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Oral Health Awareness, Social Status, Caries and Malocclusion among Schoolchildren

  • Eight hundred and fifty two students with an age range 9-13 years (mean 10.34, SD±0.56, 48% females) were recruited from the fifth grade students of different 19 primary schools in Greifswald and East Pomerania. In conjunction with the compulsory dental community examination, additional data were collected with two questionnaires for the children and their parents. Newly generated items were taken from the children’s questionnaire to form short scales for oral health-related knowledge, behaviour, attitudes. Parents’ questionnaire contains questions on socio-economic status (SES) and child’s health. The response rate was 93.2%; 78.8% for children; parents, respectively. Results: The distribution of DMFT values was highly polarized with most of the children (71%) exhibiting no carious defects, fillings or missing teeth in the permanent dentition with a mean of 0.6 ±1.2. There was a significant correlation between DMFT and social class levels (rs=-0.19, p=0.001) with mean DMFT values of 0.9 ± 1.3, 0.6 ±1.1 and 0.4 ± 0.9 for the low, medium and higher social strata, respectively. There was a clear correlation between the dental attitude and dental behaviour (rs=0.32, p=0.003). However, correlations between knowledge vs. attitude and knowledge vs. behaviour were loose. A statistically significant correlation between DMFT and dental behaviour was found (rs=-0.15, p=0.003). It should be noted that children with higher self-esteem were found to have significantly higher dental awareness scores (rs=0.19, p=0.001). General health was a significant predictor for caries incidence (rs=0.08, p=0.01). The frequency of drinking lemonade or ice tea and eating salty snacks (chips, nuts) showed clear correlations with the DMFT (rs=0.17 and 0.13, p<0.01). Prolonged daily TV watching was associated directly with DMFT values (rs=0.13, p=0.001). A significant correlation was found between caries and smoking, even after adjusting for age (rs=0.1, p=0.002). Smoking children had a significantly higher DMFT rate than children who were not smokers with a mean DMFT of 0.9 ±1.5 vs 0.6 ±1.2 (p=0.004). Interestingly, each of prolonged TV watching, more lemonade drinking and smoking were correlated directly with the low socioeconomic status (Spearman correlation coefficient of 0.13, 0.2 and 0.17, respectively, p<0.05). Regarding malocclusion, 64% the subjects had at least one type of anomaly. Crowding and maxillary overjet represented the major proportion 28% and 23%, respectively. Males exhibited significantly higher increased overbite scores than females p=0.04. Whereas the prevalence of crowding was more common in females than males (p=0.05). Amazingly, more malocclusion was registered in children with caries-free primary teeth when compared to children with carious primary teeth (p=0.05). No significant differences in the mean of dmft or DMFT value were found between normal and non normal occlusion (p>0.05). Undergoing to orthodontic treatment was associated with significantly higher dental awareness scores (p=0.003). No correlation between socio-economic status and malocclusion was registered. Conclusion: This thesis confirms the decline and polarisation of dental caries. Dental behaviour was mostly independent of dental knowledge, but depended on dental attitude. Higher scores in dental behaviour resulted in lower DMFT scores; possibly, oral health promotion should strengthen attitude and actual behaviour instead of knowledge. Higher scores in self-esteem and general health connected with lower caries incidence and higher score in dental awareness. Social inequalities was strongly linked with health inequalities with more prevalence of caries, smoking, prolonged TV watching, wrong diet habits and less sealants application among children of low SES. Hence, oral health-related interventions in children sample should be directed at the social structures with more incorporating of oral health promotion programs into other general health promotion programs. This thesis suggests that; the establishment of healthy behaviours such as a regular teeth brushing at school could be one of the most successful ways to involve all children especially children of low SES in dental care. Malocclusion traits were very common in this sample. This underlines the need for more orthodontic preventive programs among children, in order to reducing the risk factors of malocclusion. The association between prevalence of malocclusion and socio economic status could not be established. No generalised conclusion could be drawn about the relationship between caries and malocclusion.
  • Die Stichprobe bestand aus 852 Schulkindern im Alter von 9-13 Jahren, die aus Greifswald und Pommern stammten. Im Rahmen der obligatorischen schulzahnärztlichen Untersuchung wurden mit Hilfe eines Fragebogens für die Kinder sowie eines weiteren für deren Eltern zusätzliche Daten gesammelt. Die Autoren erzeugten dann aus neu generierten Elementen des verwendeten „Kinder-Fragebogens“ Kurz-Messskalen für das Wissen, das Verhalten und die Haltung zur oralen Gesundheit. Der mittlere DMFT lag in dieser Population bei 0.6 ± 1.2. Die Verteilung der DMFT-Werte war allerdings stark polarisiert, wobei die meisten Kinder keine Karieserfahrung hatten. Sie wiesen im Bereich der bleibenden Zähne keinerlei Zeichen von Kariesdefekten bzw. Füllungen oder fehlende Zähne auf. Die statistische Auswertung ergab eine negative Korrelation zwischen dem ermittelten DMFT und der sozialen Klassenzugehörigkeit (rs=-0.19, p=0.001). Die mittleren DMFT-Werte lagen für die niedrigen, mittleren und hohen sozialen Strata bei 0.9 ± 1.3, 0.6 ± 1.1 bzw. 0.4 ± 0.9. Mädchen erreichten in allen Punkten des oralen Gesundheitsbewusstseins höhere Messwerte als Jungen. Weiterhin konnte eine eindeutige positive Korrelation zwischen der Haltung zur oralen Gesundheit und dem dentalen Verhalten festgestellt werden (rs=0.32; p=0.003). Demnach ist eine positive Einstellung zur Zahngesundheit wichtig, um eine gute Zahnpflege zu gewährleisten. Allerdings fand sich keine Korrelation zwischen dem Wissen und der inneren Haltung bzw. zwischen dem Wissen und dem Verhalten hinsichtlich der oralen Gesundheit. Umfangreiche Kenntnisse zur oralen Gesundheit verbessern demzufolge weder das Gesundheitsverhalten noch die Einstellung zur oralen Gesundheit. Diese unterschiedliche Gewichtung der Einflüsse spiegelt sich auch in der Zahngesundheit wider: Der DMFT korrelierte in dieser Studie positiv mit dem Dentalverhalten (rs=-0.15; p=0.003), während die Assoziation mit dem Wissen zur Oralgesundheit schwächer ausgeprägt war (rs=-0.09; p=0.002). Die Zahngesundheit wird durch hohe Scorewerte im dentalen Verhalten und einen hohen sozioökonomischen Status positiv beeinflusst. Das Verhalten hängt dabei stark von der inneren Haltung, aber nur in sehr geringem Maße vom Wissen zu dieser Thematik ab. Möglicherweise sollten daher im Rahmen der Förderung der oralen Gesundheit statt der Vermittlung von Wissen die innere Haltung und das Verhalten gestärkt werden.

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Metadaten
Author: Samar Alsoliman
URN:urn:nbn:de:gbv:9-000862-3
Title Additional (German):Mundgesundheitskompetenz, Sozialstatus, Karies und Malokklusion bei Schulkindern
Advisor:Prof. Dr. Christian Splieth
Document Type:Doctoral Thesis
Language:English
Date of Publication (online):2010/10/28
Granting Institution:Ernst-Moritz-Arndt-Universität, Medizinische Fakultät (bis 2010)
Date of final exam:2010/10/25
Release Date:2010/10/28
GND Keyword:Karies, Kompetenz, Okklusionsstörung, Schulkind, Sozialstatus
Faculties:Universitätsmedizin / Poliklinik für Kieferorthopädie, Präventive Zahnmedizin und Kinderzahnheilkunde
DDC class:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin und Gesundheit