© Borgis - Nowa Stomatologia 3/2004, s. 103-107
Dorota Stańczak-Sionek, Maria Szpringer-Nodzak, Aleksander Remiszewski
Usage of the Clinical Examination of Children and their Mothers to Assess Risk of Dental Caries at Children up to Three Years of Age
Zastosowanie badania klinicznego dziecka i matki do określania ryzyka próchnicy u dzieci do trzeciego roku życia
Pediatric Dentistry Department, Medical University of Warsaw
Head of the Department Aleksander Remiszewski DDS, pHD
Early childhood caries poses a very difficult treatment problem for pediatric dentistry. In Poland, a frequency of caries in children aged three years and under has always been higher than in Western European countries. Nation wide epidemiological studies performed in 1992/93 showed caries to occur in 14.1% of children aged 3 years and under, and in 36-month-old children caries prevalence reached 48.65, i.e. nearly every second 3-year-old child had dental caries. The first cavities were already found in children under one year old (1, 2).
In 1975 Martheler described the phenomenon of „polarization” of caries in small children, which means that there is a noticeable difference in dental health between children with and without caries (3). In Poland in the former group, it is mainly early childhood caries (ECC) which is observed, characterized by a marked severity of the disease process and high caries increment.
Polarization can also be observed in other countries such as Bulgaria (4), and in countries with a lower fre- quency of caries (Scandinavian countries) (3).
Caries in young children is therefore a problem, even in highly developed countries.
The treatment of children with ECC is difficult and costly, and often requires to be performed under general anesthesia. Postponement or lack of treatment quickly leads to complications and has an unfavorable effect on both the future state of dentition and the general development of the child (5, 6, 7, 8, 9, 10).
Numerous authors have addressed the problem of the significance of the prevention of early caries, both at an individual and a population level, and its medical and financial implications (11, 12, 13, 14, 15, 16, 17, 18, 19, 20).
A main role in the assessment of caries risk is played by evaluation of dental health, taking in to consideration in particular the number of cavities, as well as the number of teeth (surfaces) restored and extracted due to complication of caries.
A number of authors have underlined the usefulness of a clinical dental examination in determining the risk of future caries in children (21, 22, 23, 24, 25, 26, 27). According to some reports, of greater significance in determining caries risk is the number of initial and superficial caries lesions (22, 28).
More recently, authors have drawn attention to a problem of infection of child´s oral cavity with maternal oral bacteria (10, 29). Mother´s dental health therefore influences the occurrence of early childhood caries, as has been underlined by many authors (30, 31, 32).
AIM
This publication is a part of a larger Project concerning determination of caries risk in children aged 3 years and under using questionnaires and clinical and bacteriological examinations.
The aim of the present paper is to determine the efficacy of clinical examination of one-year-old children and their mothers in determining the risk for caries over the next two years.
MATERIAL AND METHODS
The study material comprised of 122 children be- tween the ages of 12 and 15 months, and 120 mothers. The group of children included 64 boys and 58 girls (Fig. 1).
Fig. 1. The study material.
Children and mothers were recruited for the study during routine inoculation visit at a regional children´s health clinic in the Żoliborz district of Warsaw.
The study design comprised of:
1. a baseline examination of one-year-old children and their mothers,
2. control examinations of the children every 6 months,
3. statistical analysis.
The baseline examination was performed at the Inoculation Centre at the Regional Children´s Health Clinic In Żoliborz, Warsaw, in separate office. An initial clinical examination of both mothers and children was performed using a dental mirror and probe, a portable air-syringe and a free-standing dental lamp (without the use of a dental unit).
Parameters recorded in mothers included
1. the number of tooth surfaces with caries, extracted due to complication of caries and restored (DMFs),
2. the number of tooth surfaces with untreated caries (Ds).
Parameters recorded in children included
1. the number of tooth surfaces with caries, extracted due to complication of caries and restored (dmfs),
2. the number of tooth surfaces with incipient caries and superficial caries (number of surfaces C0, C1).
Control examinations were performed at six months intervals until the children reached the age of three, as follows:
– I control visit in children aged 17 to 21 months,
– II control visit in children aged 23 to 27 months,
– III control visit in children aged 29 to 33 months,
– IV control visit in children aged 35 to 40 months.
These examinations were performed at the Medical University of Warsaw, and were combined with dental preventive and treatment procedures, undertaken after obtaining mothers´ consent.
At the control examinations, the increment in dmfs values as compared to the baseline value was calculated for each child.
Statistical analysis
The results of the baseline clinical examination of children and their mothers and the results of subsequent control examinations of the children were subjected to statistical analysis.
This included calculation of Spearman´s coefficient of correlation ® between variables. A correlation of parameters investigated at the baseline with dental health of children, as described by the increment in dmfs values between subsequent examinations, was deter- mined.
RESULTS
Clinical examination of mothers
The DMFs value in the group of 120 mothers exa- mined varied from 9 to 116.
The mean DMFs value was 40.
Only one of 120 mothers of one-year-old children had no surfaces with untreated caries. The mean Ds value was 11.8.
Clinical examination of children´s dentition
Results of this examination are presented in tables 1 and 2.
Table 1. dmfs values in baseline examination.
| dmfs values | Number of children | Percentage of children |
| 0 | 97 | 79,5% |
| 1 | 8 | 6,6% |
| 2 | 8 | 6,6% |
| 3 | 1 | 0,8% |
| 4 | 1 | 0,8% |
| 5 | 1 | 0,8% |
| 6 | 3 | 2,5% |
| 12 | 1 | 0,8% |
| 20 | 1 | 0,8% |
| 22 | 1 | 0,8% |
| Total | 122 | 100,0% |
Table 2. Number of CoC1 surfaces in children´s baseline examination
| Number of surfaces C0C1 | Number of children | Percentage of children |
| 0 | 99 | 81,1% |
| 1 | 7 | 5,7% |
| 2 | 10 | 8,2% |
| 3 | 1 | 0,8% |
| 4 | 1 | 0,8% |
| 5 | 1 | 0,8% |
| 6 | 2 | 1,6% |
| 12 | 1 | 0,8% |
| Total | 122 | 100,0% |
From table 1 it can be seen that caries prevalence in group of one-year-old children studied was high and reached 20.5%. The overall mean dmfs value for children was 0.9, indicating that nearly every one-year-old child had a surface with caries, extracted or restored.
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