Caries prevalence of 5, 12 and 15-year-old Greek children: a national pathfinder survey.

Abstract

To study the caries prevalence and caries experience of 5, 12 and 15-year-old children in Greece and evaluate how the disease pattern is related to their sociodemographic parameters.
A stratified cluster sample of 1209, 1224 and 1257 of five, twelve and fifteen-year-old Greek children were randomly selected according to WHO guidelines for national pathfinder surveys and examined for dental caries, according to the BASCD criteria and standards. d3mft, D3MFT and their components, as well as d3mfs, D3MFS, Care Index (CI) and SiC were recorded and related to the demographic data collected concerning age, gender, counties, urban/rural areas and parents' educational status.
Dental caries varied considerably between the different districts, with a mean dmft/DMFT value for each age group being 1.77, 2.05 and 3.19 respectively, while 64%, 37% and 29% of them, were with no obvious dentinal caries. Children living in rural areas demonstrated significantly higher dmft/DMFT values and less dental restorative care (CI), whereas children with fathers of a higher educational level showed significantly lower dmft/DMFT values. The significant caries (SIC) index value for the three age groups was 5.01, 4.83 and 7.07 respectively. Posterior occlusal surfaces of the permanent teeth presented most of the caries in the 12 (68%) and 15-year-old group (78%).
Despite the decrease in the prevalence of caries in Greek children disparities remain. Children in rural areas and children with less educated parents had more caries and more untreated caries. All the above call for immediate intervention with comprehensive preventive programs and better geographic targeting of the dental services at a national level including targeted prevention of pit and fissure sealants on posterior permanent molars.

Full text

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Community Dental Health (2011) XX, 1–8
Received 31 July 2010; Accepted 16 May 2011
© BASCD 2011
doi:10.1922/CDH_2731Oulis05
Caries prevalence of 5, 12 and 15-year-old Greek children:
A national pathfinder survey
C.J. Oulis1, K.Tsinidou1, G.Vadiakas1, E. Mamai-Homata2, A.Polychronopoulou2 and
T. Athanasouli2
1Department of Paediatric Dentistry Dental School, University of Athens; 2Department of Preventive and Community Dentistry, Dental
School, University of Athens
Aim: To study the caries prevalence and caries experience of 5, 12 and 15-year-old children in Greece and evaluate how the disease
pattern is related to their sociodemographic parameters. Methods: A stratified cluster sample of 1209, 1224 and 1257 of five, twelve and
fifteen-year-old Greek children were randomly selected according to WHO guidelines for national pathfinder surveys and examined for
dental caries, according to the BASCD criteria and standards. d3mft, D3MFT and their components, as well as d3mfs, D3MFS, Care Index
(CI) and SiC were recorded and related to the demographic data collected concerning age, gender, counties, urban/rural areas and parents’
educational status. Results: Dental caries varied considerably between the different districts, with a mean dmft/DMFT value for each age
group being 1.77, 2.05 and 3.19 respectively, while 64%, 37% and 29% of them, were with no obvious dentinal caries. Children living
in rural areas demonstrated significantly higher dmft/DMFT values and less dental restorative care (CI), whereas children with fathers of a
higher educational level showed significantly lower dmft/DMFT values. The significant caries (SiC) index value for the three age groups
was 5.01, 4.83 and 7.07 respectively. Posterior occlusal surfaces of the permanent teeth presented most of the caries in the 12 (68%) and
15-year-old group (78%). Conclusions: Despite the decrease in the prevalence of caries in Greek children disparities remain. Children in
rural areas and children with less educated parents had more caries and more untreated caries. All the above call for immediate interven-
tion with comprehensive preventive programs and better geographic targeting of the dental services at a national level including targeted
prevention of pit and fissure sealants on posterior permanent molars.
Key words: caries prevalence, caries experience, national survey, adolescents
Introduction
During the past 20 years, many epidemiologic studies
have revealed a declining trend in the prevalence and
severity of oral diseases in Western children (Marthaler,
2004; Whelton, 2004). In Greece, a number of epide-
miologic surveys have been carried out through the years
in order to assess dental health in different areas of the
country (Mamai-Homata, et al., 1987, Oulis and Tsinidou,
1995), with only Moller and Marthaler (1988) perform-
ing a nationwide study on a representative sample of the
Greek population. However, the use of non-calibrated
examiners and the absence of standardized diagnostic
criteria in most of the studies cited above make epide-
miologic data non-comparable and question the scientific
interpretation of the results. On the other hand, there are
several epidemiologic surveys conducted in other Euro-
pean countries UK (Pitts et al., 2007), Sweden (Carina
and Sting, 2002) and Denmark (Ekstrand et al., 2007)
where the same criteria have been used and to which
our results can be compared.
The present study was part of a national pathfinder
survey aimed to assess the oral health status of the Hel-
lenic population for 5, 12, 15, 35-44, and 65-74 year-olds
and to train a number of examiners throughout the study.
The aim of this part of the study was to assess the car-
ies prevalence and the caries experience, of 5, 12 and
Correspondence to: Associate Professor C.J. Oulis, Department of Paediatric Dentistry, Dental School, University of Athens, Greece.
Email: cjoulis@paedoclinic.gr
15-year-old Greek children within the different counties
of the country and evaluate how their disease pattern is
related to variables, such as gender, parental educational
and rural-urban areas of the population.
Material and Methods
A stratified cluster sample was selected according to WHO
guidelines for national pathfinder surveys, which ensures
the participation of a satisfactory number of people that
may present different disease prevalence in the conditions
being examined (World Health Organization, 1987). To
obtain comparable data, samples were collected in the
same manner and from the same areas as in the 1985
survey (Moller and Marthaler, 1988) with four new areas
added to expand the survey. The survey covered two
cities (Athens and Thessaloniki), six counties (Achaia,
Chania, Evros, Ioannina, Kastoria, Larissa) and three
islands (Lesbos, Naxos and Kefallinia). Three com-
munities of different socio-economic backgrounds were
selected randomly within each of the cities, while one
urban and one rural community were selected randomly
within each county or island. Therefore, the survey was
conducted in 22 sites (14 urban, 8 rural) and around 50
subjects were examined at each site. Stratified random
sampling was used to select 3 schools from each city.
The sample totalled 3690 children of Greek nationality.

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Before examinations started we ensured all examiners
were calibrated for caries at surface level and for each age
group with a reference examiner was taken as the “gold
standard”. Initially this calibration covered the theory
of diagnostic criteria and common diagnostic problems,
using images of all different clinical conditions of teeth
with and without caries. The second session started
with every examiner examining 10 children twice with
the same children also examined once by the reference
examiner. Results were then analysed and disagree-
ments discussed. Each examiner was evaluated for intra
and inter-examiner reliability with an accepted level of
specificity and sensitivity level above 85% (Pine et al.,
1997). Then, after the reference examiner explained
the possible reasons for the disagreements, non-standard
examiners examined 10 new children and were again
compared with the standard until they reached agreement.
All clinical examinations were carried out by the cali-
brated examiners, assisted by an assistant as a recorder.
The examinations were held in the schools’ classrooms,
using reclining chairs and portable lights under stand-
ardised conditions recommended by the World Health
Organization. Cotton rolls and gauze were available
for moisture control and removal of plaque as necessary.
All dental surfaces were examined and caries was
diagnosed at the cavitation level (D3) threshold accord-
ing to the BASCD criteria and trainers’ pack standards
(Pitts et al., 1997), using a visual method without x-rays,
fibre-optic transillumination or compressed air. Data were
recorded on individual charts and the following indices
calculated: percentage of subjects with no evidence of
dental caries (DMFT/dmft=0), dmft/DMFT and dmfs/
DMFS indexes and the mean number of decayed (DT/dt),
missing (MT/mt) and filled (FT/ft) teeth for the permanent
and primary teeth respectively. Additionally, the Care
Index (CI) (ft/dmft% or FT/DMFT%) and the significant
caries index (SiC) representing the mean DMFT or dmft
of the one third of each age group with the highest caries
score were also calculated (Brathall, 2000).
Caries indices were analysed in relation to age,
gender, county, urban/rural areas and parental education.
Parental education was assessed in years of paternal and
maternal education and categorized into four levels: <6
years (primary), 9 years (secondary/high school), 12 years
(secondary/lyceum), >12 years (higher).
The chi-square test was used for the comparison of
proportions and the Student’s t-test and ANOVA for the
assessment of means. To explore how each sociodemo-
graphic variable affects caries prevalence in the presence
of other variables, a multivariate linear regression analy-
sis was performed. Data were processed and analysed
with SPSS (PC version 10.0) with the level of statistical
significance level set at < 0.05.
Permission from the Ministry of Education, ethical
approval of the committee of Research and Deontology
in Dentistry, of the University of Athens and parental
consent were obtained before the clinical examinations.
Results
The sample of the surveyed children was 1209, 1224, and
1257 in the 5-, 12- and 15-year-old groups respectively.
The number of children, the dmft and DMFT values for
the three age groups and their components in relation to
the different districts, residential location, gender and
parental education level, are shown in Annexes 1, 2 and
3 (available only online at cdhjournal.org).
The percentage of children without obvious caries
declined with age from 57% for the 5-year-olds to the
37% and 29% for the 12 and 15 year olds respectively.
The highest dmft/DMFT=0 value, 68%, was found for
Athens 5 year olds and the lowest 19% for Ioannina 15
year olds.
The dmft and DMFT mean values varied greatly
between districts. The mean dmft for 5-year-old Greek
children was 1.77, 2.05 for 12-year-olds and 3.19 for
15-year-olds. However, these are crude unweighted
means. Thessaloniki 5 and the 12 year olds had the low-
est scores with Athens 15-year-olds being only slightly
lower. The highest mean dmft and DMFT scores were
for Ioannina children, 3.12, 2.87 and 3.76 for the 5,
12 and 15-year-olds respectively. Rural areas showed
significantly higher means than urban areas only for the
5 and 15 year olds, namely: 2.56 cf 1.65 (p=0.001) and
3.72 cf 3.05 (p=0.005). Girls presented significantly
higher DMFT/DMFS means then boys among the 12-
year olds namely: 2.28 cf 1.79 (p=0.005) and among
the 15-year-olds 2.90 vs.3.41 (p=0.031). Additionally,
children of all ages with a higher-educated parent had
significantly lower dmft/DMFT values: e.g. for 5-year-
olds the mean dmft was 2.50 for mothers and 2.80 for
fathers with least education decreasing to 1.37 and 1.21
for those with higher educational (p=001). The same
trends were found for the 12 and 15-year-olds DMFT
scores: 2.52/2.54 cf 1.42/1.44 and 3.65/3.73 cf 2.50/2.56,
p=0.001. The care index was very low for 5-year-olds:
lowest in Kefallinia, 5%, to highest in Athens at 19%.
The 12-year-olds’ indexes were somewhat better, ranging
between 29% (Naxos) and 57% (Thessaloniki) and bet-
ter still for 15-year-olds, 36% (Achaia) to 83% (Athens)
(Annexes 1,2,3).
Caries experience in the posterior teeth were 83%
in 12- and 87% in 15-year-olds. Pit and fissure caries
(occlusal of posterior teeth, buccal of the lower molars
and lingual of the upper ones) contributed 56% and 58%
of the total caries experience of 12 and 15 year olds,
respectively. The significant caries indexes (SiC) of the
unweighted population for 5-, 12- and 15-year olds were
5.01, 4.83 and 7.07 respectively.
Multivariate analysis (Table 1) revealed that the
dmf-s/DMF-S index of the children with higher-educated
fathers with had significantly lower dmft-s/DMFT-s in
each age group (p=0.012, 0.002, 0.016 respectively). For
5-year-olds, urban children and those of higher-educated
mothers had lower dmft (p=0.001 and 0.010 respectively).
Finally, among 12-year-olds, boys (p<0.006) and children
of higher-educated mothers (0.025) scored significantly
lower DMFT-S values.
Discussion
The objective of this first national survey was to determine
the prevalence of dental caries in the Greek children and
adolescents and based on the findings to help the health
authorities to plan better dental services and improve the
dental health of the Greek population. The data presented

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in this study is part of a National Oral Health Survey of
the Hellenic population. It is the first time that a Greek
National Survey with calibrated examiners has captured
dental data at the same time and for all the age groups.
Declining trends in caries prevalence of children and
adolescents have been reported for the last two decades
in many European countries (Whelton, 2004). The same
trend was found when we compared the findings, of the
present study to the available Greek epidemiologic stud-
ies using WHO recording criteria (Mamai-Homata et al.,
1987). However, while WHO recording criteria were
used, the examiners were not calibrated so caution must
be exercised when making comparisons. Nevertheless,
within the different districts of Greece, the mean DMFT
values of 12-year-olds, showed a noticeable improvement
over the 20-25 years, ranging from 26% to 66%, with a
mean of 55% (Oulis and Tsinidou, 1995, see Table 2).
No geographical variations of caries prevalence either
north/south or east/west were observed, though large
cities predictably scored lower caries prevalence and
higher care index than smaller conurbations. Striking
disparities in dental disease prevalence among people
based on sociodemographic characteristics, such as
income, location, and parental educational level are
commonplace (Carina and Sting, 2002) and those poorer
children suffer twice as much compared to their non-
poor peers and their disease is more probably untreated.
Such disparities were found in our study and children
or adolescents living in small cities or in rural areas or
with less-educated parents, presented higher prevalence
of caries, more untreated caries (dt/DT) and less dental
care (lower Care Index). These findings agree with
other studies that attributed these findings to rural areas
generally having fewer dentists per population and more
poverty, and therefore, children with less access to and
use of dental care (Vargas et al., 2003).
As for the finding that most of the caries was found
on the occlusal surfaces of posterior permanent teeth, it
may be due to the prevalence of sealants in the same
population being very low (8%) (Oulis et al., 2011).
Although there is some caries reduction over the years
ago in Greece, the DMFT values of the older groups con-
tinue to be higher (almost double for 12 and 15 year-olds)
compared to the DMFT values found in many industrial-
ized European countries. The mean dmft for Greek 5
year-olds are close to those found recently in England
(1.47) (Pitts et al., 2002), higher than in Denmark (0.8)
(Ekstrand et al., 2007), but lower than in Scotland (2.16)
Table 2. DMFT of Greek 12-year-olds in 1983-1989 com-
pared to 2005
The following Annexes to be available only online
DistrictsDMFT
Years 1983-1989
DMFT
Year 2005
Decrease
(% decrease)
Athens
Achaia
Ioannina
Larissa
Chania
Mean
7.00
5.80
8.61
8.50
8.00
7.58
2.35
4.32
3.76
3.54
2.93
3.38
4.65 (66.4)
1.48 (25.5)
4.85 (56.3)
4.96 (58.4)
5.05 (63.1)
4.20 (55.4)
b*: Constant, se(b)**: Standard error of the constant b
Table 1. Multiple linear regression analysis for dmfs/DMFS by gender, location and
parents’ educational level of 5, 12 and 15-year-old Greek children
5 year old
Dependent
variable
Independent
variables
b*
se(b) **
t-testp
dmfs
Gender
Location
Father’s educational level
Mother’s educational level
0.125
-1.818
-0.596
-0.645
0.372
0.560
0.237
0.249
0.335
-3.244
-2.516
-2.594
0.738
0.001*
0.012*
0.010*
12 year old
Dependent
variable
Independent
variables
b se(b)t-testp
DMFS
Gender
Location
Father’s educational level
Mother’s educational level
0.898
-0.206
-0.551
-0.435
0.329
0.408
0.181
0.193
2.733
-0.505
-3.039
-2.252
0.006
0.614
0.002
0.025
15 year old
Dependent
variable
Independent
variables
b se(b)t-testp
DMFS
Gender
Location
Father’s educational level
Mother’s educational level
0.660
-0.907
-0.531
-0.246
0.399
0.499
0.220
0.233
1.652
-1.818
-2.414
-1.053
0.099
0.069
0.016
0.292

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(Pitts et al., 2006), the Netherlands (2.5) (Elfrink et al.,
2006) and Wales (2.38) (Pitts et al., 2002). As for Greek
12 year-olds, DMFT values were close to Scotland’s (1.8),
but higher than England’s (1.25), Italy’s (1.1) France’s
(1.2), Sweden’s (1.0) and Germany’s (0.8) (WHO, 2007).
Similar differences exist for the 15 year-olds, where the
mean DMFT of 3.19 is higher than in England, Wales
(1.48) (Pitts et al., 2006) and Spain (1.84) (Almerich-Silla
2006), while Denmark’s mean DMFS value of 2.97, (Ek-
strand et al., 2007) is also much higher than we found
in Greece. In 15 year-olds, 29% had no obvious decay:
much lower than the findings in Great Britain (61%) (Pitts
et al., 2007), Spain (44%) (Almerich-Silla and Montiel-
Company, 2006), Denmark (42%) (Ekstrand et al., 2007)
and Finland (74%) (Marja-Leena et al., 2008).
This study employing calibrated examiners, docu-
ments for the first time a caries reduction trend and
an improvement in dental health of the Greek children
compared to the earlier years. However, caries still af-
fects the children and adolescents of our country to a
greater extent and larger degree than other industrialised
European countries. One explanation for this may be
better and more organised national oral health systems
in these other countries, providing better and free den-
tal services to children. In Greece, dental services are
primarily private and expensive so children of lower
socioeconomic status cannot afford them. The National
Health system, on the other hand, established in Greece
in 1886 to cover all the rural and deprived areas of the
Country and offer preventive and operative (fillings)
services free to all children under 18, doesn’t seem to
meet demand adequately.
Another possible explanation is that most of the caries
was located on the occlusal surfaces of posterior teeth
due to the fact, that the low use of sealants in Greek
adolescent (Oulis et al., 2011) compared to Denmark
and Finland where sealants are applied to almost 70%
of children through national preventive programs. Ap-
plication of sealant to the occlusal surfaces of posterior
teeth have resulted in a 60% decrease in tooth decay up
to 5 years after application (Gooch et al., 2009). The
introduction of such a program combined with other
preventive measures in our population might reduce the
DMFT index to a considerable degree and reduce car-
ies prevalence to the level of other European countries.
In conclusion, although child and adolescent dental
caries prevalence and extent in Greece was lower than
in the past, it is still much higher than in most European
countries.
The great variation of caries prevalence found across
the different locations with the worst DMFT figures and
higher percentage of untreated caries found within the
poorer and less educated families necessitates early inter-
vention with comprehensive national preventive program
targeted on these groups’ children.
Paternal educational level is a significant predictor of
the extent of dental caries. It was negatively related to
DMF values and to untreated dental caries.
Since the majority of dental caries in the Greek
adolescents was found on the occlusal surfaces of the
posterior permanent teeth, a preventive program with
sealants on more tooth surfaces could eliminate caries
to a large extent.
Acknowledgments
The authors are indebted to all those board members,
coordinators of the local dental societies and examiners
who contributed to the survey as part of the “Assess-
ment and Promotion of the Oral Health of the Hellenic
Population” National Program. The survey was carried
out under the auspices of the Hellenic Dental Association
in collaboration with the Dental Schools of Athens and
Thessaloniki and the program was funded by Colgate-
Palmolive Co.
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Annexe 1. Number of children (n), no obvious caries (%), mean dmft and dmfs at 95% confidence interval and components
and Care Index(CI) for 5-year-old children according to district area, urban-rural, gender and parent’s educational level.
Examination arean No obvious
Caries (%)
dt mtftdmft (SD)
(95% CI)
dfms (SD)
(95% CI)
Care Index
CI (%)
Achaia 10159.41.41 0.010.23 1.64 (2.82)
(1.09-2.20)
0.22 1.23 (2.42)
(0.84-1.61)
0.14 1.16 (2.24)
(0.72-1.60)
0.09 1.25 (2.32)
(0.79-1.71)
0.36 3.12 (4.35)
(2.26-3.98)
0.34 2.70 (3.63)
(1.98-3.41)
0.08 1.51 (2.46)
(1.02-2.00)
0.281.94 (2.63)
(1.42-2.46)
0.542.02 (3.12)
(1.40-2.64)
0.19 2.43 (3.24)
(1.7- 3.07)
0.201.08 (2.15)
(0.7-1.42)
2.82 (5.27)
(1.78-3.86)
2.42 (5.54)
(1.53-3.31)
2.18 (4.93)
(1.21-3.15)
2.50 (5.81)
(1.35-3.65)
6.13 (10.77)
(4.00-8.26)
4.84 (7.67)
(3.34-6.35)
2.37 (4.21)
(1.53-3.21)
3.36 (6.03)
(2.16-4.56)
4.36 (7.84)
(2.80-5.92)
4.67 (7.49)
(3.18-6.16)
1.84 (4.10)
(1.18-2.49)
14.0
Athens 15167.51.020.07 18.0
Chania10263.7 1.050.0012.1
Evros 10059.01.190.00 7.2
Ioannina 10150.52.77 0.0311.5
Kastoria 10250.0 2.370.0012.6
Kefallinia10064.01.43 0.005.3
Larissa 10045.0 1.640.0214.4
Lesbos 100 53.01.530.0026.7
Naxos 10045.02.250.007.8
Thessaloniki15263.80.890.00 18.5
ANOVA F = 4.994 , p = 0,001
Location
Rural15642.92.240.000.352.56 (3.19)
(2.05-3.06)
1.65 (2.88)
(1.48-1.83)
5.26 (7.68)
(4.04-6.47)
3.01 (6.36)
(2.63-3.40)
13.7
Urban105359.41.440.000.2213.3
* t-test = 3.999 , p = 0,001
Gender
Boys60657.91.500.000.241.72 (2.92)
(1.49-1.96)
1.81 (2.96)
(1.58-2.05)
3.19 (6.48)
(2.67-3.71)
3.41 (6.69)
(2.88-3.95)
13.9
Girls 60356.61.58 0.000.2413.2
* t-test = 0.580 , p = 0,562
Father’s education
6 years or less20449.02.650.00 2.80 (3.96)
(2.25-3.35)
1.97 (2.89)
(1.58-2.36)
1.53 (2.67)
(1.27-1.78)
1.37 (2.42)
(1.11-1.62)
5.89 (10.16)
(4.49-7.29)
3.45 (5.75)
(2.67-4.23)
2.84 (5.81)
(2.29-3.39)
2.32 (4.74)
(1.82-2.81)
6.1
9 years21250.91.610.0017.2
12 years 43360.01.330.0013.7
More than 12 years35862.01.130.0018.2
ANOVA F = 14.358 p = 0,001
Mother’s education
6 years or less 16051.3 2.310.002.50 (3.81)
(1.90-3.10)
2.51 (3.54)
(2.01, 3.01)
1.67 (2.62)
(1.43-1.90)
1.21 (2.94)
(0.97-1.46)
5.10 (9.90)
(3.55-6.65)
4.85 (7.73)
(3.75-5.95)
3.02 (5.60)
(2.52-3.52)
2.12 (4.85)
(1.62-2.61)
9.2
9 years19250.02.220.0211.1
12 years48354.91.430.0015.0
More than 12 years37166.3 1.020.0017.3
ANOVA F = 12.150 , p = 0,001
Total120957.21.54 0.061.77 (2.94)
(1.60-1.93)
3.30 (6.58)
(2.93-3.67)
13.5

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7
Annexe 2. Number of children (N), no obvious caries (%), mean DMFS and DMFT at 95% confidence interval and compo-
nents and Care Index(CI) for 12-year-old children according to district area, urban-rural, gender and parent’s educational level.
Examination areaN No obvious
Caries %)
DTMTFT DMFT (S.D)
(95% C.I)
DMFS (S.D)
(95% C.I)
Care index
CI (%)
Athens 16050.00.660.010.87 1.50 (2.43)
(1.12-1.88)
2.67 (3.19)
(2.04-3.30)
1.97 (2.05)
(1.57-2.37)
2.24 (2.64)
(1.72-2.76)
2.87 (2.97)
(2.28-3.46)
2.34 (2.25)
(1.89-2.78)
1.58 (2.16)
(1.16-2.01)
2.38 (2.70)
(1.84-2.91)
2.20 (2.04)
(1.80-2.60)
2.26 (2.75)
(1.72-2.80)
1.28 (1.78)
(1.57-2.37)
2.69 (5.69)
(1.81-3.58)
4.62 (7.01)
(3.23-6.01)
3.97 (5.07)
(2.98-4.96)
3.61 (4.80)
(2.66-4.56)
5.08 (8.76)
(3.35-6.81)
4.40 (5.15)
(3.38-5.41)
2.60 (4.16)
(1.78-3.43)
3.67 (4.82)
(2.72-4.62)
3.73 (4.34)
(2.87-4.59)
3.89 (6.30)
(2.65-5.13)
2.33 (4.31)
(1.65-3.02)
58.0
Achaia 10038.01.940.03 0.86 32.2
Chania 104 38.50.980.091.0050.8
Evros 10030.01.190.011.20 53.6
Ioannina 10122.81.780.03 1.2142.2
Kastoria 10125.7 1.29 0.011.18 50.4
Kefallinia 10140.6 0.940.000.83 52.5
Larissa101 36.6 1.350.01 1.14 47.9
Lesbos100 29.0 1.000.041.1854.1
Naxos10233.31.620.06 0.6629.2
Thessaloniki15449.4 0.560.010.7357.0
ANOVA F = 2,85 p=0,002
Location

Rural24833.91.380.050.892.23 (2.71)
(1.89-2.56)
2.01 (2.44)
(1.85-2.16)
4.01 (6.23)
(3.23-4.79)
3.47 (5.48)
(3.13-3.82)
39.9
Urban 97637.91.100.020.9949.2
* t-test = 1,34 p = 0,181
Gender
Boys58039.01.100.030.771.79 (2.12)
(1.62-1.97)
2.28 (2.77)
(2.07-2.50)
3.11 (4.48)
(2.74-3.47)
4.01 (6.49)
(3.51-4.51)
43.0
Girls64435.41.200.02 1.1550.4
* t-test = -2,81 , p =0,005
Father’s education
6- years or less 28732.41.76 0.040.92 2.54 (3.01)
(2.19-2.89)
2.26 (2.54)
(1.95-2.57)
2.04 (2.36)
(1.80-2.28)
1.44 (1.91)
(1.23-1.65)
4.68 (7.10)
(3.85-5.50)
4.27 (6.82)
(3.43-5.11)
3.40 (4.73)
(2.92-3.89)
2.24 (3.30)
(1.87-2.61)
36.2
9 years25733.51.360.050.9542.0
12 years366 35.20.99 0.011.11 54.4
More than 12 years
31046.8 0.61 0.003 0.8760.4
ANOVA F = 11,1 p=0,001
Mother’s education
6 years or less24718.11.670.04 0.962.52 (2.86)
(2.16-2.88)
2.53 (2.99)
(2.16-2.91)
1.93 (2.25)
(1.72-2.14)
1.42 (1.84)
(1.20-1.64)
4.70 (6.68)
(3.86-5.54)
4.53 (7.61)
(3.56-5.49)
3.29 (4.68)
(2.85-3.72)
2.30 (3.36)
(1.91-2.70)
38.1
9 years24117.4 1.59 0.031.0541.5
12 years 44934.7 0.940.02 1.0353.4
More than 12 years28329.80.67 0.010.8257.7
ANOVA F = 10,9 p =0 ,001
Total122437.11.150.02 0.972.05 ( 2.50) 3.58 (5.64)47.3

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8
Annexe 3. Number of children (N), no obvious caries (%), mean DMFS and DMFT at 95% confidence interval and compo-
nents and Care Index(CI) for 15-year-old children according to district area, urban-rural, gender and parent’s educational level.
Examination areaNNo obvious
Caries (%)
DTMT FTDMFT (S.D)
(95% C.I )
DMFS (S.D)
(95% C.I)
Care Index
CI (%)
Achaia 10023.02.960.041.54 4.32 (4.13)
(3.50-5.14)
2.35 (3.09)
(1.85-2.85)
2.93 (3.43)
(2.28-3.57)
3.35 (3.37)
(2.73-3.98)
3.76 (3.05)
(3.17-4.35)
3.26 (3.72)
(2.54-3.98)
2.68 (2.92)
(2.11-3.26)
3.54 (3.75)
(2.82-4.27)
7.12 (8.50)
(5.43-8.81)
3.69 (5.76)
(2.76-4.62)
6.13 (9.20)
(4.40-7.86)
5.25 (6.08)
(4.12-6.37)
6.11 (6.10)
(4.93-7.30)
6.34 (8.72)
(4.64-8.03)
4.31 (5.40)
(3.24-5.37)
5.53 (6.74)
(4.23-6.84)
35.6
Athens 15040.70.420.021.9783.8
Chania 11136.01.460.041.5753.5
Evros 11420.2 1.460.041.9758.8
Ioannina 10519.01.770.06 2.0454.2
Kastoria 10426.91.40 0.08 1.86 57.0
Kefallinia10128.71.670.011.2044.7
Larissa 10523.8 2.010.09 1.6546.6
Lesbos10825.0 0.930.062.143.08 (2.77)
(2.55-3.61)
3.75 (4.16)
(2.94-4.56)
2.66 (3.20)
(2.16-3.17)
4.87 (4.79)
(3.96-5.78)
6.35 (7.96)
(4.80-7.89)
4.45 (6.08)
(3.49-5.42)
69.5
Naxos10427.91.84 0.121.8749.8
Thessaloniki 15537.40.720.031.9573.3
ANOVA,F =2.76 p = 0.002
Location
Rural 25224.22.060.061.73 3.72 (3.71)
(3.26-4.18)
3.05 (3.37)
(2.84-3.26)
6.47 (8.14)
(5.46-7.48)
5.08 (6.61)
(4.67-5.49)
46.5
Urban1005 30.0 1.280.05 1.84 60.3
*t-test = 2.83 p = 0.005
Gender
Boys 54932.1 1.370.041.602.90 (3.32)
(2.62, 3.18)
3.41 (3.54)
(3.15-3.67)
4.87 (6.81)
(4.31-5.45)
5.73 (7.06)
(5.21-6.25)
55.1
Girls708 26.41.490.061.9858.0
*t-test =-2,16,p = 0.031
Father’s education
6 years or less27120.31.980.101.803.73 (3.56)
(3.31-4.16)
3.91 (3.77)
(3.41-4.41)
3.07 (3.41)
(2.71-3.42)
2.56 (3.13)
(2.25-2.86)
6.42 (7.63)
(5.51-7.34)
6.94 (8.33)
(5.83-8.04)
5.16 (6.73)
(4.45-5.86)
4.04 (5.54)
(3.50-4.58)
48.2
9 years22021.41.990.082.0351.9
12 years35032.01.280.031.8660.5
More than 12 years40735.90.910.011.6966.0
ANOVA F =11.0 p = 0.001
Mother’s education
6 years or less24821.0 1.92 0.081.75 3.65 (3.27)
(3.24-4.06)
4.19 (4.03)
(3.63-4.75)
3.02 (3.48)
(2.71-3.33)
2.50 (2.98)
(2.17-.2.82)
5.97 (6.22)
(5.19-6.75)
7.56(9.14)
(6.28-8.84)
5.12 (6.99)
(4.50-5.75)
3.97 (5.45)
(3.37-4.56)
47.9
9 years19919.62.120.102.1651.5
12 years48032.11.27 0.041.8260.2
More than 12 years32335.30.900.011.6666.6
ANOVA F =11.9 p = 0.001
Total125728.91.430.051.813.19 (3.45)5.36 (6.96)57.0