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© Borgis - New Medicine 1/2021, s. 14-21 | DOI: 10.25121/NewMed.2021.25.1.14
Piotr Sobiech1, Anna Turska-Szybka1, Dariusz Gozdowski2, *Dorota Olczak-Kowalczyk1
Dental caries in primary teeth during early childhood in the Warsaw agglomeration
Próchnica zębów mlecznych w okresie wczesnego dzieciństwa w aglomeracji warszawskiej
1Department of Pediatric Dentistry, Medical University of Warsaw, Poland
Head of Department: Professor Dorota Olczak-Kowalczyk, PhD, DMD
2Department of Experimental Statistics and Bioinformatics, Warsaw University of Life Science, Poland
Head of Department: Professor Dorota Olczak-Kowalczyk, PhD, DMD
Streszczenie
Wstęp. Wysoka częstość występowania i poziom próchnicy wczesnego dzieciństwa u dzieci w wieku 3 lat w Polsce wskazują na wysokie ryzyko zachorowania na tę chorobę dzieci młodszych. Brak jest danych opisujących skalę problemu w Polsce.
Cel pracy. Określenie częstości występowania i poziomu ciężkiej postaci próchnicy wczesnego dzieciństwa (S-ECC), zaspokojenia potrzeb leczenia zachowawczego u dzieci w 2. i 3. roku życia z aglomeracji warszawskiej.
Materiał i metody. Badanie przekrojowe dzieci w wieku 12-36 miesięcy przeprowadzono po uzyskaniu zgody Komisji Bioetycznej WUM. Oceniono obecność próchnicowych zmian nieubytkowych (d), ubytkowych (p), wypełnień (w), braków zębowych spowodowanych próchnicą (u), ropni i przetok okołozębowych. Określono częstość S-ECC, jej nasilenie (dpuwz i dpuwp) i poziom zaspokojenia potrzeb w zakresie leczenia zachowawczego (wz/wz + pz). W analizie statystycznej zastosowano test chi-kwadrat do porównania frakcji.
Wyniki. Zbadano 496 dzieci, w tym 262 (52,8%) chłopców. S-ECC odnotowano u 44,8% badanych, dpuwz i dpuwp osiągnęły wartości 2,62 ± 3,88 i 4,46 ± 8,42. Częstość i poziom S-ECC wzrastały z wiekiem. Największy wzrost obserwowano w podgrupie > 18 do 24 miesięcy. Głównymi składowymi dpuwz były liczby zębów z próchnicą (pz). Ropnie i przetoki zdiagnozowano u 15 (3%) pacjentów. Wartości wskaźników leczenia wzrastały od 0 w najmłodszej do 0,08 w najstarszej grupie wiekowej.
Wnioski. Próchnicę zębów mlecznych w okresie wczesnodziecięcym charakteryzuje szybkie przechodzenie zmian nieubytkowych w ubytkowe i obejmowanie kolejno wyrzynających się zębów. Przy zaniedbaniach leczniczych dochodzi do powikłań skutkujących utratą zęba. Największy wzrost częstości i poziomu próchnicy obserwuje się w drugim półroczu 2. roku życia, dlatego niezbędne jest wczesne zapobieganie domowe i profesjonalne.
Summary
Introduction. The high incidence and level of Early Childhood Caries (ECC) in children aged 3 in Poland indicate a high risk of developing this disease in younger children. There are no data describing the scale of the problem in Poland.
Aim. Determining the prevalence and level of severe early childhood caries (S-ECC), the needs of conservative treatment in children in the second and third year of life from the Warsaw agglomeration.
Material and methods. A cross-sectional study of children aged 12-36 months was carried out after obtaining the consent of the Bioethics Committee of the Medical University of Warsaw. The presence of non-cavitated (d1) and cavitated caries (d2), fillings (f), and missing teeth (t) and surfaces (s) caused by caries (m), periodontal abscesses and fistulas was assessed. The frequency of ECC and its intensity (d1d2mft and d1d2mfs), conservative treatment index (f/f + d) were determined. In the statistical analysis, the chi-square test was used to compare the fractions.
Results. 496 children were examined, including 262 (52.8%) boys. S-ECC was recorded in 44.8% of the respondents, d1d2mft and d1d2mfs reached the values of 2.62 ± 3.88 and 4.46 ± 8.42. The incidence and level of S-ECC increased with age. The greatest increase was seen in the subgroup > 18 to 24 months. The main components of d1d2mft were the teeth with caries (d). Abscesses and fistulas were diagnosed in 15 (3%) patients. The treatment indexes increased from 0 in the youngest to 0.08 in the oldest age group.
Conclusions. Caries of primary teeth in the early childhood period is characterized by a rapid transformation of non-cavitated lesions into cavitated ones and subsequent eruption of teeth. With medical negligence, complications result in tooth loss. The greatest increase in the frequency and level of caries is observed in the second half of the second year of life, therefore, early home and professional prevention is essential.



Introduction
Historically, caries that develops shortly after tooth eruption was most often referred to as caries praecox, nursing caries, labial caries, baby bottle tooth decay or comforter caries (1). These terms did not precisely define the disease, but rather indicated the location of lesions, the causative factor, or emphasised their onset in early childhood. The term Early Childhood Caries (ECC) was proposed at a workshop held by the National Institute for Dental and Craniofacial Research in 1999 to describe a disease that occurs in the first 5 years of a child’s life without suggesting the causal factor. The American Dental Association (ADA) and the American Academy of Pediatric Dentistry (AAPD) define early childhood caries as the presence of one or more decayed, missing or filled teeth (due to caries) in a child 72 of months age (5 years and 11 months) or younger, i.e. children before the age of 6 years (2). At the same time, Severe Early Childhood Caries (S-ECC) was defined to refer to “atypical”, “rapidly progressive”, “acute”, or “rampant” pattern of dental caries.
This form is diagnosed for:
– any sign of smooth surface caries in < 3-year-olds,
– carious lesions on at least 4 surfaces in 3-year-olds,
– carious lesions on 5 surfaces in 4-year-olds,
– and carious lesions on at least 6 surfaces in 5-year--olds (2-5).
Defining the presence of any carious lesion in children in the first three years of life as S-ECC emphasizes the high dynamics of the disease process in freshly erupted teeth, which may lead to the rapid destruction of dentition (6-8).
The scale of the problem of early childhood caries in the group of the youngest children is not fully known as most of the epidemiological studies in various countries were conducted in older children. Studies in a group of 3-year-olds, showing the frequency and the level of caries in primary teeth, as well as the treatment needs associated with this disease and its complications, indicate that younger children are also affected. In Poland, epidemiological research was conducted among 3-year-old children in 2002, 2009, 2015 and 2017 as part of a Ministry of Health programme “Monitoring of Oral Health in Polish Population”. The incidence of caries was estimated at 41.1% in 2017 and was only 15% lower than in 2002. Severe early childhood caries, defined as d2mft > 4, was reported in 1 in 5 children. Over the past 15 years, the d2mft has also slightly decreased, from 2.9 in 2002 to 1.85 in 2017 (9). The prevalence of ECC in this age group varies from country to country. It is lower in most European countries compared to Poland. Higher rates were recorded only in Lithuania (50.6% in 2010) (10). The same rates were 11.7% in 2013 in England, 8.7% in 2013 in Italy, and 14% in 2015 in Germany (11-13).
The epidemiological studies conducted in a group of 3-year-olds in Poland also revealed major negligence in the prevention and treatment of dental caries. The needs for conservative treatment of cavitated lesions were covered only in 7% of children at this age (9). The need for rapid treatment was found in 7.3% of children and immediate treatment due to pain or infection was needed in 3% of 3-year-olds. No current data to estimate the scale of the problem of primary teeth caries in children in early childhood are available in Poland. The prevalence of caries in children in the first three years of life was estimated in 2003 and 2006 at 35.3-55.6%, respectively (14).
Aim
The aim of the study was to assess the prevalence and the level of severe early childhood caries (S-ECC), the level of satisfaction of the needs in the treatment of caries in 2-3-year-olds from the Warsaw agglomeration, as well as the dynamics of the carious process.
Material and methods
The study involved a clinical dental examination of children invited to participate in the programme to assess oral health and the course of teething at the Department of Pediatric Dentistry at the Medical University of Warsaw in 2011-2017. The obtained results were analysed statistically. The study was approved by the Bioethics Committee of the Medical University of Warsaw (KB/221/2009).
Children aged 12-36 months and their parents/legal guardians from Warsaw and areas located no more than 20 km away from Warsaw were included in the study.
The inclusion criteria included a written consent for child’s participation in the clinical evaluation and parental completion of a questionnaire, as well as child’s cooperation enabling clinical examination.
Children aged less than 12 months and over 36 months, those with intellectual disability, chronic diseases, pharmacotherapy likely to affect dental health, those whose parents/legal guardians failed to complete the questionnaire, and children residing outside the study region were excluded from the study.
The children were classified into four age subgroups:
I. > 12-18 months
II. > 18-24 months
III. > 24-30 months
IV. > 30-36 months.
The clinical examination of oral health was performed in a dentist’s office equipped with a shadowless lamp, using a mirror and a WHO-621 periodontal probe. The number of erupted teeth, the presence of carious lesions, filled and missing teeth, fistulas and abscesses was assessed. All tooth surfaces were evaluated in subsequent quadrants. Carious lesions were assessed according to the criteria of the modified International Caries Detection and Assessment System (ICDAS II) (15).
International Caries Detection and Assessment System (ICDAS II):
0. – no evidence of any change in enamel transparency after 5 sec air drying,
1. – white opacity hardly visible on wet surface, clearly visible after drying,
1a. – dark opacity hardly visible on wet surface, clearly visible after drying,
2. – white opacity clearly visible when dry,
2a. – dark opacity clearly visible on wet surface,
3. – localized enamel breakdown (without clinical visual signs of dentinal involvement) within opaque or discoloured enamel,
4. – underlying dark shadow from dentine with or without enamel loss,
5. – distinct cavity with visible dentine,
6. – extensive cavity with visible dentine.
Lesions coded 1 and 2 were diagnosed as carious if located in the gingival (plaque retention site) or chewing area and were described as “d1”. Lesions coded at least 3 were classified as cavitated caries and described as “d2”. The following parameters were assessed:
– mean number of teeth present in the oral cavity,
– frequency of S-ECC, i.e., percentage of children with d1d2mft > 0,
– d2mft, d2mfs, d1d2mft, d1d2mfs and their components, where d1t/d1s denotes teeth/tooth surfaces with non-cavitated lesions (ICDAS II code 1 and 2), d2t/d2s denotes cavitated caries, mt/ms – missing due to caries, and ft/fs – filled (3, 5).
Oral health was assessed by three specialists in pediatric dentistry, who were appropriately trained and calibrated. During calibration, each specialist examined the same group of 10 children independently. Cohen’s kappa coefficients ranging from 0.89 to 0.95 were obtained.
During the research, dietary and hygienic recommendations were provided, preventive procedures were performed (application of fluoride varnish 0.5% NaF) or children were qualified for and offered dental treatment.
In the statistical analysis, the chi-square test was used to compare the fractions (percentages, e.g., of carious teeth) between the two groups. Statistica 13 was used for statistical analyses. The level of significance was < 0.05 for all analyses. The level of significance was < 0.05 for all analyses.
Results
A total of 496 children, including 262 (52.8%) boys, participated in the study. The size of the age subgroups ranged from 105 in the youngest group to 133 in the age subgroup > 24-30 months (tab. 1).
Tab. 1. Age structure of children aged 12-36 months included in the study
Age (months)Number n/%Mean age ± SD (months)
> 12-18105 (27.2%)15.52 ± 2.06
> 18-24129 (25.8%)21.76 ± 1.83
> 24-30133 (26.0%)21.76 ± 1.83
> 30-36129 (20.1%)33.75 ± 1.55
Total496 (100%)24.16 ± 6.93

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otrzymano: 2021-01-22
zaakceptowano do druku: 2021-02-12

Adres do korespondencji:
*Dorota Olczak-Kowalczyk
Zakład Stomatologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Binieckiego 6, 02-097 Warszawa
tel.: +48 (22) 116-64-24
dorota.olczak-kowalczyk@wum.edu.pl

New Medicine 1/2021
Strona internetowa czasopisma New Medicine