Oral health and factors related tooral health in Polish schooichiidren

Oral EpidemioiogyMaria Wierzbieka, Peter Carlsson*,Izabeia Struzycka, Ewa Iwanicka-Frankowska and Douglas Bratthall*Department of Conservative Dentistry. MedicalAcademy of Warsaw, Warsaw. Poland and'Department of Cariology, University of Lund,Malmo, Sweden

Wierzbieka M, Carlsson P, Struzycka I, Iwanicka-Frankowska E, Bratthall D; Oralhealth and factors related to oral health in Polish schoolchildren. Community DentOral Epidetniol 1987; 15; 216-7.

Abstract - The oral health and factors related to oral health were surveyed in 168schoolchildren, aged 10-12 years, attending one school in Warsaw. The children wereexamined for dental caries and gingival status, dental plaque and salivary Strepto-coccus tnutans and Lactobacillus counts. An interview on dietary habits and use offluoridated toothpaste was also performed. The results showed a tnean DMFT of4.7 in the sample. Gingival Index 1 and Plaque Index 3 were median scores for themajority of the children. S. mutans was demonstrated in 94% of the ehildren andhigh numbers were found in 15%. Lactobacillus sp. were present in all examinedchildren, with high counts in 56% of the subjects. The interview revealed that mostof the ehildren eat ftve or six times per day and consume candies or cakes eaeh day.Fluoridated toothpaste was not used regularly by any of the children. In conclusionthis study shows a high prevalence of dental disease and an unfavorable combinationof etiologic factors.

Key words: cariogenic diet; dental caries;gingivitis; Lactobacillus; Streptococcus mutans

Peter Carlsson, Department of Cariology,School of Dentistry, S-21421 Malmo, Sweden

Accepted for publication 7 February 1987

In many populations, dental caries inchildren has deelined considerably dur-ing the last decades. In Poland, however,this tendency is probably less pro-nounced since a high prevalence of dentalearies was still reported in 1982 (1, 2).In order to find means to change thissituation, a preventive program was de-signed and tested in a clinical trial. Afirst logical step was, however, to investi-gate the oral health and factors relatedto oral health in the population selectedfor the study.

Material and methods

Schoolchildren from a school in Warsawwere selected for the study. The schoolrecruited children from an area of apart-ment houses outside the city center.Classes were selected to include allchildren born in 1970 and half of thechildren born in 1971 who were attendingthe school. The sample thus selected con-sisted of 168 children aged 10-12 yr atthe examination, which was carried out1982. The ehildren had not received or-ganized dental treatment or preventivemeasures for 1 yr. Dental caries was diag-nosed by clinical examination with mir-

ror and explorer and by bitewing radio-graphs. The clinical ftnding of definitecavitation or the finding on the radio-graphs of a radiolueency involving morethan two-thirds of the enamel thicknesswas recorded as decay using the DMFindex.

The approximal, buccal and lingualsurftices of teeth 16, 12, 24, 36, 32 and44 (FDI system) were examined for thepresence of dental plaque, and the gin-gival status was examined for the corre-sponding gingival units. The findingswere recorded as Plaque Index (Pll) ac-cording to SILNESS & LOE (3) and Gin-gival Index (GI) according to LOE & SIL-NESS (4).

Data on dietary habits were eollectedby an interview on the overall frequencyof food intakes and the frequency of con-sumption of highly cariogenic foodstuffs.The interview was carried out in a separ-ate room with one subjeet at a time, fol-lowing a predetermined protocol. Ques-tions on the use of fluoridated toothpasteand exposure to fluorides from othersources were also included in the inter-view.

The prevalence of Streptococcus mu-tans in the saliva of the subjects was in-

vestigated by a culturing method (5) onseleetive MSB-agar plates. The fmdingswere recorded as the nutnber of coloniesfound on a predetermined area of theagar plates. Salivary Lactobacilluscounts were obtained by the commer-cially available Dentocult culturingmethod (6) in 79 children after temporaryrestoration of carious cavities. The cul-tures were read according to the manu-faeturer and recorded as '"log salivaryeount.

Resuits

The dental caries prevalence was 95% inthe sample with a tnean DMFT of 4.7and a range from 0 to 14. The meanDMFT subdivided into D and F frac-tions was 3.9 DT and 0.8 FT. The DFSdistribution is shown in Fig. 1.

Dental plaque was found on 99% ofthe exatnined surfaces and heavy ac-cumulation was recorded on 79%. Thetnajority of the children had a tnedianPll of 3 (Table 1). Gingivitis was diag-nosed in 78% ofthe gingival units wheretnild and moderate infiammation madeup 94% of the infiamed units. With fewexceptions the median GI was 1-2, the

Oral health in PolLih sehoolchildren 217IN

DIV

II

dz

8 0

6 0

4 0

2 0

0

Table 2. Distribution of 168 Polish schoolchildtcn according to frequency of ingestion ofcariogenic foodstuffs

1 - 5 6-10 11-15 > 15DFS

Fig. J. Distribution of 168 Polish schoolchil-d ren , aged 10-12 yr, according to DFS.

majority of the children having GI 1(Table 1).

In the interview, the majority of thechildren claimed to have five to sevenfood intakes a day and to consume can-dies at least once each day (Table 2).According to the answers in the inter-view, fluoridated toothpaste was not usedregularly by any of the children.

The prevalence of S. mutans andLactobacillus sp. is shown in Table 3.

Discussion

The data on dental caries prevalence inthe present study confirm observationsofa high caries level in Poland. Althoughdiagnostic methods and criteria do not

Type ofproduet

CandiesChocolateCakes

Table 3. Percentage

Sm 0

/o 6

3

% 30

Occa-sionally

3248

Frequency of ingestionOnce Once Twice

a week a day a day

225440

606689

distribution of individuals according to

491224

S. mutans

Streptococcus tnutans count (Sm)Sm 1-10 Sm 11-50 Sm 51-100

25

"'log4

14

37

Lactobacillus count5

18

17

More thantwice a day

2945

Noanswer

582

and Lactobacillus count

Sm > 100

15

6

38

161

n

79

allow direct comparisons, the presentdata are in agreetnent with the findingsby BARANSKA-GACHOWSKA et al. (2) in

children frotn Katowice, Poland. Likethe children in this study, those childrenwere not under regular dental care.

The high prevalence of dental eariescan be explained by the background fac-tors which were studied. Dental plaquewas present in abundatice and S. tnutansfound in nearly all the subjects. Further-more, cariogenic foodstuffs were fre-

quently ingested and the Lactobacilluscounts support this finding. The resultingehallenge was not met by fiuoride in wa-ter, toothpaste, or other topical appli-cations of fiuoride.

In conclusion, the findings in thisstudy justify efforts to promote dentalhealth in the population. The findingsalso indicate in which areas preventivemeasures can be applied and are thusvaluable when planning a preventive pro-gram . .

Table 1. Distribution of 168 Polish schoolchil-dren aged 10-12 yr according to medianPlaque Index (Pll) and Gingival Index (GI)

Median Pll % Median GI

00.511.522.53

0001

121

154

000171

92

00.511.522.53

135

1075

3701

83

643

2201

168 168

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