Community Dentistry
ASSOCIATION BETWEEN SANOGEN BEHAVIOR AND CARIES
EXPERIENCE IN SOME SCHOOL POPULATION OF IAŞI, ROMANIA
Carina BALCOŞ1, Anca STUPU2, Veronica PINTILICIUC1, Livia BOBU1,
1
Assist. Prof. PhD, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
2
Univ. Assist. PhD Student, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
3
Prof. PhD, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
Corresponding author: Anca Stupu; e-mail: stupanca@yahoo.com
Abstract
Introduction. To analyze the association between caries
experience and the eating and oral hygiene habits of some
school children of Iaşi, Romania. Materials and methods.
232 first-grade students from 5 elementary schools of Iaşi
were selected for the study. They filled in a questionnaire
(response rate: 92.8%) and oral examination was made
according to WHO criteria. Statistical analysis was used to
evaluate the correlation between student’s oral health
status and the responses given in the questionnaire.
Results and discussion. Participants to the study show a
high prevalence of dental caries (76.8%), which may be due
to the fact that most of these children eat sweets and
snacks, have poor oral hygiene habits, and extremely low
rates of using dental health care products. Sanogenic
behavior has been associated with caries experience in both
sexes. Conclusions. The results obtained indicate the need
for improved access to dental health care and education in
every school, so that children can develop good oral
hygiene habits.
Keywords: caries, sanogen behavior, oral hygiene, student.
1. INTRODUCTION
The past few decades have witnessed an
increased focus on the importance of oral health
on the social, psychological and developmental
well-being of children. Although effective and
advanced dental prevention measures and
treatment options are increasingly available,
dental decay remains one of the most common
chronic childhood diseases (60-90%). According
to the World Health Organization, in 2010, 50%
of children worldwide aged 5-6 years should be
caries-free, whereas the average decayed, missing
and filled teeth in permanent dentition (DMFT)
index would be reduced to < 1.0 at 12 years of
age. By 2011, the global average DMFT index for
12 year-old school children was 1.67 and 78% of
International Journal of Medical Dentistry
Lucia BÂRLEAN3
countries have a DMFT index < 3.0, as registered
in local students [1].
Studies conducted in previous years evidenced
the main factors which may lead to caries, such
as eating habits, oral hygiene habits, parents’
educational level, socio-economic status, and
health care habits. The frequent consumption of
sugary drinks and sweets, together with the
absence of regular meals, is likely to be the cause
of increased dental caries. In terms of the
frequency of teeth-brushing, children who brush
once a day have a higher number of decayed
teeth, as well as a worse index of dental caries
than those who brush three or more times a day
[2]. Moreover, children usually adopt these oral
hygiene behaviors during the critical period
when they attend elementary school. If they fail
to develop good and correct teeth cleaning
behavior, their overall oral health will be affected.
The present study focused on the association
between caries experience and the eating and
oral hygiene habits of a group of school children
of Iaşi, Romania.
2. MATERIALS AND METHODS
The experimental group was formed of 232
children, 6-7 years of age, from 5 different
school. These children were given an oral health
examination and asked to fill in a questionnaire.
After the research team explained the contents
of the study using a written description to the
legal representatives of the participants, they
signed an informed consent form. The survey
response rate was of 92.8%. The oral health
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examination of all participants was conducted
by a single dentist calibrated on diagnostic
methods and standards for the oral health
examination survey released by the World
Health Organization. The number and
conditions of children’s deciduous and
permanent teeth were recorded. Where term
decayed (dt, DT) is used, this represents a carious
deciduous (permanent) tooth without fillings or
the occurrence of secondary caries after failure
of a filling. Where term extraction (mt) is used,
this indicates the removal of a deciduous tooth
due to severe caries. Where term missing (MT)
is used, this represents a permanent tooth
missing as a result of caries. Finally, where term
filled (ft, FT) is used, this indicates a deciduous
(permanent) tooth filled due to caries, with
permanent or temporary materials [3].
The study involved filling in of a structured
questionnaire aimed at collecting information
on the demographic profile, educational
status, income, occupation, dental visits and
their reasons, oral hygiene practices, dietary
habits, exposure to fluorides, underlying
systemic diseases and awareness towards oral
diseases.
Statistical analysis was used to produce a
frequency distribution table, percentages,
averages, and standard deviations for the
collected data. In addition, t tests and analysis
of variance (ANOVA) were applied to analyze,
compare, and evaluate the oral health status
of the different sexes in first and fourth grade
school children. These results were further
used to analyze the oral hygiene and eating
habits of the school children in addition to
recording their prior experience of visits to
the dentist. Subsequently, the correlation
between these factors was explored to identify
the possible causes of oral diseases. Statistical
analysis was carried out using SPSS version
14.0 (SPSS Inc., Chicago, IL, USA) for
Windows.
3. RESULTS
Table 1 gives details regarding the sex
distribution of subjects (54.74% were girls and
45.26% were boys) and the dental caries
experience of school children’s primary dentition,
determined by oral examination. The prevalence
of dental caries in primary dentition is of 76.8%
and of 10.8%, respectively, in permanent
dentition. No statistically significant difference
was observed between boys and girls.

Table 1. Sex- and age-weighed dental caries status

Female Male p Caries prevalence

n (%) 127 (54.74%) 105 (45.26%) 76.80%

Dmft 3.62 4.26
Dt 2.70 ±1.72 3.12 ±2.46 0.72
Mt 0.32 ±0.59 0.54 ±0.87 0.86
Ft 0.60 ±1.23 0.90 ±1.54 0.38
n(%)
DMFT 0.6 0.9 10.80%
DT 0.5±0.13 0.72±0.24 0.12
MT 0 0
FT 0.1±0.07 0.18±0.08 0.16

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 ASSOCIATION BETWEEN SANOGEN BEHAVIOR AND CARIES EXPERIENCE IN SOME SCHOOL
POPULATION OF IAŞI, ROMANIA

Table 2 lists the frequencies of eating sweets,
snacking, oral hygiene habits, and dental health
care habits. Statistical analysis shows that most
children - 79.31% - occasionally consume snacks
or sweets and only 5.7% of them indicated that
they never eat snacks or sweets.
As to the sanogenic attitudes after eating sweets
and snacks, the results show that 71.98% of the
subjects wash their teeth from time to time, whereas
36.20% of them never clean their mouth. Only
9.48% of the students brushed their teeth every
day, whereas 5.17% of them did not brush their
teeth daily. As for those who apply brushing after
eating, most of the students – 87.06% - did this only
occasionally, while 3.87% of them brushed their
teeth every time after eating. Less than half of the
children (36.20%) brushed their teeth for more than
3 minutes. Most students only went to a dentist
when they had a dental problem (71.55%) and 6.3%
of them had never visited a dentist.

Table 2. Snacking, eating sweets, oral hygiene habits, and dental healthcare habits

Variable n (%)
Number of times a day that snacks and/or sweets are eaten
• Never 12(5.17)
• Occasionally 184(79.31)
• Once or twice a day 10(4.31)
• > 3 times a day 26(11.20)
I clean the mouth after eating sweets
• Sometimes yes, sometimes no 167(71.98)
• Yes, I always brush my teeth after eating sweets 34(14.65)
• Yes, I always rinse my mouth after eating sweets 49(21.12)
• No 84(36.20)
I brush my teeth every day
• No 12(5.17)
• Sometimes yes, sometimes no 198(85.34)
• Every day 22(9.48)
I brush my teeth after eating
• No 21(9.05)
• Sometimes yes, sometimes no 202(87.06)
• Every time 9(3.87)
I brush my teeth for at least 3 minutes
• Yes 84(36.20)
• No 148(63.79)
Dental care habits
• Periodical check-up 24(10.34)
• Occasional check-up 28(12.06)
• Visit a dentist only when having dental problems 166(71.55)
• Never go to a dentist 14(6.03)

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Carina BALCOŞ, Anca STUPU, Veronica PINTILICIUC, Livia BOBU, Lucia BÂRLEAN

Table 3 shows a statistically significant
difference between brushing after eating and the
components of DMFT indices in mixed dentition
(0.086, 0.784, 0.018). In the case of dt/DT, the
students who did not brush their teeth after
eating had the highest scores, while those who
brushed their teeth every time recorded the
lowest scores. The dt/DT was higher among
those who brushed for < 3 minutes than of those
who brushed their teeth for > 3 minutes.
Moreover, a statistically significant difference
was found between the category of those usually
brushing for > 3 minutes and the dt/ DT score
(p= 0.023, 0.745, 0.321). Briefly, children with
poor oral hygiene habits have a poor oral health.
Although the analyses of health care habits and
oral health status of school children did not
show significant differences, the value of the
dmft/DMFT indices was higher in children who
only see a dentist when they have dental
problems (dmft =7.84) than in those who have
regular or occasional check-ups (dmft =7.26).

Table 3. Association between dental caries status for mixed dentition and oral
hygiene/dental health care habits

dmft /
n(%) dt / DT mt/MT ft / FT
DMFT
I brush my teeth after eating
• No 12(5.17) 4.26 0.55 1.64 6.45
• Sometimes yes, sometimes no 198(85.34) 2.65 0.32 0.87 3.84
• Every time 22(9.48) 1.23 0.27 0.64 2.14

p 0.086 0.784 0.018 0.124

I usually brush my teeth for at
least 3 minutes
• Yes 84(36.20) 2.92 0.63 0.97 4.52
• No 148(63,79) 4.86 0.74 1.86 7.46

p 0.023 0.745 0.321 0.032

Dental healthcare habits

• Periodical check-up 24(10.34) 4.92 0.59 1.01 6.52
• Occasional check-up 28(12.06) 5.46 0.57 1.23 7.26
• Visit a dentist only when
166(71,55) 5.87 0.82 0.93 7.62
having dental problems
• Never go to a dentist 14(6,03) 5.92 1.06 0.86 7.84

p 0.284 0.452 0.186 0.466

4. DISCUSSION Some reduction in the prevalence of dental

Despite the marked decline in dental caries in
developed countries over the past years, the
prevalence of dental decay remains high and
favourable trends are diminishing. In the
developing countries, dental caries has increased
due to an increased exposure to dietary sugars
and also to low socio-economic factors [4,5].
caries was recorded in both developed and
developing countries, however the prevalence
remains high in populations with a low
socioeconomic status. Therefore, the
socioeconomic indices are associated with risk
factors for dental caries [6-9].
The statistical analyses presented in the study
indicate that the prevalence of dental caries in
the first class of 5 elementary schools in Iaşi,

186 volume 21 • issue 3 July / September 2017 • pp. 183-188

 ASSOCIATION BETWEEN SANOGEN BEHAVIOR AND CARIES EXPERIENCE IN SOME SCHOOL
Romania was 76.8%, a value lower than the
national prevalence of dental caries (84.3%)
registered in a study finalised in 2011 on a sample
including 548 students with ages between 6 and
8 years. Our findings confirm the division
between Western and Eastern Europe, being
similar to those recorded in other Eastern
European countries but higher than those of the
Western European ones [10,11].
Dental caries in preschool children is due to a
combination of factors, including colonization of
teeth with cariogenic bacteria, type of food and
frequency of food exposure to cariogenic bacteria,
susceptible teeth. Caries risk is greatest if sugars
are consumed at high frequency, in a form
retained in the mouth for long periods. Sucrose
is the most cariogenic sugar because it can form
glucan, which permits a firm bacterial adhesion
to teeth and limits the diffusion of acid and
buffers in the plaque.
Toothbrushing with fluoride tooth pastes
seems to have a preventive effect on caries risk,
although the quality of the studies performed
particularly among adults is poor. Recommending
toothbrushing as a strategy in managing caries
is based on the fact that a more frequent
toothbrushing with a fluoride dentifrice and a
good oral hygiene seems associated with reduced
caries risk. Some studies, that include clinical
measures of oral hygiene, suggest that a good
oral hygiene, involving not only frequent
brushing but also effectiveness of brushing, is
associated with reduced caries risk [12]. In the
present study, oral health behavior, such as last
dental visit, reasons for the last dental visit,
toothbrushing frequency, eating sugary food
between meals, were found as closely associated
with caries experience in children.
The role of tooth-brushing in the prevention of
tooth decay has long been considered self-evident.
Yet, there is little evidence supporting the idea that
tooth brushing per se reduces caries. The relationship
between the individual oral hygiene status and
caries experience is weak, and instructional
programs designed to reduce caries incidence by
promoting oral hygiene have failed. However,
there is convincing evidence for the decay-
preventing benefit of tooth-brushing when used
with a fluoride-containing toothpaste. Three recent
publications have shown that daily tooth-brushing
International Journal of Medical Dentistry
POPULATION OF IAŞI, ROMANIA
with fluoride toothpaste in 3 to 6 year-old children
significantly reduces caries incidence [13].
5. CONCLUSIONS
The present results indicate that the children
of Iaşi have a high prevalence of dental caries,
because most of them like to eat sweets and
snacks and have poor oral hygiene habits. The
results can also serve as a reference for improved
access to dental health care and education in
every school, so that children can develop good
oral hygiene habits.
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