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Community Dentistry



Carina BALCOŞ1, Anca STUPU2, Veronica PINTILICIUC1, Livia BOBU1,

Assist. Prof. PhD, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
Univ. Assist. PhD Student, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
Prof. PhD, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
Corresponding author: Anca Stupu; e-mail: stupanca@yahoo.com

Abstract countries have a DMFT index < 3.0, as registered

Introduction. To analyze the association between caries
in local students [1].
experience and the eating and oral hygiene habits of some Studies conducted in previous years evidenced
school children of Iaşi, Romania. Materials and methods. the main factors which may lead to caries, such
232 first-grade students from 5 elementary schools of Iaşi as eating habits, oral hygiene habits, parents’
were selected for the study. They filled in a questionnaire
(response rate: 92.8%) and oral examination was made educational level, socio-economic status, and
according to WHO criteria. Statistical analysis was used to health care habits. The frequent consumption of
evaluate the correlation between student’s oral health sugary drinks and sweets, together with the
status and the responses given in the questionnaire.
absence of regular meals, is likely to be the cause
Results and discussion. Participants to the study show a
high prevalence of dental caries (76.8%), which may be due of increased dental caries. In terms of the
to the fact that most of these children eat sweets and frequency of teeth-brushing, children who brush
snacks, have poor oral hygiene habits, and extremely low once a day have a higher number of decayed
rates of using dental health care products. Sanogenic
behavior has been associated with caries experience in both
teeth, as well as a worse index of dental caries
sexes. Conclusions. The results obtained indicate the need than those who brush three or more times a day
for improved access to dental health care and education in [2]. Moreover, children usually adopt these oral
every school, so that children can develop good oral hygiene behaviors during the critical period
hygiene habits.
Keywords: caries, sanogen behavior, oral hygiene, student. when they attend elementary school. If they fail
to develop good and correct teeth cleaning
1. INTRODUCTION behavior, their overall oral health will be affected.
The present study focused on the association
between caries experience and the eating and
The past few decades have witnessed an oral hygiene habits of a group of school children
increased focus on the importance of oral health of Iaşi, Romania.
on the social, psychological and developmental
well-being of children. Although effective and
advanced dental prevention measures and
treatment options are increasingly available,
dental decay remains one of the most common The experimental group was formed of 232
chronic childhood diseases (60-90%). According children, 6-7 years of age, from 5 different
to the World Health Organization, in 2010, 50% school. These children were given an oral health
of children worldwide aged 5-6 years should be examination and asked to fill in a questionnaire.
caries-free, whereas the average decayed, missing After the research team explained the contents
and filled teeth in permanent dentition (DMFT) of the study using a written description to the
index would be reduced to < 1.0 at 12 years of legal representatives of the participants, they
age. By 2011, the global average DMFT index for signed an informed consent form. The survey
12 year-old school children was 1.67 and 78% of response rate was of 92.8%. The oral health

International Journal of Medical Dentistry 183


examination of all participants was conducted averages, and standard deviations for the
by a single dentist calibrated on diagnostic collected data. In addition, t tests and analysis
methods and standards for the oral health of variance (ANOVA) were applied to analyze,
examination survey released by the World compare, and evaluate the oral health status
Health Organization. The number and of the different sexes in first and fourth grade
conditions of children’s deciduous and school children. These results were further
permanent teeth were recorded. Where term used to analyze the oral hygiene and eating
decayed (dt, DT) is used, this represents a carious habits of the school children in addition to
deciduous (permanent) tooth without fillings or recording their prior experience of visits to
the occurrence of secondary caries after failure the dentist. Subsequently, the correlation
of a filling. Where term extraction (mt) is used, between these factors was explored to identify
this indicates the removal of a deciduous tooth the possible causes of oral diseases. Statistical
due to severe caries. Where term missing (MT) analysis was carried out using SPSS version
is used, this represents a permanent tooth 14.0 (SPSS Inc., Chicago, IL, USA) for
missing as a result of caries. Finally, where term Windows.
filled (ft, FT) is used, this indicates a deciduous
(permanent) tooth filled due to caries, with 3. RESULTS
permanent or temporary materials [3].
The study involved filling in of a structured
questionnaire aimed at collecting information Table 1 gives details regarding the sex
on the demographic profile, educational distribution of subjects (54.74% were girls and
status, income, occupation, dental visits and 45.26% were boys) and the dental caries
their reasons, oral hygiene practices, dietary experience of school children’s primary dentition,
habits, exposure to fluorides, underlying determined by oral examination. The prevalence
systemic diseases and awareness towards oral of dental caries in primary dentition is of 76.8%
diseases. and of 10.8%, respectively, in permanent
Statistical analysis was used to produce a dentition. No statistically significant difference
frequency distribution table, percentages, was observed between boys and girls.

Table 1. Sex- and age-weighed dental caries status

Female Male p Caries prevalence

n (%) 127 (54.74%) 105 (45.26%) 76.80%

Dmft 3.62 4.26
Dt 2.70 ±1.72 3.12 ±2.46 0.72
Mt 0.32 ±0.59 0.54 ±0.87 0.86
Ft 0.60 ±1.23 0.90 ±1.54 0.38
DMFT 0.6 0.9 10.80%
DT 0.5±0.13 0.72±0.24 0.12
MT 0 0
FT 0.1±0.07 0.18±0.08 0.16

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Table 2 lists the frequencies of eating sweets, 9.48% of the students brushed their teeth every
snacking, oral hygiene habits, and dental health day, whereas 5.17% of them did not brush their
care habits. Statistical analysis shows that most teeth daily. As for those who apply brushing after
children - 79.31% - occasionally consume snacks eating, most of the students – 87.06% - did this only
or sweets and only 5.7% of them indicated that occasionally, while 3.87% of them brushed their
they never eat snacks or sweets. teeth every time after eating. Less than half of the
As to the sanogenic attitudes after eating sweets children (36.20%) brushed their teeth for more than
and snacks, the results show that 71.98% of the 3 minutes. Most students only went to a dentist
subjects wash their teeth from time to time, whereas when they had a dental problem (71.55%) and 6.3%
36.20% of them never clean their mouth. Only of them had never visited a dentist.

Table 2. Snacking, eating sweets, oral hygiene habits, and dental healthcare habits

Variable n (%)
Number of times a day that snacks and/or sweets are eaten
• Never 12(5.17)
• Occasionally 184(79.31)
• Once or twice a day 10(4.31)
• > 3 times a day 26(11.20)
I clean the mouth after eating sweets
• Sometimes yes, sometimes no 167(71.98)
• Yes, I always brush my teeth after eating sweets 34(14.65)
• Yes, I always rinse my mouth after eating sweets 49(21.12)
• No 84(36.20)
I brush my teeth every day
• No 12(5.17)
• Sometimes yes, sometimes no 198(85.34)
• Every day 22(9.48)
I brush my teeth after eating
• No 21(9.05)
• Sometimes yes, sometimes no 202(87.06)
• Every time 9(3.87)
I brush my teeth for at least 3 minutes
• Yes 84(36.20)
• No 148(63.79)
Dental care habits
• Periodical check-up 24(10.34)
• Occasional check-up 28(12.06)
• Visit a dentist only when having dental problems 166(71.55)
• Never go to a dentist 14(6.03)

International Journal of Medical Dentistry 185


Table 3 shows a statistically significant was found between the category of those usually
difference between brushing after eating and the brushing for > 3 minutes and the dt/ DT score
components of DMFT indices in mixed dentition (p= 0.023, 0.745, 0.321). Briefly, children with
(0.086, 0.784, 0.018). In the case of dt/DT, the poor oral hygiene habits have a poor oral health.
students who did not brush their teeth after Although the analyses of health care habits and
eating had the highest scores, while those who oral health status of school children did not
brushed their teeth every time recorded the show significant differences, the value of the
lowest scores. The dt/DT was higher among dmft/DMFT indices was higher in children who
those who brushed for < 3 minutes than of those only see a dentist when they have dental
who brushed their teeth for > 3 minutes. problems (dmft =7.84) than in those who have
Moreover, a statistically significant difference regular or occasional check-ups (dmft =7.26).

Table 3. Association between dental caries status for mixed dentition and oral
hygiene/dental health care habits

dmft /
n(%) dt / DT mt/MT ft / FT
I brush my teeth after eating
• No 12(5.17) 4.26 0.55 1.64 6.45
• Sometimes yes, sometimes no 198(85.34) 2.65 0.32 0.87 3.84
• Every time 22(9.48) 1.23 0.27 0.64 2.14

p 0.086 0.784 0.018 0.124

I usually brush my teeth for at
least 3 minutes
• Yes 84(36.20) 2.92 0.63 0.97 4.52
• No 148(63,79) 4.86 0.74 1.86 7.46

p 0.023 0.745 0.321 0.032

Dental healthcare habits

• Periodical check-up 24(10.34) 4.92 0.59 1.01 6.52
• Occasional check-up 28(12.06) 5.46 0.57 1.23 7.26
• Visit a dentist only when
166(71,55) 5.87 0.82 0.93 7.62
having dental problems
• Never go to a dentist 14(6,03) 5.92 1.06 0.86 7.84

p 0.284 0.452 0.186 0.466

4. DISCUSSION Some reduction in the prevalence of dental

caries was recorded in both developed and
developing countries, however the prevalence
Despite the marked decline in dental caries in remains high in populations with a low
developed countries over the past years, the socioeconomic status. Therefore, the
prevalence of dental decay remains high and socioeconomic indices are associated with risk
favourable trends are diminishing. In the factors for dental caries [6-9].
developing countries, dental caries has increased The statistical analyses presented in the study
due to an increased exposure to dietary sugars indicate that the prevalence of dental caries in
and also to low socio-economic factors [4,5]. the first class of 5 elementary schools in Iaşi,

186 volume 21 • issue 3 July / September 2017 • pp. 183-188


Romania was 76.8%, a value lower than the with fluoride toothpaste in 3 to 6 year-old children
national prevalence of dental caries (84.3%) significantly reduces caries incidence [13].
registered in a study finalised in 2011 on a sample
including 548 students with ages between 6 and 5. CONCLUSIONS
8 years. Our findings confirm the division
between Western and Eastern Europe, being
The present results indicate that the children
similar to those recorded in other Eastern
of Iaşi have a high prevalence of dental caries,
European countries but higher than those of the
because most of them like to eat sweets and
Western European ones [10,11].
snacks and have poor oral hygiene habits. The
Dental caries in preschool children is due to a
results can also serve as a reference for improved
combination of factors, including colonization of
access to dental health care and education in
teeth with cariogenic bacteria, type of food and
every school, so that children can develop good
frequency of food exposure to cariogenic bacteria,
oral hygiene habits.
susceptible teeth. Caries risk is greatest if sugars
are consumed at high frequency, in a form
retained in the mouth for long periods. Sucrose
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