Journal of Romanian Medical Dentistry 223

AbstractDental caries represent one of the main risk factors for

gingival inflammation. This study is a cross-sectionalclinical survey performed in schools of Bucharest on 1,600school children aged 11 to 14 years. Silness and LoeGingival Caries Index (GCI) was used for evaluating theimplication of caries in the pathology of gingival inflam-mation. The prevalence of dental caries (GCI > 0) wasunder 20%. The teeth mostly altered were the first perma-nent molars.

Key words: dental caries, gingival inflammation,prevalence, distribution

INTRODUCTION

Dental plaque has the most important role inthe etiology of gingival inflammation, togetherwith many other predisposing factors, one ofthem being dental caries.

Caries are involved in the pathology of peri-odontal diseases through three mechanisms:causing pain, thus making the patient to avoidoral hygiene, so that plaque accumulation in-creases gingival inflammation; cervical cariesretains the dental plaque, which producesgingival inflammation and gingival enlarge-ment; destroying the enamel marginal crests, thetraumatisms caused by food under the interden-tal gingiva being inevitable1.

The main outcome of this study is the distri-bution of dental caries involved in the pathologyof chronic gingivitis induced by plaque.

DISTRIBUTION AND PREVALENCE OF DENTAL CARIES INVOLVED INTHE PATHOLOGY OF GINGIVAL INFLAMMATION IN CHILDREN: A

CLINICAL SURVEY IN SCHOOLS IN BUCHAREST

C. Funieru1, N. B\nicioiu2, Adina Dumitrache3,C. B\icu[4, Elena Funieru5, H.T. Dumitriu6

1. Assist. Prof., PhD. Student, Dept of Preventive Dentistry., Faculty of Med Dent, U.M.Ph. Bucharest2. Assist. Prof., PhD. student, Dept of Oro-dental Diagnostic and Ergonomy, Faculty Med Dent. U.M.Ph. Bucharest3. Assoc. Prof. PhD, Dept ofOral Health and Behaviors Science, Faculty of Med Dent, U.M.Ph. Bucharest4. Assoc. Prof. PhD, MD, Dept of Internal Medicine of Colentina Hospital, Faculty of Medicine, U.M.Ph. Bucharest5. DMD, Bucharest, Romania6. Prof. PhD, DMD, Dept of Periodontology, Faculty of Med Dent, U.M.PhD. BucharestCorresponding author: Cristian Funieru; Thycristi@yahoo.com, 0723268929

MATERIALS AND METHOD

A cross-sectional, clinical, randomized studywas performed in some schools of Bucharest, incooperation with Bucharest Public Health Serv-ice and Bucharest Educational Inspectorate. Thesample group was to include 1,600 school chil-dren, the 3.2.2 version of EpiInfo software beingused on a 95% confident interval, 2.42% esti-mated error, 50% intuitive prevalence (maxi-mum sample size) and a 58,000 base population(schoolchildren from Bucharest gymnasiumschools)2. The algorithm of our research meth-odology was based on the random cluster assig-nation method (one cluster = one class, 25 pupils– the proper number recommended by Bucha-rest Educational Inspectorate). A large data basewas created from all secondary educationclasses, the population being classified accord-ing to three principles: school forms(5th, 6th, 7th

and 8th), existence of dental school surgeries andurban areas3 (as established by Bucharest CityHall). Dividing the length of our sample (1,600)by 25 (the proper number of schoolchildren perclass), we found the number of clusters thatshould be randomly selected – 64. Maintainingthe proportion from base population, we foundout how many classes should be selected fromall categories, after which 64 classes were ran-domly selected from their proper categories, us-ing a computer-generated random number ta-ble. The age of the schoolchildren was between11 and 14 years.

Pediatric dentistry

224 volume 14 • issue 3 July / September 2010 •

The clinical protocol was based on commonclinical dental examinations and on some indi-ces for evaluating the etiology of chronic gingi-vitis. For investigating dental caries in relationto the gingiva, the Silness and Loe Gingival Car-ies Index (GCI) was used. The scores obtained arethe following: 0 – no caries, 1 – supragingivalcaries, 2 – subgingival caries and 3 – large cavi-tation4. For further investigation concerning de-cays in relation to gingival margin, score 1 wasmodified with “supragingival caries closer than1 mm from gingival margin”. To obtain themean value of GCI on every schoolchild in-cluded in sample, we calculated first the meanvalue of the four surfaces – tooth score and thenthe mean value of every score. The mean valueof GCI in the sample was also established. To

find caries distribution, we proceeded as fol-lows: first we assigned every score to all sur-faces and then we calculated every mean valuefor all surfaces, which assured a proper distribu-tion of dental caries in relation to gingiva.

All the above data were recorded in an origi-nal paper assessment form devised by us. Theresults were analyzed with the 16.0 version ofSPSS software. Every child selected in the sam-ple had a patient consent signed by parents. Themodel of patient consent and clinical protocolwas approved by the Ethical Committee of the“Carol Davila” University of Medicine. Ourstudy had also approvals from Bucharest PublicHealth Service and Bucharest Educational In-spectorate.

Maxillary teeth Mandibular teeth Tooth Surface GC

I Tooth Surface GCI Tooth Surface GCI Tooth Surfaces GCI

17 B 0.00 27 B 0.00 37 B 0.01 47 B 0.01 17 M 0.00 27 M 0.00 37 M 0.00 47 M 0.00 17 D 0.00 27 D 0.00 37 D 0.00 47 D 0.01 17 P 0.00 27 P 0.00 37 L 0.00 47 L 0.01 16 B 0.04 26 B 0.00 36 B 0.07 46 B 0.09 16 M 0.06 26 M 0.07 36 M 0.08 46 M 0.10 16 D 0.04 26 D 0.05 36 D 0.11 46 D 0.11 16 P 0.03 26 P 0.05 36 L 0.09 46 L 0.09 15 B 0.02 25 B 0.00 35 B 0.02 45 B 0.01 15 M 0.05 25 M 0.04 35 M 0.04 45 M 0.05 15 D 0.03 25 D 0.03 35 D 0.03 45 D 0.04 15 P 0.01 25 P 0.02 35 L 0.02 45 L 0.02 14 B 0.01 24 B 0.00 34 B 0.01 44 B 0.00 14 M 0.02 24 M 0.02 34 M 0.01 44 M 0.01 14 D 0.02 24 D 0.02 34 D 0.01 44 D 0.02 14 P 0.01 24 P 0.01 34 L 0.00 44 L 0.00 13 B 0.01 23 B 0.00 33 B 0.00 43 B 0.00 13 M 0.01 23 M 0.01 33 M 0.00 43 M 0.00 13 D 0.01 23 D 0.01 33 D 0.00 43 D 0.00 13 P 0.01 23 P 0.00 33 L 0.00 43 L 0.00 12 B 0.00 22 B 0.00 32 B 0.00 42 B 0.00 12 M 0.02 22 M 0.02 32 M 0.00 42 M 0.00 12 D 0.02 22 D 0.01 32 D 0.00 42 D 0.00 12 P 0.00 22 P 0.00 32 L 0.00 42 L 0.00 11 B 0.00 21 B 0.00 31 B 0.00 41 B 0.00 11 M 0.02 21 M 0.02 31 M 0.01 41 M 0.01 11 D 0.02 21 D 0.02 31 D 0.00 41 D 0.00 11 P 0.00 21 P 0.00 31 L 0.00 41 L 0.00

Legend: B – buccal, P – palatal, L – lingual, M – mesial, D – distal

Table 1

DISTRIBUTION AND PREVALENCE OF DENTAL CARIES INVOLVED IN THE PATHOLOGY OF GINGIVALINFLAMMATION IN CHILDREN: A CLINICAL SURVEY IN SCHOOLS IN BUCHAREST

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Journal of Romanian Medical Dentistry 225

RESULTS

The prevalence of dental caries in relation togingival margin is the following (fig. 1):

83.40%

16.60%No caries

Caries present

Fig. 1: Prevalence of caries in relation to gingivalmargins

This was the prevalence calculated in the sam-ple. Using the estimated error, the prevalence inthe base population was estimated at about14.18% - 19.02%.

The mean values of GCI from every surfaceare listed in Table 1.

The mean value of GCI in the sample was 0.02.Gingiva was affected by caries in different ways:

-simple gingival inflammation;-gingival enlargement;-gingival polyps (figs. 2 and 3).

Figs. 2 and 3: Gingival polyps

DISCUSSION

The prevalence of caries with implications ingingival inflammation was low (under 20%),which, however, does not make their role totallynon-significant. Nevertheless, the results of ourstudy are representative only over an interval of11-14 years., even if it is possible to have furtherimplications on advanced ages, as well. Schatzleestablished the prevalence of caries involved ingingival inflammation by grouping the values ofthe gingival index (GI), as follows: 0.91% for GI= 0; 7.06% for GI = 1; 16.05% for GI = 2. These arethe results obtained in groups with ages under20 years5. It is obvious that the prevalence in ourstudy is a little bit higher.

As to caries distribution, the first molars arethe most affected by caries in relation to thegingival margin. It is known that the first per-manent molars are more affected by dental car-ies starting from 7 years, in mixed dentition6,which might explain the high values of GCI re-corded on the surfaces of the first molars. Themean values per tooth are the following: rightupper first molar – 0.04; left upper first molar –0.04; left lower first molar – 0.09; right lower firstmolar – 0.1, explaining why the lower first mo-lars are more affected than the upper ones. Anearlier eruption should be also considered. Also,we can say that the proximal surfaces are moreaffected then the others and, therefore, cariesappear as predisposing factors especially for in-terdental gingiva. After the first molars, the sec-ond premolars seem to be more affected by car-ies in relation to gingiva. Their scores may bymuch higher because the second temporary mo-lars were considered for score assignation whenthey did not erupt yet. Surely, they are more af-fected by caries than any tooth from secondarydentition at this age. The rest of the teeth showinsignificant values of GCI – very close to zero.

CONCLUSIONS

The prevalence of caries in relation to gingivais low. The distribution of caries permits the fol-lowing concluding remarks:

C. Funieru, N. B\nicioiu, Adina Dumitrache, C. B\icu[, Elena Funieru, H.T. Dumitriu

226 volume 14 • issue 3 July / September 2010 •

- the permanent first molars are the most af-fected;

- the lower first molars are more affectedthan the upper ones;

- the interdental surfaces are the most af-fected;

- the next affected teeth are the second per-manent premolars/second temporary mo-lars.

The above results should be used in recom-mendations in oral prevention programs. Chil-dren must be more careful regarding their inter-dental and free gingiva of the first molars whendental brushing is performed.

References

1.Dumitriu HT. Parodontologie, 2009, Editura Via]aMedical\ Româneasc\: 145, 146;

2.www.ismb.edu.ro/Subpagini/stareinv/2009/Starea%20ivatamant_2007_08.ppt;

3.http://www1.pmb.ro/pmb/zonafisc/zonare2004. htm;4.Schaltze M, Lang NP, Anerud A, Boysen H, Loe H.

Thy influence of margins of restorations on the peri-odontal tissues over 26 years, 2001. Journal of Clini-cal Periodontology; 28: 57-64;

5.Schaltze M, Loe H, Burgin W, Anerud A, Boysen H,Lang NP. Clinical course of chronic periodontitis – I.Role of gingivitis, 2003. Journal of Clinical Period-ontology; 30: 887-901;

6.McDonald RE, Avery DR. Dentistry for the Child andAdolescent – 2003, seventh edition. Mosby, Inc.;212;

DISTRIBUTION AND PREVALENCE OF DENTAL CARIES INVOLVED IN THE PATHOLOGY OF GINGIVALINFLAMMATION IN CHILDREN: A CLINICAL SURVEY IN SCHOOLS IN BUCHAREST

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