Oral Health in Bosnia and Herzegovina Schoolchildren - Findings of First National Survey

Research Article

Austin J Dent. 2014;1(2): 1010.

Oral Health in Bosnia and Herzegovina Schoolchildren - Findings of First National Survey

Nina Markovic* and Amra Arslanagic Muratbegovic

Department of Preventive and Pediatric Dentistry, University of Sarajevo, Bosnia and Herzegovina

*Corresponding author: Nina Markovic, Department of Preventive and Pediatric Dentistry, University of Sarajevo, Bolnicka 4a, 71000 Sarajevo, Bosnia and Herzegovina

Received: August 20, 2014; Accepted: September 16, 2014; Published: September 18, 2014


Aim: The aim of this study was to investigate the oral health of schoolchildren in Bosnia and Herzegovina (BH) according to the WHO methods and propositions.

Materials and Methods: Survey was conducted as observational, descriptive (cross-sectional) study. Study sample were children aged 6 and 12. A total of 1,120 children were examined. Observable oral health parameters were dental caries, periodontal condition and demarcated opacities.

Results: In 12-year-olds the DMFT was 4.16 ± 2.92, and the decayed teeth constituted the major part of the index (45.43%). In 6-year-olds the DMFT was 6.71 ± 3.89, and the decayed teeth constituted the major part of the index (88.79%). 43% of 12-year-olds had healthy periodontal tissues. The prevalence of developmental defects of enamel among BH twelve-year-olds was 32.8%.

Conclusion: Results of national survey for two monitoring children population groups revealed insufficent preventive and currative dental care in all examined sites in BH.

Keywords: Oral health; Schoolchildren; DMFT; dmft; Periodontal status; DDE


BH: Bosnia and Herzegovina; WHO: World Health Organization; DMFT: Decayed, Missing, Filled Index; dmft: Decayed, Missed, Filled Index; CPITN: Community Periodontal Index of treatment Needs; DDE: Developmental Defects of Enamel


Good oral health is essential for optimal general health and life quality. It encompasses the integrity and health of specific parts of the oral cavity - teeth, oral mucosa, masticatory muscles, tongue, TMJ and salivary glands - used to perform the functions of chewing, speech and swallowing. The World Health Organization (WHO) recommends conducting periodic national oral health surveys. Ten oral health parameters has to be evaluated in precisely defined sample age groups [1]. Obtained data enables planning of measures to improve the oral health of the population of relevant countries. Similar research was conducted only in parts of Bosnia and Herzegovina's territory. Ivankovic 1997 carried out research in three cantons of the Federation of BH, pointed average DMFT (±SD) to 6.2 ± 4.0 in twelve-year-olds while in six-year-olds it was 4.8 ±3.9 [2]. The above research conducted in Bosnia ans Herzegovina (BH) indicates a poor state of oral health in our country, especially among children. Epidemiological data about the oral health status which our country currently lacks are prerequisite for developing a program and measures for the improvement of oral health. Bosnia and Herzegovina (BH) is made up of two entities: the Federation of Bosnia and Herzegovina (FBH) further divided into 10 cantons and the Republic Srpska (RS). It covers an area of some 51,128 km2, and has population of 3,717,130 million people. In the year 2000, the country had 787 active dentists [3].

Primary oral health care in Federation of Bosnia and Herzegovina is organized within public health services and private practice. Accessibility to insurance-funded oral health care differs between cantons in Federation of Bosnia and Herzegovina as administrative units and Republic Srpska as one of two entities. The aim of this study was to present and discuss the findings of the first national oral health survey of schoolchildren population in BH according to the WHO indicators and methods.

Material and Methods

The survey was carried out as an observational, descriptive (cross-sectional) study. The study was conducted during the year 2004 from March to May. The oral health survey was performed in total number of 1,240 schoolchildren aged 6 (N=560) and 12 (N=560). Study group 1 consisted of 6- year- old children (mean 6.2, SD ±0.9) attending the first grade of primary school. Study group 2 consisted of 12-year-old children (mean 12.2, SD ±0.8) attending the sixth grade of primary school. Children were examined in the following survey locations: Sarajevo as the capital (n=160; 40 examinees on four locations), Tuzla as a large town (n=80; 40 examinees on two locations, Banja Luka as a large town (n=80; 40 examinees on two locations); followed by Mostar, Gorazde, Siroki Brijeg, Visoko, Sanski Most as small towns but representatives of cantons with 40 examinees in each location. Selection of location sites and methods of oral health status evaluation was done according to the WHO criteria for countries with high caries prevalence [1]. Six-year-olds were targeted in order to determine the status of primary teeth, which is proven to be an important predictor of the health of permanent teeth. The age of twelve years is very important and was recommended by WHO as the earliest age in permanent dentition for assessment of oral health. The condition of twelve-year-olds' permanent teeth determines their future oral health.Therefore, this population subgroup was selected for international comparisons and observation of oral disease trends. Oral health assessments were carried out in schools, under natural light, using dental mirrors and CPITN-E periodontal probe. Oral health status was evaluated by one trained and calibrated examiner. Periodontal status was recorded by using CPI index according to WHO recommendations for subjects under 15 years of age [1]. Kappa statistics were used to present intra-examiner reliability Training and intra-examiner calibration was performed on 25 twelve-year-olds (k=0.91 for DMFT, k=0.89 for CPI, k=0.84 for DDE).

Obtained results were recorded using special WHO oral health assessment form.

The Statistical Package for Social Science, version 13.0 (SPSS Inc., Chicago, IL, SAD) was used. Results were analyzed by means of descriptive statistic (Frequencies, percentages, arithmetic mean value, standard deviation) following WHO guidelines for presenting results of survey for these population groups [1].


A study of caries prevalence has shown that the disease is wide-spread among twelve and six year olds in Bosnia and Herzegovina. In 12-year-olds the DMFT was 4.16 (S.D. ± 2.92) in that the D-component constituted the major part of the index (45.43%), followed by 42.07% of filled teeth and 12.50% of extracted teeth (Table 1). Percentage of children without active decay was 36.54%. In different locations DMFT was recorded in ranges from 2.70 (S.D.± 2.25) to 5.38 (S.D. ± 2.76). Although distribution of DMFT components varies in different location sites it is obvious that both preventive and currative dental care are insuffitient in all location sites. Results for all examined locations are presented in Table 1.