Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

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© Borgis - Nowa Stomatologia 2/2018, s. 55--65 | DOI: 10.25121/NS.2018.23.2.55
*Małgorzata Staszczyk, Magdalena Kępisty, Iwona Kołodziej, Dorota Kościelniak, Iwona Gregorczyk-Maga, Jadwiga Ciepły, Anna Jurczak
Dental caries status and trend in 5-, 7- and 12-year-old children from the Małopolskie region in comparison to the Polish population
Ocena stanu i trend próchnicy u dzieci 5-, 7- i 12-letnich z województwa małopolskiego w porównaniu do populacji polskiej
Department of Paedodontics, Institute of Dentistry, Jagiellonian University Medical College, Cracow
Head of Department: Anna Jurczak, MD, PhD
Streszczenie
Wstęp. W 2016 roku dzieci 5-, 7- i 12-letnie z województwa małopolskiego zostały objęte badaniem stanu zdrowia jamy ustnej w ramach realizowanego w naszym kraju cyklicznie od 1997 roku Ogólnopolskiego Monitoringu Zdrowia Jamy Ustnej wśród wybranych grup wiekowych populacji.
Cel pracy. Ocena frekwencji i poziomu próchnicy u dzieci 5-, 7- i 12-letnich z województwa małopolskiego oraz obserwacja trendu choroby próchnicowej w tym województwie w ostatnich latach w odniesieniu do populacji polskiej.
Materiał i metody. Badaniem objęto 673 dzieci z województwa małopolskiego, w tym 223 w wieku 5 lat, 225 w wieku 7 lat oraz 225 w wieku lat 12. Stan uzębienia badano według zaleceń i kryteriów klasyfikacji WHO. Oceniano frekwencję i poziom próchnicy dzieci małopolskich w odniesieniu do wyników wcześniejszych badań prowadzonych w tym województwie. Uzyskane wyniki porównano także do wyników dla całej populacji krajowej z obecnego i poprzednich ogólnopolskich monitoringów. Badania przeprowadzono za zgodą Komisji Bioetycznej przy Warszawskim Uniwersytecie Medycznym Nr KB 190/ 2016.
Wyniki. Frekwencja próchnicy dzieci 5-, 7- i 12-letnich z województwa małopolskiego objętych badaniem wyniosła odpowiednio: 74,9; 84,9 i 81,8%. Średnie wartości wskaźnika puwz wyniosły: 4,55 (5-latki) i 5,38 (7-latki), a PUWZ dla poszczególnych grup wiekowych odpowiednio: 0,03; 0,56 i 3,54. Nieznaczny spadek wartości tych wskaźników zauważany jest u 5- i 7-letnich dzieci z Małopolski (spadek frekwencji odpowiednio o 2,5 i 6,7% oraz spadek puwz o 0,71 u 5-latków w stosunku do 2011 roku). Dzieci małopolskie jako jedyne z całej populacji polskich 12-latków utrzymały tendencję spadkową frekwencji (spadek o 12,7% w stosunku do monitoringu z 2010 roku). Redukcja ta wymaga jednak potwierdzenia w kolejnych badaniach monitoringowych.
Wnioski. Przedstawione wyniki badań wskazują na utrzymującą się wysoką zapadalność na próchnicę zębów dzieci w województwie małopolskim oraz całym kraju. Konieczna jest intensyfikacja działań mających na celu poprawę tego stanu poprzez edukację zarówno dzieci, jak i rodziców, szeroko zakrojone działania profilaktyczne oraz podniesienie świadomości prozdrowotnej pacjentów.
Summary
Introduction. In 2016, 5-, 7- and 12-year-old children from the Małopolskie region were included in the study of oral health as part of the Nationwide Monitoring of Oral Health programme, which has been periodically implemented in selected index groups of the Polish population since 1997.
Aim. To evaluate the prevalence and level of dental caries in 5-, 7- and 12-year-old children from the Małopolskie region and to observe the dental caries trend in this region in recent years in relation to the Polish population.
Material and methods. The study covered 673 children from the Małopolskie region, including 223 aged 5, 225 aged 7 and 225 aged 12 years. Dental condition/state of dentition was examined according to the WHO recommendations and criteria. The prevalence and level of dental caries in children from the Małopolskie region were evaluated and compared with the results of earlier studies from this province. The obtained results were also compared with the results for the entire Polish population from the current and previous nationwide monitoring studies. The studies were conducted upon the consent of the Medical University of Warsaw Ethics Committee no. KB 190/2016.
Results. Dental caries prevalence in 5-, 7- and 12-year-old children from the Małopolskie region that were covered by the study was 74.9, 84.9 and 81.8%, respectively. The average values of dmft were 4.55 (in the age group of 5) and 5.38 (in the age group of 7), while DMFT for particular age groups was 0.03, 0.56 and 3.54, respectively. Slight decrease in the value of these indications of caries is noticed for 5- and 7-year-old children from the Małopolskie region (decrease in prevalence by 2.5 and 6.7%, respectively, as well as a fall in the value of dmft by 0.71 in the age group of 5, relative to 2011). The group of 12-year-old children from our region, as the only one from the entire Polish population of children of this age, have kept a downward trend of caries prevalence (a fall by 12.7% relative to the monitoring study from 2010). This reduction needs to be confirmed in the next monitoring studies.
Conclusions. The presented results indicate stable high prevalence of dental caries in children of the Małopolskie region and in the whole country. It is therefore necessary to enhance actions intended to improve this situation through education of both children and their parents, widespread prophylaxis, and greater health-oriented awareness of patients.
Słowa kluczowe: próchnica zębów,
Key words: dental caries, DMFT, DMFT.
Introduction
Dental caries is one of the most common diseases of the oral cavity (1, 2). It is also the most common chronic disease of childhood (3-5). It is considered a social disease based on its prevalence, severity and treatment costs (1).
According to WHO dental caries is a local pathological process leading to the decalcification of enamel and dentin, disintegration of hard dental tissues and the resultant cavity (2). It is a multi-factor disease caused by the coexistence and influence of plaque and carbohydrates supplied with food on vulnerable dental tissues for some time (1, 2). Dental caries is considered to be the result of imbalance of alternating dynamic physiological processes of demineralisation and remineralisation. The predominance of demineralisation leads to the loss of mineral substances, although the process is reversible until a cavity develops (1, 2).
The initiation and progression of dental caries is dependent to a large extent on sociomedical and behavioural factors (socioeconomic conditions, knowledge on caries prevention and healthy behaviour) (1, 2).
The complaints associated with an untreated caries process and the resultant complications affect the general health and quality of life of patients at any age (1). Pain and complications of caries in children can cause sleep disturbances, difficulties chewing food and gastrointestinal disorders leading to a low BMI (6-10). Tooth loss resulting from the lack of treatment of caries in children and adolescents can also lead to speech impairment, chewing difficulties as well as malocclusion and abnormal development of the stomatognathic system.
Consequently, as expected, clear recommendations have been issued by international institutions and organisations regarding the need for the assessment of public health systems, the development of oral health monitoring systems as well as efficacy of health promotion and oral health prevention programmes (11-16). This is achieved by epidemiological studies of oral health status conducted in accordance with the principles adopted by the World Health Organization (WHO) and through WHO health goals for a given year. Such actions have contributed to the improvement of oral health in many countries. Over nearly 20 years, starting from 1981, when WHO and FDI proposed oral health goals to be achieved by 2000, 70% of countries managed to achieve them. This means, for example, that 85% of the world population of 12-year-olds (a group which is most frequently studied and compared) had no more than 3 teeth affected with caries. Poland, together with Bulgaria, Hungary, Latvia and Lithuania was in a group of countries whose mean DMFT value was larger than 3. It was 3.8 in Poland and only 48.9% of children had a DMFT of ≤ 3 (11, 17-22).
Epidemiological studies based on WHO criteria have been conducted in Poland since 1987. In 1987-1995 they were part of a Ministry of Health statutory programme. The Nationwide Monitoring of Oral Health programme, commissioned by the Ministry of Health, has been conducted periodically since 1997. The programme studies the factors affecting oral health among the so-called index age groups in the population. These groups and the intervals between the studies were selected based on the physiological changes in the stomatognathic system and age-related changes of caries dynamics (1, 11, 18).
As the results of these studies show, over 27 years (up to 2014 inclusive) a small downward trend was observed in Poland regarding both caries prevalence and its severity expressed with dmft and DMFT indices. However, the values of these indices are still disturbingly high, particularly when compared with the data from other European countries (18, 23-28). Thus, they indicate a persistently high incidence of caries in children in Poland and the need for more intensive action to improve the situation.
Aim
The aim of the study is to evaluate the prevalence and severity of caries expressed as the mean dmft index for deciduous teeth and DMFT for permanent teeth in 5-, 7- and 12-year-old children from the province of Małopolskie, Poland, and to observe the trend of caries disease in this province in recent years relative to the Polish population.
Material and methods
In the Małopolskie province, the Nationwide Monitoring of Oral Health study of 2016 covered 673 children, including 223 individuals aged 5 years (116 from urban and 107 from rural areas, 110 girls and 113 boys), 225 aged 7 years (131 from urban, 94 from rural areas, 106 girls and 119 boys) and 225 aged 12 years (121 from urban and 104 from rural areas, 118 girls and 107 boys).
The children’s state of dentition was examined according to WHO recommendations and criteria (29). Clinical examination was conducted using a diagnostic mirror and a WHO probe in artificial light. The presence of cavities in deciduous and permanent teeth as well as the number of teeth removed due to caries and restored teeth were recorded, among other aspects. An additional socio-medical study was conducted using a questionnaire recommended by WHO which was supplemented with questions assessing sociodemographic factors.
The studies were conducted upon the consent of the Medical University of Warsaw Ethics Committee no. KB 190/2016. Statistical analysis of the obtained results was performed using R software, version 3.4.0. Qualitative variables were compared between groups using the chi-square test (with Yates’ correction) or the Fisher’s exact test for low expected numbers in the tables. Quantitative variables were compared in two groups using the Student’s t-test (for a normal distribution of a variable in the groups under analysis) or the Mann-Whitney’s test (for a variable with a non-normal distribution). Data variability was evaluated using the standard deviation (SD). Normality of the variable distribution was tested using the Shapiro-Wilk test. A level of significance of 0.05 was adopted for analysis, therefore, all p values below 0.05 were interpreted as significant relationships.
Results
The prevalence of caries in the group of 5-year-olds was 74.9% with children in urban and rural areas as well as boys and girls achieving a similar result. In the group of 7-year-olds caries was present in 191 children, which accounts for 84.9% of the subjects. Caries prevalence was similar between cities and the country as well as between boys and girls (tab. 1).
Tab. 1. Prevalence of caries in 5-, 7- and 12-year-old children by gender and place of residence. The results of the current monitoring study of 2016 (1)
5-year-oldsp*7-year-oldsp*12-year-oldsp*
n%n%n%
Girls7971.82%0.3748983.96%0.85710387.29%0.038
Boys8877.88%10285.71%8175.70%
City8775.00%0.99910983.21%0.528872.73%< 0.001
Country8074.77%8287.23%9692.31%
*Chi-square test. Statistical significance of differences for p < 0.05
In the group of 12-year-olds 184 children (81.8% of the subjects) were affected by caries. It was the lowest figure in this age group among all provinces included in the studied population. A statistically significant higher prevalence was observed in girls: 87.3% (vs. 75.7% for boys) and in the inhabitants of rural areas: 92.31% (vs. 72.7% for children living in cities) (tab. 1).
The severity of caries in the Małopolskie province was determined using mean dmft and DMFT indices (tab. 2). In the group of 5-year-olds the mean value of dmft ± SD was 4.55 ± 4.16. The main component of the dmft index was the number of decayed deciduous teeth (mean dt ± SD = 4.03 ± 4.04). No statistically significant differences between dmft values for urban and rural areas and for girls and boys have been observed (tab. 3). However, what is worthy of note is the higher values for decayed teeth (dt) in boys (4.27 ± 4.23) and inhabitants of rural areas (4.21 ± 4.05) in comparison with girls (3.77 ± 3.83) and urban dwellers (3.86 ± 4.03) (tab. 3).
Tab. 2. The values of dmft and DMFT for 5- and 7-year-olds and DMFT for 12-year-olds. The results of the current monitoring study of 2016 (1). The analysis was conducted using the Mann-Whitney test
Index5-year-olds7-year-olds12-year-olds
NmeanSDNmeanSDNmeanSD
dt2234.034.042254.573.57
mt2230.020.182250.120.64
ft2230.51.242250.681.33
dmft2234.554.162255.383.73
DT2230.030.172250.30.752251.641.97
MT22300225002250.030.22
FT223002250.260.772251.882.15
DMFT2230.030.172250.561.112253.542.92
Tab. 3. The values of dmft and the dt, mt, ft components by gender and place of residence for 5- and 7-year-olds. The results of the current monitoring study of 2016 (1)
 5-year-oldsp*7-year-oldsp*
NmeanSDNmeanSD
dmftGirls1104.24.040.2151065.053.520.344
Boys1134.884.271195.673.89
dmftCity1164.464.220.6671314.983.650.069
Country1074.644.11945.933.78
dtGirls1103.773.830.4481064.323.420.435
Boys1134.274.231194.793.69
mtGirls1100.020.190.3361060.060.270.181
Boys1130.030.161190.180.84
ftGirls1100.411.050.5061060.671.430.314
Boys1130.581.41190.71.24
dtCity1163.864.030.5221314.063.370.016
Country1074.214.05945.283.74
mtCity1160.020.130.9321310.150.790.883
Country1070.030.22940.10.36
ftCity1160.581.420.3441310.781.320.052
Country1070.411.02940.551.34
*Mann-Whitney test

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otrzymano: 2018-03-16
zaakceptowano do druku: 2018-04-06

Adres do korespondencji:
*Małgorzata Staszczyk
Pracownia Stomatologii Dziecięcej Instytut Stomatologii Uniwersytet Jagielloński Collegium Medicum
ul. Montelupich 4, 31-155 Kraków
tel.: +48 (12) 424-54-20
malgosia.staszczyk@gmail.com

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