Magdalena Błachowska, *Justyna Opydo-Szymaczek, Natalia Torlińska-Walkowiak
Factors affecting dental caries development in primary dentition of pre-school children
Czynniki wpływające na rozwój próchnicy zębów mlecznych u dzieci przedszkolnych
Department of Pediatric Dentistry, Chair of Pediatric Dentistry, Poznań University of Medical Sciences, Poland
Head of Department: Justyna Opydo-Szymaczek, DDS, PhD
Streszczenie
Wstęp. Ocena czynników wpływających na rozwój próchnicy zębów u dzieci jest punktem wyjścia do przygotowania efektywnych programów profilaktyki próchnicy.
Cel pracy. Celem pracy były ocena występowania próchnicy zębów u dzieci przedszkolnych zamieszkujących dwa tereny: z optymalną i z niską zawartością fluorków w wodzie pitnej oraz ustalenie wpływu wybranych czynników na stan uzębienia badanych dzieci.
Materiał i metody. Badaniami objęto grupę 73 dzieci obojga płci w wieku 4-7 lat uczęszczających do dwóch niepublicznych przedszkoli: w Środzie Wielkopolskiej (37 pacjentów) i Turku (36 pacjentów). Rodzice pacjentów zostali poproszeni o wypełnienie ankiety dotyczącej diety, higieny i profilaktyki próchnicy. Stan zdrowia jamy ustnej oceniono z zastosowaniem lusterka, zgłębnika i lampy czołowej. Higienę oceniano z wykorzystaniem wskaźnika płytki (PlI) według Silnessa i Löe, a stan uzębienia, obliczając liczbę powierzchni zębów mlecznych z próchnicą, usuniętych i wypełnionych z powodu próchnicy (puwp), natomiast frekwencję próchnicy, obliczając odsetek dzieci z puwp > 0. Analizy statystyczne przeprowadzono z zastosowaniem programu STATISTICA (wersja 12.5.192.0, StatSoft, Poland), przyjmując poziom istotności statystycznej p < 0,05.
Wyniki. Nie wykazano istotnych statystycznie różnic pomiędzy wskaźnikami próchnicy zębów mlecznych w obu miejscowościach z wyjątkiem liczby powierzchni zębów usuniętych z powodu próchnicy, która była niższa w Środzie Wielkopolskiej (w środowisku optymalnie fluorkowanym). Wielkość liczby puwp u badanych dzieci była uzależniona przede wszystkim od skuteczności codziennych zabiegów higienicznych oraz diety.
Wnioski. Wyniki wskazują na potrzebę edukacji prozdrowotnej z wdrażaniem prawidłowych nawyków higienicznych i żywieniowych, również w rodzinach o wysokim statusie socjoekonomicznym.
Summary
Introduction. The assessment of factors influencing the development of tooth decay in children is the basis for the preparation of effective caries prophylaxis programs.
Aim. The aim of the study was to assess the occurrence of tooth decay in preschool children living in two areas: with optimal and low fluoride content in drinking water, and to determine the influence of selected factors on the dental condition of the studied children.
Material and methods. The study included a group of 73 children of both sexes aged 4-7 attending two private kindergartens: in Środa Wielkopolska (37 patients) and Turek (36 patients). The parents of the patients were asked to complete a questionnaire on diet, hygiene and caries prophylaxis. Oral health was assessed using a mirror, probe and headlamp. Oral hygiene was assessed using the plaque index (PlI) according to Silness and Löe, dental caries by calculating the number of primary teeth surfaces with caries, removed and filled due to caries (dmfs), and caries frequency by calculating the percentage of children with dmfs > 0. Statistical analyzes were performed with the use of STATISTICA (version 12.5.192.0, StatSoft, Poland), with the statistical significance level p < 0.05.
Results. No statistically significant differences were found between the caries indices of primary teeth in both localities, except for the number of teeth surfaces removed due to caries, which was lower in Środa Wielkopolska (in an optimally fluoridated environment). The dmfs number in the examined children depended primarily on the effectiveness of daily hygiene procedures and diet.
Conclusions. The results indicate the need for pro-health education with the implementation of correct hygienic and nutritional habits, also in families with high socio-economic status.
Introduction
Dental caries is a disease of a very complex etiology, which consists of a number of factors, such as the resistance of the hard dental tissues, the oral environment, microflora, and the composition of the diet (1-4). Factors reducing the risk of caries development include, among others, living in an area with fluoridated water or using fluoride supplements, drinking water instead of juices and carbonated drinks, brushing teeth with fluoride toothpaste, or professional fluoride prophylaxis treatments (1, 2).
In Poland, the water is not artificially fluoridated and in most localities the natural fluoride concentration is below 0.3 mg/l; in few places it remains within the optimal range for oral health (0.5-1.0 mg/l), and the upper limit (1.5 mg/l) is rarely exceeded (5, 6). Children have access to free dental care and preventive treatments in offices providing services under the contract with the National Health Fund. However, research shows that only 1/3 of patients aged seven years go to the dentist for regular check-ups and preventive visits (7).
The prevalence of caries in pre-school children recorded in recent years during monitoring studies is high and does not meet the WHO assumptions for 2000 (50% of 5-6-year-olds without caries) and the detailed objectives of the National Health Program for 2006-2020 (60% of children aged 6 years without caries) (8-10). The assessment of the factors influencing the development of tooth decay in children in Poland is therefore very important and should be the basis for the preparation of effective caries prevention programs.
Aim
The aim of the study was to assess the intensity of tooth decay in preschool inhabitants of two environments: with optimal and suboptimal fluoride concentration in tap water and factors influencing the development of caries in the studied children.
Material and methods
The research was approved by the Bioethics Committee of the Medical University of Poznań (resolution 362/17). A group of 73 children of both sexes (32 girls and 41 boys) aged 4-7 years participated in the study. All respondents attended two non-public kindergartens: in Środa Wielkopolska (37 patients) and Turek (36 patients), where the content of fluoride in tap water in 2010-2018, according to the data obtained at the sanitary and epidemiological station, ranged between 0.68 and 0.74 mg/l (optimal fluoride concentration) or 0.19 and 0.30 mg/l (sub-optimal fluoride concentration), respectively. The basis for qualification for the study group was: living from birth in the area of Turek or Środa Wielkopolska and parents’ declaration of willingness to participate in the research. The criteria excluding from the study were systemic diseases (except for allergies not requiring the use of drugs), disability, elimination diets.
The parents of the patients were asked to complete a questionnaire on diet, hygiene, and caries prevention. Oral health was assessed using a mirror, probe, and headlamp.
The dental condition was determined according to the criteria of the World Health Organization (11). Caries lesions were diagnosed when an evident cavity, undermined enamel were found in a pit or fissure or on the smooth surface of the tooth with softened bottom and/or walls in a tactile examination. A tooth surface with a temporary filling, with a sealant and concomitant caries or with secondary caries was classified in this category. In the case when caries completely damaged the tooth crown and only the root remained, the caries covering all surfaces of the tooth crown was marked in the diagram. In cases of doubt as to the presence of caries, a diagnostic decision was made assuming the absence of caries.
In all subjects, the dmfs number was calculated, i.e., the sum of the tooth surfaces with caries (ds), the number of tooth surfaces removed due to caries (ms) and the tooth surfaces filled due to caries (fs). The tooth surface with white or chalky stains, discoloration or rough spots – hard on the probe, discolored pits and fissures with no visible signs of undermining of the enamel, hard bottom and wall on examination with the WHO probe and cavities that were classified as abrasive based on the interview or viewing and touching, were not included in the dmfs index.
Oral hygiene was assessed using the PlI plaque index according to Silness and Löe (12) on four surfaces (distal, mesial, lingual and buccal) on index teeth: 55, 52, 63, 75, 72, 83 or (in the absence of index teeth) on their permanent successors or teeth adjacent to them according to the scale: 0 – no plaque, 1 – thin deposit visible only after moving the probe along the gingival margin or after staining, 2 – deposit visible to the naked eye, moderate accumulation in the gingival area, 3 – thick layer plaques around the pocket and the gingival margin.
The value of the index is the quotient of the sum of the values obtained for each surface of all tested teeth and the number of tested surfaces. PlI values in the range of 0-0.6 indicate good oral hygiene, 0.7-1.8 mean, and 1.9-3.0 mean poor oral hygiene.
Caries frequency was calculated as the percentage of children with dmfs above 0.
Statistical analyzes were performed with the use of Statistica for Windows (version 125.192.0), with the statistical significance level p < 0.05.
Results
In total, 36 children from Turek and 37 children from Środa Wielkopolska were examined, including 32 girls and 41 boys. The mean age in both populations did not differ statistically significantly, as did the sex ratio (p > 0.05) (tab. 1).
Tab. 1. Characteristics of the study group
| | Number (percentage) of examined children | Age in years mean ± SD | Number (percentage) of girls | Number (percentage) of boys |
| Turek | 36 (49%) | 5.42 ± 1.08 | 17 (47%) | 19 (53%) |
| Środa Wielkopolska | 37 (51%) | 5.54 ± 1.04 | 15 (41%) | 22 (59%) |
| Total | 73 (100%) | 5.48 ± 1.05 | 32(44%) | 41(56%) |
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