Dental caries and oral health practices in 12-year-old children in Lodz*

Dental caries is considered to be a complex disease. Caries prevalence is related not only to individual genetic factors, but also to social ones. Up to now science has been unable to find a remedy for susceptibility caused by inheritance, but a favourable environment for good oral health can be created. Many authors state that nutritional habits and oral health practices are of paramount importance in the control and reduction of this disease (1-4). The relationship between external factors and caries prevalence is especially relevant in childhood. Until 1989 Poland formed part of the East Communist bloc, but political and economic changes since then have created new opportunities for health promotion and effective co-operation between the authorities and the professionals. The process of opening up to the West caused not only economic changes but influenced social behaviour, including nutrition and oral health practices, especially among younger Poles. Strident TV promotion of dental products by western companies, and easy access to these new brands, has improved the quality of hygiene procedures. On the other hand, an explosive increase in the consumption of sweet confectionery, and the collapse of oral health care previously provided in grammar schools, might increased the incidence of caries among 12-year-olds. Poland is one of the East European countries where caries incidence is considered to be moderate to high. The state of dental health among 12-year-olds in Lodz has been assessed several times. In 1993 dental decay incidence in 12-year-olds measured by the DMFT index was 4.8 (5), and in 1995 the index reached a value of 4.26 (6), which compares with the results from 1998 where the value was estimated as 4.0 (7).

The aim of our study was to assess the state of oral health and the extent of preventive practices among 12-year-old children in Lodz.

The study took place from April to May 2000 in the city of Lodz. A sample of 263 12-year-old children, 142 boys and 121 girls, was selected from grammar schools in Lodz. Schools were randomly selected from the total number of grammar schools in the city. Each school was visited before the survey to deliver the questionnaires, and teachers were asked to distribute and collect papers. Consent to a dental examination was obtained from both the participants and their parents. The questionnaire used for the interviews was designed by the authors. The following information was collected:

1.children´s personal data (sex, age),

2.oral health practices (frequency of toothbrushing, using other cleaning aids, frequency of dental visits),

3.nutritional habits (frequency of eating sweets or snacks between meals),

4.awareness of dental health advice,

5.attitude towards dental care.

All children were seen by one examiner (JLP) who had received training in clinical methodology, and had wide experience in the clinical diagnosis of caries lesions. Children were seated in a chair and natural light was used. Dental examination was made by using a dental mirror and sometimes a probe to inspect the extent of dental plaque (DI-S), or to check doubtful diagnoses. No radiographs were used. The WHO caries diagnostic criteria (8) were used to assess the dental state of the children, and the Simplified Debris Index to measure the level of oral health. Following the recommendations of Green and Vermillion, 1964 (9) all six surfaces of the teeth were inspected. In the posterior area of the mouth: the buccal part of the upper and lingual surfaces of the lower selected molars, and in the anterior area: the labial surface of the upper right and the lower left central incisors. The maximum score per tooth was 3, and for a person 18. An individual index was obtained by dividing the total score by 6. Children were divided into three groups: 0-group with DI-S = 0 and a very good state of hygiene, 1-group with DI-S = 1 and a good state of hygiene, 2-group with DI-S = 2 and a poor state of hygiene, and 3-group with DI-S = 3 and a very poor state of hygiene.

Data were recorded on specially designed cards and then entered into the computer.

For the statistical inference of the accumulated material, mean values were adopted for measurable readings, with standard deviation and 95% reliability of the arithmetical means. The nature of decay in the examined cases was subjected to the Shapiro-Wilk test. To establis

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