Dental Status of Children with Special Needs in Banjaluka

Oral health is an important part of general health and an important indicator of the quality of life. Diseases such as dental caries, periodontal disease, teeth loss, and changes in oral mucosa are serious health problems with high frequency in many countries in the world. Oral diseases significantly reduce the quality of people’s lives, and the cost of treating these diseases is significant burden on the health fund [1]. The World Dental Federation (FDI) and the World Health Organization (WHO) have set standards of oral health and associated tissues that enable food intake, speech and socializing without active disease, health disorder or disability that add to overall good health and well-being [2]. The WHO has adopted in 2000 the strategy for prevention of oral diseases and promotion of oral health and defined indicators of oral health, such as: number of visits to dentist, frequency of brushing teeth, complete loss of teeth, fluoridation, treated caries, untreated caries, dental erosions, oral and pharyngeal cancers. Since 60-90% of school children in the world have dental caries, the WHO and the FDI introduced in 2005 the program of pedagogical prevention and promotion of oral health through schools [3]. Bosnia and Herzegovina is one of the countries with high prevalence of dental caries among school children. According to the report of the WHO 9496% of school children have caries while 78% of the population over 65 years is edentulous [2]. The WHO defines child with special needs as a child that in a given period of time is not physically or mentally Dental Status of Children with Special Needs in Banjaluka


INTRODUCTION
Oral health is an important part of general health and an important indicator of the quality of life.Diseases such as dental caries, periodontal disease, teeth loss, and changes in oral mucosa are serious health problems with high frequency in many countries in the world.Oral diseases significantly reduce the quality of people's lives, and the cost of treating these diseases is significant burden on the health fund [1].The World Dental Federation (FDI) and the World Health Organization (WHO) have set standards of oral health and associated tissues that enable food intake, speech and socializing without active disease, health disorder or disability that add to overall good health and well-being [2].The WHO has adopted in 2000 the strat-egy for prevention of oral diseases and promotion of oral health and defined indicators of oral health, such as: number of visits to dentist, frequency of brushing teeth, complete loss of teeth, fluoridation, treated caries, untreated caries, dental erosions, oral and pharyngeal cancers.Since 60-90% of school children in the world have dental caries, the WHO and the FDI introduced in 2005 the program of pedagogical prevention and promotion of oral health through schools [3].Bosnia and Herzegovina is one of the countries with high prevalence of dental caries among school children.According to the report of the WHO 94-96% of school children have caries while 78% of the population over 65 years is edentulous [2].
The WHO defines child with special needs as a child that in a given period of time is not physically or mentally able to participate in normal activities of its age group.Mentally challenged persons, mostly because of impaired judgment and understanding, and lack of independence live in specialized institutions and require special attention and care, especially in terms of oral health.Oral health has a major impact on everyday living and quality of life of these people since they usually have other diseases that worsen their health.Children with special needs have difficulties in maintaining oral hygiene, they require special conditions, and because of previous negative experience they often show emotional vulnerability in dental office.Significant role in the development of oral and dental diseases has insufficient knowledge about the causes of these diseases, poor eating habits, low level of oral hygiene and inadequate number of visits to dentist [4].One of possible ways to treat oral diseases in persons with mental disabilities is to perform dental interventions in general anaesthesia.It facilitates the treatment both for individuals and therapists ensuring proper, detailed and complete dental care.
Raising the level of oral health in these subjects can be successfully achieved by proper application of procedures and preventive measures, and continuous monitoring of the status of their mouth and teeth.It is the fact that children with special needs have lower level of oral hygiene, more frequently periodontal diseases, higher prevalence of untreated caries, more extracted and fewer restored teeth than healthy children.
The aim of this study was to determine the status of teeth and the prevalence of dental caries in children with special needs in the institution "Zaštiti me" in Banjaluka.

MATERIAL AND METHODS
The study was conducted as a cross-sectional study from January to April 2010 among the residents from the institution "Zaštiti me" in Banjaluka.The study included 82 children (53 boys and 29 girls) with mixed and permanent dentition age 5-15 years.Respondents were divided in four groups according to diagnosis.The first group included 6 children with combined disorders of speech development and hearing; in the second group were 12 children with neurological disorders without mental retardation; the third group included 20 children with mild mental retardation; and the fourth group consisted of 44 children with moderate mental retardation.
All parents or guardians were explained the goal of the research and how data would be collected.Each parent/ guardian signed voluntary consent for participation in the research.

RESULTS
The results are shown in Tables 1-4.The mean DMFT of all examined teeth was 9.77.According to the analysis of subcomponents of DMFT, the most frequent were decayed 83.83%, restored 9.52% and extracted teeth 6.65%.
The first group of children had the DMFT index of 13.84.Most teeth were affected by caries (69.87), 15.68 were extracted, whereas the least were restored teeth (8.45).In the second group of children the DMFT index was 9.92.Most teeth were affected by caries (68.25), restorations had 9.68 teeth, while 7.86 teeth were extracted.For the third group of children the DMFT index was 7.20.Most teeth were affected by caries (60.42), restorations (11.94) while 4.72 were extracted.In the fourth group of children the DMFT index was 10.35.Most teeth were carious (7.29), restored (8.31), and extracted (3.29) (Table 1).
Table 2 shows the distribution of composite restorations in examined children.The greatest percentage of children 79.27% did not have a single composite restoration of class I, and 93.90% of children did not have composite restorations of class II.Some respondents (13.41%) had one class I composite restoration, 2.44% of the children had two composite restorations, 2.43% three and 2.43% had four composite restorations.The class II composite restorations had 3.66% of examined children and 2.44% had two class II composite restorations.None of 82 children had composite restorations of class IV and V.
Table 3 shows the distribution of amalgam restorations in examined children.Most children did not have any amalgam fillings.82.92% of children had none amalgam fillings of class I whereas 90.24% had no amalgam fillings of class II.Only one child had 4 amalgam fillings of class I (1.21%), while eight of them had one amalgam filling of class I (9.76%).One amalgam filling of class II had six children (7.32%) and one child only had three amalgam fillings of class II (3.66%).
Since the group of patients with moderate mental retardation included 44 children where 28 of them had a diagnosis of Down syndrome, a separate cross-sectional study of their oral health status was done (Table 4).In children with Down syndrome the DMFT index was 12.47 (in males 10.99 and 15.57 in females).Both, boys (74.25) and girls (72.06) had most teeth affected by caries, restorations (boys 9.55, girls 6.42) and extractions (boys 2.37, girls 3.6).

DISCUSSION
Poor condition of oral health in children with impaired mental development is mainly the consequence of deteriorated general condition of these patients, and frequent neglect of this aspect of their health.As they are not able to independently take care of their oral hygiene it is eventually reflected on the overall of their oral health.The problem of maintaining oral hygiene is the consequence of reduced and sometimes complete absence of muscle    movement coordination or failure to follow advice about preventive measures.Proper oral hygiene is certainly the most important factor in the prevention of oral diseases, but also an important prerequisite in preventing rapid progress of already deteriorated oral health.
Results of this study showed that residents of the institution "Zaštiti me" in Banja Luka had high DMFT index (9.77)which clearly indicated poor condition of their oral health.This result was expected given that majority of children in the institution is not able to independently maintain oral hygiene due to potential motor, sensor and intellectual disability.These patients are more prone to tooth decay and periodontal diseases.On the other hand, this group of patients is not able to fully understand the need and take responsibility for maintaining oral hygiene.Therefore, it is necessary to educate parents or guardians about the importance and significance of this aspect of their health [6,7].Poor health conditions and poor oral hygiene are associated with low socio-economic status in most families of children with special needs.
According to the results of many studies, a major influence on the increased incidence of dental caries in this population has an improper diet [8,9,10].Long stay at home followed by eating snacks and drinking sweetened beverages increases significantly the incidence of tooth decay [11].
Children with special needs require unique social and health care, which is due to specific and limited possibilities more expensive than regular dental care.The role of dentist in prevention and treatment is extremely important having in mind limited cooperation of these children.Often, both approach and treatment of these patients must be modified [8].
The current study showed that the total DMFT index was 9.77.High mean of DMFT indicated poor status of oral health in these patients, not caused only by their inability to maintain oral hygiene but also having inadequate dental care.The first dental visit of these children usually occurs much later than in healthy children.Oral status of these children showed higher susceptibility to caries, dental, oral and orthodontic anomalies, poor oral hygiene, and tendency to gingival and periodontal diseases.Numerous studies in the world have confirmed these findings and found poor state of mouth and teeth in children with mental disorders with large number of extracted teeth and small number of restorations.The DMFT values in these patients in Australia were 14.6, Taiwan 14.9, the United States13.6 and in Western European countries 15.85.This strongly suggests that beside the importance of health care system, the development of the country or region may play an important role in maintaining oral health [12,13,14].
Research carried out in Bosnia and Herzegovina in 2009 included 70 female residents from the institution for mentally handicapped people in Visegrad age 30 to 55 years.Poor oral health was found in 90% patients whereas in 4.3% only, the status was satisfactory; however in 5.7% of patients examination was not possible [11].In US study conducted from April 2009 through 2010 which included 4,732 adult patients with special needs the total DMFT index was 13.9 and increased with age [15].There was no difference between genders in the value of DMFT index.The DMFT index in respondents age 20-39 years was 9.1.If these results are compared with the DMFT index of 10.8 for 2006 in healthy adolescents in Foca-eastern municipality in Bosnia, it can be concluded that the development of the country is definitely one of the main factors that affect the state of oral health.It is important to note that this study in adolescents was conducted soon after the end of war in Bosnia and Herzegovina [16].
Of 82 children with special needs who participated in this study 28 were diagnosed with Down syndrome.According to the data from their records, they were missing front teeth; most of them had destructive periodontal disease and bruxism.Together with poor oral hygiene, this certainly contributed to the loss of a large number of teeth.The DMFT index in these children was 12.47.The study of Rodriguez Vasquez et al. [17] showed the mean DMFT of 3.92 in patients with Down syndrome which is not in accordance with the results of the current or any earlier study.These results could be explained by the fact that patients in their study were hospitalized, and their diet was under constant supervision where sugar intake was under strict control.
Only one of the respondents from the current study had fixed appliance which is consistent with findings of Lustig et al. [18], who reported three patients with fixed appliances out of 114 respondents.An explanation could be found in the fact that such complex dental intervention requires more visits, and it is possible only in a special institution with increased attention and engagement of therapists or family members.
It is worrisome that 77 (93.9%) of the total number of examined children did not have any composite restoration class II and 65 (79.27%)children did not have class I. Also, very small number of children had amalgam fillings, while restorations of glass-ionomer cements were not found in any child.

CONCLUSION
High percentage of carious teeth, small percentage of restorations and extracted teeth, as well as inadequate oral hygiene are main characteristics of dental status in children with special needs in the institution "Zaštiti me" in Banjaluka.These findings suggest the need to raise dental care of these children at higher level, organize workshops for parents and guardians as well as medical staff in institutions for children with disabilities.Courses could assist in training parents or guardians to maintain the proper oral hygiene, and stress the importance of oral health for better quality of life of these children.

UVOD
Oral no zdra vlje je va žan deo op šteg zdra vlja po je din ca i znača jan po ka za telj nje go vog kva li te ta ži vo ta.Bo le sti usnog apara ta, kao što su ka ri jes, bo le sti pa ro don ci ju ma, gu bi tak zu ba i pro me ne na oral noj slu zni ci, ozbi ljan su zdrav stve ni pro blem s vi so kom uče sta lo šću u mno gim ze mlja ma sve ta.Obo lje nja usta i zu ba vidno uma nju ju kva li tet ži vo ta lju di, a tro ško vi njiho vog le če nja znat no op te re ću ju zdrav stve ni fond [1].Svet ska sto ma to lo ška fe de ra ci ja (World Den tal Fe de ra tion -FDI) i Svet ska zdrav stve na or ga ni za ci ja (SZO) po sta vi le su stan dar de zdra vlja usne šu plji ne i pri dru že nih tki va ko ji omo gu ća va ju ishra nu, go vor i so ci ja li za ci ju bez ak tiv ne bo le sti, bez po re me ća ja zdrav stve nog kom fo ra ili one spo so blje no sti, a do pri no se op štem do brom zdra vlju i ose ća nju [2].SZO je 2000.go di ne do ne la strate gi ju za pre ven ci ju oral nih bo le sti i pro mo ci ju oral nog zdra vlja, te de fi ni sa la po ka za te lje sta nja oral nog zdra vlja kao što su: broj po se ta sto ma to lo gu, broj pra nja zu ba, pot pu ni gu bi tak zu ba, sta nje flu o ri za ci je, le če ni ka ri jes, ne le če ni ka ri jes, ero zi je zu ba i oral ni i kar ci nom ždrela.U sve tu 60-90% de ce škol skog uz ra sta ima ka ri jes, te su SZO i FDI 2005.go di ne pred sta vi le Pro gram pre ven ci je i pro mo ci je oral nog zdra vlja kroz ško le [3].Bo sna i Her ce go vi na je ze mlja s vi so kom pre va len ci jom ka ri je sa me đu de com škol skog uz ra sta (94-96%), a pre ma iz ve šta ju SZO, 78% sta nov ni štva sta ri jeg od 65 go di na ne ma zu be [2].
Pre ma de fi ni ci ji SZO, de te s po seb nim po tre ba ma je ono de te ko je u od re đe nom vre men skom pe ri o du ni je u sta nju fi zič ki ili men tal no da uče stvu je u nor mal nim ak tiv no sti ma svo je uz ra sne gru pe.Men tal no ome te ne oso be, ko je su naj če šće zbog po re meće nog ra su đi va nja i raz u me va nja i ne sa mo stal no sti sme šte ne u spe ci ja li zo va ne usta no ve, zah te va ju po seb nu pa žnju i bri gu u sva kom smi slu, a naročito u po gle du oču va nja zdra vlja usta i zu ba.Oral no zdra vlje ima ve li ki uti caj na sva ko dnev no funkci o ni sa nje i kva li tet ži vo ta ovih oso ba s ob zi rom na to da je ono obič no do dat no na ru še no usled obo lje nja dru gih si ste ma i or ga na.De ca s po seb nim po tre ba ma ima ju po te ško ća u odr žava nju hi gi je ne usta i zu ba, zah te va ju po seb ne uslo ve u sto ma tolo škim or di na ci ja ma i ne ret ko, zbog pret hod nih lo ših is ku sta va, po ka zu ju emo tiv nu pre o se tlji vost u sto ma to lo škoj or di na ci ji.Zna čaj nu ulo gu u na stan ku obo lje nja usta i zu ba ima ju ne dovolj na zna nja o uzro ci ma na stan ka ovih obo lje nja, lo še na vi ke u is hra ni, ni zak ni vo oral ne hi gi je ne i ne do vo ljan broj po se ta sto ma to lo gu [4].Je dan od mo gu ćih na či na sa na ci je lo ših zu ba oso ba ome te nih u men tal nom raz vo ju je ste i vr še nje sto ma tolo ških in ter ven ci ja u op štoj ane ste zi ji.Ti me se ovim oso ba ma i te ra pe u tu olak ša va po stu pak, ali i obez be đu je pra vil na, de talj na i pot pu na sto ma to lo ška za šti ta.
Po di za nje ni voa oral nog zdra vlja kod ovih oso ba mo že se uspe šno po sti ći pra vil nom pri me nom po stu pa ka i me ra preven ci je i ne pre sta nim pra će njem sta nja nji ho vih usta i zu ba.Či nje ni ca je da de ca s po seb nim po tre ba ma ima ju ni zak ni vo oral ne hi gi je ne, če šća obo lje nja pa ro don ci ju ma, ve ću pre va lenci ju ne sa ni ra nog ka ri je sa i vi še eks tra ho va nih a ma nje plom bira nih zu ba u od no su na zdravu de cu.Cilj ra da bio je da se utvr de sta nje zu ba de ce s po sebnim po tre ba ma u usta no vi "Za šti ti me" u Ba nja lu ci i pre va len ci ja ka ri je sa kod ovih oso ba.

MATERIJAL I METODE RADA
Is tra ži va nje je ura đe no kao stu di ja pre se ka od ja nu a ra do apri la 2010.go di ne me đu šti će ni ci ma usta no ve "Za šti ti me" u Ba njalu ci.Stu di jom su ob u hva će na 82 de te ta s me šo vi tom i stal nom den ti ci jom (uz ra sta 5-15 go di na), i to 53 de ča ka i 29 de voj či ca.Is pi ta ni ci su svr sta ni u če ti ri gru pe pre ma di jag no zi.Pr vu grupu či ni lo je še sto ro de ce s kom bi no va nim smet nja ma raz vo ja go vo ra i slu ha, dru gu gru pu 12 de ce s ne u ro lo škim po re me ćaji ma bez men tal ne re tar da ci je, tre ću gru pu 20 de ce sa bla gom men tal nom re tar da ci jom, dok su če tvr tu gru pu či ni la 44 de te ta s ume re nom men tal nom re tar da ci jom.
Svim ro di te lji ma ili sta ra te lji ma su pred sta vlje ni svr ha is traži va nja i po da ci o is tra ži va nju, a sva ki ro di telj, od no sno sta ra telj je svo jim pot pi som po tvr dio do bro volj ni pri sta nak za uče šće de te ta u is tra ži va nju.
Sto ma to lo ški pre gle di su oba vlje ni u skla du s uput stvom SZO.Ana li za sta nja zu ba je iz vr še na po mo ću sto ma to lo škog ogle dal ceta, sto ma to lo ške pra ve i aprok si mal ne son de pri dnev noj sve tlosti [5].Pre gle dom su utvr đe ni sle de ći po da ci: ka ri jes (K), zdrav zub (Z), zub u ni ca nju (N), eks tra ho van zub (E), ano don ci ja (X), frak tu ra (F), ra dix re lic ta (R), amal gam ski is pun (A), kom po zitni is pun (C), gla sjo no mer-is pun (G) i ke ra mič ka kru ni ca (KR).Po da ci su upi sa ni u sto ma to lo ške kar to ne pa ci jena ta.
U ta be li 2 pri ka za na je ras po de la kom po zit nih is pu na kod pre gle da ne de ce.Ta ko 79,27% de ce ni je ima lo ni je dan kompo zit ni is pun pr ve kla se, dok 93,90% de ce ni je ima lo ni je dan kom po zit ni is pun dru ge kla se.Naj vi še is pi ta ni ka -13,41%ima lo je je dan kom po zit ni is pun pr ve kla se; 2,44% de ce ima lo je dva kom po zit na is pu na, 2,43% tri, a 2,43% če ti ri.Dru gu kla su kom po zit nih is pu na ima lo je 3,66% de ce, a 2,44% po dve dru ge kla se.Ni jed no de te od 82 pre gle da na de te ta ni je ima lo kom pozit ni is pun če tvr te i pe te kla se.
U ta be li 3 da ta je ras po de la amal gam skih is pu na kod pre gleda ne de ce.Ta ko đe, ve ći na de ce ni je ima la ni je dan amal gam ski is pun pr ve kla se (82,92%) i ni je dan amal gam ski is pun dru ge kla se (90,24%).Sa mo jed no de te ima lo je če ti ri amal gam ska is pu na pr ve kla se (1,21%), dok je osmo ro njih ima lo po je dan amal gam ski is pun pr ve kla se (9,76%).Po je dan amal gam ski is pun dru ge kla se usta no vljen je kod še sto ro de ce (7,32%), a sa mo jed no de te ima lo je tri amal gam ska is pu na dru ge kla se (3,66%).

DISKUSIJA
Lo še sta nje usta i zu ba de ce ome te ne u men tal nom raz vo ju uglav nom je po sle di ca te škog op šteg sta nja ovih bo le sni ka, ali i če stog za ne ma ri va nja ovog aspek ta nji ho vog zdra vlja.Ove oso be ni su spo sob ne da sa mo stal no bri nu o ade kvat nom odr ža va nju hi gi je ne usta i zu ba, što se vre me nom od ra ža va i na op šte oral no zdra vlje.Pro blem odr ža va nja oral ne hi gi je ne po sle di ca je smanje nog, a ne ka da i pot pu nog iz o stan ka mi šić ne ko or di na ci je po kre ta, od no sno ne mo guć no sti pra će nja sa ve ta u ve zi s mera ma pre ven ci je.Pra vil no odr ža va nje oral ne hi gi je ne je si gur no naj va žni ji fak tor u pre ven ci ji na stan ka obo lje nja usta i zu ba, ali i zna ča jan pred u slov u spre ča va nju br zog na pre do va nja već na ru še nog oral nog zdra vlja.
Re zul ta ti ove stu di je su po ka za li da šti će ni ci usta no ve "Za štiti me" u Ba nja lu ci ima ju vi so ke vred no sti in dek sa KEP (9,77), što ja sno uka zu je na lo še sta nje nji ho vih usta i zu ba.Ova kav re zul tat je bio oče ki van s ob zi rom na to da ve ći na de ce u ovoj usta no vi ne mo že da sa mo stal no odr ža va oral nu hi gi je nu zbog po ten ci jal nog mo tor nog, sen zor nog i in te lek tu al nog in va li di teta.Ta kvi bo le sni ci su, zbog ne mo guć no sti odr ža va nja ade kvatne hi gi je ne usta i zu ba, sklo ni ji ka ri je su i obo lje nji ma de sni.S dru ge stra ne, oni ne mo gu da pot pu no raz u me ju po tre bu za odr ža va njem oral ne hi gi je ne i pre u zmu od go vor nost.Sto ga je po treb no edu ko va ti ro di te lje ili sta ra te lje i osta le od ra sle oso be ko je su u okru že nju de te ta s po seb nim po tre ba ma o va žno sti i zna ča ju ovog aspek ta nji ho vog zdra vlja [6,7].Lo ši zdrav stve ni uslo vi i lo še odr ža va nje oral ne hi gi je ne po ve za ni su i sa ni skim so ci o e ko nom skim sta tu som ve ći ne po ro di ca de ce s po seb nim po tre ba ma.
Pre ma re zul ta ti ma broj nih stu di ja, ve li ki uti caj na po ve ća nu in ci den ci ju ka ri je sa kod ovih oso ba ima i ne pra vil na is hra na [8,9,10].Du go traj ni bo ra vak u ku ći pra ćen kon zu mi ra njem gric ka li ca i slat kih na pi ta ka zna čaj no uti če na po ve ća nu in ciden ci ju ka ri je sa [11].
De ca sa smet nja ma u raz vo ju zah te va ju po seb nu so ci jal nu i zdrav stve nu za šti tu ko ja je, zbog spe ci fič no sti pri stu pa i ogra niče nih mo guć no sti ra da, znat no sku plja od uobi ča je ne sto ma tolo ške za šti te.Ulo ga sto ma to lo ga u pre ven tiv nom i ku ra tiv nom de lo va nju iz u zet no je va žna, pri če mu se mo ra uze ti u ob zir ogra ni če nost ove de ce za sa rad nju.Na osno vu sve ga to ga često se mo ra ju pri la go đa va ti i pri stup i le če nje u sto ma to lo škoj or di na ci ji [8].
Na še is tra ži va nje je po ka za lo da je uku pan in deks KEP ispi ti va ne de ce bio 9,77.Vi so ka sred nja vred nost ovog in dek sa uka zu je na lo še sta nje oral nog zdra vlja ovih bo le sni ka ko je ni je uzro ko va no sa mo nji ho vom ne mo guć no šću odr ža va nja oralne hi gi je ne, već i neo d go va ra ju ćom i ne do volj nom sto ma to loškom za šti tom.Oni u pr vu po se tu sto ma to lo gu naj če šće od la ze mno go ka sni je ne go zdra va de ca.Sta nje usta i zu ba ove de ce po ka zu je ve ću sklo nost ka ka ri je su, den tal nim, oral nim i or todont skim po re me ća ji ma, te sla bu oral nu hi gi je nu, sklo nost ka upa la ma gin gi ve i pa ro don ci ju ma.Broj na is tra ži va nja u sve tu ta ko đe po tvr đu ju ove na la ze i uka zu ju na lo še sta nje usta i zu ba de ce ome te ne u men tal nom raz vo ju, na ve li ki broj eks tra ho vanih zu ba i ma li broj is pu na.Vred nost in dek sa KEP kod ovih bo le sni ka u Austra li ji bi la je 14,6, u Taj va nu 14,9, u SAD 13,6, a u za pad no e vrop skim ze mlja ma 15,85.Ovo ne dvo smi sle no po ka zu je da, osim si ste ma zdrav stve ne za šti te, i raz voj ze mlje, od no sno re gi o na mo že bi ti je dan od zna čaj nih fak to ra sta nja oral nog zdra vlja [12,13,14].
Is tra ži va nja oba vlje na u Bo sni i Her ce go vi ni 2009.go di ne ob u hva ti la su 70 že na sta ro sti od 30 do 55 go di na sme šte nih u do mu za men tal no hen di ke pi ra ne oso be u Vi še gra du.Ve oma lo še sta nje oral nog zdra vlja utvr đe no je kod 90% bo le sni ka; kod 4,3% sta nje je bi lo za do vo lja va ju će, a kod 5,7% ni je bi lo mo gu će iz vr ši ti pre gled [11].U SAD je iz me đu apri la 2009.i kra ja 2010.go di ne iz ve de na stu di ja ko ja je ob u hva ti la 4.732 od ra sla is pi ta ni ka s po seb nim po tre ba ma [15].Utvr đe no je da je uku pan in deks KEP bio 13,9, te da se nje go va vred nost pove ća va la sa go di na ma sta ro sti.Ni je bi lo raz li ke u vred no sti ma in dek sa KEP me đu po lo vi ma.Kod is pi ta ni ka sta ro sti iz me đu 20 i 39 go di na in deks KEP je bio 9,1.Ka da se ova kvi na la zi upo re de s vred no sti ma in dek sa KEP od 10,8 iz 2006.go di ne na pod ruč ju is toč ne Bo sne (op šti na Fo ča) kod zdra vih ado le scena ta, mo že se za klju či ti da je i raz voj ze mlje je dan od glav nih fak to ra ko ji mo gu da uti ču na sta nje oral nog zdra vlja sta novni štva.Va žno je is ta ći da je ovo is tra ži va nje kod ado le sce na ta ura đe no ne po sred no na kon rat nih dej sta va u Bo sni i Her cego vi ni [16].
Od 82 de te ta s po seb nim po tre ba ma ko ja su ob u hva će na na šom stu di jom, 28 de ce je bo lo va lo od Da u no vog sin dro ma.Pre ma po da ci ma iz nji ho vih kar to na, pri me će no je da im ne dosta ju pred nji zu bi i da ve ći na ima de struk tiv nu pa ro don to pa ti ju i bruk si zam.Ovo je uz lo šu hi gi je nu usta u zu ba sva ka ko do prine lo gu bit ku ve ćeg bro ja zu ba.Vred nost in dek sa KEP ove de ce bi la je 12,47.Stu di ja Ro dri gez Vas ke za (Ro dri gu ez Va squ ez) i sa rad ni ka [17] uka za la je na sred nju vred nost in dek sa KEP od 3,92 kod is pi ta ni ka sa Da u no vim sin dro mom, što ni je u skla du s re zul ta ti ma na šeg is tra ži va nja, ni ti s na la zi ma mno gih drugih stu di ja.Ovo se ob ja šnja va či nje ni com da su ovi is pi ta ni ci bi li ho spi ta li zo va ni, te da je nji ho va is hra na bi la pod stal nom kon tro lom u po gle du uno še nja še će ra hra nom.
Sa mo je dan is pi ta nik na še stu di je imao je fik snu na dok nadu, što je u skla du s na la zi ma Lu sti ga (Lu stig) i sa rad ni ka [18], ko ji na vo de da su sa mo tri bo le sni ka od 114 ima la fik sne nadok na de.Ob ja šnje nje ova kvog na la za bi mo glo bi ti u či nje ni ci da ova ko slo že na sto ma to lo ška in ter ven ci ja zah te va vi še po se ta sto ma to lo gu, što je mo gu će sa mo u po seb noj usta no vi i uz po veća nu bri gu i an ga žo va nje te ra pe u ta, od no sno čla no va po ro di ce.
Za bri nja va po da tak da 77 de ce (93,9%) u na šem is tra ži va nju ne ma ni je dan kom po zit ni is pun dru ge kla se, kao i da 65 de ce (79,27%) ne ma ni je dan kom po zit ni is pun pr ve kla se.Ta ko đe, ve o ma ma li broj de ce ima amal gam ske is pu ne, dok is pu ni od gla sjo no mer-ce me na ta ni su na đe ni ni kod jed nog de te ta.

ZAKLJUČAK
Vi sok pro ce nat zu ba za hva će nih ka ri je som, ma li pro ce nat plombi ra nih i eks tra ho va nih zu ba, kao i neo d go va ra ju ća oral na hi gije na, opi su ju sta nje usta i zu ba de ce s po seb nim po tre ba ma ko ja bo ra ve u usta no vi "Za šti ti me" u Ba nja lu ci.Ovi na la zi uka zu ju na po tre bu po di za nja sto ma to lo ške za šti te ove de ce na vi ši ni vo, na po tre bu or ga ni zo va nja edu ka tiv nih ra di o ni ca za ro di te lje i sta ra te lje ove de ce, kao i za za po sle ne u usta no va ma za de cu ome te nu u raz vo ju.Kur se vi ma bi se mo glo po mo ći u obu ci ro dite lja, od no sno sta ra te lja, u pra vil nom odr ža va nju oral ne hi gi je ne i uka za ti na zna čaj oral nog zdra vlja u ži vo tu ove de ce.

NAPOMENA
Is tra ži va nje je re a li zo va no u okvi ru pro jek ta br.19-6-020-961-112-09 Mi ni star stva na u ke i teh no lo gi je Re pu bli ke Srp ske.
This research was supported by the project No.19-6-020-961-112-09 of the Ministry of Science and Technology of the Republika Srpska.