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Med Pregl 2015; LXVIII (11-12): 387-393. Novi Sad: novembar-decembar.387
Corresponding Author: Dr Jelena Pantelinac, Dom zdravlja “Dr Milorad Mika Pavlović”,
22320 Inđija, Srpskocrkvena 5, E-mail: jelenapantelinac@gmail.com
Summary
Introduction. Pregnancy may pose an increased risk for the develo-
pment of caries and other oral health problems. Continuous screening
of oral health status, implementing appropriate preventive measures
(particularly oral hygiene, healthy diet plans and education) is of para-
mount importance not only for oral health but also for the general heal-
th status of the future mother and her offspring. Effects of Food on
Caries Development. Caries prevention through healthy diet implicates
the reduction in frequency and amount of intake of cariogenic food,
above all of refined carbohydrates, i.e. sugars and sweets. Foods known
to have caries-prophylactic effects should predominate in healthy diet
plans. They mainly include solid foods, which have mechanical effects
on teeth cleaning, as well as foods providing sufficient amounts of vi-
tamins (A, C, D) and a variety of elements and compounds (calcium,
phosphates, fluorides) favoring the preservation and remineralization
of tooth structures. Education of Pregnant Women on Healhy Deit.
In accomplishing these goals, education and direct positive communi-
cation between the educator and the pregnant woman play a crucial role.
Educative approach is always individual and determined by the patient’s
specific cultural and socioeconomic features and status, as well as her
habits, motivation and willingness to accept relevant recommendations.
Accomplishing the aforementioned goals requires the appropriate orga-
nization and professional competence within the preventive dental ser-
vice and its close cooperation with the relevant medical institutions and
social support in the framework of public health protection. Conclusion.
Preserving of oral health during pregnancy is predominantly influenced
by the following factors: 1) healthy diet, 2) oral hygiene, 3) patients’
education, 4) regular control of oral health, 5) appropriate organization
of dental services and 6) community engagement.
Keywords: Dental Caries; Preventive Dentistry; Oral Health; Pre-
gnancy; Mass Screening; Diet; Nutrition Policy; Public Health, Den-
tistry; Tooth Remineralization; Oral Hygiene; Diet, Cariogenic; Food
Habits; Health Education, Dental
Sažetak
Uvod. Tokom trudnoće rizik za nastanak karijesa zuba i drugih
poremećaja oralnog zdravlja je povećan. Redovni skrining stanja
oralnog zdravlja, sprovođenje odgovarajućih preventivnih mera
(prvenstveno oralne higijene, zdrave ishrane i edukacije) veoma su
značajni ne samo za oralno zdravlje nego i za opšte zdravstveno
stanje buduće majke i njenog potomstva. Uticaj hrane na razvoj
karijesa. U prevenciji karijesa zdravim načinom ishrane treba re-
dukovati učestalost i količinu unosa kariogene hrane, prvenstveno
rafinisanih ugljenih hidrata, odnosno šećera i slatkiša. U zdravoj
ishrani prednost ima hrana sa profilaktičkim dejstvom na karijes.
Ovde spada čvršća hrana, koja ima mehanički efekat u odnosu na
čišćenje zuba, kao i hrana koja obezbeđuje dovoljan unos vitamina
(A, C, D) i određenih elemenata i jedinjenja (kalcijuma, fosfata,
fluorida) koji pomažu u očuvanju i remineralizaciji građe zuba.
Edukacija trudnica o zdravoj ishrani. U postizanju ovih ciljeva
pomaže edukacija uz direktnu i pozitivnu komunikaciju između
edukatora i trudnice. Edukativni pristup je individualan jer svaka
trudnica ima specifična kulturološka i socioekonomska obeležja i
status, uz različite navike, motivisanost i spremnost za prihvatanje
datih preporuka. Za ostvarivanje pomenutih ciljeva potrebna je
odgovarajuća organizacija i stručnost stomatološke preventivne
službe i njena saradnja sa drugim medicinskim službama, uz druš-
tvenu podršku u okviru javnog zdravlja. Zaključak. U očuvanju
oralnog zdravlja tokom trudnoće važne uloge imaju: 1. zdrav način
ishrane, 2. oralna higijena, 3. edukacija trudnica, 4. redovne stoma-
tološke kontrole, 5. organizacija stomatološke službe i 6. društveno
angažovanje.
Ključne reči: Karijes; Preventivna stomatologija; Oralno zdravlje;
Trudnoća; Skrining; Ishrana; Pravila ishrane; Javno zdravlje, sto-
matologija; Remineralizacija zuba; Oralna higijena; Kariogena
ishrana; Navike u ishrani; Zdravstveno obrazovanje, stomatologija
REVIEW ARTICLES
PREGLEDNI ČLANCI
University of Novi Sad, Faculty of Medicine, Novi Sad1 Review article
Institute of Public Health of Vojvodina, Novi Sad2 Pregledni rad
Health Center “Dr Milorad Mika Pavlović”, Inđija3 UDK 616.314-002-084:613.2]-055.26
Dental Clinic of Vojvodina, Novi Sad4 DOI: 10.2298/MPNS1512387J
THE ROLE OF NUTRITION IN CARIES PREVENTION AND MAINTENANCE OF
ORAL HEALTH DURING PREGNANCY
ULOGA ISHRANE U PREVENCIJI KARIJESA I OČUVANJU ORALNOG ZDRAVLJA U TRUDNOĆI
Marija JEVTIĆ1, 2, Jelena PANTELINAC1, 3, Tatjana JOVANOVIĆ ILIĆ3,
Vasa PETROVIĆ3, Olja GRGIĆ1 and Larisa BLAŽIĆ1, 4
Acknowledgments. This paper was supported by the grant No. TR31095 of the Ministry of Education, Science and Technological
Development of the Republic of Serbia.
388
Introduction
Pregnancy is associated with an increased risk
for development of dental caries and other oral
health problems [1–5]. Specific alterations of hor-
monal status in pregnant women such as the increase
and change in progesterone and estrogen levels as
the most prominent ones stimulate fluid retention in
the body that may result in gingival swelling (ede-
ma). These changes are responsible for the increased
sensitivity of the gums, hyperemia and tendency for
bleeding, gingivitis, periodontitis, pyogenic granu-
loma, increased tooth mobility, plaque formation as
well as substantial colonization of bacteria involved
in caries pathogenesis [2, 4, 6–8].
Minozzi et al. [9] have identified the following
major etiologic factors which play a role in caries
development during pregnancy: 1) modified saliva
composition (elevated acidity and mucin levels) that
favors the formation of bacterial plaque; 2) changes
in dietary habits (smaller but more frequent meals
to prevent nausea, vomiting and hypoglycemia); 3)
inadequate dietary intake of minerals, vitamins and
other protective compounds; 4) erosive effects of
gastric acid (frequent vomiting and regurgitation);
5) poor oral hygiene, and 6) inadequate dental sur-
veillance and monitoring.
Dental caries is a change of multifactorial etiology
defined as the demineralization of the inorganic portion
and destruction of the organic structure of the tooth
[10]. Demineralization of the enamel and dentin, which
make a solid inorganic portion of the tooth, is caused
by organic acids produced in dental plaque as a by-
product of anaerobic sugar degradation by bacteria
from the diet of the host. Besides the sugar and spe-
cific bacteria, the caries development is determined by
bacterial species, tooth resistance, quality of the saliva
and salivary secretion rate. The saliva contains sub-
stantial amounts of calcium and phosphates, and the
pH range of pH7 (neutral) promotes the enamel rem-
ineralization process. However, the acid environment
resulting from the elevated acidity of the saliva during
pregnancy enhances the demineralization, which then
predominates over remineralization process, thus stim-
ulating the caries development [1, 2, 4, 6]. The tooth
demineralization is attributed to organic acids, which
increase the solubility of calcium hydroxyapatite in the
dental hard tissues. Furthermore, the factors that may
contribute to the development of caries during preg-
nancy include poor quality (composition) of food and
inadequate dietary regimen as well as inadequate oral
hygiene [1, 2, 6, 9, 11].
It is of vital importance to preserve and improve
oral health in pregnancy not only because of the
pregnant woman herself, but for the outcome of
pregnancy, health and development of the newborn
baby. In that respect, periodontitis in pregnant wom-
en can be associated with premature birth, low birth
weight of the newborn [2, 9, 12–15] as well as preec-
lampsia [15, 16]. Furthermore, cariogenic bacteria
(including Streptococcus mutans) from the oral cav-
ity of the mother with caries can be transmitted to
her baby’s mouth, which is significantly related to
the prevalence or incidence of caries in the child [1,
2, 9]. Adequate dental health protection in pregnant
women is indispensable and it should encompass
the implementation of preventive and therapeutic
measures and regular check-ups during pregnancy,
as well as the active involvement of pregnant wom-
an in preserving and maintenance of her oral health.
The aforementioned practices are of multiple ben-
efits for both oral health of the woman and preg-
nancy outcome, prenatal health and reduced inci-
dence of caries in her child [9, 17–20]. The active
involvement of the pregnant woman and her close
cooperation with the dentist, gynecologist and oth-
er specialists are of crucial importance for the ac-
complishment of these goals [3–5, 9]. The above-
mentioned measures and activities contribute to the
improvement of health status among the general
population. To reach the final positive outcome in
this sphere, interdisciplinary health care practices
and cooperation should be linked with identifying
the role of the existing environmental risk factors
and novel approaches and new aspects in dentistry,
medicine, pharmacy and other fields related to pub-
lic health [21–24].
The integrated prenatal health care and protection
should encompass preventive measures and control
of oral health of a pregnant woman; however, it is
often neglected in everyday practice [2]. Solving of
this problem is supported and improved by a range
of relevant handbooks and guidelines offering recom-
mendations on the preservation and improvement of
oral health during pregnancy [3, 6, 7, 11, 19, 25].
Effects of Food on Caries Development
in Pregnant Women
“Cariogenic” Food and its Impact
Some foods may increase the risk of caries for-
mation during pregnancy, which should be taken
into consideration when planning the diets for preg-
nant woman.
Easily digestible carbohydrates (mainly sugars)
are considered potential factors that may provoke
caries formation because acid by-products of their
bacterial decomposition attack and damage the den-
tal enamel and tooth structure. Monosaccharides,
glucose, and disaccharides (including saccharose
and lactose) are direct substrates in this process.
Maltodextrin, broken down by salivary amylase into
the aforementioned “aggressive” mono- and disac-
charides, also plays a role in caries formation [1, 11].
Frequent and abundant intake of standard sugar
(saccharose) and products containing substantial
amounts of sugar and honey (sweets) are considered
important risk factors in the caries development [6].
Other risk factors encompass prolonged keeping of
carbohydrates in the mouth, especially when taking
sticky candies that tend to adhere to the teeth. Some
food of plant origin such as corn flakes and similar
Jevtić M, et al. Caries Prevention During Pregnancy
Med Pregl 2015; LXVIII (11-12): 387-393. Novi Sad: novembar-decembar.389
processed cereals mostly used for breakfast dem-
onstrate similar properties. Such products are rich
in polysaccharides, thus easily decomposed by bac-
teria into acid compounds.
Restriction of concentrated carbohydrates in the diet
has positive effects on not only oral health, but also on
the prevention of overweight/obesity and diabetes and
related health conditions and complications, which
nowadays represent critical healthcare issues in both
pregnant women and general populations [26–28].
Consuming abundant amounts of foods contain-
ing organic acids, such as fruit juice, yoghurt, fer-
mented milk and cream may contribute to caries
formation. Harmful effects of these foods manifest
as direct demineralization of tooth surface and con-
sequent erosion of dental enamel. Fruit juices have
particularly high cariogenic potential as they contain
both acids and carbohydrates (glucose, fructose, sac-
charose). To that end, fruit juices should not be con-
sumed between meals. Taking fruit juices and bever-
ages at mealtime (immediately before/after or during
the meal) is recommendable because their cariogen-
ic effects are less pronounced. Lemonade has the
highest cariogenic potential of all fruit juices since it
contains both sugar and citric acid. Due to their car-
iogenic nature, some dairy products (yoghurt, fer-
mented milk, cream and sour milk cheese) are
strongly recommended to be consumed during meals
in order to reduce their own cariogenic effects [3–5].
The increased acidity in the mouth during preg-
nancy is commonly due to the presence of gastric acid
produced by frequent vomiting at the initial stage of
pregnancy and gastric reflux during the later preg-
nancy stages. Acute acid reflux into the mouth results
from a decreased esophageal sphincter tone and move-
ment of the acid contents of the stomach because of
the increased abdominal pressure caused by the en-
larged uterus [3–5, 7]. The presence of gastric acid in
the mouth can provoke erosion of dental enamel; there-
fore, immediate rinsing of the mouth with water is
highly recommendable. After vomiting, the acid neu-
tralization can be accomplished by rinsing the mouth
with sodium bicarbonate solution (1 teaspoon of bak-
ing soda in a glass of water) [3–5]. Some pregnant
women avoid frequent tooth brushing because of nau-
sea and vomiting tendency as well as because of vul-
nerable gums prone to bleeding and pain in contact
with the toothbrush, which adds to the persistent acid-
ity of the mouth and its negative effects [3–5]. Some
pregnant women tend to take frequent smaller meals
(because of nausea), yet without teeth brushing after
the meal, thus promoting intensive bacterial activity
and carbohydrate decomposition and consequent in-
crease of mouth acidity [7].
Frequent Intake of Foods Contributing to
Development of Caries
Besides consuming large amounts of sugar in
one meal, frequent intake of sugar, i.e. carbohy-
drates throughout the day puts pregnant women at
a substantial risk. The practice of taking sweet
snacks between the main meals causes prolonged
retention of carbohydrate in the mouth for a long
period. Thus, besides the type and amount of die-
tary carbohydrates, one should take into considera-
tion the frequency of their intake as well as the
duration of retention of food in the mouth [6]. Some
authors recommend to reduce the number of high-
sugar meals to fewer than four, with a maximum
sugar amount of less than 60 g/day [20]. Moynihan
P and Petersen PE from the WHO Collaborating
Centre for Nutrition and Oral Health recommend
that the frequency of consumption of foods contain-
ing free sugars should be limited to a maximum of
4 times per day along with tooth brushing with
fluoride toothpaste at least twice a day. These au-
thors also encourage the production of sugar-free
products and candies containing artificial sweeten-
ers as an alternative to the products rich in concen-
trated and free sugars [29]. Such strategy may pre-
vent both dental and other health problems, such as
overweight, which is quite a common condition dur-
ing pregnancy. Promoting healthy food and dietary
habits needs to be appropriately addressed through
adequate marketing strategies [26, 27].
Caries-Prophylactic Effects of Some Foods
Cariogenic food, i.e. food rich in carbohydrates
and acids, should be avoided while encouraging
caries-preventive diets in order to reduce the risk of
caries development. Prophylactic effects on dental
caries is best accomplished with diets providing suf-
ficient amounts of vitamins, minerals and specific
elements and compounds such as vitamins A, C, D,
calcium, phosphate and fluoride. Furthermore,
some foods exert a positive mechanical cleansing
action on teeth, thus representing a potential protec-
tive factor in caries prevention [6].
Indispensable vitamins are primarily provided
by the adequate intake of fruits and vegetables and
related foods. Fresh fruits and some vegetables
(though to a somewhat lesser extent) contain carbo-
hydrates that may undergo bacterial fermentation
and convert to acidic products; however, high water
contents in such foods dilute the concentration and
effects of carbohydrates while their fiber contents
helps mechanical teeth cleaning thus reducing the
risk of caries development.
Vitamin A plays an important role in the devel-
opment of healthy bones and teeth and in the regen-
eration of mucosa, skin and other tissues as well.
Major natural sources of vitamin A are orange-
colored foods, melon, peach and some vegetables
such as carrot, courgette, savoy cabbage (kale),
spinach and red peppers. Milk and dairy products
and eggs are also a good source of vitamin A [6].
Vitamin C offers a range of health benefits. Be-
sides its role in collagen synthesis, vitamin C pre-
vents gum bleeding, promotes iron and calcium
resorption and has a powerful antioxidative poten-
tial. High vitamin C foods include rose hip, red cur-
rant, bilberry, lemon, orange, tangerine, grapefruit,
390
kiwi, papaya, raspberry, strawberry, sour cherry,
melon, watermelon, paprika, tomatoes, cabbage and
other leafy vegetables, broccoli, cauliflower, kohlrabi,
parsley, potatoes and other fruits and vegetables [6].
Vitamin D is essential for the adequate absorption
and metabolism of calcium and phosphates, and it is
of particular importance for the maintenance of bone
and teeth density during pregnancy as well as for the
proper development of the bones and teeth of the
fetus. Good sources of vitamin D are milk and dairy
products, fatty saltwater fish (salmon, tuna, sardines,
herring, mackerel, and swordfish), fish oil and eggs.
The human body is capable of synthesizing vitamin
D in the skin cells through the sunlight-mediated
pathway; however, only moderate and controlled ex-
posure to sunlight is advisable during pregnancy [6].
Calcium, along with phosphorus and vitamin D,
is an important component in the bone and teeth
mineralization. The best food sources of calcium
are milk and dairy products (cheese, yoghurt), sar-
dines, salmon, leafy greens, beans, lentil, sesame
seed, soybean, figs, fruit juices (strawberry), dried
fruits, almond, hazelnut and grains [6].
Phosphorus is an integrative component of teeth
and bones, and it is contained in milk, cheese, eggs
(egg yolk), peanut butter, meat, fish and fish oil,
barley, legumes, walnut, fruit juices (red currant
and raspberry) and brown bread [6].
Liver, which is rich in vitamin D and vitamin A,
calcium and phosphorus, has not been listed in the
aforementioned sources because of its particularly high
vitamin A content that (if consumed frequently) could
negatively affect the development of the fetus [6].
Foods containing substantial amounts of dietary
fibers (roughage) are of solid consistency and their
mechanical mincing during chewing process ena-
bles mechanical cleansing of teeth, promotes blood
circulation in the gums, improves defense capacity
of periodontal tissues, improves the keratinization
and tonus of gingival tissue and stimulates salivary
secretion. This group of foods includes some veg-
etables (carrot, cucumber, radish, celery, cabbage,
lettuce, etc.) and nuts. The major benefit of such
foods is that they provide adequate intake of vita-
mins and minerals without an increased bacterial
production of acid compounds in the oral cavity [6].
The mechanical effects of teeth cleansing can be
attributed to some fruits of solid consistency (e.g.
some apple varieties, pears, etc.).
Meat and fish are an important source of proteins
as the major building block, so the adequate intake of
these foods during pregnancy is essential. Meat and
fish consumption does not induce acidity in the oral
cavity, and thus it may help to prevent dental caries [6].
Hard cheese, as a good source of calcium and phos-
phates, manifests caries-prevention properties through
its positive effects on mineralization and remineraliza-
tion of teeth. Cheese is also a strong sialogogue [1, 29].
It does not increase the acidity in the oral cavity, on
the contrary – it inhibits the acidification process in
the mouth thus acting as a preventive agent against
caries. Such positive effects are characteristic mainly
for hard (mature) cheeses, whereas fresh and sour milk
cheeses as well as yoghurt increase the acidity of the
mouth; therefore their consumption should be limited
to mealtime [12].
Mobley C et al. recommend chewing sugar-free
gum to protect and maintain oral health. The beneficial
effects of chewing gum are manifested by mechanical
teeth cleansing, improvement of gum tonus, stimula-
tion of salivary secretion and reduction of acidity and
bacterial count in the mouth [12]. Chour VG and Chour
GR identified some leading factors contributing to car-
ies development. Besides the refined carbohydrates
and cariogenic bacteria, they emphasized the role of
xerostomia (dry mouth), i.e. reduced secretion of the
saliva, which can occur during pregnancy [30].
Education of Pregnant Women on Healthy Diet
Nutrition during pregnancy and its effects on car-
ies development among the population of pregnant
women and consequent caries in children is deter-
mined by a wide range of factors, including cultural
and socio-economic ones [1–3, 12, 19]. Individual de-
terminants such as behavioral orientation (character-
istics, habits and education about nutrition), bad habits
(smoking, repeated consumption of sweets and alco-
hol), actual oral health status, willingness and motiva-
tion of a pregnant woman to accept the recommenda-
tions are of great importance for preserving oral health
during pregnancy. Furthermore, dietary recommenda-
tions should be tailored and adapted to the objective
circumstances and family and social conditions of the
pregnant woman’s life [1, 2, 11, 20, 30].
The first step in creating healthy diet during preg-
nancy is to identify potential current nutritional imbal-
ance. The subsequent step includes the correction and
modification of dietary habits, that is, eliminating bad
and promoting good eating habits. Having in mind
specific cultural and socio-economic characteristics
of pregnant women, their different habits, motivation
and willingness to accept relevant recommendations,
an individualized, patient-centered approach is of vi-
tal importance [1, 2, 11, 20, 30, 31].
In regard to individual educational approach, the
direct contact between the counselor and pregnant
woman and their adequate verbal and non-verbal pos-
itive communication are the most important moments.
These methods should motivate the pregnant woman
to participate actively in the education program and to
accept the recommended routine. The counselor should
show a certain degree of empathy and take the perspec-
tive of the patient, i.e. pregnant woman [19, 32].
Besides the personal contact, nutrition coun-
seling of pregnant women may include a range of
informative and educational materials as a useful
education tool [19, 32, 33].
Education process is highly complex, encompass-
ing initial assessment of the type and model of nutri-
tion as well as recording of particular eating habits of
the pregnant woman (in workshops, pregnancy cours-
Jevtić M, et al. Caries Prevention During Pregnancy
Med Pregl 2015; LXVIII (11-12): 387-393. Novi Sad: novembar-decembar.391
es, and specially designed questionnaires for statistical
processing). The assessment and, if necessary, correc-
tion and modification of eating pattern including meal
composition and number of meals taken per day play
a major role in caries-prevention procedures. The strat-
egy of healthy diet and nutrition education focus on
reducing the amount and rate of consumed carbohy-
drates, i.e. sugars [1–3, 7, 11, 20, 30]. Whenever pos-
sible, adequate oral hygiene should be practiced after
each meal containing sugars [1–3, 7, 11, 20, 32–34].
Besides the harmful effects of refined carbohydrates
(sugars) on oral health, they pose a substantial risk of
overweight in pregnant women, which is known to be
related to the development of periodontitis [35].
In addition to the restricted consumption of re-
fined carbohydrates as harmful factors, a sufficient
intake of beneficial food ingredients that promote
teeth remineralization (vitamins A, C, D, calcium,
phosphates and fluorides) plays an important role
in caries prevention. Substantial amounts of such
elements are provided from organic milk and dairy
products made using natural and healthy processing
methods [36]. Education process should emphasize
that healthy eating is of importance not only for oral
health of pregnant woman but also for her general
health condition, pregnancy course and health status
of her baby, which will give her motivation to accept
the recommendations and advice [11, 20].
Though not directly related to nutrition yet in the
aspect of general healthcare, pregnant women are
strongly encouraged to avoid alcohol and smoking.
Negative and harmful effects of smoking on oral health
of general population are well established, and they
can contribute to the development of periodontitis,
tooth loss, carcinoma, etc. In pregnant women, such
harmful effects are even more aggravated [20, 37].
Highly complex nature of oral health issue in
pregnant women and its relation to her overall health
status, quality of life, pregnancy outcome and health
of her baby requires a multidisciplinary approach and
involvement of health professionals and specialists
of different profiles, i.e. dentists, general practitioners
and gynecologists. Such an approach is useful in all
communities, and particularly among populations of
lower cultural and educational status and poorer eco-
nomical status characterized by higher incidence of
the aforementioned morbidities. In that respect, the
style and methods of promotion of oral health and
education should be adapted to the relevant popula-
tion [7, 38]. Establishing preventive prenatal oral
health institutions with educated and professional
staff, assessment and control of oral health status of
the pregnant women and referring them to relevant
health centers, adequate and successful education
programs as well as broader community engagement
and social support to such programs and activities
are highly valuable [39–42]. The importance of social
and financial support for oral health, particularly
among the populations of poorer cultural, educa-
tional and economical status, was demonstrated in
2005 in Serbia through the Law on Health Insurance,
which restricted the rights of adult population to oral
health care. The consequence of this Law was a sub-
stantially reduced access to oral health protection and
dental services that were formerly covered by manda-
tory social security funds, which consequently lead
to drastic deterioration of oral health status within
adult population [43–45] including women before
pregnancy.
Conclusion
The importance of following factors in preserv-
ing oral health during pregnancy should be empha-
sized: 1) healthy diet, 2) oral hygiene (regular teeth
brushing), 3) education and motivation of pregnant
women to practice appropriate procedures actively,
4) regular control of oral health status and potential
introduction of relevant therapeutic measures, 5)
appropriate organization and competence of preven-
tive dental services and their cooperation with
other medical care departments, and 6) community
engagement and social support.
The aforementioned factors play an important
role in the field of both dental health care (particu-
larly preventive dentistry) and the healthcare system
as a whole. They significantly affect and contribute
to overall health status of the population. Evidently,
systematic activities and initiatives undertaken by
relevant decision makers in this field are of utmost
importance for the improvement of both oral and
general health status of the population.
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Rad je primljen 3. VII 2015.
Recenziran 7. VII 2015.
Prihvaćen za štampu 17. VII 2015.
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