Natalia Grygorowicz-Godowska1, Barbara Kapuścińska1, Anna Piejko1, *Angelika Kobylińska2, Paula Piekoszewska-Ziętek2
Characteristics of early childhood caries and treatment rates in Polish and Ukrainian children presenting to a university dental clinic
Charakterystyka próchnicy wczesnego dzieciństwa i wskaźnika leczenia u dzieci polskich i ukraińskich zgłaszających się do uniwersyteckiej poradni stomatologicznej
1Department of Paediatric Dentistry, University Dental Center, Medical University of Warsaw, Warsaw, Poland
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
2Department of Paediatric Dentistry, Medical University of Warsaw, Warsaw, Poland
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
1Zakład Stomatologii Dziecięcej, Uniwersyteckie Centrum Stomatologii WUM, Warszawa, Polska
Kierownik Zakładu: prof. dr hab. n. med. Dorota Olczak-Kowalczyk
2Katedra i Zakład Periodontologii Uniwersytet Medyczny we Wrocławiu, Wrocław, Polska
Kierownik Katedry i Zakładu: prof. dr hab. n. med. Tomasz Konopka
Streszczenie
Wstęp. Próchnicę zębów mlecznych u dzieci, które nie ukończyły 71. miesiąca życia, określa się mianem próchnicy wczesnego dzieciństwa (ECC). Wśród czynników wystąpienia ECC wyróżnia się m.in.: wysoki poziom bakterii Streptococcus mutans w jamie ustnej matki, nawyki umożliwiające przenoszenie śliny matki do jamy ustnej dziecka, niedostateczną higienę jamy ustnej, częste spożywanie cukrów przez dziecko, obecność aktywnych plam próchnicowych, potrzebę specjalistycznej opieki pediatrycznej oraz pochodzenie z rodziny imigranckiej. Po wybuchu konfliktu zbrojnego na terenie Ukrainy znaczna liczba obywateli tego kraju przybyła do Polski. Zgodnie z obowiązującymi przepisami uchodźcy z Ukrainy uzyskali prawo do korzystania ze świadczeń zdrowotnych finansowanych ze środków publicznych na warunkach przysługujących osobom ubezpieczonym w Polsce.
Cel pracy. Celem badania była analiza porównawcza stanu zdrowia jamy ustnej dzieci narodowości polskiej i ukraińskiej w wieku poniżej 6. roku życia zgłaszających się do uniwersyteckiej poradni stomatologicznej w celu diagnostyki i leczenia.
Materiał i metody. Badaniami objęto 60 dzieci polskich w wieku od 0 do 5 lat i 11 miesięcy (średnia wieku: 47,2 mies.) i 47 dzieci ukraińskich w wieku od 0 do 5 lat 11 miesięcy (średnia wieku: 52,74 mies.). Podczas badania klinicznego oceniono stan higieny jamy ustnej, uzębienia oraz występowanie powikłań choroby próchnicowej z wykorzystaniem wskaźników OHI-S, puwz, ICDAS II i pufa oraz określono zaspokojenie potrzeb leczenia zachowawczego próchnicy w stosunku do potrzeb terapeutycznych, obliczając wskaźnik leczenia. Zebrane dane poddano analizie statystycznej.
Wyniki. Zarówno w częstości występowania próchnicy nieubytkowej i ubytkowej, jak i powikłań próchnicy wyższe wskaźniki zaobserwowano w grupie dzieci ukraińskich, aczkolwiek w obu grupach wskaźniki były wysokie. Średnia wartość wskaźnika OHI-S wyniosła 1,68 u dzieci polskich oraz 2,52 u dzieci ukraińskich. W przypadku wskaźnika puwz średnie wartości wynosiły odpowiednio 4,55 dla dzieci polskich i 6,66 dla dzieci ukraińskich, natomiast średnie wartości wskaźnika pufa wyniosły 0,37 w grupie polskiej i 0,50 w grupie ukraińskiej. Warto zaznaczyć, że dzieci polskie charakteryzowały się istotnie wyższym wskaźnikiem leczenia, który wyniósł 0,17, podczas gdy w grupie dzieci ukraińskich osiągnął on jedynie 0,05.
Wnioski. Wyższe wartości wskaźników OHI-S, puwz, ICDAS II oraz pufa w grupie dzieci ukraińskich mogą świadczyć o większych zaniedbaniach higienicznych i terapeutycznych. Wyższy wskaźnik leczenia w grupie dzieci polskich wskazuje na lepszy dostęp do opieki stomatologicznej. Częstość występowania próchnicy wczesnego dzieciństwa i jej powikłań zarówno w populacji polskiej, jak i ukraińskiej pozostaje bardzo wysoka, co wskazuje na pilną potrzebę działań profilaktycznych w obu grupach.
Summary
Introduction. Early childhood caries (ECC) is defined as the presence of carious primary teeth in children under 71 months of age. Factors contributing to early childhood caries include high maternal levels of Streptococcus mutans, habits that facilitate maternal saliva transfer to the child, poor oral hygiene, frequent carbohydrate intake by the child, the presence of active carious lesions, the need for specialized paediatric care, and coming from an immigrant family. Following the outbreak of armed conflict in Ukraine, Poland experienced a substantial influx of Ukrainian refugees. Under current regulations, refugees from Ukraine are granted access to publicly funded healthcare services on the same terms as Polish citizens who are insured.
Aim. The aim of the study was to conduct a comparative analysis of the oral health status of Polish and Ukrainian children under the age of 6 years who presented to the University Dental Clinic for diagnosis and treatment.
Material and methods. The study included 60 Polish children aged 0 to 5 years and 11 months (mean age: 47.2 months) and 47 age-matched Ukrainian children (mean age: 52.74 months). During the clinical examination, the patients were assessed for oral hygiene, dental health, and the presence of carious complications using the OHI-S, dmft, ICDAS II, and pufa indices. The extent to which conservative treatment needs were met was determined by calculating the Care Index. The collected data were then analysed statistically.
Results. Both non-cavitated and cavitated caries, as well as caries-related complications, were more prevalent among Ukrainian children, although high rates were observed in both groups. The mean OHI-S in Polish and Ukrainian children was 1.68 and 2.52, respectively. The mean dmft values were 4.55 for Polish and 6.66 for Ukrainian children, respectively, while the mean pufa was 0.37 in the Polish group and 0.50 in the Ukrainian group. It is noteworthy that Polish children had a significantly higher Care index, which was 0.17 compared to only 0.05 in the group of Ukrainian children.
Conclusions. Higher OHI-S, dmft, ICDAS II and pufa indices in the group of Ukrainian children may indicate greater neglect of oral hygiene and dental treatment. In contrast, higher Care Index observed in Polish children suggests better access to dental care. The incidence of Early Childhood Caries and its complications remains very high in both the Polish and Ukrainian populations, highlighting the urgent need for preventive measures in both groups.
Introduction
Despite the growing health awareness and knowledge of the risk factors of caries, primary dental caries remains a significant health problem in Poland and worldwide (1-3). It is referred to as Early Childhood Caries (ECC) in the youngest patients (4). ECC is defined as the presence of one or more cavitated or non-cavitated carious lesions in primary teeth, or teeth that have been extracted or filled due to caries, in children up to 71 months of age, i.e., before 6 years old (5). The global incidence of ECC is estimated at about 48% (1). In Poland, an increase in the number of ECC cases among children was observed following the outbreak of the armed conflict in Ukraine and the subsequent influx of refugees from the eastern border. Between February 2022 and February 2023, approximately one million refugees crossed the Polish border, with the largest groups being women aged 18-65 years (48.8%) and children (45.2%) (6).
Ukrainian citizens who arrived in Poland due to the war, specifically after February 24, 2022, have been granted the right to access medical services on the same terms as insured Polish citizens (7-11). Consequently, the number of young Ukrainian patients in dental care facilities funded by the National Health Fund has increased considerably.
Significant medical needs have been observed among refugee children, stemming from multiple overlapping factors such as the absence of proper hygiene and dietary habits, interrupted dental treatment, irregular dental check-ups, and chronic stress associated with the political situation in their home country (11, 12). Risk factors for ECC include immigrant status, general health issues, excessive dietary sugar intake, poor health awareness among both parents and children, and thereby inadequate oral hygiene, as well as limited access to healthcare services (13).
Aim
The aim of the study was to conduct a comparative analysis of the oral health status of Polish and Ukrainian children under 6 years of age.
Material and methods
Polish and Ukrainian patients presenting to the Department of Paediatric Dentistry at the Medical University of Warsaw between March 2022 and March 2023 for diagnosis and treatment were invited to participate in the study. Advanced treatment needs, with pain being the most frequently reported symptom, were the primary reason for these visits.
The inclusion criteria were: age < 6 years, parental consent to participate in the study, cooperative child, and Polish or Ukrainian nationality. The exclusion criteria were: age > 6 years, lack of consent to participate in the study, uncooperative child, history of systemic diseases, and ongoing pharmacotherapy. After collecting medical history data and verifying inclusion and exclusion criteria, the assessment of dental health status was initiated. Since the study was a medical experiment, approval from the bioethics committee was not required (statement of the Bioethics Committee of the Medical University of Warsaw No. AKBE/298/2024).
During the clinical examination, the patients were assessed for oral hygiene status, dental health, and the presence of caries complications using the OHI-S, dmft, ICDAS II, and pufa indices. The extent to which the need for conservative caries treatment was met relative to the overall therapeutic needs, was determined by calculating the Care Index.
The simplified Oral Hygiene Index (OHI-S) (14), consisting of two components: the Debris Index (DI-S) and the Calculus Index (CI-S), was used to assess oral hygiene status in the youngest patients. Since children are significantly less likely to present with dental calculus, this assessment is typically limited to DI-S.
The basic indicator of primary teeth health status used in the study was dmft, which is the total number of decayed (d), missing (m) and filled (f) teeth. The maximum value of the index for primary teeth is 20. The study also used a clinical classification system, the International Caries Detection and Assessment System 2007 (ICDAS II), which accounts for the presence of carious lesions, including active carious spots (coded as ICDAS II 1 and 2) and cavities (ICDAS II ≥ 3) (2). The prevalence and severity of the consequences of untreated caries were determined using the pufa index (13), which assesses pulpal involvement (p), ulcerations (u), fistulas (f), and abscesses (a).
The dmft components were used to calculate the Care Index (CI). CI is defined as the ratio of the number of filled teeth to the sum of filled teeth and teeth with active caries (TTR = T / [T + P]) (14).
The participants were grouped by nationality: Polish children in Group 1 (G1), and Ukrainian children in Group 2 (G2). Statistical analysis was conducted using the Student’s t-test for quantitative variables and the Pearson chi-square test for qualitative variables. Microsoft Excel was used for the analysis, with a significance level set at p < 0.05.
Results
The study included 108 children with a mean age of 4 years and 1 month and a median age of 4 years and 5 months, who met the inclusion criteria. There were 60 Polish children (19 girls, 41 boys) in G1, and 47 Ukrainian children (27 girls, 20 boys) in G2. Descriptive statistics are presented in table 1.
Tab. 1. Descriptive statistics for the analysed variables
| | ICDAS II ≥ 3 | pufa | OHI | Age (months) |
| Mean | 4.42593 | 1.54630 | 2.05556 | 49.52778 |
| SD | 4.2452 | 2.4925 | 1.12602 | 15.8264 |
| Min | 0 | 0 | 0 | 9 |
| 25% | 2 | 0 | 1 | 37.75 |
| 50% | 3 | 0 | 3 | 53 |
| 75% | 6 | 2 | 3 | 63 |
| Max | 20 | 12 | 3 | 71 |
Chi-square tests assessed the relationship between qualitative variables such as gender and nationality and dental indicators. None of the tests achieved statistical significance at the 0.05 level.
The data were not normally distributed, which meant that the classic Student t-test may have not been optimal, therefore a nonparametric test (Mann-Whitney test) was used. Nonparametric tests showed a statistically significant difference between girls and boys in terms of the frequency of caries and the level of oral hygiene.
Mann-Whitney tests for Polish and Ukrainian children showed that they differed significantly in terms of the number of advanced carious lesions and the level of oral hygiene, with the Ukrainian population showing worse results.
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