Oral health status and treatment needs of Iraqi and Yemeni dental students (A comparative study)

The aim of this study is to compare oral health status (dental caries, periodontal disease and treatment needs) of Iraqi and Yemeni dental students. The sample included 100 Iraqi dental students and 90 Yemeni dental students of fourth grade, age ranged between 22–23 years old of both sexes. The study revealed that there was a significant difference in the DMFT between Iraqi and Yemeni dental students for the total sample at p < 0.05 level, with significant difference between Iraqi and Yemeni dental students for both sexes at p < 0.01 level. The results also revealed that there was no significant difference in the type of treatment required for the total sample between females of Iraqi and Yemeni dental students, but with significant difference in the treatment need between males of Iraqi and Yemeni dental students. Highest percentage of treatment need for Iraqi and Yemeni students were for 1 surface restoration. The highest CPITN code percentage for Iraqi students was for code 2 (calculus) followed by code 1 with a significant difference between Iraqi males and females students at p<0.01 level, while for Yemeni dental students the highest CPITN code percentage was for code 1 followed by code 2. There was a significant difference in the total sample between Iraqi and Yemeni dental students at p<0.01 level; i.e., Iraqi students require scaling while Yemenis require oral health instruction.


INTRODUCTION
Dental caries and periodontal disease are very important public health problems because of their high prevalence. (1) These two diseases spread widely that almost every body in the world is affected with one or both of them. Dental caries and periodontitis, although generally are not life threatening, are nevertheless of significant importance. (2) An understanding of the molecular nature of these diseases could aid the development of novel methods of prevention, control and increase our knowledge of their etiology. (3) Dental caries is a bacterial disease modified by diet and condition in the mouth. (4)(5)(6) Many other factors affecting prevalence and severity of dental caries as age, (7) Oral health status and treatment needs of Iraqi and Yemeni dental students (A comparative study) sex, (8,9) socioeconomic status, (8) oral hygiene, (10) fluoride (11) and race. (8)

MATERIALS AND METHODS
This study was conducted during the period between November 2001 to January 2002 among Iraqi and Yemeni dental students. A random sample was composed of 100 Iraqi students (62 males and 38 females) and 90 Yemeni students (77 males and 13 females); age range between 22-23 years old selected from the fourth grade. As a general rule observed in Yemen, female numbers are relatively low in comparison with male numbers. The clinical examination was carried out in the College of Dentistry using plane mouth mirrors, sharp sickle shaped explorers and periodontal probes to detect the dental plaque and gingival health.
The indices used for assessment of dental caries, gingival and periodontal co-nditions were as follow: 1) DMFT by World Health Organization (1997) (12) for caries status and treat-ment needs to obtain and calculate the Decayed "D", Missing "M" and Filled "F" for each tooth. 2) CPITN by World Health Organization (1987) (13) for assessment of gingival and periodontal health status and their treatment needs. The statistical analysis of the data included the mean and standard error for dental caries and periodontal health using F, Fisher exact, and chi-square tests.

RESULTS
Table (1) shows the distribution of the sample by sex for Iraqi and Yemeni dental students (area of residence). One hundred Iraqi dental students (62 males and 38 females) and 90 Yemeni dental students (77 males and 13 females).  Table (2) shows the mean DMFT and its components for Iraqi students for both sexes. It has been shown that the mean DMFT for the total sample was 6.34. The results revealed that the mean DMFT for females (7.76) was higher than that for the males with a significant difference between them at 0.05 level. The highest proportion was for DT followed by FT then MT. Table (3) shows the mean DMFT and its components by sex for Yemeni dental students. It has been shown that the mean DMFT for the total sample was 4.1. There was no significant difference between males and females Yemeni dental students. The highest proportion was for DT followed by FT then MT, with a significant difference in the MT, FT but not in DT proportions.  Table (4) shows the percentage of treatment needs for the sample (both groups) by sex.
It has been shown that the highest percentage of treatment need for Iraqi and Yemeni dental students was for 1 surface restoration followed by 2 surfaces restoration then other types of dental treatment need.
The results showed that there was no significant difference in the treatment need for the total sample for both students' groups as well as for the females of the two groups but there is a significant difference for the male students.
Table (5) shows the number and percentage of Iraqi dental students distributed according to the highest CPITN code by sex. It has been found that the highest percentage was for code 2 followed by code 1. The highest percentage was for males with a significant difference for codes 1 and 2 at 0.001 level.
Table (5) also shows the number and percentage of Yemeni dental students distributed according to the highest CPITN code be sex. It has been found that the highest percentage was for code 1 followed by code 2 with difference between them at p<0.001 level.
As a total sample there was a significant difference between Iraqi and Yemeni dental students at p < 0.01 level.

DISCUSSION
The criteria selected for the assessment of caries experience in the study followed WHO Oral Health Surveys. (12) This method ensures that the data collected in a wide range of environment is comparable. It also provides a standard measurement of oral disease and conditions as a base for planning and evaluating oral health. The results of this study have shown that the mean DMFT for the total sample of Iraqi dental students was 6.34 and 4.1 for Yemeni students. This variation in the DMFT values may be attributed to differences in dietary habits of different communities especially consumption of refined sugars and may be attributed partly to the adoption of different diagnostic criteria in various studies. (  The Iraqi female dental students have higher mean DMFT (7.76) than Yemenis. This is in accordance with the study of Al-Naimi. (9) There was no significant difference in the mean DMFT of Yemeni dental students for both sexes. This result is in agreement with other studies. (14,15) The study also revealed that the decayed component of the DMFT score had the greatest value. This means the presence of a high percentage of carious teeth that are untreated. This is in accordance with other studies in the developing countries. (2,14) This reveals the limited restorative approach in most of developing countries due to limited resources. This is in contrast to other studies in the developed countries where the majority of the DMFT index was formed of filled teeth and less missing teeth. (16,17) Concerning Table (4), it has been shown that there was a high need for dental treatment. This is in contrast to the findings in Hong Kong where a very small proportion of students needed dental treatment. This may be attributed to implementation of water fluoridation. (18) The Table shows that majority of Yemeni students were in need of 1 surface restoration. This result is in agreement with the results reported by other studies. (19,20) While for the Iraqi students, the majority of them were in need of 2 surfaces restoration. This result was in accordance with those of Stahl and Katz, (21) which sh-ow that the risk of occlusal caries has extended into the late and post-teenage years. (22) The Community Periodontal Index of Treatment Needs (CPITN) was used in this study to assess the periodontal disease status. This index since it was adopted by WHO and FDI has been used in many studies as a basic epidemiological tool for the assessment of the nature and magnitude of the need for periodontal treatment and as an aid for planning public dental services. The results of CPITN have shown that for Iraqi dental students only 4% of the students examined had healthy ging-iva without any sign of periodontal dise-ase, while for Yemeni students the percen-tage was 7.8%. This means that the preval-ence of periodontal disease in this study was very high for both groups. This is in accordance with a study carried out in Baghdad by Al-Mufti. (23) The study also revealed that about half of the Yemeni dental students (47.8%) had bleeding gum with higher percentage for the females than for males. This is in contrast to what has been found in developed countries where females have better

Comparison of oral health status and treatment needs of Iraqi and Yemeni students
Al-Rafidain Dent J Vol. 5, No. 1, 2005 oral hygiene because they practice regular and effective oral hygiene measures more than males. (24,25) While for the Iraqi students the highest score was for calculus. This is in accordance with the results of other studies which found that calculus had the highest score. (2,7,26,27) The percentage of students who needed scaling reflects the massive need for periodontal therapy. This condition is universal in most of the developing countries. This high need for professional treatment (scaling) can not be coped within these countries because it is quite expensive and costly. In addition to that it needs a lot of time and enormous number of dental personnel which can not be coped with the limited resources present in these countries. There should be more emphasis on primary prevention of periodontal disease by means of improvement of oral hygiene measures; in addition to setting health education programs for groups of students rather than giving oral hygiene instructions to individuals. This step will be less time consuming and more economical.

CONCLUSIONS
Dental caries experience in the sample was high and the risk of occlusal caries had extended into the late and post-teenage years that it is necessary to apply fissure sealant to the students' teeth in addition to dietary restriction of sugar.
Concerning periodontal disease, calculus is more prevalent among Iraqi students while bleeding gum is more prevalent among Yemeni students. So Iraqi students are in need of scaling while Yemeni students need intensive oral hygiene education program.