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© Borgis - New Medicine 1/2020, s. 26-31 | DOI: 10.25121/NewMed.2020.24.1.26
*Piotr Sobiech, Anna Turska-Szybka, Angelika Kobylińska, Dorota Olczak-Kowalczyk
The first dental visit of a 3-year-old child. Reasons and socioeconomic determinants
Pierwsza wizyta dziecka w wieku żłobkowym w gabinecie stomatologicznym. Powody i uwarunkowania socjoekonomiczne
Department of Paediatric Dentistry, Medical University of Warsaw, Poland
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
Streszczenie
Wstęp. Próchnica wczesnego dzieciństwa dotyka aż 41,1% polskich dzieci w wieku 3 lat. Nieleczona może mieć wpływ na ogólny stan zdrowia, być przyczyną miejscowych infekcji oraz obniżać jakość życia.
Cel. Ocena odbywania pierwszych wizyt w gabinecie stomatologicznym dzieci w pierwszych trzech latach życia w aglomeracji warszawskiej.
Materiał i metody. Przeprowadzono badanie kwestionariuszowe rodziców/opiekunów prawnych dzieci w wieku powyżej 12 do 36 miesięcy, zamieszkałych w aglomeracji warszawskiej. Kwestionariusz zawierał pytania dotyczące czynników socjoekonomicznych (poziomu wykształcenia i wieku obojga rodziców, liczby dzieci w rodzinie, poziomu ekonomicznego rodziny) i pierwszej wizyty dziecka w gabinecie stomatologicznym (wiek i powód jej odbycia). Analizie statystycznej poddano dane z prawidłowo, kompletnie wypełnionych kwestionariuszy (współczynnik korelacji rang Spearmana w celu oceny powiązań między wybranymi zmiennymi oraz z użyciem testu chi-kwadrat do porównania udziałów procentowych, p <0,05).
Wyniki. Do analizy włączono 496 z 827 zwróconych kwestionariuszy. Średni wiek dzieci osiągnął wartość 24,16 ± 6,92 miesiące. Wizytę u dentysty odbyło 249 (50,2%) dzieci. Najczęstszymi powodami pierwszej wizyty były: przegląd uzębienia (47,4%), uraz zęba (19,7%) i obecność ubytków próchnicowych (13,3%). Pierwsze wizyty z powodu urazu odbywały najczęściej dzieci w wieku 12-18 miesięcy. Tylko 57 (11,5%) dzieci zgłosiło się do dentysty w pierwszym roku życia. Wśród nich najczęstszym powodem wizyty było badanie kontrolne (34; 6,9% całej badanej grupy). Stwierdzono wzrastającą częstość odbywania pierwszej wizyty u dentysty z wiekiem dziecka, a także ujemną zależność między poziomem wykształcenia rodziców a wizytą spowodowaną bólem zęba, pojawieniem się ropnia lub obecnością zmian próchnicowych. Odbycie wizyty z powodu próchnicy zębów było także związane z niższym wiekiem matki.
Wnioski. Zalecenie odbycia pierwszej wizyty stomatologicznej w pierwszym roku życia dziecka nie jest w Polsce realizowane w zadowalającym stopniu. Konieczne jest rozpowszechnianie rekomendacji wśród personelu medycznego sprawującego opiekę pediatryczną i stomatologiczną.
Summary
Introduction. Early childhood caries affects 41.1% of Polish 3-year-olds. If left untreated, it can affect overall health, cause local infections, and reduce quality of life.
Objective. To evaluate the first dental visits of children in the first three years of life in the Warsaw agglomeration.
Material and methods. A questionnaire survey of parents/legal guardians of children aged 12 to 36 months, living in the Warsaw agglomeration was conducted. The questionnaire included questions about socioeconomic factors (level of education and age of both parents, number of children in the family, economic level of the family) and the child's first dental visit (age and reason for visiting). Statistical analysis was performed on data obtained from correctly completed questionnaires (Spearman's rank correlation coefficient to assess the relationships between selected variables and using the chi-square test to compare the percentages, p <0.05).
Results. 496 out of 827 returned questionnaires were included in the analysis. The mean age of the children was 24.16 ± 6.92 months. 249 (50.2%) children visited the dentist. The most common reasons for the first visit were: dental check-up (47.4%), tooth trauma (19.7%) and the presence of carious lesions (13.3%). The first visits due to trauma were usually reported by children aged 12-18 months. Only 57 (11.5%) children visited the dentist in the first year of life. Among them, the most frequent reason for the visit was check-up (34; 6.9% of the entire study group). There was an increasing frequency of the first dental visit with the age of the child, as well as a negative correlation between the level of education of parents and the visit caused by toothache, abscess or the presence of carious lesions. Tooth decay as a reason of first dental visit was also associated with the lower age of the mother.
Conclusions. The recommendation to schedule the first dental visit in the first year of a child's life is not satisfactorily implemented in Poland. It is necessary to disseminate recommendations among the medical personnel providing pediatric and dental care.
Introduction
Dental caries in primary teeth is characterised by high dynamics of its clinical course and a high risk of tooth destruction and pulpopathy. Untreated caries may cause pain, local and systemic infections, the need for tooth extraction, antimicrobial therapy, hospital stay, and even death (1-3). Decayed or missing teeth make it difficult to chew food and reduce the quality of child’s life (4, 5).
Early Childhood Caries (ECC) is still a health issue in many countries. Its occurrence in freshly erupted teeth in the youngest children is particularly alarming. Dental caries affects up to 41.1% of Polish 3-year-olds (6). The incidence among 3-year-olds in European countries varies. Lower incidence compared to Poland was recorded in Italy (8.7%), England (11.7%), Germany (13.7%), Wales (14.5%) and Latvia (36.5%), whereas higher incidence was reported in Lithuania (50.6%) (7-13).
Early prevention of dental caries is necessary to reduce the risk of caries in the youngest children, and thus the incidence of this disease. Proper home prevention, referred to as “dental home”, is of key importance (15). The Canadian Dental Association (CDA) (16), the European Academy of Pediatric Dentistry (EAPD) (17), the American Academy of Pediatric Dentistry (AAPD) (18) and the American Academy of Pediatrics (AAP) (19) recommend that the first dental visit (FDV) should take place by 12 months of age, i.e. during the eruption of the first primary teeth. Its main goals include reduction of the risk of ECC, parental education and motivation in terms of healthy behaviours, as well as application of fluoride varnish, especially in the case of high risk of caries (EAPD, AAPD, AAP).
A nationwide survey conducted in Poland in 2017 in a group of 1,638 parents/legal guardians of 3-year-olds showed that up to 52.4% of children have never been to the dentist’s. More than half of children who were reported for dental appointment had their visit between 2 and 3 years of age (26.7% of the total population), while only one in 10 children had their visit in the second 6 months of life (4.6% of the total study population). Unfortunately, carious lesions and dental pain were the reason for the visit in up to 16.3 and 2.4% of children, respectively (6).
Aim
The aim of this paper was to assess reporting for the first dental visit among 3-year-olds in Warsaw.
Material and methods
We conducted a questionnaire study among parents/legal guardians invited to participate in a programme assessing oral health and tooth eruption in children in the Department of Paediatric Dentistry, Medical University of Warsaw between 2010 and 2017. The study was approved by the Bioethics Committee of the Medical University of Warsaw (No. KB/221/2009).
The inclusion criteria for parents/legal guardians included a written consent to participate in the study, child’s age between > 12 to 36 months, residence in Warsaw (≤ 20 km from Warsaw). The questionnaire included questions on socioeconomic factors (parental age and education level, number of children in the family, family’s financial status) and the child’s first dental visit (age and reason). The questionnaire was checked and verified after a pilot study among 20 parents reporting their children for a routine check-up.
Properly completed questionnaires with all questions answered were included in the final analysis. The obtained data were analysed statistically using the Spearman rank correlation coefficient to assess the relationships between selected variables, and the chi-square test to compare percentages. A p-value < 0.05 was considered statistically significant.
Results
Out of 827, a total of 496 questionnaires properly completed by parents/legal guardians of children aged between 12 and 36 months (105 children aged ≤ 18 months, 129 children aged > 18 to 24 months, 133 children aged > 24 to 30 months, and 129 children aged > 30 to 36 months) were included in the final analysis. Mean age was 24.16 ± 6.92 months. The exclusion of 331 questionnaires was due to missing answers to any of the questions or child’s age < 12 or > 36 months. The characteristics of parents/legal guardians is presented in table 1. The number of children in the family ranged from 1 to 4 (mean 1.63 ± 0.71).
Tab. 1. Socioeconomic characteristics of parents/legal guardians
ParametersNumber N (%)
Maternal age ≤ 25 years43 (8.7%)
26-35 years364 (73.4%)
≥ 36 years89 (17.9%)
Paternal age≤ 25 years21 (4.2%)
26-35 years329 (66.3%)
≥ 36 years146 (29.5%)
Maternal educationprimary19 (3.8%)
secondary157 (31.7%)
higher320 (64.5%)
Paternal educationprimary16 (3.2%)
secondary156 (31.5%)
higher 324 (65.3%)
Maternal self-assessment of financial status low8 (1.6%)
average 234 (47.2%)
high254 (51.3%)

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otrzymano: 2020-01-21
zaakceptowano do druku: 2020-02-18

Adres do korespondencji:
*Piotr Sobiech
Zakład Stomatologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Binieckiego 6, 02-097 Warszawa, Polska
tel.: +48 (22) 116-64-24
piotrsobiech@op.pl

New Medicine 1/2020
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