The aim of the study was to assess the oral health of a group of schoolchildren from primary classes in the municipality of Galati.
Material and method: Cross-sectional study upon a group of 181 children (89 boys, 92 girls) aged between 6-10 years (mean age = 9.07±1.32 years) attending a school from Galați. Prevalence index of caries in permanent dentition (Ip), the mean values of the caries experience indexes (DMF-T, DMF-S) and the bacterial plaque index (IPB) were assessed, as well as the distribution of these indexes according to age and gender. Statistical analysis of data was performed using Man-Whitney tests (p<0.05).
Results: a) Ip=39.78% (at least one first permanent molar was affected); Ipboys=37.07%; Ipgirls=42.39%; b) DMF-T=0.88±1.34 (DMF-Tboys=0.63±1.03; DMF-Tgirls =1.12±1.55;SS); DMF-S=0.96±1,56 (DMF-Sboys=0.69±1.21, DMF-Sgirls=1.23±1.80; SS); c) dental status (2503 permanent teeth): 89.45% were caries free, 2.28% with initial caries on occlusal surface, 4.83% – untreated caries lesions, 2.08% – sealants, 1.36% – dental fillings; d) IPBboys=1.25±0.77, IPBgirls=1.32±0.65 (NS).
Conclusions: 1) Caries prevalence in permanent teeth was very high, even shortly after their appearance, first permanent molars being the most affected; 2) Girls had higher values of caries prevalence, as well as the caries experience indexes; 3) From the first year of school, the dental check-up must be carried out in order to detect children with high caries risk and to establish an individualized prevention program, by applying local methods such as fissure sealing and improving oral hygiene, methods whose effectiveness is already recognized.
Keywords: caries experience, permanent teeth, schoolchildren
Dental caries remains one of the most widespread diseases in the entire world, representing a public health problem especially for the developing countries . Studies conducted in Romania regarding oral health of children, especially for the age group 6 and 12 [2, 3] have shown only a slight decrease in the frequency of dental caries in the last 20 years, therefore the caries prevalence in children continues to be far from the WHO target for 2020 . At the same time, these studies reported lower values of caries in children from cities such as Bucharest, Târgu Mureș compared to other large cities (Timișoara, Cluj, Iași). Also, studies regarding caries activity of first permanent molars (FPM) from localities with different socio-economic level and environmental factors have indicated increased values of the caries activity indexes, the highest values being found in the population from the rural area .
In general, almost all published studies have analyzed the oral health status, especially the dental health status, of pupils from certain regions of the country, whether in the capital or in large cities or in some rural localities. Since there are no national surveys, there are still areas where such assessments have not been made or the results have not been published. One such example is represented by the municipality of Galați, capital city of the county, with a population of 292,600 inhabitants (2012 census), harbour on the Danube and the main steel center of Romania.
In this context, the purpose of the present paper is to assess the oral health of a sample of schoolchildren from Galați.
Material and method
A cross-sectional clinical study was performed in one of the randomly chosen primary schools of Galați, in order to evaluate the oral health status of the schoolchildren in municipality. Children from grades 0 to IV of the school were included in the study.
Inclusion criteria in the study were:
– Children with 6 years of age or older at the time of examination, with mixed or permanent dentition;
– Children without general health conditions;
– Children whose parents signed the consent for examination.
The examination of the children was performed by a single examiner (B.A.) and its purpose was to evaluate the dental health status and oral hygiene status of the schoolchildren. The examination took place at school’s dental office only by using mirror and dental probe. The teeth were dried before examination with air spray. No dental radiographs were performed.
Name, gender, age, dental status and simplified plaque index (IP-S) were noted in the examination file.
Data was stored in a database and statistically analized using Microsoft Excel 2007 and SPSS 20.0.
Prevalence index of caries in the permanent dentition, the mean values of the caries experience indexes were calculated, as well as the distribution of these indexes according to age and gender. In addition, the mean values and distribution by sex were calculated for the plaque index. Statistical data analysis was performed using Man-Whitney tests. Significance was set at p£ 0.05.
The study sample consisted of 181 schoolchildren (89 boys, 92 girls) aged between 6 and 10 years (mean age= 9.07±1.32 years). According to the age group, the entire sample was divided in two groups: one group that included children between 6 and 8 years (n=54 children) and another with children aged 9-10 years (n=127 children).
I. Caries lesions in permanent teeth
a) Caries prevalence index (Ip) in permanent teeth
For the entire sample, 39.78% (n=72) of the children had carious lesions in the permanent teeth, all these children having at least one first permanent molar (FPM) affected. Ip for girls was 42.39% and for boys 37.07% (p>0,05).
The distribution of Ip according to the age group showed that about 35.18% of children had caries in permanent teeth at the age of 6-8 years. The Ip value increased at the study group aged 9-10 years, with no statistically significant differences (NS) (Table I).
Table I. Distribution of caries prevalence index by the age groups
b) Caries experience indexes
In the entire sample, children had 0-5 permanent teeth and 0-7 surfaces affected by caries. The mean values of the caries experience indexes according to the age group and gender are shown in Table II. There were no SS differences between caries experience indexes according to the age group, but there were SS differences regarding the gender of the child.
Table II. Caries experience indexes in permanent teeth
c) Dental status of permanent teeth
Of the 2503 erupted permanent teeth, 89.45% were caries free, 2.28% had initial occlusal caries, 4.83% – untreated caries lesions, 1.36% had dental fillings and 2.08% had sealants.
Regarding FPM status, from 694 erupted FPM(96.24% of the total possible) only 62% were caries free and 8.07% had initial occlusal caries. Also, 17% had untreated caries lesions, 7.78% – sealants and 4.9% – dental fillings. 95.87% of affected FPM had caries on occlusal surfaces.
d) Plaque index
The plaque index value in girls was 1.32±0.65 and for boys 1.25±0.77, with no statistically significant differences (p=0.537).
Data from the literature showed that the socio-economic level influences the caries prevalence on permanent teeth [5, 6] and environmental factors can put their mark on tooth mineralization with consequences on quality of hard dental tissues and their response to the cariogenic factors action [7, 8]. Although in our study we did not analyze in particular the economic level of the families from which the children came from or the degree of employment of the parents, it is possible that these socio-economic factors, together with the increased degree of industrial pollution in the municipality of Galați, have influenced their oral health.
Analyzing the caries frequency, it was observed that more than one third (39.78%) of children had caries lesions on permanent teeth, a higher value compared to the results obtained by Saravanan et al. (2008) and Smadi et al. (2016), but very close to the value reported by Behal et al. (2016) in studies performed on groups of children of similar ages (Table III).
Table III. Comparative studies regarding caries prevalence in permanent teeth
Caries prevalence in permanent teeth was higher in girls than boys (42.39% and 37.07%, respectively).
Regarding caries experience indexes on permanent teeth, the value of DMF-T index was close to that reported by Levine et al. in England and Smadi et al.,  in Jordan, in studies conducted on samples of children with similar ages. In another study conducted in India, the value of DMF-T index was about 2 times higher and the values of DMF-S was 4 times higher (Table IV).
Table IV. Comparative studies regarding caries experience indexes in permanent teeth
The mean values of the caries experience indexes increased with age, but the differences were not statistically significant. According to gender distribution, girls presented significantly higher values of these indexes compared to boys.
Regarding the first permanent molar, studies have shown that this tooth is of particular importance in specifying the dental health status, being the most frequent first permanent tooth affected by decay [1, 2, 4].
In our study, the prevalence of caries on FPM for the entire sample was 38%, a lower value than the values obtained compared to those reported by Stanciu et al. (2011) on the three samples analyzed in industrial areas, as well as in the study conducted by Șerban et al. (2013) for the age group 9-10 years. Referring to the two age groups analyzed, for the age group 6-8 years, the IpFPM in our study was higher than that reported by Bereșescu et al. (2012)  and Șerban et al. (2013) , but smaller than that found by Chirca et al. (2016)  (Table V).
Tabel V. Comparative studies regarding caries prevalence in FPM
Studies from the literature have shown that there is an 8-fold higher caries vulnerability for pit and fissure surfaces compared to the smooth dental surfaces . In the present study, 95.87% of affected FPM had caries on the occlusal surfaces. It should be mentioned that 7.78% of FPM had pit and fissure sealings on occlusal surfaces, almost 4 times higher than the one reported by Luca et al.  in the study conducted in Bucharest in 2002, but smaller than one reported by Chirca et al. in the study carried out in 2019 on a school population with a mean age of 8 years and 10 months ± 1 year and 2 months in Pitești municipality (Table VI).
Tabel VI. Comparative studies regarding FPM status
Analyzing the bacterial plaque index, although its mean value was slightly higher in girls than in boys, however, the differences were not SS. Although these differences were NS, the caries experience indexes were SS higher in girls than in boys, which points out that there were also other factors that favored caries occurence. Because occlusal caries of M1P were the most common for the entire study sample, the higher values of DMFT and DMFS indexes found in girls could be explained by the fact that the first molars erupt earlier in girls than in boys and tooth brushing is not effective enough to clean the occlusal pits and fissures.
1) Caries prevalence in permanent teeth was very high, even shortly after their appearance, permanent first molars being the most affected;
2) Girls had higher values of caries prevalence, as well as the caries experience indexes;
3) From the first year of school, the dental check-up must be carried out in order to detect children with high caries risk and to establish an individualized prevention program, by applying local methods such as fissure sealing and improving oral hygiene, methods whose effectiveness is already recognized.
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