ORAL HYGIENE AS THE DOMINAT DETERMINAT OF HEALTH

Uvod/Cilj Naučni i zdravstveni temelji u prevenciji karijesa zasnivaju se na stavu da je prepoznavanje karijesa na nivou kavitacije prekasno da bi se zadovoljila savremena načela struke. Međutim, kod nas još ne postoji dovoljno razvijena svijest o važnosti oralnog zdravlja za cjelokupno zdravlje pojedinca, a još manje o važnosti sprovođenja oralne higijene. Materijal i metod Istraživanje je sprovedeno po tipu studije presjeka, od maja do septembra 2009. godine u stomatološkim ordinacijama Doma zdravlja Tivat. Istraživanje su radili stomatološki timovi sa pacijentima starosti do petanaest godina. Instrument istraživanja bio je upitnik i stomatološki pregled usta i zuba. Pregled je izvršen prema metodologiji i kriterijima SZO. Odgovori dobijeni tokom intervjua upoređivani su sa podacima kliničkog pregleda. Rezultati Analizirajući dobijene odgovore ustanovljeno je da najviše ispitanika pere zube dva puta dnevno, a stomatologa najčešće posjećuju jednom u šest mjeseci. Istraživanje je pokazalo da je kod 57% ispitanika pregledom uočeno postojanje karioznih mliječnih zuba. Kod više od 63% ispitanika nađeni su stalni kariozni zubi. Kod 14% ispitanika nađen je gingivitis, a kod 44,7% ispitanika uočena je ortodontska anomalija. Polovina ispitanika koja rijetko pere zube ima problema sa gingivitisom. Postoji statistički visoko značajna razlika u pojavi gingivitisom u vezi sa učestalošću pranja zuba. Zaključak Postoji značajna razlika u održavanju higijene usta i zuba prema polu, kao i prema nekim drugim socio-demografskim karakteristikama ispitanikla. Studija je pokazala povezanost karijesa i gingivitisa sa učestalošću pranja zuba i frekvencije posjeta stomatologu.


Introduction
Scientific and health foundations in caries prevention are based on the view that in order to meet modern principles that already exist within the profession it is too late if the caries is detected in the cavitation stage.Measures and activities that are implemented prior to the onset of cavitation are basic principles of modern preventive treatment of caries in order to ensure proper and adequate disease preven tion and to use all features of modern preven tive treatment 1 .However, there is not enough awareness of the importance of oral health to overall health of an individual and even less about the importance of practicing oral hygiene.Health education of parents and children about proper oral hygiene should be the basis of ex tensive prevention of caries.Basic information and guidelines regarding oral health protection and the importance of dental check-ups are given not only to parents but also to their chil dren primarily through pre-school institutions, schools and pediatric clinics.School age is the period when long-lasting habits are acquired and information regarding health education is timely provided.Health education is a measure of preventive care which through development of proper health behavior and changes of harm ful health behavior, education and dissemina tion of information regarding medical treatment can achieve health improvement, prevention and also treatment and mitigation of diseases 2 .
The main etiological factor for caries and periodontal disease is dental plaque.Microbial dental plaque, which is non-mineralized layers of microorganisms in organic matrix of poly saccharides i.e. deposits on teeth, is the primary cause of gingivitis 4 .Oral hygiene is an impor tant factor in the fight against dental caries es pecially in urban population due to consump tion of refined food.It is known that microbial dental plaque accumulates faster in children than in adults.The level of oral hygiene chang es microbial accumulation on dental plates and the plaque control is the basis for prevention of dental caries and periodontal diseases.In epi demiologic oral research it is important to de termine the level of oral hygiene and degree of inflammatory changes of the gingiva.The level of oral hygiene is determined by OHI-index 1 .
Pored toga, kao instrument istraživanja poslužio je stomatološki pregled usta i zuba za dobijanje podataka o oralnom zdravlju ispiti of the implementation of health education pro grams is to reduce primarily the incidence of caries and periodontal diseases, but also other oral cavity diseases 5 .In addition, it is essential to provide preventive dental check-ups so that the importance of oral disease prevention could be emphasized.The key recommendation is that prevention is the most cost-effective form of oral health care 6 .

Aim
The main objectives of this study were as sessment of oral hygiene habits among primary school children as well as the impact of current behavior in the field of oral hygiene on identi fied oral health disorders.

Materials and methods
The research was carried out as a cross sectional study from May to September 2009 in dentist offices at the Medical Center Tivat.It was conducted with patients under the age of 15 who were provided with free dental care in the reformed health care system in Montenegro by dental teams.
The research instrument was a question naire.The questions included in the question naire were related to the oral hygiene habits.The questionnaire consisted of 16 questions of which 15 were closed questions about oral hygiene habits and dental check-ups.This sec tion of the questionnaire was filled in, after the respondents gave their answers, by the nurse who worked in the dental office where the oral health services were provided to respondents.The last question number 16 was also filled in by the nurse according to dentist examination that is an objective finding of oral health.These findings determined the condition of oral health and they included the total number of present teeth during examination, both deciduous and permanent teeth, total number of carious teeth, both deciduous and permanent ones and pres ence of gingivitis and orthodontic anomalies.
In addition, dental examination was used as a research instrument in order to obtain infor mation on the condition of oral health in exam ined children.The examination was done in ac cordance with WHO methodology and criteria vane djece.Pregled je izvršen prema metologiji i kriterijima SZO-a, služeći se stomatološkim ogledalima, standardnim parodontnim sonda ma CPITN i osvjetljenjem prigodnim za ovu vrstu pregleda.Parametri korišteni za procjenu statusa oralnog zdravlja bili su indeksi: DMFT i SiC, mjesni parodontni indeks i indeks razvo jnih defekata u caklini (RDC).
The parameters used to assess the condition of oral health were indices: DMFT I SiC, com munity periodontal index and index of develop mental defects of enamel (DDE).
The answers obtained from the question naire were correlated with the data obtained by examination of oral health according to proto col of good medical practice for this type of ex amination.
Methods of descriptive statistics and sta tistical methods for determining significance of difference, using the chisquare test for cat egorical characteristics, and one factor analysis of variance (ANOVA) for determining impact of individual factors on the objective condition of oral health in children, were used for statisti cal data analysis.

Results
The study included all patients who visited dental offices at the Medical center Tivat during three summer months in 2009.Analysis of re spondents according to gender showed that half of the respondents were male i.e. female.The age of respondents ranged from 11 to 15 years.
The research showed that there was a highly significant statistical difference among respon dents in frequency of tooth brushing in relation to their financial position (X 2 test = 23.132,p<0.001).Among respondents who rarely brushed their teeth, most numerous were those who assessed their financial situation as bad (40%), followed by those who assessed their financial situation as satisfactory.Respondents who had good financial position most frequent ly brushed their teeth (Table 1).
Frequency of tooth brushing was signifi cantly different with regard to the respondents' mother's education level (X 2 test = 18,664, p<0.05).Respondents whose mothers had high er education most frequently brushed their teeth twice a day or more often than that.Respon dents whose mothers had completed only pri mary school either rarely or once a day brushed their teeth (Table 2).

Diskusija
Istraživanje je pokazalo da postoji značajna povezanost materijalne situacije u porodicama ispitivane djece i obrazovanja njihovih majki sa frekvencijom pranja zuba, kao i sa urednošću posjećivanja stomatologa.Posjete stomatologu i frekvencija pranja zuba značajno su povezane The frequency of visits to dentist is statisti cally significantly correlated with development of gingivitis.Gingivitis the least frequently oc curred in patients who visited dentist whenever it was necessary, that is when they noticed or felt any change.More than a half of respondents visited dentist only when they had toothache or had problems with gingivitis (Table 4).sa oboljenjima usta i zuba ispitanika, procjenje no na osnovu relevantnih pokazatelja zdravlja.
Numerous studies have confirmed that there is a difference in children's attitudes towards regular dental checkups with regard to social and educational background of their families.Although children become familiar with oral hygiene very early and their parents are more and more aware of the importance of oral health to overall wellbeing of their children, the role of parents and their children in maintaining oral health is often not enough, so it is necessary to visit a dentist.In order to avoid caries and seri ous complications, a dentist should be visited regularly even if one has healthy teeth 7 .
The behavior of children is directly related to the process of socialization which is pri marily taken place at their homes.Therefore, appropriate measures are needed in order to modify the behavior and they should be taken by parents 8 .The data showed that there was a difference in children's attitudes towards regu lar dental checkups with regard to social and educational background of their parents 9 .Obvi ously, the attitude that regular preventive check ups can prevent oral diseases is not present as a current practice in respondents' families.In order to avoid caries and serious complications, a dentist should be visited regularly even if one has healthy teeth.
Determinates which are recognized as sig nificant predictors of oral diseases by most authors are as follows: family income level, education level, taking extra calcium -milk consumption during pregnancy, oral hygiene habits, and oral healthcare as well as general nutrition habits 10 .This study has confirmed the abovementioned determinants as significant predictors of oral health.

Conclusion
Frequency of tooth brushing and visits to a dentist are significantly correlated with oral health of children aged 11 to 15 in Montenegro.
Tooth brushing behavior of children is sig nificantly conditioned by financial position of respondents' families as well as with education level of their mothers.

Table 3 .
Frequency of occurrence of gingivitis in respondents with regard to frequency of tooth brushing