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© Borgis - New Medicine 1/2021, s. 22-30 | DOI: 10.25121/NewMed.2021.25.1.22
Piotr Sobiech1, Anna Turska-Szybka1, Dariusz Gozdowski2, *Dorota Olczak-Kowalczyk1
Caries distribution pattern in primary dentition in children in early childhood from the Warsaw agglomeration
Rozmieszczenie próchnicy w uzębieniu mlecznym u dzieci w okresie wczesnodziecięcym z 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 (ECC) u dzieci w wieku 3 lat w Polsce wskazują na wysokie ryzyko zachorowania na tę chorobę dzieci młodszych. Próchnica najczęściej rozwija się na powierzchniach okludalnych zębów trzonowych. Rozmieszczenie próchnicy w uzębieniu mlecznym zmienia się wraz z wiekiem. U dzieci młodszych zęby sieczne szczęki są najczęściej dotknięte próchnicą, natomiast u starszych – zęby trzonowe. Brak jest aktualnych danych opisujących rozmieszczenie próchnicy u dzieci młodszych w Polsce.
Cel pracy. Ocena rozmieszczenia próchnicy z uwzględnieniem powierzchni w uzębieniu mlecznym u dzieci w 2. i 3. roku życia z aglomeracji warszawskiej.
Materiał i metody. W badaniu przekrojowym dzieci w wieku 12-36 miesięcy w ocenie stanu uzębienia uwzględniano obecność próchnicowych zmian nieubytkowych (d), ubytkowych (p), wypełnień (w), braków zębowych spowodowanych próchnicą (u). Określono częstość ECC, jej nasilenie (dpuwz i dpuwp). W analizie statystycznej zastosowano test chi-kwadrat do porównania frakcji (udziałów procentowych).
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. Najczęściej zmianami próchnicowymi były objęte zęby sieczne przyśrodkowe szczęki (34,2%) oraz pierwsze zęby trzonowe obu łuków (21,0%, w tym 23,5% dla szczęki i 18,6% dla żuchwy). Zmiany próchnicowe najczęściej występowały na powierzchniach wargowych zębów siecznych szczęki (19,1%) oraz okludalnych zębów pierwszych trzonowych (19,4%).
Wnioski. Próchnicę zębów mlecznych w okresie wczesnodziecięcym charakteryzuje szybkie przechodzenie zmian nieubytkowych w ubytkowe i obejmowanie kolejno wyrzynających się zębów. Zmianami próchnicowymi najczęściej dotknięte są powierzchnie wargowe zębów siecznych przyśrodkowych szczęki oraz okludalne zębów pierwszych trzonowych.
Summary
Introduction. The high incidence and level of early childhood caries (ECC) in children aged 3 years in Poland indicate a high risk of developing this disease in younger children.
Caries most often develops on the occlusal surfaces of molars. The distribution of caries in primary dentition changes with age. In younger children, the maxillary incisors are most often affected by caries, while in the older ones – molars. There are no current data describing caries distribution in younger children in Poland.
Aim. Assessment of caries distribution, taking into account the surface in primary dentition in children in the second and third year of life from the Warsaw agglomeration.
Material and methods. This was a cross-sectional study conducted among children aged 12-36 months to assess dental condition for the presence of non-cavitated (d1) and cavitated caries (d2), fillings (f), and missing (m) teeth (t) and surfaces (s) caused by caries. The frequency of ECC and its intensity (d1d2mft and d1d2mfs) were determined. In the statistical analysis, the chi-square test was used to compare the fractions (percentages).
Results. A total of 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, respectively. Central maxillary incisors (34.2%) and the first molars of both arches (21.0%, including 23.5% for the maxilla and 18.6% for the mandible) were most commonly affected by carious lesions. Carious lesions were most often found on the labial surfaces of the maxillary incisors (19.1%) and occlusal first molars (19.4%).
Conclusions. Primary teeth caries in the early childhood period is characterized by a rapid transformation of non-cavitated lesions into cavitated ones and subsequent eruption of teeth. Carious lesions most are most often found on the labial surfaces of the central incisors of the maxilla and occlusal surfaces of the first molars.



Introduction
Exposure of a primary tooth to cariogenic factors shortly after its appearance in the oral cavity is associated with a high risk of carious process and disease progression. The enamel of freshly erupted teeth shows a low degree of mineralisation and high porosity.
High susceptibility to bacterial acids and high enamel permeability contribute to the rapid occurrence of signs of caries following exposure to bacterial acids and transformation of non-cavitated into cavitated lesions (1). Poor mineralisation of the thin dentin layer and the straight course of the wide dentinal tubules promote rapid deepening of the cavity and pulpopathy. The period of early childhood, the second year of a child’s life in particular, seems to be of key importance for maintaining healthy primary dentition. A 2-year-old child usually already has erupted incisors, which are followed by first molars, then canines, and, in some children, also second primary molars. At about 31 months of age, a child already has twenty primary teeth. The time of exposure of the teeth to the oral cavity environment at the age of 36 months ranges from 24 to 30 months for medial incisors, from 18 to 30 months for the lateral incisors, from 17 to 27 months for first molars, from 12 to 22 months for canines and 5 to 17 months for second molars (2). Considering the average duration of post-eruptive maturation of enamel of 2-4 years after tooth eruption, children aged 2-3 years should be considered a group of increased risk of caries and its rapid progression. Therefore, the presence of any carious, non-cavitated or cavitated lesion on the smooth surfaces of a child’s teeth before the age of 3 years is classified as severe early childhood caries (S-ECC). This form is diagnosed in the presence of carious lesions on at least 4 surfaces of the teeth in 3-year-olds, 5 surfaces in 4-year--olds, and at least 6 surfaces in 5-year-olds (3-5). S-ECC refers to “atypical”, “progressive”, “acute” or “rampant” pattern of dental caries.
Aim
The aim of the study was to assess caries distribution in primary dentition in children in the early childhood period from the Warsaw agglomeration depending on age.
Material and methods
The research was conducted in 2011-2017 as part of a programme assessing the oral health and the course of first teething. The study was approved by the Bioethics Committee of the Medical University of Warsaw (KB/221/2009). Cooperative children aged > 12-36 months from Warsaw and areas located no more than 20 km from Warsaw were enrolled in the study after obtaining an informed written consent of the parent/legal guardian for their child to participate in the clinical examination. Children aged less than 12 months and over 36 months, those with intellectual disability, chronic diseases, pharmacotherapy likely to affect dental health, and children residing outside the Warsaw agglomeration were excluded from the study.
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 (6). The number of erupted teeth, the presence of carious lesions, filled and missing teeth due to caries were assessed, considering each tooth surface in subsequent quadrants. Carious lesions were assessed according to the criteria of the modified International Caries Detection and Assessment System (ICDAS II) (7). Non-cavitated lesions with ICDAS-II codes 1-2 were diagnosed as carious when found in the perigingival area or on the chewing surface and were denoted as “d1”. Cavitated lesions (ICDAS II codes ≥ 3) were denoted as “d2”. We estimated the number of teeth present in the oral cavity, the number and percentage of teeth with caries (d1d2mft > 0) as well as d1d2mft and d1d2mfs components, where d1t/d1s stands for teeth/tooth surfaces with non-cavitated lesions (ICDA II code 1 and 2), d2t/ d2s – with carious lesions, mt/ms – missing due to caries, and ft/fs – fillings (6, 7).
The distribution of carious lesions was assessed in the entire study group and in four age subgroups: > 12-18 months, > 18-24 months, > 24-30 months, and > 30-36 months.
The study was conducted 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.
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.
Results

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otrzymano: 2021-01-15
zaakceptowano do druku: 2021-02-05

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
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