INTRODUCTION

The term refugees describe people who enforce to leave their hous-es and normal daily lifestyle under different and difficult circumstanc-es1). Such abnormal changes lead to involve in stressful life conditions2). The worst oral health condition was often found among these groups of people3,4). The psychological stress and sadness reflect negatively on them, in a way that can affect their health as well the oral as a part of this health5).

The most important oral health problems that the refugees complain from are:

1-Caries. Caries is a bacterial disease that destroys tooth structure6). The DMF index is used for measuring the prevalence of dental caries among populations and it is supported by the World Health Organization (WHO). The (DMF) is the synonym of Decayed, Missing, Filled, a mean index that used to record caries epidemiology for many years ago7). The missing teeth recorded by such an index were referred to as lost teeth by any other cause rather than dental caries and what lost also due to dental caries, including primary teeth that remain within the pres-ence of permanent dentition. The third molar counted or not depend on the researcher's way. D recorded when the tooth caries or filled. F recorded When any type of filling was found or defected filling without

caries. When the tooth filled not due to caries but for another causes it was not considered as an F8).

2 - Root caries is another destructive form of caries, mostly appear on teeth of old adult and cause tooth loss9). Thus, it may reflect the oral health-related to elderly peoples10). Root caries increase within age and it is difficult to examine due to the variety of lesion, or their prevalence11).

International Medical Journal Vol. 27, No. 3, pp. 357 - 359 , June 2020

ORAL MEDICINE

Caries Index, Root Caries Index and Gingival Index in Immigrants at the Camp of Arbat in Sulaimaniya

Governorate, Iraq

Raida Noori Hamid, Shaimaa Hamid Mudher, Shakir Mahmood Ali

ABSTRACTObjective: Maintaining good oral hygiene still consider one of the important daily requirements for keeping general health

conditions among all populations. The circumstances that refugee inforced to face and live with, may affect on providing such essential oral health need, which by turn reflect on their oral health status. This study was done to estimate the statues of oral health for refugees who live in Arbat camp, Al-Sulaimaniya Governorate, Iraq by examining the incidence of the crown and root caries, as well as the gingival inflammation.

Methods: The examination of crown, root, and gingiva was done for 200 people (male and female) who lived in the camp. Indices such as DMFT, RCI, and GI. Cross-sectional studies were used to assess the prevalence of caries in crown and root in addition to gingival inflammations of these groups. The statistical analysis was established using the statistical package of SPSS-24.

Results: A statistical significance was recorded a noticeable increase in values of DMF Mean ± SD with both of male 10.3 ± 3.2 and female 11.2 ± 3.5. The RCI was shown the same increase and the values of RCI Mean ± SD were 0.4 ± 0.3 and 0.4 ± 0.4 for males and females respectively. Such significance was also demonstrated in the GI Mean ± SD and the results were 0.8 ± 0.6 for males and 0.8 ± 0.7 for females.

Conclusions: Analysing the obtained results revealed on the important fact that refugees need for more oral health instruc-tions and follow up the motivation to understand the value of preserving healthy oral status, in which by turn can reflect posi-tively on their general health in a way make them able to face their unusual life circumstances.

KEY WORDS caries index, root caries index, gingival index, and immigrants

Received on December 4, 2019 and accepted on April 10, 2020Department of Oral Medicine, College of Dentistry, University of AnbarAldoura City, Baghdad, IraqCorrespondence to: Riada Noori Hamid (e-mail: rnh1189@gmail.com)

357

C 2020 Japan Health Sciences University & Japan International Cultural Exchange Foundation

Table 1.Age (years) Gender

Male Female Total

No % No % No %

< 30 11 45.8 13 54.2 24 12.0 30---39 26 60.5 17 39.5 43 21.5 40---49 38 52.8 34 47.2 72 36.0 50---59 23 50.0 23 50.0 46 23.0 => 60 7 46.7 8 53.3 15 7.5 Total 105 52.5 95 47.5 200 100.0

Mean ± SD 43.0 ± 10.3 43.5 ± 10.7 43.2 ± 10.5(Range) (25-65) (25-65) (25-65)

Hamid R. N. et al.358

Root caries is considered to be a preventable disease. However, it is not responses to the preventable method such as fluoridation, fluoridated toothpaste at the same degree9).

3-Gingivitis, A disease that affects gingival tissue due to inflamma-tion, it is a reversible periodontal disease12). The dental plaque which is a bacterial biofilm adheres to the surface of the tooth can cause such inflammation if it is not removed. The inflammation if not treated, gin-givitis will develop and further disease progression will be periodontitis. Gingivitis is reversible when good oral hygiene is applied, but the neglecting will cause the development of periodontitis, by which loss of tissue and bone will occur and by the end, tooth loss occurs13). Different gingival conditions are measured by the Gingival Index14) that illustrates the qualitative changes in the gingiva, as well as the prevalence and severity of gingivitis. It measured gingivitis for all tissues around the tooth by degrees from 0 to 3. They are 0 = when the gingiva is normal; 1 = inflammation is mild ---on probing there is no bleeding, but slight edema and a slight change in color, on probing there is no bleeding; 2 = Inflammation is moderate --- edema, redness, and glazing, on probing there is no bleeding; 3= inflammation is severe ---redness and edema, with ulceration with a tendency to spontaneous bleeding. The Gingival Index is made for all selected teeth. Whereas the gingival index from 0.1-1.0 is mild inflammation; 1.1-2.0 mean moderate inflammation, and 2.1-3.0 mean severe inflammation. Therefore, in a study like this and its performed work we need ideal descriptive data about the oral health of refugees, to change the predominant unhealthy attitudes among them15). Study the oral health status in this group of people was important to assess and plan further comprehensive dental health programs for all

communities16).

MATERIALS & METHOD:

The research has been planned to study the influence of leaving the person his/her usual home or place on his/her oral health. This study was carried out on 200 males and females aged 25-65 years old living in one of the refugees camp (Arbat, Sulaimaniya governorate, Iraq). Usual examination of tooth caries in crown and root, in addition to the condi-tion of the gingiva, was done by using diagnostic instruments (probe, mirror), cotton rolls, and portable light, the collected information were recorded by using of caries index for the crown and root in addition to the gingival index. The crown caries index was simply based on count-ing the number of decayed, missing (due to caries only) and restored teeth. The final DMF Index was shown the summation of teeth or sur-faces with decayed (D), missing (M), or filled (F) for an individual.

RCI calculated by the number of filled and decayed root surfaces proportionally to the number of exposed root surfaces17).

Then calculated by the following formula;

The number of root surfaces with carious root lesions/ number of surfaces with gingival recession. (Formula for calculating root caries index percentages).

The condition of each root surface was analysed according to the following criteria:

a) The gingival recession occur when the cement enamel junction was visible18).

b) Signe of root caries the exploratory probe easy to penetrate a root surface, change in the color of the tooth surface (darkened, chalky)19).

c) All the restored root surface was considered as filled such as abrasion, erosion or caries20).

The gingival index was calculated by summation of the scores of

Table 2. Gender P

Male Female Total value

DMF (Decayed, 10.3 ± 3.2 11.2 ± 3.5 10.7 ± 3.3 0.074Missed, Filled Index) (1-19) (2-19) (1-19)RCI (Root Caries 0.4 ± 0.3 0.4 ± 0.4 0.4 ± 0.6 0.379Index) (0-1.0) (0-1.0) (0-7.0)GI (Gingival Index) 0.8 ± 0.6 0.8 ± 0.7 0.8 ± 0.7 0.764 (0-2.7) (0-2.5) (0-2.7)Data were presented as Mean ± SD (Range)

Figure 1A Figure 1B

Figure 2

Caries Index, Root Caries Index and Gingival Index in Immigrants in Iraq 359

the four areas of the tooth that can be summed and divided by four, add-ing to that the values of each tooth then divided by the number of exam-ined teeth to give an idea about the GI of the individual.

GI = score for 4area/4 (for one tooth)A cross-sectional study was used to know the prevalence of dental

caries and gingivitis for people who lived in Arbat camp. Statistical analysis was calculated by using an available statistical package of SPSS-24 (Statistical Packages for Social Sciences- version 24).

Analysis of collected data (DMF, RCI, and GI) was demonstrated in simple measures of mean, range, percentage, frequency, and standard deviation.

Quantitative data were calculated by using the Students’ t-test to be compared between two independent means, and when comparing more than two independent means ANOVA test was used.

RESULTS

The results of this study according to the Table 1 which took the male and female ages range between 25 and 65and, the recorded Mean ± SD was 43.0 ± 10.3 for male and Mean ± SD for female 43.2 ± 10.5.

The higher number of male 38 for an interval between 40_49, while the higher number of female 34 for the same interval.

The distribution of the DMF value among the refugees was shown in (Figure1, A), the greater distribution of it 11 then 10 and 12 in second degree until reach to 1 and 2 in the last degree.

The distributions of RCI value shown in (Figure 1, B).The distribution of GI value was shown in (Figure 2).The result of Table 2 was showed that all the variables measured in

this study sample of males and females are nearly showed the same val-ues.

DISCUSSION

The comparison of this study results with other studies that had been done on other refugees’ sample was very difficult due to the sam-ple size, the environment where these people live, and the standardisa-tion of the indicators used. The social condition was the main cause to obtain unsatisfactory results about the oral health status that was found in previous studies21,22,15).

The factors that associated with making people being refugees were related to social evidence effect on health and lead to increase the health status outcomes which were considered stronger features of different individual variable such as age, sex or race23).

In 1999 to 2004 the third National Health and Nutr i t ion Examination Survey reach to facts that 30.8% rate of root caries was in persons between 50 and 64, while 10.4% was the prevalence rate of root caries in adult between 20 to 3424) This was recorded when using the same criteria and indicators to evaluate root caries for teeth of adults and elderly people leading to compare between time passing and place25). The upper molars were more affected by root caries than other upper teeth. Generally, the upper teeth were more susceptible to root caries than lower teeth26). The prevalence and prognosis of root caries cannot be correctly estimated due to the presence of restoration for either to treat abrasion or root sensitivity. The diagnosis, knowing the causative factors and appropriate treatment recommendations give appropriate criteria about root caries.

The overall health status of any refugee camp was significantly affected by oral health care services that presented for the population in, this should take into consideration the number of these people, and the need to consider them as a part of the main community population27).

(The most common oral pathologies are caries and periodontal dis-eases, which affect all populations along different their life stages3).

The long-standing gingivitis with GI scores of 2 or more, would lead to periodontitis. Persistent periodontitis for a long time would lead to an increase in the risk factor for loss of tooth which had proved by recent research28). To prevent periodontitis we must decrease or prevent gingivitis in population, which was considered the first step to avoid periodontitis29).

Important information given by examiners encourages oral health promotion. We must know the way that makes people in camp take care of their oral health4,8,)

The dental care according to different studies will increase due to health insurance, dental care is considered as one of the supporting fac-tors toward seeking health care services30)

REFERENCES

1) Spallek J, Zeeb H, Razum O. Prevention among immigrants: the example of Germany. BMC Public Health 2010; 10: 92: 1-6.

2) Shuval JT: The relationship of health to the social and cultural context of the society. In Social dimensions of health: The Israeli experience Westport, Connecticut London; 1992: 172-180.

3) Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiyae C: The global burden of oral diseases and risks to oral health. Bulletin of the World Health Organization 2005, 83: 661-669. [PMC free article] [PubMed].

4) US Department of Health and Human Services: Oral Health in America: a report of the Surgeon General. Executive summary. Rockville, MD: US Department of Health and Human Services, National Institute of Health, National Institute of Dental and Craniofacial Research; 2000.

5) Selwitz RH, Ismail AI, Pitts NB: Dental caries. Lancet 2007, 369: 51-596 6) Locker D: Research on oral health and quality of life --- a critical overview, Editorial.

Community Dental Health 2008, 25: 130-131. 7) Locker D: Self-esteem and socioeconomic disparities in self perceived oral health. J

Public Health Dent 2009, 69(1): 1-8. doi: 10.1111/j .1752-7325.2008.00087.x. [PubMed] [Cross Ref].

8) Cappelli DP, Mobley CC. Prevention in Clinical Oral Health Care. Philadelphia, Pa: Mosby Elsevier; 2007.

9) Griffin SO, Griffin PM, Swann JL, Zlobin N. Estimating rates of new root caries in older adults. J Dent Res. 2004; 83: 634-8. [PubMed]

10) Slade GD, Spencer AJ, Roberts-Thomson K. Tooth loss and chewing capacity among older adults in Adelaide. Aust N Z J Public Health. 1996; 20: 76-82. [PubMed]

11) Saunders RH, Jr, Meyerowitz C. Dental caries in older adults. Dent Clin North Am.2005; 49: 293-308. [PubMed].

12) The American Academy of Periodontology. Proceedings of the World Workshop in Clinical Periodontics. Chicago: The American Academy of Periodontology; 1989: I/23-I/24.

13) "Parameter on Plaque-Induced Gingivitis". Journal of Periodontology 71 (5 Suppl): 851. 2000. doi:10.1902/jop.2000.71.5-S.851. PMID 10875689.

14) Löe, H.; Silness, J. Periodontal disease in pregnancy. Acta Odontologica Scandinavica, Vol. 21, (December 1963), pp. 533-551, ISSN 0001-6357.

15) Zini A, Vered Y, Sgan-Cohen HD. Are immigrant populations aware about their oral health status? A study among immigrants from Ethiopia. BMC Public Health 2009 9: 205: 1-6.

16) Silk, H (March 2014). "Diseases of the mouth.". Primary care 41 (1): 75-80.doi:10.1016/j.pop.2013.10.011. PMID 2443988

17) Katz RV: Assessing root caries in populations: The evolution of the Root Caries Index. J Public Health Dent. 1980, 40: 7-16. 10.1111/j.1752-7325.1980.tb01844.x.View ArticlePubMedGoogle Scholar.

18) Fure S, Zickert I. Prevalence of root surface caries in 55, 65 and 75-year-old Swedish individuals. Community Dent Oral Epidemiology 1990; 18: 100-105. [ Links ]

19) Katz RV. The clinical identification of root caries. Gerodontology 1986; 5: 21-24. [ Links ]

20) Beck JD, Hunt RJ, Hand JS, Field HM. Prevalence of root and coronal caries in a non-institutionalized older population. J Am Dent Assoc 1985; 111: 984-967.

21) Barbara JS, Greenberg Jay V K, Holly S. Dental Case Management Increasing Access to Oral Health Care for Families and Children With Low Incomes. J Am Dent Assoc, 2008; 139: 11: 121-141.

22) Gao XL, McGrath C. A Review on the Oral Health Impacts of Acculturation. J Immigrant Minority Health 2011; 13: 202-213.

23) Cruz GD, Chen Y, Salazar CR, MPH, Karloopia R, LeGeros RZ. New Determinants of Oral Health Care Utilization Among Diverse Groups of Immigrants in New York City. J Am Dent Assoc 2010; 141; 871-878.

24) Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital Health Stat 11. 2007; 248: 1-92.

25) Rihs LB, Souza MLR, Wada RS. Root caries in areas with and without fluoridated water at southeast region of S?o Paulo State, Brazil. J Appl Oral Sci. 2008; 16(1): 70-4. DOI: 10.1590/S1678-77572008000100014.

26) Walls AWG, Silver PT, Steele JG. Impact of treatment provision on the epidemiologi-cal recording of root caries. Eur J Oral Sci. 2000; 108(1): 3-8. DOI: 10.1034/j.1600-0722.2000.00767.x [ Links ]

27) ISTAT "Istituto nazionale di Statistica". Condizioni di salute, fattori di rischio e ricorso ai servizi sanitari. (Health conditions, risk factors and health care utilization) Ava i l ab le f rom: h t tp : / /www. i s t a t . i t / s a l a s t ampa /comunica t i / non_ca len -dario/20070302_00/ testointegrale.pdf (last access: June 2011).

28) Lang, N.P., Schäzle, M.A., Löe, H., 2009. Gingivitis as a risk factor in periodontal dis-ease. J. Clin. Periodontal. 36(Suppl 10), 3-8.

29) Burt, B.; Research, Science and Therapy Committee of the American Academy of Periodontology. Position paper: epidemiology of periodontal diseases. Journal of Periodontology, Vol. 76, No. 8 (August 2005), pp. 1406-19, ISSN 0022-3492.

30) Manski RJ, Cooper PF. Dental care use: does dental insurance truly make a difference in the US? Community Dent Health. 2007; 24(4): 205-212. [PubMed]