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

fd