*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.
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-olds | p* | 7-year-olds | p* | 12-year-olds | p* |
| n | % | n | % | n | % |
| Girls | 79 | 71.82% | 0.374 | 89 | 83.96% | 0.857 | 103 | 87.29% | 0.038 |
| Boys | 88 | 77.88% | 102 | 85.71% | 81 | 75.70% |
| City | 87 | 75.00% | 0.999 | 109 | 83.21% | 0.52 | 88 | 72.73% | < 0.001 |
| Country | 80 | 74.77% | 82 | 87.23% | 96 | 92.31% |
*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).
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
- Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
- Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
- Aby kupić kod proszę skorzystać z jednej z poniższych opcji.
Opcja #1
29 zł
Wybieram
- dostęp do tego artykułu
- dostęp na 7 dni
uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony
Opcja #2
69 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 30 dni
- najpopularniejsza opcja
Opcja #3
129 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 90 dni
- oszczędzasz 78 zł
Piśmiennictwo
1. Olczak-Kowalczyk D, Kaczmarek U, Bachanek T et al.: Monitoring Zdrowia Jamy Ustnej. Monitorowanie stanu zdrowia jamy ustnej populacji polskiej w latach 2016-2020, Minister Zdrowia, Program na lata 2016-2020. WUM, Warszawa 2017.
2. Olczak-Kowalczyk D, Szczepańska J, Kaczmarek U: Współczesna stomatologia wieku rozwojowego. Med Tour Press International, Otwock 2017: 261-274.
3. Wójcicka A, Zalewska M, Czerech E et al.: Próchnica wieku rozwojowego chorobą cywilizacyjną. Przegl Epidemiol 2012; 66: 705-711.
4. Peterson SN, Snesrud E, Liu J et al.: The dental plaque microbiome in health and disease. PLoS ONE 2013; 8: e58487.
5. Strużycka I, Wierzbicka M, Jodkowska E et al.: Stan zdrowia jamy ustnej oraz potrzeby profilaktyczno-lecznicze dzieci w wieku 6 lat w Polsce w roku 2012. Przegl Epidemiol 2014; 68: 139-142.
6. Bissar A, Schiller P, Wolff A et al.: Factors contributing to severe early childhood caries in south-west Germany. Clin Oral Investig 2014; 18: 1411-1418.
7. Bagińska J, Rodakowska E, Wilczyńska-Borawska M et al.: Index of clinical consequences of untreated dental caries (pufa) in primary dentition of children from north-east Poland. Adv Med Sci 2013; 21: 1-6.
8. Figueiredo MJ, de Amorin RG, Leal SC et al.: Prevalence and severity of clinical consequences of untreated dentine carious lesions in children from a deprived area of Brazil. Caries Res 2011; 45(5): 435-442.
9. Leal SC, Bronkhost EM, Fan M et al.: Untreated cavitated dentine lesions: impact on children’s quality of life. Caries Res 2012; 46: 102-106.
10. Benzian H, Monse B, Heinrich-Weltzien R et al.: Untreated severe dental decay: a neglected determinant of low Body Mass Index in 12-year-old Filipino children. BMC Public Health 2011; 11: 558.
11. Strużycka I, Wierzbicka M, Jodkowska E et al.: Wyniki Monitoringu Stanu Zdrowia Jamy Ustnej populacji młodych dorosłych w Polsce w 2012 roku. Nowa Stomatol 2013; 18: 195-199.
12. Hobdell M, Petersen PE, Clarkson J et al.: Global Goals for oral health 2020. Int Dent J 2003; 53: 285-228.
13. Petersen PE: The World Oral Health Report 2003: continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003; 31 (suppl. 1): 3-24.
14. Petersen PE, Kwan S: The 7th WHO Global Conference on Health Promotion – towards integration of oral health. Community Dent Health 2010; 27 (suppl. 1): 129-136.
15. Petersen PE: Improvement of global oral health – the leadership role of WHO. Community Dent Health 2010; 27: 194-199.
16. Petersen PE: World Health Organization global policy for improvement of oral health – World Health Assembly 2007. Int Dent J 2008; 58: 115.
17. WHO: Oral Health Surveys. Basic methods 1997. 4th ed. WHO, Geneva 1997.
18. Wierzbicka M, Kaczmarek U: Trend choroby próchnicowej u 12-letnich dzieci na podstawie badań monitoringowych stanu zdrowia jamy ustnej. Czy polskie dzieci mają szanse na osiągnięcie narodowego i europejskiego celu zdrowia jamy ustnej? Dent Med Probl 2009; 46: 149-156.
19. FDI: Global goals for oral health in the year 2000. Int Dent J 1982; 32: 74-77.
20. Global caries data for 12-year-old age group WHO Oral Health Country/Area Profile Programme; http://www.whocollab.od.mah.se/exp/globalcar.html.
21. Global Oral Health – CAPP: http://www.whocollab.od.mah.se/expl/regions.html.
22. Health21. The health for all policy framework for WHO European Region. World Health Organization Regional Office in Europe. WHO, Copenhagen 1999.
23. Małkiewicz E, Wierzbicka M, Szatko F et al.: Monitoring Zdrowia Jamy Ustnej. Polska 2010. Stan zdrowia jamy ustnej i jego uwarunkowania oraz potrzeby profilaktyczno-lecznicze dzieci w wieku 6 i 12 lat oraz osób dorosłych w wieku 35-44 lat. WUM, Warszawa 2010.
24. Wierzbicka M, Szatko F, Strużycka I et al.: Monitoring Zdrowia Jamy Ustnej. Polska 2011. Stan zdrowia jamy ustnej i jego uwarunkowania oraz potrzeby profilaktyczno-lecznicze dzieci w wieku 5, 7 i 15 lat. WUM, Warszawa 2011.
25. Wyniki badań epidemiologicznych prowadzonych w ramach programu „Monitoring Zdrowia Jamy Ustnej” w 2010 roku. Ministerstwo Zdrowia, Warszawa 2010; http://www.mz.gov.pl/wp-content/uploads/2014/11/wynik_bada_mat_2010.pdf.
26. Wyniki badań epidemiologicznych prowadzonych w ramach programu „Monitoring Zdrowia Jamy Ustnej” w 2011 roku. Ministerstwo Zdrowia, Warszawa 2011; http://www.mz.gov.pl/wp-content/uploads/2014/11/monitoring_ju_2011.pdf.
27. Global caries data for 12-year-old age group WHO Oral Health Country/Area Profile programme; www.mah.se/CAPP/Country-Oral-Health- Profiles/According-to-Alphabetical/Global-DMFT-for-12-year-olds-2011.
28. https://www.mah.se/CAPP/Country-Oral-Health-Profiles/EURO/.
29. WHO: Oral Health Surveys. Basic methods 2013. 5th ed. WHO, Geneva 2013.
30. Jurczak A, Kościelniak D, Gregorczyk-Maga et al.: Caries status among children residing Cracow compared with the rest of Poland. J Stoma 2014; 67: 781-799.
31. Kwapińska H, Zarzecka J, Fijał D et al.: Frekwencja i intensywność próchnicy u dzieci krakowskich szkół. Porad Stomatol 2003; 5: 18-22.
