in permanent dentition in children aged 5 and 7 in Poland and its association with dental caries in primary dentition
Próchnica zębów stałych u dzieci w wieku 5 i 7 lat w Polsce i jej związek z próchnicą zębów mlecznych**
1Department of Paediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
2Department of Experimental Design and Bioinformatics, Faculty of Agriculture and Biology, Warsaw University of Life Sciences
Head of Department: Associate Professor Krzysztof Pawłowski, PhD
3Department of Conservative Dentistry and Pedodontics, Medical University of Wrocław
Head of Department: Professor Urszula Kaczmarek, MD, PhD
Wstęp. Stan zębów stałych oceniany jest najwcześniej u dzieci 6-letnich lub starszych. Przed ukończeniem 6. roku życia wyrzyna się jednak 25% pierwszych zębów trzonowych, a przed ukończeniem 5. roku życia – 5%.
Cel pracy. Ocena częstości występowania i poziomu próchnicy zębów stałych u dzieci w wieku 5 i 7 lat oraz związku z próchnicą zębów mlecznych.
Materiał i metody. Badanie przekrojowe w 2016 roku dzieci w wieku 5 i 7 lat przeprowadzono zgodnie z zaleceniami WHO. Grupy badane wyłoniono w losowaniu trzywarstwowym. Odnotowano liczbę wyrzniętych zębów stałych, puwz/PUWZ, PUWP, SiC, frekwencję próchnicy. W analizie statystycznej zastosowano test chi-kwadrat do porównania frakcji oraz test t-Studenta do porównania średnich.
Wyniki. Zbadano 893 dzieci 5-letnich i 897 7-letnich. Próchnica zębów występowała odpowiednio u 76,9 i 89,4% dzieci, częściej na wsi. Wyrzynający się lub wyrznięty co najmniej jeden ząb stały posiadało odpowiednio 26,2 i 98,8% dzieci, spośród których u 6,4 i 29,7% występowała próchnica zębów stałych. PUWZ osiągnęło wartość odpowiednio 0,10 ± 0,48 i 0,62 ± 1,16 przy średniej liczbie wyrzniętych zębów 1,62 ± 1,48 i 3,65 ± 0,91. U dzieci 5-letnich próchnica dotyczyła 6,3% zębów pierwszych trzonowych, u 7-letnich 0,3% siecznych szczęki i 16,1% pierwszych trzonowych (PUWZ6 = 0,59 ± 1,07). W obu grupach u dzieci z PUWZ ≥ 1 istotnie wyższe były wartości puwz niż u dzieci z PUWZ = 0. U dzieci 7-letnich próchnica zębów mlecznych zwiększała ponad 5-krotnie ryzyko rozwoju próchnicy zębów stałych (OR = 5,66 (2,71-11,84); p < 0,001).
Wnioski. Próchnica pierwszych stałych zębów trzonowych pojawia się w krótkim czasie po wyrznięciu, częściej u dzieci mieszkających na wsi. Jej rozwojowi sprzyja próchnica zębów mlecznych, stąd konieczność ich leczenia w okresie poprzedzającym wyrzynanie zębów stałych.
Introduction. The condition of permanent dentition is first assessed in children who are 6 years old or older. However, 25% of the first molar teeth erupt before the age of 6 and 5% – before the age of 5.
Aim. The assessment of the frequency of occurrence and the level of dental caries in permanent dentition in children aged 5 and 7 and of the association with the dental caries of primary dentition.
Material and methods. A cross-sectional study enrolling children aged 5 and 7 carried out in 2016 in accordance with the recommendations of WHO. The members of the study groups were identified in three-stage stratified sampling A note was taken of the number of emerged permanent teeth, dmft/DMFT, DMFS, SiC, the prevalence of caries. In the statistical analysis the chi-square test was applied for comparing fractions and the t-test – for comparing mean values.
Results. 893 children aged 5 and 897 children aged 7 were examined. Dental caries occurred in respectively 76.9 and 89.4% of children, more frequently in rural areas. At least one erupting or erupted permanent tooth was present in respectively 26.2 and 98.8% of children of which 6.4 and 29.7%, had caries of permanent teeth. DMFT reached a level of respectively 0.10 ± 0.48 and 0.62 ± 1.16 with the mean number of erupted teeth equal 1.62 ± 1.48 and 3.65 ± 0.91. In 5-year-old children caries was present in 6.3% of first molar teeth, in 7-year-olds in 0.3% maxillary incisors and 16.1% of first molars (DMFT6 = 0.59 ± 1.07). In both groups in children with DMFT ≥ 1 the values of dmft were significantly higher than in children with DMFT = 0. In 7-year-old children caries of primary dentition increased the risk of the development of caries of permanent dentition more than 5 times (OR = 5.66 (2.71-11.84); p < 0.001).
Conclusions. Caries of the permanent first molar teeth occurs shortly after eruption, more frequently in children inhabiting rural areas. Its development is promoted by caries of primary teeth, thus the necessity to treat them in the period preceding the eruption of permanent teeth.
Epidemiologic studies in children confirm the predisposition to the occurrence of caries in permanent first molar teeth shortly after their appearance in the oral cavity. The factors conducive to the development of caries in this group of teeth include greater susceptibility of enamel to acids, the presence of deep furrows in the chewing surface and a long eruption time. The quantity of plaque accumulating on an erupting tooth is significantly higher than that on a fully erupted tooth because during occlusion with the opposing tooth some of the plaque is removed mechanically as a result of this contact. Moreover, the chewing surface of the erupting tooth during eruption is located below the chewing surface of the neighbouring primary second molar tooth and it is exposed to the risk of ineffective cleaning (1). With the presence of cariogenic biofilm in a child with caries of primary teeth the surface of the erupting permanent tooth may be settled over by mature plaque containing cariogenic bacteria (2).
The eruption period of particular teeth demonstrates high differentiation, i.e. from the appearing of a part of the dental crown in the oral cavity until its full eruption with reaching contact with the opposing tooth. Studies carried out among Danish children demonstrated that the eruption start age of permanent first molar teeth in girls ranges from 5 years 3 months to 7 years 8 months in girls (mean 6.1 years) and from 5 years 2 months to 7 years 10 months (mean 6.3 years) in boys. The eruption duration in girls is by average 15.3 months (ranging from 5 to 32 months) and 15.4 months in boys (ranging from 7 to 28 months) (1).
Studies carried out in a group of 2354 children from Warsaw demonstrated that the permanent teeth which erupt earliest are central incisors and the first mandibular molars as well as first maxillary molars which appear in the oral cavity in 50% of children most frequently about the age of 6 (3, 4). However, the mean age when 25% permanent first molar teeth have already erupted does not exceed 6 and 5% of these teeth erupt even before the child is 5 years old (4). The assessment of the condition of permanent teeth in the period of their appearance in the oral cavity and determining the association between the occurrence of dental caries in their scope and the caries of primary dentition therefore also requires examining 5-year-old children. In this age group however only primary teeth are assessed (5-9). The majority of studies assessing the condition of permanent teeth which have only just erupted, refers however to children older than 5 (10-13).
The aim of this paper is the assessment of the frequency of occurrence and of the level of caries of permanent dentition in children aged 5 and 7 and of the connection with caries of primary dentition.
Material and methods
Within the scope of the implementation of the program prepared by the Ministry of Health entitled “Monitoring the Health Condition of the Oral Cavity of Poles” cross-sectional studies of children aged 5 and 7 (2016) were carried out in four voivodships (the Lower Silesian, Masovin, Lesser Poland and the Lublin Voivodships). The study groups were defined in a three-stage stratified sampling (poviat/communes, urban/rural areas and kindergartens/schools). The inclusion criteria for the studies included the age of 5 and 7, written informed consent of the parents/legal guardians of the children for the participation in the studies, the child’s cooperation allowing for performing the examination. The group count determined at the confidence interval of 95% and margin of error of ± 3% was 600 patients.
Examinations were performed by dentist surgeons who had undergone training and calibration (Cohen’s kappa coefficients between the reference rater and the remaining raters ranged from 0.698 to 0.938 in the group of 5-year-old children and from 0.779 to 0.895 in the 7-year-old children group). The examinations were performed in artificial lighting with the application of a dental mirror and the WHO 621 periodontal probe, in accordance with the WHO examination rules and criteria for classifying clinical conditions (14). The researchers calculated the mean number of erupted permanent teeth, dmft, DMFT, DMFS, SiC, the percentage of children with dental caries (%DMFT/dmft > 0) and with dental caries in permanent dentition (%DMFT > 0), as well as the percentages of teeth with caries in all the studied subjects and in subgroups of children without and with at least one erupted permanent tooth.
The statistical analysis was performed with the application of the chi-square test for comparing fractions (percentage shares) and with the application of the t test for comparing mean values. Moreover, the odds ratios were determined together with the confidence intervals for the selected categorical variables. The analyses were performed in the Statistica 12 Software, the accepted level of significance was 0.05.
The consent of the Bioethics Committee of the Medical University of Warsaw was obtained (no. KB/190/2016).
In total the study enrolled 1790 children (i.e. 83% of those invited to participate in the study), including 893 children aged 5 and 897 aged 7. The sizes of the studied populations with taking into consideration the place of inhabitance, the sex, the presence of permanent dentition and the occurrence and level of caries have been presented in table 1.
Tab. 1. The size of the studied populations of children aged 5 and 7 years taking into consideration the place of inhabitance (city/village) and sex
|Parameters||5-year-old children ||7-year-old children|
|Place of inhabitance||city||559/893 (62.6%)|| 539/897 (60.1%)|
|village||334/893 (37.4%)||358 /897 (39.9%)|
|Sex||female||433/893 (48.5%)||458/897 (51.1%)|
|male ||460/893 (51.5%)||439/897 (48.9%) |
|The presence of at least one permanent tooth||234/893 (26.2%)||886/897 (98.8%)|
|dmft/DMFT > 0||686/893 (76.9%)||802/897 (89.4%) |
|DMFT > 0||15/893 (1.7%)|| 263/897 (29.3%)|
|In total||893 (100%)||897 (100%) |
| ||mean ± SD|
|dmft||4.70 ± 4.33||5.61 ± 3.50|
|Number of permanent teeth||0.81 ± 1.68||8.82 ± 2.90|
|DMFT||0.03 ± 0.25||0.59 ± 1.07|
|SiC ||0.08 ± 0.43||1.77 ± 1.17|
|DMFT 2/3||0.00 ± 0.00||0.00 ± 0.00|
|DMFS||0.03 ± 0.31||0.71 ± 1.49|
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