Summary:
Oral health status and treatment needs of 15 year-old Greek children.
A National Pathfinder Survey.
Introduction:
During the past 20 years, many epidemiologic studies have revealed a declining
trend in the prevalence and severity of oral diseases in Western children.
Nevertheless, valid direct comparisons of data on dental health remains a
problem due to the lack of standardized criteria, as well as changes in the
diagnostic criteria and treatment intervention of carious lesions.
Aim:
The aim of this study, as part of a National Pathfinder survey of the Hellenic
population, was to assess the prevalence of caries, oral hygiene, gingival
status, orthodontic needs and trauma of 15 year-old Greek adolescents and to
correlate them to sociodemografic factors and their knowledge, behavior and
attitudes in regard to oral diseases and measures to prevent them.
Material and Methods:
A stratified cluster sample of 1131 healthy Greek 15 year-old children was
randomly selected and examined by 10 calibrated examiners.
The study design included:
I. Socio-demographic data retrieved through from the school registers
and children.
II. Clinical examination, after parental written consent, with a dental
mirror and periodontal probe in the classroom, using all the asepsis and
antisepsis measures, to record:
a. dental caries with a combined ICDAS II and WHO index (ICDAS 0-2 and
D3-6MFT) criteria.
b. oral hygiene and periodontal status estimated as mean of the
simplified debris - DI-s, calculus- CI-s and community periodontal - CPI index.
need for orthodontic treatment (modified Index of Orthodontic Treatment Need
(IOTN)).
c. dental trauma (modified Ellis classification).
ΙΙΙ. Completion of a structured questionnaire about the knowledge,
attitudes and behavior related to oral health, through an interview.
Statistical analysis:
Data were processed and analyzed with SPSS with the level of statistical
significance level set at < 0.05. Non parametric tests were applied due to the
non symmetric distribution of caries in the population. After the descriptive
data analysis, uni- and multi variable regression models were performed to
investigate which of the socio-demographic and behavioral factors are risk
indicators and affect dental caries and periodontal status.
Results:
• The overall mean D3-6MFT value of the surveyed children was 2.52and
the mean D3-6MFS value was 3.6, showing statistically significant different
variation across the different districts of the country. The D3-6MFT scores
varied from 1.66-3.69 and the D3-6MFS varied from 2.24-4.61. Children of rural
areas showed significantly higher D3-6MFT and D3-6MFS values compared to
residents of urban areas. In the present study, 33.2% of the 15-year olds were
caries-free, demonstrating a great difference between rural and urban areas and
according to their oral health self-assesment. Only 16.4% of the adolescents
had sealants.
• The Care Index was only 26.67% ranging from 36.48% in the county of
Chania to 18.99 % in the county of Larisa, respectively.
• The mean DI-s value of the sample was 0.54, demonstrating a
statistically significant variation within the different counties, gender,
location and parental educational status. In general, girls, children of urban
areas and with parents of a higher level of education showed significantly
lower DI-s values compared to boy residents of rural areas with parents of a
lower level of education.
• The mean CI-s of the sample was 0.26and the mean OHI 0.80. As in the
DI-s a statistically significant variation was found within the different
counties, and according to gender, location and parental educational status.
• With respect to the periodontal status (CPI index), only 31.6% of the
15-year-olds were healthy, whereas 21% presented with hemorrhage upon probing,
44.3% with calculus and 3.1% had pockets. Statistically significant differences
were observed among counties, gender, location, tooth brushing frequency and
parental educational status.
• Traumatic injuries were recorded in 9.1% of the population with
considerable variations within the different districts. The higher scores were
recorded in boys. Correlation was found between increased overjet (>3mm) and
dental trauma.
• There was a strong correlation between smoking and alcohol consumption
with caries levels and worst periodontal status.
• Almost one-third of the population (33.7%) demonstrated orthodontic
problems according to the modified IOTN index.
Conclusions:
• Dental caries in the 15-year-old Greek adolescents, although it was
found lower than in the past years, it is much higher compared to adolescents
in most industrialized European countries.
• Paternal educational level establishes a significant predictor of
dental caries level and 15 year-old Greek children urban residents, with
advanced parental educational level show the best oral hygiene compared to the
rest of the study children.
• The worst D3-6MFT figures and higher percentage of untreated caries
needs found within the more uneducated people, a fact that necessitates a more
drastic and early intervention based on a better targeting of the dental
services.
• Since the majority of dental caries in the Greek adolescents was found
on the occlusal surfaces of the posterior teeth, a more tooth surfaces
targeting preventive program with sealants could eliminate caries to a large
extent.
Acknowledgments:
This coordinated epidemiological survey, conducted as part of the National
Program “Assessment and Promotion of the Oral Health of the Hellenic
Population” was carried out under the auspices of the Hellenic Dental
Association and the coordination of Prof. Constantine Oulis, in collaboration
with the Dental Schools of Athens and Thessaloniki. Postgraduate student
Sifakaki Maria is a scholar of the State scolarship foundation and the
completion of this thesis was co-financed by the Project "Scholarships SSF"
from resources of the OP "Education and Lifelong Learning" by the European
Social Found (ESF), NSRF 2007-2013.
Keywords:
Caries, Adolescents, Treatment needs, Children, National survey
