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10.2
21.17
27.37
31.65
0
5
10
15
20
25
30
35
NHANES III (8-11) Europe (9-15) Lebanon (8-11) Arab (11-14)
IOTN>4-5
325
205
Public Schools
Consented
Not consented
Assessment of oral health in elementary school children in Beirut:
a comparison between private and public schools Antoine E. HANNA 1, Celine M. MOUKARZEL 1, Ramzi V. HADDAD 1, Monique CHAAYA 2, Miran JAFFA 2, Joseph G. GHAFARI 1
Oral health encompassing dental decays, oral hygiene and malocclusion (bite problems) varies with socioeconomic and educational backgrounds.
Aims: 1- Compare indices of various components of oral health between children in private (PV) and public (PB) schools in Lebanon. 2-
Investigate associated demographic socioeconomic and behavioral factors. Methods: Malocclusion, DMFT (Decayed, Missing, Filled Teeth) and
plaque (hygiene gauge) indices were measured in 655 elementary school children (6-11 years) in PB (n=325; 153 girls, 172 boys) and PV (n=330;
177 girls, 153 boys) in Beirut. Calibrated dentists recorded: 1- occlusal parameters: overjet (OJ), overbite (OB), posterior crossbite (PXB), midline
diastema and crowding (Irregularity Index), 2- DMFT score and 3- Plaque index. Following standardized procedures. Socio-demographic and
behavioral data regarding children and parents were collected through a questionnaire completed by the parents. Results: The mean DMFT score was significantly higher (7.50±3.98) in PB compared to PV (3.50±3.41). The mean plaque index was also greater in PB (1.35±0.23) compared to
PV (1.20±0.15) (p<0.001). A Higher DMFT score was associated with poor oral health perception, breast feeding and Public school. Plaque index
was associated with the oral health perception. Malocclusion in its major components (OJ, anterior XB, and occlusal relations) was statistically
significantly more severe in PB versus PV. Age was positively associated with OJ, OB and PXB. Increased sucking habit duration was associated
with a shallower OB and PXB. Crowding was more severe among males and associated with an increase in the DMFT score. Computed
orthodontic treatment need scores revealed that nearly 25% of the children are in urgent need of treatment. Conclusion: DMFT and malocclusion
severity scores were higher in public than private schools, and were higher than similar data in the USA and European countries. Accordingly,
more prevention strategies are needed in Lebanon with more attention to children in public schools.
Oral health is a standard of the oral and related tissues which enables an individual to eat, speak and socialize without active disease,
discomfort or embarrassment and which contributes to general well-being" (WHO, 1982)
Three major components of Oral health assessment:
1- Dental decays 2- Oral hygiene 3- Malocclusion
The impact of oral health components on daily life varies from mild to severe. Severe effects may include general health complications as well
as speech, psychological and behavioral problems.*
The dentist involved in promoting dental public health must detect oral diseases early and recommend strategies to diminish their impact.
In Lebanon, high prevalence of dental caries has been reported (mid-1990’s). No data exist on malocclusion severity Updated data are
needed for proper perspective on oral health status and comparison with American and European populations. *Majewski, R., Snyder, C., Bernat, J. (1988). ASDC Journal of Dentistry for Children, 55, 339–342.
Cl I occlusion Cl I malocclusion
Cl II malocclusion Cl III malocclusion
1- Compare the prevalence of a- DMFT and plaque indices, b- malocclusion in children attending private and public schools
2- Investigate the association of dental conditions and personal/behavioral conditions
(age, gender, grade, socioeconomic status, education, occupation and annual income of the parents, smoking, maternal smoking during pregnancy, nutritional habits)
3- Build up a cohort for subsequent follow-up on oral health and oral health surveys
Type Sample Stratification Area
Cross-sectional Elementary school children
(6-11 yrs.)
School type:
Public vs. Private Beirut
Clinical examination
DMFT score
D: Decayed
M: Missing
F: Filled
T: Teeth
Plaque index
Recording of soft debris and mineralized
deposits on the four surfaces of 6 teeth:
0: No plaque
1: Presence of a film of plaque
2: Moderate accumulation of soft deposit
3: Abundance of soft matter.
1- Crowding 2- Midline diastema
3- Posterior crossbite 4- Overjet 5- Overbite
6- Molar/Canine occlusion
Completed by parents; included 40 questions about:
1- Socio-demographic background of child and
parents
2- Socio-economic status of the parents
3- Health status of the child and behavioral factors.
Calibration of the measures was performed prior to the beginning of the data collection to ensure reliability and validity
Frequency analysis
Characteristics*
School type
Public (n=325)
%
Private (=330)
%
Family Income (LL)
<500,000 33.6 1.4
500,000-999,999 49.4 14.2
1,000,000-3,000,000 15.1 57.6
>3,000,000 2.1 26.4
Education of informant
Low (Illiterate-Primary-Elementary) 45.4 7.7
Average (Secondary-Intermediate) 44.1 20.0
High (College / university) 10.5 72.4
Maternal smoking during pregnancy
Cigarettes 20.4 7.0
Sucking Habits
Yes 19.56 14.9
No 80.43 85.1
Frequency of teeth brushing
≤Once/ day 64.1 66.3
2-3times/day 18.6 31.9
Rarely 17.3 1.80
Previous dental consultation 70.4 85.9
26.4
23.8
7.3
16.9
26
18.7
15.9
4.8
14
28
22.5
20
3.6
7.1
20.6
0
5
10
15
20
25
30 Malocclusion Components
Public Private NHANES III
Sev
ere
Overjet Overbite Open bite Post. Crossbite Irregularity index
Sev
ere
1.35 1.2
0.71
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Public Private New Zealand
PI*
7.3
3.5
1.75
0
1
2
3
4
5
6
7
8
Public Private NHANES
DMFT*
*
†
*ONLY CHARACTERISTICS WITH STATISTICALLY SIGNIFICANT DIFFERENCES (0.0001<P<0.05) ARE DISPLAYED
Performed on the final model that includes the significant variables at the bivariate level
(p<0.2). DMFT and plaque indices were analyzed using the linear regression. Malocclusion
components were analyzed using the multiple logistic regression.
1- Severity scores of oral health components (DMFT, PI and malocclusion) are higher in public than
in private schools
2- Lebanese children have more severe DMFT and malocclusion components than children in
Western countries
3- Dental health components are associated with specific behavioral factors of both parents and
children
1- Division of Orthodontics and Dentofacial Orthopedics, Department of Otolaryngology- Head and Neck surgery, Faculty of Medicine/AUBMC
2- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut
† Broadbent et al. JADA 2011;142(4):415-426 – Data not available in NHANES
Questionnaire
* National Health and Nutrition Examination Survey
Malocclusion (NHANES III)*
WHO
The World Health Organization(WHO) goals for better oral health worldwide:
1- 50% of 5-6 year-olds to be free of dental caries
2- Global average = 3 DMFT at age 12 years
3- 85% of the population should retain all teeth at the age of 18 years
4- A database system should be established for monitoring changes in oral health
No such goals are established for malocclusion characteristics ___________________________________________________________________________________________________________________
In our study: DMFT in private schools (3.5) close to WHO goal (3); DMFT in public schools is nearly
double (7.3)
330
860
Private Schools
Consented
Not consented
1- DMFT score tends to :
● Increase in children with bad oral health perception compared to those with good
oral health
perception (β: 2.80; P<0.001)
● Decrease in bottle-feeding compared to breast-feeding (β: -0.78; P=0.04)
2- PI index tends to increase by in a bad oral health perception compared to a good one (β: 0.034; P=0.004)
3- OJ, OB and Xbite increase with age (OR:1.35, 1.2, 1.71 respectively; P<0.05)
4- Increased sucking habit duration associated with shallower OB (OR:0.98; P<0.001) and
posterior crossbite (OR:1.01; P<0.001)
5- Crowding is more prevalent among males (OR:1.69;P<0.001) and is associated with
higher level of dental decays (OR:1.04; P<0.001)
Multivariate analysis
IOTN
The Index of Orthodontic
Treatment Need (IOTN) was
calculated based on the registered
malocclusion components.
-Rashed Al-Azemi and Jon Årtun. Med Princ Pract 2010;19:348–
354
-Abu Alhaija, wt al. Eur J Orthod, .2004 Vol.26, No.3, pp. 261-263.
Europe IOTN: UK, Norway,Germany, Spain & Finland
1- Education campaigns for parents should emphasize the importance of primary intervention, early
screening, prevention and timely treatment
2- Orthodontic screening should be integrated with other medical/dental screenings on an annual
basis
3- Mouth breathing and sucking habits should be evaluated by physicians and parents
4- Further research is required to study:
• Feasibility of creating affordable preventive/interceptive orthodontic care centers
• Cost effective insurance plan(s)
5- Long term follow-up on the screened subjects to build up a Cohort
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