Children's dental health in Europe. An epidemiological investigation of 5- and 12-year-old children from eight EU countries.

This thesis is based on a cross-sectional comparative study of dental health, treatment needs and attitudes to dental care in groups of 5- and 12-year-old children from the following eight cities in respective EU countries: Athens-Greece, Berlin-Germany, Cork-Ireland, Dundee-Scotland, Gent-Belgium, Sassari-Italy, Stockholm-Sweden and Valencia-Spain. A total of 3,200 children, 200 in each age group, were clinically examined by well-calibrated dentists, the parents completing a questionnaire on dental habits, parental and children's attitudes to dental care, smoking habits and parental occupations. The results disclosed pronounced differences in dental health and treatment need among the children from the different countries. The Scottish, Italian and German 5-year-olds exhibited the highest values for decayed, missing and filled teeth (dmft). The m component dominated for the Scottish sample, the d component in the Italian and d and f in the German sample. The highest values for DMFT in the 12-year-olds were found in the German, Greek and Italian samples followed by the Swedish sample. The F component dominated in the German and Swedish samples, while D dominated in the Greek and Italian samples. Analyses of the influence of socio-demographic and behavioural factors on the dental health, expressed as dmft/DMFT, showed that the most important factors explaining differences in caries experience were toothache, social class of the family and dental fear in the children. The frequency of similar attitudes (dental fear) in subjects and parents was 50% or higher in all the samples, and the frequency of similar dental attendance patterns in child and parent was 42% or higher in all the samples. For both age groups the proportion of subjects with regular dental attendance habits was highest in the Swedish, Belgian, German and Scottish samples. These findings, together with the high frequency of regular attenders without treatment need in the Swedish 5-year-olds indicate that organization of dental care must be closely adapted to the population it is set to serve. Separate strategies are necessary to manage the dental needs of healthy respectively diseased children. Reliable epidemiological data are necessary for planning, so that resources can be directed to the individuals with the greatest needs. However, to reach the children before onset of disease, parents, teachers, general health workers, sports coaches etc. must work jointly together with the dental profession. Among the eight countries, there is greater similarity in the organization of dental care for schoolchildren than for pre-school children. Only the Swedish system offers both preventive and restorative treatment irrespective of initiatives from the parents. In the other countries parents are mainly responsible for arranging for restorative treatment, above all for pre-school children. Different policies to promote dental health in the child population can be seen. Fluoridation of domestic water supplies has been implemented in Ireland, and the frequent use of fissure sealants in the Scottish, Irish and also the Belgian 12-year-olds is another example of a cost-effective measure influencing the dental health.