Experience and Prevalence of Dental Caries Among 15-year Old Adolescentsin the Eastern Region of the Republic of Macedonia

Research Article

J Dent App. 2014;1(4): 68-74.

Experience and Prevalence of Dental Caries Among 15-year Old Adolescentsin the Eastern Region of the Republic of Macedonia

Vesna Ambarkova1*, Valentina Spasova2 and Raffaella Matteucci Gothe3

1MSc, DDS, University St. Cyril and Methodius, Faculty ofDental Medicine, Department of Paediatric andPreventive Dentistry, Skopje, Republic of Macedonia

2PHO Health Center Dr. Pance Karagozov, Sector for preventive and pediatric dentistry str: HristijanKarpoš bb, 2000Štip, Austria

3Institute of Public Health, Medical Decision Making and HTA, street: Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria

*Corresponding author: Vesna Ambarkova PhD., Candidate. MSc, DDS, University St. Cyril and Methodius, Faculty of Dental Medicine, Department of Paediatric andPreventive Dentistry, Vodnjanska 17 University Dental Clinic Center Sv. Pantelejmon, Skopje 1000 , Republic of Macedonia

Received: July 02, 2014; Accepted: September 16, 2014; Published: September 18, 2014


Aim: The aim of this study was to investigate the experience and prevalence of dental caries among secondary school adolescents (first grades) in Eastern Region of the Republic of Macedonia.

Methods: In this cross-sectional study, adolescents from8 Secondary Schools (first grades, N= 414) were selected. Participants dental status was evaluated using the 2013 World Health Organization caries diagnostic criteria for Decayed, Missing or Filled Teeth (DMFT) by 2 calibrated examiners.

Results: The total number of adolescents the sample was 414, comprising 188 (45.4%) females and 226 (54.6%) males. The mean DMFT was 5.77, with standard deviation (SD) of 4.02 and 95% confidence interval (CI) of 5.38- 6.16. Significant caries (SiC) index was 10.22.The prevalence of caries-free adolescentswas9.4%. The percentage of untreated caries or the ration of D/ DMFT was 0.49 (49.05%). The prevalence of dental caries in secondary school adolescents was 90.6%.

Conclusions: Dental caries experience was seen to be high among 15- year old secondary school adolescents(first grades) in Eastern Region of the Republic of Macedonia.

Keywords: Caries; Caries prevalence; DMFT index; Macedonia


Dental caries is a public oral health problem and one of the major unmetneeds in oral health amongst the teenage population of the Republic of Macedonia, It is an infectious-contagious disease implying an imbalance of normal molecular interactions between the teeth's surface/subsurface and the adjacent microbial biofilm [1]. It becomesexpressed during a certain period of time as an accumulative demineralizationwhich, if not treated, has the potential for producing cavities in the enamel andcollateral damage in dentine and pulpar tissues [2].

It is widely recognized that adolescents are among theleast likely to use the health services [3] and some studies have shown that dental care is the most common typeof unmet health care need in adolescence [4,5]. It is therefore worrying that adolescents reduce their utilization ofdental services [6], and may altogether cease to attend thedentist upon leaving school [7]. Adolescents may be at greater risk for dental disease during a developmental periodswhen they are establishing oral care habits [8]. Based on the information from the Ministry of Education and Science there are 91.167 students attending 113 secondary schools in the Republic of Macedonia. Number of students at first grade of secondary schools are 20.017, in the whole country.

The results for the state of oral health and rehabilitation needs of our Macedonian population obtained from epidemiological study in 1990, worked as part of a joint Yugoslav study "Assessment of oral health and treatment needs of the population of Yugoslavia by applying the basic criteria of the WHO initiative" indicate a very serious condition. DMFT scores were in range from 0.54 in six-year children to 23.84 in the population of 65 years [9].

The high level of caries prevalence in 15 years old in the Republic of Macedonia was recorded in 1991 (DMFT 8.13) by Neceva et al. [10]. At the same time dentistry in Macedonia had its rapid development as well in manpower and equipment, but strictly oriented toward therapeutic dentistry. This argument and such high DMFT gave the initiative idea for creating a National Strategy for prevention of oral diseases in child population of Macedonia in 2007 [11].

Children from this age group were born in 1997/98 and were not exposed to fissure sealing of the first permanent molars right after their eruption, which was part of the National Caries Preventive Program and National Strategy and started to be implemented in 2007 [11].

In the future we expect as a result of the application and implementation of the National Strategy for prevention of oral diseases in children from 0 to 14 years of age, launched in 2007, DMFT index in this group of children drastically to be reduced.

The aim of this study was to investigate the experience and prevalence of dental caries among secondary school adolescentswithin the Eastern Region of the Republic of Macedonia and evaluate how their disease pattern is related to variables, such as gender, rural-urban areas of the population.


Statistical data that was collected were from 15-year-old secondary schooladolescents children in the Eastern part of the Republic of Macedonia. For each child following data was recorded: age, sex (male or female), ethnic group, area (urban or rural), city/ village, number of decayed teeth (DT), number of missing teeth (MT) and number of filled teeth (FT). Then, the DMFT score, the sum of DT, MT and FT, was calculated and recorded for each child. The size of the statistical sample was 414.

The sample for the present cross-sectional study was 414 secondary school children from first grades, attending secondarymunicipality schools and gymnasiums in the cities from this region (Gymnasium Koco Racin and secondary municipality school" Koco Racin"(auto mechanics and mechatronicians) from Sveti Nikole. secondary schools Gošo Vikentiev and Ljubco Santov from Kocani, secondary school Metodi Mitevski Brico from Delcevo and secondary municipality school Nikola Nehtenin, secondary textile school Dimitar Mirasciev and high musical school Sergej Mihajlov secondary music school from Štip. Based on the information from the Macedonian Institute of Statistic [12] there are approximately 7172 students attending 13 secondary schools in this region. From 505 secondary school students in Delcevo, 131 are at first grade, while in Kocani from 2.745 students in total from secondary schools in Kocani 446 are at first grade.

The research was carried out within 2012 and 2013, and included 414 secondary school pupils of both sex at the age of 15 in the eastern area of the Republic of Macedonia. The parameters used to estimate oral health condition were mean number of decayed, missing and filled teeth due to caries (DMFT), Significant Caries Index (SiC). Caries status was registered by Klein-Palmer system DMF(D-Decayed, M-Missing, F-Filled).A dental team clinically examined all the subjects in line with World Health Organization (WHO) methodology and criteria [13]. Two examiners were trained and standardized using a Kappa test (>0.90) before starting the study. All data were expressed as mean ± standard deviation for continuous variables; frequencies and percentages were calculated for categorical data.

All the chosen children from the sample were checked by the standard dental diagnostic equipment (plane dental mirror, dental standard probe) under the artificial light on the dry teeth, on the dental chair. It was decided to use cluster sampling because it was more economical and achievable withinthe constraints of resources and finance.

Permission for the study was obtained from the school authorities, who sought and obtained consent from the parents of the children concerned.Ethical approval was obtained from the Ministry of Health.

A new index called the 'Significant Caries Index' (SiC)was recently proposed by the World Health Organization (WHO) to draw attention to thoseindividuals with the highest caries scores in each population [14]. The SiC Index leads tosignificant gains for society and for the persons concerned as more specific targetedpreventive actions can be implemented. The SiC is the mean DMFT of one third of the studygroup with the highest caries score.

Statistical Analysis

Statistical analysis was accomplished by using non-parametric Mann-Whitney U Test to see if there are differences in mean DMFT scores between sexand area groups. Kruskal-Wallis Test was performed to see if there are differences in mean DMFT scores between the cities group. Descriptive statistic was performed by calculating median and interquartile range. A standard statistical package SPSS Statistics 20 was used for performing the data analysis.


In Table 1 and 2, the distribution of individuals in studied sample is given.