Dental Caries, Oral Hygiene Skills and Nutritional Skills
Abstract
Dental caries causes teeth loss, aesthetic problems, inflammation of the gums and
eriodonteum and affects chewing. Many factors such as lack of oral hygiene and proper
utrition skills are responsible for dental caries development. In Sisian region, Armenia, the
revalence of dental caries among children was about 80 percent in 2003. This study
ssessed the association between dental caries, oral hygiene and nutritional skills, among
isian schoolchildren aged 12.
The study utilized a cross -sectional survey design. The sample size was calculated
onsidering the 80 percent prevalence of dental caries, and 80 percent response rate.
ystematic random sampling was used to select the study population (n=126).
The statistical analysis was conducted using the SPSS 11.0 and STATA 7.0 statistical
ackages. Simple and multiple linear regression analyses were performed to find and assess
e association between different covariates and DMFT score.
The survey revealed that the prevalence of dental caries among 12 years old children
as 86 percent. The mean DMFT score was 2.84 ±1.95. Dietary habits appeared to not
ffect the DMFT score. The situation was different regarding oral hygiene skills. Most of
e participants (79 percent) did not have proper oral hygiene skills. The regression analysis
uggested that daily twice teeth brushing could be protective against dental caries (regression
oefficient 0.7 P=0.043). It was revealed also, that rural residence is associated with DMFT
core (regression coefficient=1.1, P=.007). Results indicate a need to improve oral health
kills and preventive practices among the study population. Further research is needed in
vestigating the possible causes of association between the place of the residence and dental
aries. In addition, this survey revealed that schools and dental clinics did not participate in
ral health encouragement, thus this study recommends inc luding schools and dental clinics
oral health promotion campaigns among children.
[NextPage]1. Introduction
Dental caries are chronic diseases of multifactor etiology and pathogens (Meskin,
Berry and Currier, 1994). Many factors, such as bacteria Streptococcus Mutans and
Lactobacillus, cariog enic diet, poor oral hygiene and salivary flow rate can cause dental
caries (Meskin, Berry & Kennedy, 1996, Harris & Christen 1987, Schortenboer , 1971).
Dental caries are one of the public heath concerns for several reasons. Teeth affected with
dental caries are sources of infection, which can cause an inflammation of dental pulp,
periodonteum, and gums (Borovski , Ivanov, Maksimovski & Maksimovskaya, 1998;
Tatintcyan, Arevshatyan, Minalyan, et al. 1997). If left untreated, this disease gradually leads
to teeth loss, which causes chewing difficulties and aesthetic problems (Allen, 2003).
Dental caries affects a large proportion of the world population, regardless of age,
gender, ethnicity and place of residence (Hicks, Garcia-Godoy & Flaits, 2004; Wallace &
Last, 1992). More than 98 percent of people worldwide suffer from dental caries (Tatintcyan,
et al . 1997). According to Wallace and Last (1992), about 93.8 percent of adults in the
United States had teeth affected by dental caries. The situation was about the same in Former
Soviet countries. For example, in Moscow the prevalence of dental caries was estimated to
be 97.2 percent and in Saint -Petersburg 96.2 percent (Tatintcyan et al. 1997).
[NextPage]2. Literature Review and Background
Dental caries are preventable disease s (Burton, Smith & Nichols, 1980). Water
fluoridation is an effective tool for prevention of dental caries on the national level. In 1996
the fluoride levels in Yerevan water were below those recommended by the World Health
Organization (WHO) (Chilingaryan, 1999). Currently there is no available data on water
fluoride levels in Armenia. Preventive interventions on individual and community level are directed to the
maintenance of optimal oral hygiene and proper nutrition. These goals are reached through
education and through delivery of preventive dental health services , which include
professional cleaning of teeth by dentists and application of fluoride containing varnishes or
gels (Petersen, 2003).
The current literature highlights the opinion, that correct oral hygiene reduces the risk
of dental caries development. Almost all preventive programs usually include oral hygiene
instructions or educational part of oral hygiene (Borovski et al. 1998; Tatintcyan et al. 1997;
Harris & Christen 1987; Ingersoll, 1982). Many studies provided evidence of strong
association between dental caries development and poor oral hygiene (Dohnke-Hohrmann &
Zimmer 2004 ; Ohara, Kawaguchi, Shinada & Sasaki, 2000).
A preventive program, which consisted of educational part and fluoride varnish
applications, was implemented from 1996 to 2000 in Neukolln, Germany (Dohnke-
Hohrmann & Zimmer 2004). After completing the program, the research team carried out a
cross-sectional study to evaluate the effectiveness of the pro gram. A review of 80,589 dental
records revealed a decline of Decayed, Missing, and Filled Teeth indices (DMFT shows sum
of Decayed, Missing, and Filled Teeth of an individual ), among children with average dental
caries risk. The researchers concluded that proper oral hygiene, in combination with fluoride
varnish applications twice a year, is effective in preventing incipient dental caries (Dohnke-
Hohrmann & Zimmer 2004).
Japanese researchers conducted a program based on school dental health activities in
Hiraizumi, Japan (Ohara, et al . 2000). The focus of this program was dental health education.
The evaluation of this program showed that the improvement of oral hygiene skills resulted in
a decline in dental caries indices among schoolchildren (Ohara, et al . 2000). 3
There is some controversy in the literature regarding the role of sugar consumption in
dental caries development. A research conducted in Thailand among 12 years old
schoolchildren, revealed an association between sugar consumption and dental caries
development (Petersen, Hoerup, Poomvisent, Prommajan & Watanapa, 2001).
Burt and Pai (2001) have conducted a systematic review of the literature regarding
this issue. They had reviewed and assessed about 69 reports of different studies. According
to this investigation, only in one study the investigators found a strong relationship between
sugar consumption and dental caries development. Nineteen investigations showed a
moderate relationship, while the remaining studies found the relationship to be weak or none
(Burt & Pai, 2001). [NextPage]
In the former Soviet Union, since mid 1970s, pediatric dentists were carrying out
“dispansersatia” of children. The process included clinical examination of children and som
preventive interventions. One of the preventive tools was “hygiene hours” in schools, durin
which schoolchildren received instructions about proper oral hygiene. The results of the
educational part were evaluated using the Oral Hygiene Index of Feodorov-Volodkina (Index
of Feodorov-Volodkina show s the amount of plaque on the teeth surface. The grade 5 is the
highest grade and it shows absence of oral hygiene. The grade 1 is the lowest grade and it
shows perfect oral hygiene.). The index was 4.5 in 1977 and in 1988 it decreased to 2.0. The
DMFT index in was 4.5 1976 and it decreased to 1.8 in 1988 (Chilingaryan, 1999).
According to the WHO recommendations , the lowest level of DMFT score is from 0 to 1.1
(Borovski, et al . 1998). DMFT index equal to 1.8 shows low intensity of dental caries. So
the “dispansersatia” and the preventive tools, which were used, showed high effectiveness i
prevention of dental caries (Chilingaryan, 1999). However, after the collapse of the former
Soviet Union, “dispansersatia” ceased. This resulted in increase in revalence of dental
caries and DMFT indices in Armenia.After introduction of decentralization and privatization in health care system in the
[NextPage]early 1990s , the surveillance of dental caries prevalence became irregular and inconsistent.
Most of the dental cl inics and polyclinics in Armenia are private, and are not regulated by the
Ministry of Health. So these facilities do not report any data about dental caries prevalence
and DMFT indices of served population to the Ministry of Health or to the State Health
Agency.
In 2003 the United Methodist Committee on Relief (UMCOR) implemented Dental
Care program in some regions of Armenia, during which dentists examined the
schoolchildren and provided them with a treatment if needed. The program revealed that the
prevalence of dental caries among Armenian schoolchildren was 80 percent . Unfortunately,
the results of this program are not available by regions. Only Sisian region data are available:
the prevalence of dental caries among schoolchildren was 80 percent. However, no studies
explored the possible causes of high prevalence of dental caries among schoolchildren or
designed a dental caries preventive plan.
From March to April 2005 all Sisian schoolchildren aged 12 were examined by a
licensed dentist wo rking in Sisian Stomatological Polyclinic. This check -up was ordered by
the Ministry of Health of the Republic of Armenia. However, the official report of the results
of the check-up was not available by the start of this survey.
The aim of this investigation was to examine oral hygiene and nutritional skills of
schoolchildren aged 12, and to explore the association between o ral hygiene, nutritional skills
and dental caries.
The research questions of this survey were:
? What are the oral hygiene skills of schoolchildren aged 12 in Sisian region?
? What are the nutritional skills of schoolchildren aged 12 in Sisian region?