Early childhood caries in preschool children of Kosovo - a serious public health problem

BMC Public Health Early childhood caries in preschool children of Kosovo - a serious public health problem Agim Begzati 0 Merita Berisha 2 Kastriot Meqa 1 0 Department of Pedodontics and Preventive Dentistry, School of Dentistry, Medical Faculty, University of Prishtina , Prishtina , Republic of Kosovo 1 Department of Periodontology and Oral Medicine, School of Dentistry, Medical Faculty, University of Prishtina , Prishtina , Republic of Kosovo 2 National Institute of Public Health of Kosovo, Department of Social Medicine, Medical Faculty, University of Prishtina , Prishtina , Republic of Kosovo Background: Even though it has been widely studied, early childhood caries (ECC) remains a serious public health problem, especially in countries where there is no national program of oral health assessment and no genuine primary oral health care, such as in Kosovo. The purpose of this study was to assess the prevalence of ECC and analyze caries risk factors. Methods: The subjects were 1,008 preschool children, selected by stratified random cluster sampling, in the municipality of Prishtina, capital of Kosovo. Data were collected through clinical examination and interviews. Dmft data were recorded according to WHO criteria. Bacterial examination (CRT bacteria test) and plaque test of GreeneVermillion were used. Results: The mean dmft of preschool children was found to be 5.8. The prevalence of ECC was 17.36%, with a mean dmft of 11 3.6. Streptococcus mutans prevalence in ECC children was 98%. A significant correlation between dmft and S mutans counts (105 CFU/mL saliva) was demonstrated. A correlation was also found between daily sweets consumption and dmft in children with ECC (P < 0.001). Comparing the dmft of ECC children and duration of bottle feeding showed a statistical correlation (P < 0.001). The mean plaque test was 1.52. None of the examined children had ever used fluoride. Conclusion: The prevalence of ECC was high among preschool children in the municipality of Kosovo. We recommend increasing parents' knowledge of proper feeding habits and oral health practices, and increasing preschool children's accessibility to dental services. - Background Kosovo, the youngest European country, lies in the Balkan Peninsula in Southeastern Europe. The population of Kosovo in 2000 was estimated at 2 million [1], with 32.8% of the population being age 14 or younger [2]. The health care system is facing difficult organizational issues, with many problems and challenges ahead. There are no concrete activities in preventive dentistry organized by Kosovos Ministry of Health. Some preventive activities are accomplished by the Group for Public Oral Health Promotion, established in 2000 and supported by nongovernmental organizations. During the promotion of oral public health in urban kindergartens, the presence of extensive dental disease in children, known as early childhood caries (ECC), was recorded. ECC is an acute, rapidly developing dental disease occurring initially in the cervical third of the maxillary incisors, destroying the crown completely. Early onset and rampant clinical progression makes ECC a serious public health problem. Due to varying clinical, etiological, localization, and course features, this pathology is found under different names such as labial caries (LC), caries of incisors, nursing bottle mouth, rampant caries (RC), nursing bottle caries (NBC), nursing caries, baby bottle tooth decay (BBTD), early childhood caries (ECC), rampant infant and early childhood dental decay, and severe early childhood caries (SECC) [3-14]. According to Davis, the definition of this pathology has always been complex and difficult to be described, but when it is seen, you know what its about [15]. Up to now there have been many proposals for definition and diagnostic criteria, described in detail by Ismail & Sohn [16]. The preferred and most commonly used term today is early childhood caries (ECC), proposed by the Centers for Disease Control and Prevention (CDC) [11]. The prevalence of ECC varies in different countries, which may depend on the diagnostic criteria. While in some developed countries having advanced programs for oral health protection, the prevalence of ECC is around 5% [7,8,17-19]. In some countries of Southeastern Europe (Kosovos neighbors), this prevalence reaches 20% (Bosnia) and 14% (Macedonia) [20,21]. Much higher ECC prevalence has been reported for such places as Quchan, Iran (59%) [22] and Alaska (66.8%) [23]. In American Indian children the prevalence is 41.8% [23]. Similarly, in North American populations, the prevalence in high-risk children ranges from 11% to 72% [24]. Numerous biological, psychosocial, and behavioral risk factors are involved in the etiology of ECC, supporting the multifactorial character of the disease [25-27]. Based on this concept, dental caries can be defined as demineralization of tooth tissue consequent to a dental infection that is dependent on frequent exposure to fermentable carbohydrates and is influenced by saliva and fluoride and other trace elements [14]. A very important role is attributed to the bacterium Streptococcus mutans-called the window of infection [28], in that it is responsible for the primary oral infection in the first phase of ECC [29,30]. Dietary habits are also deeply implicated in the development of ECC, despite the fact that it is considered an infectious disease [31]. Consumption of sweets with high concentrations of glucose, saccharine, or fructose, especially if taken in processed juices [32], and their prolonged intake play an important role in caries development in children with ECC [33]. The purpose of this study was to evaluate the prevalence of ECC and various caries risk factors such as quantity of cariogenic S mutans colonies, oral hygiene, sweets preference, bottle feeding in preschool children, and fluoride use. Methods Included in the study were 1,008 children of both sexes, from 1 to 6 years of age, from 9 kindergartens of Prishtina, capital of Kosovo. The sample was random, representing 80% of all kindergarten children. The sample size was calculated with a confidence level of 95% and a confidence interval of 2. Dental examination and diagnostic criteria The children were examined in well-lit premises, using a flashlight as the light source, and a dental mirror and dental probe, by two dentists (AB and KM). Diagnostic criteria were calibrated [34], with inter-examiner reliability resulting in kappa = 0.91, based on the examination of 35 children of different ages. Dental caries was scored as the number of decayed, missing, or filled primary teeth (dmft). ECC was defined as initial occurrence of caries in cervical region of at least two maxillary incisors. Using a careful lift-the-lip examination, the presence or absence of ECC was recorded depending on the presence of noncavity caries/white spot lesions or cavity caries. In order to study the clinical and etiological as (...truncated)