The Effect of Oral Hygiene on the Caries Prevalence among Schoolchildren in Foča

Department for Pediatric and Preventive Dentistry, Dentistry Program, School of Medicine, University of East Sarajevo, Foča, Bosnia and Herzegovina; Clinic for Pediatric and Preventive Dentistry, School of Dentistry, University of Belgrade, Belgrade, Serbia; Department for Periodontology and Oral Medicine, Dentistry Program, School of Medicine, University of East Sarajevo, Foča, Bosnia and Herzegovina


INTRODUCTION
Oral diseases including teeth are the most widespread human diseases.Lifestyle, habits, industrialization and urbanization have led to changes in oral health.Highly processed, sticky and soft foods that can be eaten on the streets and less cooked in the family environment as well as reduced usage of raw food (fresh fruits and vegetables) have influenced increased incidence of oral diseases.In adequate oral hygiene, retention of deposits on teeth and surrounding area also contribute to the development of these diseases.Dental plaque is rich in bacteria that have negative effect on oral tissue depending on the location as well as microbial composition [1].There are many fac tors that support faster creation, accumulation and reten tion of plaque in caries predilection areas which causes changes in teeth and surrounding tissues [2].Therefore, caries and periodontal disease are considered as "plaque induced diseases".Tooth decay occurs most often due to insufficient knowledge of oral health, and therefore in appropriate behavior towards one's teeth health [3].Etio pathogenesis of caries is well known.Cariogenic oral flora in the presence of fermentable carbohydrates produces organic acids which lower the pH in the mouth, disturbing complex dynamic plaque equilibrium and causing enamel demineralization.This process eventually leads to the de velopment of initial decay, and later a cavity [4].
Numerous epidemiological studies conducted on chil dren indicate great variation in caries prevalence among different countries [5].Scientists believe that tooth de cay, as a multifactorial disease, can be prevented only by multiple interactions of various preventive measures [6].Adequate oral hygiene, a balanced diet, fluoride prophyl axis and recall visits can preserve dental health.At the end of the last century, developed European countries and North America, having realized a problem, have begun implementation of preventive and prophylactic measures in order to fight these diseases [7].Developed countries have put under control the problem of tooth decay, but in developing countries this is not the case and dental caries is still major economic problem.
Efficient removal of dental plaque is critical for health of hard dental and periodontal tissues.Although severe forms of periodontal diseases are less prevalent in chil dren as compared to adults, it starts usually with gingi vitis.Therefore it is necessary to begin early prevention in order to contribute to its effectiveness [8].
Bearing in mind the fact that the health system of the Republika Srpska emphases treatment of currently present oral diseases, rather than applying preventive measures, we can predict prolonged unsatisfactory state of oral health in children in this area.
The aim of this study was to determine the level of oral hygiene and its effect on the distribution of dental caries in schoolchildren in Foča as well as to evaluate the habits important for preservation of oral health.

MATERIAL AND METHODS
This study was conducted as a descriptive cross sectional study that included 239 children of both genders (slightly more boys) from Foča.Research target group were school children attending four elementary schools in Foča, aged 12 years.
Age of twelve years is particularly interesting and important.It is a period of intensive development of children, especially girls.In the majority of cases at this age permanent dentition is present.Phylogenetically, the third molars are only missing.Motor skills are also exten sively developed and manual dexterity for independent oral hygiene maintenance is achieved.Epidemiological studies in this age are extremely important, because they provide an insight into the permanent dentition (the number of teeth, shape, color, position, arrangement, re lationship, caries, habits and diet).For this reason twelve year olds are usually assessed to determine the prevalence of teeth and periodontal diseases on the international level [9].
Data about socioeconomic status, number of family members, parents' education and employment and num ber of dental visits in the last year were collected using a questionnaire, filled out by parents.
Four schools were selected for our study.Two schools were located in towns (urban) and two in suburban (rural) parts of Foča municipality.After presenting school principals with research plan and obtaining written con sent from children's parents, the examinations were con ducted in accordance with The Declaration of Helsinki on children's rights.Oral hygiene and teeth status evaluation was performed in classrooms, with the use of dental ex plorer and mirror on daylight, as proposed for this type of research.
Klein-Palmer's (DMFT) system for the evaluation of caries distribution, as well as for analysis and calculating the Average Caries Index (ACI) value was used.
Evaluation of oral hygiene was performed with the use of relevant indexes: Oral Hygiene Index (OHI), that repre sents a sum of Greene-Vermillion index of soft deposits or "Debris Index" (DI) and Greene's hard debris index or "Calculus Index" (CI).

RESULTS
ACI value for all children included in the study was 5.43.Lower value of ACI was found in examined children in urban areas (4.92) while the value was higher in the chil dren from rural areas (6.09) (Graph 1).There was no dif ference in ACI value between boys (5.40) and girls (5.58).
The structure of DMFT showed that the most of teeth were restored.The average number of carious teeth was 2.27 and extracted teeth 0.63, while the average number of restored teeth was 2.58 per child.Interesting fact in this study was that more children from rural areas had carious teeth while children from urban areas had more teeth with fillings (Graph 2).
The average index of soft deposits was 0.83.The value of plaque index in the range of 0.1 to 0.6 (good hygiene) had 49% of examined children, the value of 0.71.8 (poor hygiene) was found in 45.6%, while the value of 1.9 to 3.0 (very poor hygiene) was obtained in 5.4% of respondents.
Average value of hard deposits was 0.1.The value of calculus index in the range of 0.1 to 0.6 (good hygiene) was found in 97.2%, the value of 0.71.8 (poor hygiene) was detected in 2.4%, while the value of 1.9 to 3.0 (very poor hygiene) was found in 0.4% of respondents.Overall, girls had less hard deposits on their teeth than boys.
Graph 1. Distribution of the average caries index (ACI) values in schools in relation to children's gender (%) Gra fi kon 1. Ras po de la vred no sti ka ri jes-in dek sa oso be (KIp) po ško la ma u od no su na pol de te ta (%) A and C -schools in urban area; B and D -schools in rural area A i C -škole iz gradske sredine; B i D -škole iz seoske sredine Graph 2. Distribution of DMFT index characteristics in children of examined schools Gra fi kon 2. Ras po de la obe lež ja in dek sa KEP pre ma ško la ma ob uhva će nim is tra ži va njem D -decayed tooth; M -missing tooth; F -filled tooth K -karijesni zub; E -ekstrahovani zub; P -plombirani zub The average value of oral hygiene index of all children was 0.93.The value of oral hygiene index that ranged from 0.1 to 1.2 (good hygiene) had 75% of respondents, the value of 1.3 to 3.0 (poor hygiene) was found in 23.8%, while the value of 3.1 to 6.0 (very poor hygiene) was ob tained from 1.2% of respondents.Girls had better oral hy giene (0.67) than boys (1.11), especially in urban schools (Graph 3).
More than half of the children in this study belonged to the middle socioeconomic class.High education of mothers was recorded in 2.5% of examined children, ex clusively in urban areas, most of mothers had third and fourth grade of secondary education.
Analysis of data revealed that 90% of respondents had at least one or more visits to the dentist in the past year.Children from urban schools more often visited dentist as opposed to children in rural regions (Graph 4).However, higher percentage of boys in rural areas did not visit a dentist in the past year than the girls of the same region.
The most common reason for visiting a dentist was a toothache in 43.5%, followed by restorative treatments in 29.7% while recall exams were the reason for dental visit in just 26.8% of students.Girls more seriously take the importance of oral health and are more likely go for re storative (15.9%) and recall examinations (3.8%), whereas boys have greater fear of dental visits and they more likely go to see a dentist when they have a toothache (30.5%).Distance from dental clinics, fear of just thinking about the intervention, lack of interest and knowledge about the importance of oral health, as well as the "lack of current painful condition in the mouth" are the reasons why a small group of children have not visited dentist.

DISCUSSION
Dental caries remains a significant social and public health problem in many developed and especially in developing countries.Health Policy of the World Health Organization (WHO) has put the goal of 3 teeth in DMFT (two with fill ings and one either extracted or decayed tooth) of twelve year olds until the year 2000.Most European countries have reached this goal long ago.The guidelines for the 21 st century were decreasing number of persons with carious teeth and 1.5 of DMFT [7].Although some countries in our region reached that goal or are close to it [5,1013], our study showed that we are still far away from original goals of the WHO.
Average number of affected teeth per child from urban area was lower compared to their peers from rural area.Number of children who attend schools in urban areas is larger and dental clinics are more approachable to them.Also, more frequent presence of dentists in schools and timely information about oral health is available.However, one study from Thailand reported higher values of the average caries index in children from urban areas [14].
National study of the Veneto region (Italy) indicated the average value of caries index of 2.6 in fourteen year olds [15], while it was 0.8 in twelve year olds [16] whereas in Yemen it was 3.22 for 1214 years old [17], 3.13 in Jor dan [18], 1.62 in Iran [19], and 3.11 in Mexico [20].
Preventive and restorative dental visits were the most common for twelveyear old Greeks, 1.6% of them have never visited a dentist, and their ACI was 2.5 [21].The average caries index in HeidelbergGermany was 1.5 [22] with observed difference between immigrants who showed higher ACI value compared to children born in Germany [23].
The value of debris index in Yemeni children was slightly higher (1.28) than in our study, while the value of the calculus index was lower 0.02 [17].In Jordan, the debris index value was 1.46 [18] compared to Pančevo (1.17) [11].More than half of children from Abu Dhabi showed poor oral hygiene, however their caries index was 3.27 [24].A study conducted in the Republic of Serbia (2008) showed that twelve year olds have on average 2.8 permanent teeth diseased (from 1.0 to 5.1) in different regions [25].
Children should visit dentist for recall exams at least twice a year, in accordance with the risk for tooth de cay.In cariesrisk groups the number of visits should be higher.It is unacceptable that children, despite poor oral health, do not go for regular recall exams.The results also showed that children from rural areas had many ortho dontic problems, but they rarely went to see dentist.How ever, such health ignorance is present in other parts of the world as well.Interesting data is coming from Sudan.More than 50% of twelve years olds have never visited a dentist, while nearly 46% of them went to the dentist for the first time because of a toothache.Apart from irregular visits their average decay index was 0.42 while the value of debris index was 1.30 [26].
Although in most countries a downward trend in the prevalence of caries is recorded, regardless of whether they used prevention program and prevention methods (fluoridation of drinking water, fluoridated salt, fluorid ated milk), in the examined region in our study this re duction was not noticed.A large number of decayed teeth can be still found.Instead of the current approach where carious lesions were firstly noted and then treated, new concept of the treatment should be based on early detec tion of risk factors and their elimination as well as early detection of initial lesion, its inactivation by prophylactic measures, or restoration with minimally invasive methods [4,13].

CONCLUSION
The results showed that the presence of larger number of dental clinics, better access to the information relevant for oral health resulted in better oral hygiene and lower number of carious teeth in examined children from urban areas.These results are not satisfactory indicating that promotion of oral health is still a goal to be achieved and not just in rural areas but also in urban areas.

UVOD
Obo lje nja usta i zu ba su naj ra spro stra nje ni ja obo lje nja čo ve ka.Stil ži vo ta, na vi ke, te in du stri ja li za ci ja i ur ba ni za ci ja do ve le su do pro me na u sta nju oral nog zdra vlja lju di.Sve vi še pre ra đe na, le plji va, me ka hra na ko ja se mo že kon zu mi ra ti na uli ci, a sve ma nje spre mlje na u kru gu po ro di ce i ko ri šće na u iz vor nom ob li ku (sve že vo će i po vr će), uti ca la je na po ve ća nu in ci den ci ju po ja ve bo le sti usta i zu ba.Ne pra vil no odr ža va nje hi gi je ne usne du plje i za dr ža va nje na sla ga na zu bi ma i oko njih ta ko đe do pri no se raz vo ju ovih bo le sti.Den tal ni plak obi lu je ve li kim bro jem bak te ri ja ko je će kadtad is po lji ti svo ja lo ša svoj stva, što je u di rekt noj za vi sno sti od lo ka li za ci je i mi kro bi o lo škog sa sta va den tal nog pla ka [1].Ve li ki je broj fak to ra ko ji pot po ma žu br že stva ra nje, aku mu li ra nje i za dr ža va nje zub nog pla ka na ka ri jes pre di lek ci o nim me sti ma, či me omo gu ća va ju na sta nak pro me na na zu bu i oko nje ga [2].Zbog to ga se za ka ri jes i pa ro don to pa ti je, kao naj če šće bo le sti usne šu plji ne, ka že da su "bo le sti uslo vlje ne pla kom".Ka ri jes naj če šće na sta je usled ne do volj nog po zna va nja, a sa mim tim i neo d go va ra ju ćeg po na ša nja pre ma sop stve nom oral nom zdra vlju [3].Eti o pa to ge ne za ka ri je sa je da nas re la tiv no do bro po zna ta.Ka ri o ge na oral na flo ra u pri su stvu fer men ta bil nih uglje nih hi dra ta stva ra or gan ske ki se li ne ko je sni ža va ju pH vred nost u usti ma, na ru ša va ju slo že nu di na mič ku rav no te žu zub nog pla ka, iza zi va ju de mi ne ra li za ci ju gle đi i do vo de do po ja ve ini ci jal nog ka ri je sa, a vre me nom i ka vi te ta na zu bu [4].
Broj na epi de mi o lo ška is tra ži va nja ura đe na kod de ce uka zu ju na ve li ku raz li ku u ras pro stra nje no sti ka ri je sa me đu po je di nim ze mlja ma [5].Is tra ži va či sma tra ju da se ka ri jes, kao mul ti fak tor ska bo lest, mo že spre či ti je di no vi še stru kim me đu sob nim dej stvom ra znih pre ven tiv nih sred sta va [6].Iz to ga pro iz la zi da se od go va ra ju ćom oral nom hi gi je nom, urav no te že nom is hra nom, upo tre bom flu or ske pro fi lak se i kon trol nim pre gle di ma mo že oču va ti zdra vlje zu ba.Kra jem pro šlog ve ka raz vi je ne ze mlje Evro pe i Ame ri ke, uvi dev ši pro blem, po če le su s pri me nom pre ven tiv nopro fi lak tič kih me ra ra di su zbi ja nja ovih bo le sti [7].One su pro blem ka ri je sa sta vi le pod kon tro lu, ali za ne raz vi je ne ze mlje to ni je slu čaj i ve li ka ras pro stra nje nost ka ri je sa i da lje je ve li ki eko nom ski pro blem.
Efi ka sno ukla nja nje den tal nog pla ka je od pre sud nog zna ča ja ka ko za zdra vlje zu ba, ta ko i za zdra vlje pa ro don tal nih tki va.Iako su te ži ob li ci obo lje nja pa ro don ci ju ma ma nje pre va lent ni kod de ce u od no su na od ra sle, oni po či nju sa gin gi vi ti si ma, te je neo p hod no pre ven ci ju za po če ti u naj mla đem uz ra stu da bi ona bi la efi ka sna [8].
Ima ju ći u vi du či nje ni cu da je u zdrav stve nom si ste mu Re pu bli ke Srp ske ak ce nat dat na sa na ci ji za te če nog oral nog sta nja, a ne na me ra ma pre ven ci je, mo že se oče ki va ti za dr ža va nje po sto je ćeg, ne za do vo lja va ju ćeg sta nja oral nog zdra vlja de ce.
Cilj ovog ra da je bio da se utvr de ni vo i uti caj oral ne hi gi je ne na ras pro stra nje no sti ka ri je sa kod de ce škol skog uz ra sta u Fo či, kao i da se pro ce ne na vi ke u oču va nju zdra vlja usta i zu ba.

MATERIJAL I METODE RADA
Stu di ja je ura đe na kao de skrip tiv na stu di ja pre se ka ko jom je ob u hva će no 239 de ce iz Fo če oba po la (ne znat no ve ći broj de ča ka).Cilj na gru pa is tra ži va nja bi li su uče ni ci če ti ri osnov ne ško le, uz ra sta od 12 go di na.
Ovaj uz rast je po seb no in te re san tan i va žan.To je pe riod in ten ziv nog raz vo ja de ce, po seb no de voj či ca.U naj ve ćem bro ju slu ča je va u ovom uz ra stu do la zi je do sme ne svih zu ba, od no sno pri su stva pre te žno stal ne den ti ci je.Fi lo ge net ski je di no ne do sta ju tre ći mo la ri.U ovom uz ra stu in ten ziv no se raz vi ja ju i mo to rič ke ve šti ne, ko je mo gu uti ca ti i na ma nu el nu spret nost pri odr ža va nju sa mo stal ne oral ne hi gi je ne.Epi de mi o lo ška is tra ži va nja su za ovaj pe riod iz u zet no va žna, jer da ju uvid o sta nju stal ne den ti ci je (broj, ob lik, bo ja, po lo žaj, ras po red, me đu sob ni od nos, po sto ja nje ka ri je sa, iz gra đe ne hi gi jen ske na vi ke, na čin is hra ne).Zbog to ga su dva na e sto go di šnja ci oda bra ni kao op šti deč ji uz rast za nad zor ras pro stra nje no sti obo lje nja usta i zu ba, kao i za upo re đi va nja me đu ze mlja ma [9].
Po da ci o so ci o e ko nom skom sta tu su po ro di ce, bro ju čla no va, struč noj spre mi i za po sle no sti ro di te lja i bro ju po se ta de te ta sto ma to lo gu u pro te klih go di nu da na do bi je ni su po mo ću an ke te, ko ju su po pu ni li roditelji.
Za ovo is tra ži va nje iza bra ne su če ti ri osnov ne ško le -dve ko je se na la ze na pod ruč ju gra da (ur ba na sre di na) i dve iz pri grad skog de la op šti ne Fo ča (ru ral na sre di na).Na kon upo zna va nja di rek to ra ško la s pla nom is tra ži va nja i do bi ja nja sa gla sno sti ro di te lja (sve je vr še no u skla du s Hel sin škom de kla ra ci jom o po što va nju pra va de te ta) obavljeni su pre gle di de ce.Pro ce na sta nja oral ne hi gi je ne i zdra vlja zu ba vr še na je po mo ću sto ma to lo škog ogle da la i son de pri dnev nom sve tlu u uči o ni ca ma, što je pred vi đe no ovom vr stom is tra ži va nja.
Za pro ce nu ras pro stra nje no sti ka ri je sa ko ri šćen je Klajn-Pal me rov (Klein-Pal mer) si stem (KEP), po mo ću ko jeg su ana li zi ra ne i do bi je ne vred no sti pro seč nog ka ri jesin dek sa po oso bi (KIp).
Pro ce na ste pe na hi gi je ne usta i zu ba vr še na je po mo ću in dek sa oral ne hi gi je ne (IOH), ko ji pred sta vlja zbir vred no sti in dek sa me kih na sla ga (IMN) po Grin-Ver mi li o nu (Gre e ne-Ver mil lion) i in dek sa tvr dih zub nih na sla ga (ITN) po Gri nu (Gre e ne).
Po sma tra ju ći struk tu ru KEP uoče no je da ima vi še zu ba ko ji su sa ni ra ni.Pro se čan broj ka ri je snih le zi ja bio je 2,27, pro se čan broj eks tra ho va nih zu ba 0,63, dok je pro se čan broj zu ba s is pu ni ma bio 2,58 po de te tu.Ve li ki broj de ce iz ru ral ne sre di ne imao je zu be za hva će ne ka ri je som, dok je kod de ce iz grad ske sre di ne bi lo vi še zu ba s is pu ni ma (Gra fi kon 2).
Vi še od po lo vi ne de ce ob u hva će ne ovom stu di jom pri pa da lo je sred njoj so ci o e ko nom skoj kla si.Vi so ku struč nu spre mu ima lo je 2,5% maj ki is pi ta ne de ce, i to is klju či vo one ko ja ži ve u gra du, dok su osta le maj ke ima le tre ći i če tvr ti ste pen sred nje struč ne spre me.
Ana li zom po da ta ka utvr đe no je da je 90% is pi ta ni ka ba rem jed nom u pro te klih go di nu da na po se ti lo sto ma to lo ga.De ca ko ja po ha đa ju grad ske ško le su če šće od la zi la na pre gle de kod sto ma to lo ga, za raz li ku od de ce ko ja idu u pri grad ske ško le (Gra fi kon 4).Ka da je u pi ta nju raz li ka iz me đu is pi ta ni ka po po lu, ve ći pro ce nat de ča ka iz ru ral nih sre di na ni je ni jed nom po se tio sto ma to lo ga u pro te klom pe ri o du u od no su na de voj či ce iz iste re gi je.
Naj če šći raz log od la ska kod sto ma to lo ga bi la je zu bo bo lja (43,5%); sle de re sta u ra tiv ni tret ma ni (29,7%) i kon trol ni pre gle di (26,8%).De voj či ce su ozbilj ni je shva ta le zna čaj oral nog zdra vlja, pa su če šće od la zi le na re sta u ra tiv ne i kon trol ne pre gle de (15,9% i 13,8%), dok je kod de ča ka za be le žen ve ći strah od od la ska kod sto ma to lo ga, pa su se na pre gle de naj če šće ja vlja li ka da ima ju zu bo bo lju (30,5%).Uda lje nost sto ma to lo ške am bu lan te, strah pri sa moj po mi sli na in ter ven ci je, ne za in te re so va nost za oral no zdra vlje, ne po zna va nje va žno sti sop stve nog oral nog zdra vlja i "ne po sto ja nje tre nut nih bol nih sta nja u usti ma" raz lo zi su zbog ko jih ma nja gru pa de ce ni je od la zi la kod sto ma to lo ga.

DISKUSIJA
Ka ri jes je i da lje zna ča jan dru štve ni i zdrav stve ni pro blem u ve li kom bro ju raz vi je nih ze ma lja, a po seb no u ze mlja ma u raz vo ju.Zdrav stve na po li ti ka Svet ske zdrav stve ne or ga ni za ci je (SZO) se do 2000.go di ne za sni va la na po sti za nju do tri zu ba sa KEP (dva sa is pu nom i jed nim zu bom ko ji je ili iz va đen ili za hva ćen ka ri je som) kod dva na e sto go di šnja ka.Ve ći na evrop skih ze ma lja odav no je do sti gla po sta vlje ni cilj, pa je u smer ni ca ma za 21. vek na zna če no da se oče ku je sma nje nje bro ja oso ba s ka ri je som, kao i 1,5 zu ba s nje go vim obe lež jem za re fe rent no go di šte [7].Iako su taj cilj do sti gle ili mu se pri bli ži le ne ke ze mlje iz na šeg okru že nja [5,1013], na osno vu ove stu di je se uoča va da je sta nje još da le ko i od pr vo bit nih ci lje va SZO.
Pro se čan broj obo le lih zu ba po de te tu iz grad ske sre di ne je ne što ni ži u od no su na vr šnja ke iz se o skih pod ruč ja.Broj de ce ko ja po ha đa ju ško le u gra du je do sta ve ći, ali su nji ma pri stu pač ni je sto ma to lo ške am bu lan te, če šće ško le ima ju sto ma to lo ga i do stup ni je su pra vo vre me ne in for ma ci je o zdra vlju oral nih tki va.Stu di ja iz Taj lan da uka zu je na ve će vred no sti pro seč nog KIp kod de ce ko ja ži ve u gra du [14].
Pre ven tiv ni i re sta u ra tiv ni pre gle di bi li su naj če šći raz lo zi po se te sto ma to lo gu dva na e sto go di šnja ka u Grč koj; 1,6% is pi ta ni ka ni je po se ti lo sto ma to lo ga, dok je pro seč na vred nost KIp bi la 2,5 [21].Pro seč na vred nost ovog in dek sa kod de ce uz ra sta od 12 go di na u Haj del ber gu, u Ne mač koj, bi la je 1,5 [22], s tim da je uoče na raz li ka iz me đu do se lje ni ka, kod ko jih su za be le že ne ve će vred no sti KIp, i de ce ro đe ne u Ne mač koj, kod ko je su pro seč ne vred no sti ovog in dek sa bi le ma nje [23].
Na re dov ne sto ma to lo ške pre gle de de ca bi tre ba lo da od la ze naj ma nje dva pu ta go di šnje, u skla du s ri zi kom od na stan ka ka ri je sa.Kod de ce sklo ne ka ri je su broj po se ta mo rao bi bi ti i ve ći.Ne pri hva tlji vo je da de ca iz ovog re gi o na, i po red lo šeg zdrav stve nog sta nja zu ba, ne ma ju na vi ku od la ska na pre gle de.Iz re zul ta ta se vi di da de ca iz ru ral nih de lo va op šti ne ima ju iz ra že ni je den to ge ne pro ble me, ali baš oni re đe od la ze sto ma to lo gu.Me đu tim, ta kva zdrav stve na ne pro sve će nost vla da i u dru gim kra je vi ma sve ta.Za ni mlji vi su, na pri mer, po da ci iz Su da na.Na i me, vi še od 50% dva na e sto go di šnja ka ko ji ži ve u ovoj ze mlji ni ka da ni je po se ti lo sto ma to lo ga, dok ih se sko ro 46% pr vi put ja vi lo na pregled zbog zu bo bo lje.Po red ne re dov nih po se ta, pro seč na vred nost nji ho vog KIp bi la je 0,42, dok je vred nost plakin dek sa bi la 1,30 [26].
Iako je u ve ći ni ze ma lja za be le žen trend pa da pre va len ci je ka ri je sa bez ob zi ra na to da li su te ze mlje ko ri sti le pre ven tiv ni pro gram i pre ven tiv ne me to de (flu o ri sa na pi ja ća vo da, flu o ri sa na ku hinj ska so, flu o ri sa no mle ko) ili ne, uoče no je da u is pi ti va nom re gi o nu sma nje nje ras pro stra nje no sti ka ri je sa ni je ta ko oset no.I da lje se kod de ce be le ži ve li ki broj obo le lih zu ba.Ume sto do sa da šnjeg le če nja ka ri je sa, gde se pr vo uoča va la ka ri je sna le zi ja, a za tim vr ši la nje na sa na ci ja, no vi kon cept u le če nju bi tre ba lo da se za sni va na ra nom pre po zna va nju fak to ra ri zi ka i nji ho vom ukla nja nju, kao i ra nom ot kri va nju po čet ne le zi je, nje nom inak ti vi sa nju pro fi lak tič kim me ra ma, ili zbri nja va nju mi ni mal no in va ziv nim me to da ma [4,13].

ZAKLJUČAK
Re zul ta ti su po ka za li da su po sto ja nje vi še sto ma to lo ških am bu lan ti i bo lja do stup nost in for ma ci ja va žnih za oral no zdra vlje do ve li i do bo lje oral ne hi gi je ne i ni žeg pro seč nog bro ja ka ri je snih zu ba kod is pi ti va ne de ce iz grad ske sre di ne.Do bi je ne vred no sti ni su za do vo lja va ju će, što poka zu je da je na pro mo ci ji zdra vlja usta i zu ba po treb no vi še ra di ti ne sa mo kod de ce u se o skim sre di na ma, već i kod de ce ko ja ži ve u gra du.

Graph 3 .
Average values of soft deposits (DI), hard deposits -calculus (CI) and oral hygiene indices (OHI) by examined schools Gra fi kon 3. Pro seč ne vred no sti in dek sa me kih na sla ga (IMN), indek sa tvr dih naslga (ITN) i in dek sa oral ne hi gi je ne (IOH) pre ma ško la ma ob u hva će nim is tra ži va njem Graph 4. Distribution of children's dental visits in the previous year by examined schools (%) Gra fi kon 4. Ras po de la bro ja po se ta de ce sto ma to lo gu u pro te kloj go di ni pre ma ško la ma ob u hva će nim is tra ži va njem (%)