Milchzahnkaries und dentales Bewußtsein von Kindern im Vorschulalter in Zusammenhang mit sozio-ökonomischen Aspekten

Caries in Deciduous Teeth and Dental Behaviour of Pre-school
Children in Relation to Socio-economic Aspects A. Vanin
Introduction In our with scientifically orientated society, there
are, unfortunately, still differences in the standard of oral
hygiene of pre-school children from different backgrounds. This
study aims to demonstrate the existing difference and hopefully,
measures can be taken to address the issue. Materials and Methods
During the period of 2 years (1999-2001) 67 children from families
of lower socio-economic group (KG2) and 62 children from those of
higher socio-economic group (KG1) in the city of Augsburg
constituted the cohort. Detailed examinations were carried out on
each child in the beginning and at the end of the two years´
period. At the beginning of the study, individual dental and
orthodontic examinations were carried out with mirror and probe.
The respective parents were request to fill in questionnaires
related to the nutrition, oral hygiene and behaviour of their
children and themselves. During the study, a detailed information
evening was organised in both Kindergarten. The parents were
required to complete questionnaires about the family and
socio-economic status in order to compare and to confirm the
statistical data of Augsburg. At the end of the study, the same
system of dental and orthodontic examination was conducted. The
children answered questionnaires, which were similar to those
completed by their parents. During the two years, the children were
given instruction on oral hygiene and in particular, the technique
of tooth-brushing. Results The quantity of sweets that the parents
from lower socio-economic group gave their children was higher
(64,2%) than those from higher social status (54,8%). The children
from the former group drunk more acidic beverages (40,3%, KG1-29%)
as well as more sweet beverages (41,8%, KG1- 30,6%). The respective
parents were less involved in the tooth cleaning of their children
(22,6%) in comparison with the other social group (1,4%). The was a
significant (p=0,001) improvement in the modified approximal plaque
index during the two years in both kindergartens (API 25-50% in KG1
from 24,2 to 29%, in KG2 from 7,5 to 14,9% - API 75-100% in KG1
from 29 to 9,7%, in KG2 from 40,3 to 32,9%). The incidence of new
caries in deciduous teeth was noted in both Kindergarten (KG1 t=0
27,4; t=1 24,2%, KG2 t=0 53,7; t=1 50,7%). In KG1 there were more
children with dmf-s=0 (69,4% t=0 and 64,5% t=1) than in KG2 (40,3%
t=0, 31,3% t=1). About 12% of the children coming from lower
socio-economic group had dmf-s=16 to 44 (KG1 only 3,2%). In all
children, fissure Caries (t=0 12,4%, t=1 11,6%) has a higher
incidence rate than approximal Caries (t=0 4,7%, t=1 7,2%). The
number of erupted first permanent molars has increased by the time
the second phase of examinations was conducted. These teeth were
Caries-free in the higher social class children and 27,4% were
sealed. Among the children of lower social class, 6% of the erupted
first permanent molars had fissure Caries, 1,5% approximal Caries
and 16,4% were sealed. It follows that the “Treatment need” (t=1
KG2 50,7%, KG1 25,8%) and the “Treatment degree” (t=1 KG2 49,3%,
KG1 26,2%) were higher in the lower socio-economic group´s
children. Orthodontically, the data indicated some degree of
malocclusion dento-alveolar disproportion, especially, the increase
in overbite (t=0 19,4%, t=1 17,1%). Concerning the data of the
Post-lactal level and from the developing Angle-class, it is
possible to confirm the percentage data of Bishara (1988).
Discussion Although there was a general reduction of deciduous
Caries in our two years´ study, the fact remains that the children
from low income families were significant more prone to dental
disease (p=0,002). These children had significantly more carious
tooth surfaces (p=0,001). The percentage of dmf-s=16 to 44 in the
lower socio-economic group´s children compare to that of the higher
socio-economic group indicates a Caries polarisation. A difference
in the combination of fissure Caries and approximal Caries between
the two kindergartens was found. It shows a significant
disadvantage for the former group´s children (p=0,001). The early
childhood caries was hardly ascertained, however, significantly
common in the lower social class children (p=0,002 t=0, p=0,001
t=1). The dietary element was the obvious influencing factor in
giving rise to carious lesion, as the consumption of sweets had
exceeded the recommended level 10%. The oral hygiene (API) was
generally worse in the same group of children. They also have got
less attention and care given their parents during the tooth
cleaning. Consequently the socially inferior children show a
significantly higher “treatment degree” (p=0,002) as well as a
higher “treatment need” (p=0,002). Regarding the oral hygiene
behaviour, the frequency of the dental check-ups tallied with the
frequency of tooth cleaning of children (0,788) and of parents
(0,787). The circle closes with the frequency of tooth cleaning of
children and parents (0,938). This correlated, in fact, positiv to
the frequency of the check-ups. Summary This study shows a decline
in the caries incidence in deciduous teeth as well as an
improvement of oral hygiene by pre-school children. It would appear
that children from families of low income groups would require some
attention from our society in order to achieve better oral health.
Acknowledgment The author wishes to thank Prof. Dr. I.
Rudzki-Janson, director of the orthodontic faculty
Ludwig-Maximilians-University in Munich, who supported this work,
as well as Dr. T. Euba. A special gratitude to Dr. E. Paschos for
her advice.