Dental and periodontal health and treatment needs in a mother/child rural Puerto Rican population.
Abstract: Background: Oral research directed toward the maternal and child dyads is important because mothers are a source of dental caries pathogens and are the health behavior managers and trainers of children. The objectives of this study were: 1) to evaluate the oral health status of the mothers in a sample of 100 children aged 12 to 60 months from a rural community in Puerto Rico, and 2) to compare the children with their mothers' oral health status.

Methods: A sample of 71 women and 100 of their children, (Mean Age= 28.8 years [+ or -] 9.0, and 36.41 mos [+ or -] 18.2, respectively) were evaluated for DMFT/S and periodontal health or deft/s. A NIDCR calibrated dentist performed all dental evaluations of children and mothers utilizing NIDCR criteria. Descriptive statistics were produced.

Results: Mothers' bleeding point prevalence in at least one site was 63%; prevalence of at least one site with pocket depth of 4 to 6 mm was 37 %. Calculus prevalence was, no calculus 25%, supragingival calculus 56.7%, subgingival calculus 2.2%, supra and sub gingival calculus 16.3%. Mean Dental Indices for mothers were DMFS (16.51 [+ or -] 0.02), DMFT (12.20 [+ or -] 6.76), Caries (2.93 [+ or -] 2.86), Filling (7.07 [+ or -] 8.76), Missing (2.93 [+ or -] 4.53). Children's Mean Dental Indices were defs (4.32 [+ or -] 9.7), deft (2.30 [+ or -] 4.0), decalcifications lesions (1.36 [+ or -] 1.9), caries (1.96 [+ or -] 3.2) and surfaces caries (3.81 [+ or -] 8.68), fillings (0.22 [+ or -] 0.83) and extracted teeth (0.043 [+ or -] 0.45).

Conclusions: Significant levels of treated and untreated caries and gingival disease were observed in this sample. The importance for primary and secondary prevention, as well as treatment for periodontal and dental disease, in rural Puerto Rican communities is evident from this investigation. Supported by NIDCR Grant No. RO1 DE 12628. [P R Health Sci J 2010;1:36-39]

Key words: Mother child oral health, Women periodontal health

El estudio y la investigacion en salud oral materno infantil es de suma importancia ya que en el binomio madre / nino, la madre suele ser la fuente de los patogenos dentales que causan las caries y son ademas las responsables de las practicas en salud de sus hijos. Objetivos: Los objetivos de este estudio fueron: 1) evaluar el estado de salud oral de las madres de un grupo de 100 ninos entre las edades de 6 a 60 meses de edad de una comunidad semi rural de Puerto Rico y 2) comparar la salud oral de los ninos con la salud oral de sus madres. Metodos: La muestra de conveniencia de 71 mujeres y 100 de sus ninos, (Edad promedio= 28.8 anos [+ or -] 9.0, y 36.41 meses [+ or -] 18.2, respectivamente) fueron evaluados para los indices COPD/S y enfermedad periodontal y copd/s. Un dentista calibrado en los criterios de NIDCR (Instituto Nacional de Investigacion Dental y Craneofacial) realizo todas las evaluaciones dentales tanto de las madres como de los ninos. El analisis estadistico consistio de estadisticas descriptivas y la prueba de chi cuadrado usando el programa EPI-INFO. Resultados: La prevalencia para las madres de al menos un punto de sangrado fue de 63%, la prevalencia de al menos una bolsa periodontal de 4 a 6 mm fue de 37%. Prevalencia de calculo fue de 25% no presencia de caculo, 56.7% calculo supragingival, 2.2% calculo subgingival calculus, 16.3% presencia de calculo supra y sub gingival. Los indices de caries dentales para las madres fueron los siguientes: COPS (16.51 [+ or -] 0.02), COPD (12.20 [+ or -] 6.76), Caries (2.93 [+ or -] 2.86), Restauraciones (7.07 [+ or -] 8.76), Dientes Ausentes (2.93 [+ or -] 4.53). Para los ninos los indices de caries fueron cops (4.32 [+ or -] 9.7), copd (2.30 [+ or -] 4.0), lesiones de decalcificacion (1.36 [+ or -] 1.9), caries (1.96 [+ or -] 3.2), caries por superficie (3.81 [+ or -] 8.68), restauraciones (0.22 [+ or -] 0.83) y dientes ausentes (0.043 [+ or -] 0.45). Conclusiones: El grupo estudiado presenta altos niveles de enfermedad dental con caries no tratadas y presencia de enfermedad periodontal en las madres. La importancia de la prevencion primaria y secundaria tanto como la promocion en salud oral en el area materno infantil se evidencian en esta investigacion.
Article Type: Perspectiva general de la enfermedad/trastorno
Subject: Enfermedades periodontales (Investigacion cientifica)
Enfermedades periodontales (Analisis de casos)
Madre y lactante (Investigacion cientifica)
Madre y lactante (Cuidado y tratamiento)
Madre y lactante (Enfermedades)
Author: Del Valle, Lydia M. Lopez
Pub Date: 03/01/2010
Publication: Name: Puerto Rico Health Sciences Journal Publisher: Universidad de Puerto Rico, Recinto de Ciencias Medicas Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Universidad de Puerto Rico, Recinto de Ciencias Medicas ISSN: 0738-0658
Issue: Date: March, 2010 Source Volume: 29 Source Issue: 1
Geographic: Geographic Name: Puerto Rico
Accession Number: 219519247
Full Text: This is the first study in PR regarding women's oral health and their children's oral health status. Several studies have provided evidence of the association between mothers' oral and their children's oral health (1-14).

This association between a mothers' oral health and that of their children has been previously studied and has provided evidence of the vertical transmission of streptococcus mutans (sm) between mother and child thus increasing the risk of caries in young children (15-30). Since the presence of active carious processes in mothers provides the reservoir for the transmission of sm to their children thereby increasing children's caries risk, the importance of good maintenance of the oral health of the mothers is a priority in prevention of dental disease in children. The mothers' oral health profoundly impacts the health and dental health of their children. Caries as a dental condition is an infectious and transmissible disease that also has general health implications. Statistics report that 18% of premature births are attributable to poor oral health in mothers (31- 35). Although still controversial, some studies provide evidence that pregnant women with poor oral health are more likely to have a premature and / or low birth weight baby. 35- 42 Children of mothers with poor oral health are five times more likely to have oral health problems. National policymakers are working to educate families about the crucial oral health needs of pregnant women, new mothers and young children. Advocacy efforts have targeted increasing oral health care access for at risk populations and promotion of dentists and pediatricians as part of the oral health service team for pregnant women, women of childbearing age and young children.

Recent research and programs for the prevention of oral diseases, such as Early Childhood Caries (ECC), have focused on maternal/infant relationships. ECC condition is epidemic in Hispanic pre school children and is influential in determining the risk of caries in permanent teeth (35-42). As previously stated Early Childhood Caries is a severe condition with a high prevalence among Hispanic children especially Puerto Rican children and other ethnic minorities. The high prevalence of ECC in low income Puerto Rican children has been analyzed in several studies performed by the author of this paper (43-50).

Also programs dealing with the accessibility to dental care have recently focused on the dyad of mother and child in order to maintain dental health in both (8).

The purpose of this study was to evaluate the oral health status of the mothers of a convenience sample of 100 children aged 12 to 60 months from a rural community in Gurabo, Puerto Rico and to compare the children's oral health with their mothers' oral health status.


A convenience sample of 100 children aged 12 to 60 months of age and 71 of their mothers were recruited in the Local Medical Center of Gurabo, a semi rural community in Puerto Rico. Mothers were recruited to participate with their children by the nurses and the health educator at the Center. The study was explained to the participant mothers and an IRB and HIPAA consent form was signed if the subject agreed to participate. Then both mother and child were evaluated for caries and periodontal disease following NIDCR criteria by a calibrated dentist (PI). The caries exam consisted of evaluation of all present teeth for caries status and decalcification lesions, previous restorations and missing teeth due to carious involment. The periodontal evaluation consisted of examination for the presence of calculus, periodontal pockets and cej (cemento enamel junction) for calculation of loss of attachment in 2 quadrants of the mouth (one upper and one lower). A total of 3 questionnaires were administered by 3 trained interviewers. The 3 questionnaires consisted of the RAPPID Scale from the University of Washington in Seattle, sociodemographic and a diet questionnaires and closed contact interview. Data was analyzed using the EPI-INFO Program (EPI 6) and descriptive statistics were calculated. Also chi square test was used to measure significant associations mothers' oral health and children's oral health.


Mothers' mean age was 28.88 years [+ or -] 9.06 (Age range 17-31). Children's mean age was 36 months [+ or -] 18.15 (age range 6 -69 months). Results of descriptive analysis of dental indices for children are presented in Table 1. Results of descriptive analysis for mothers' dental indices are presented in Table 2.

The mean prevalence of pocket depth of at least 1 site with depth of 4 to 6 mm on mothers' sample was mesial pockets, 15.53% [+ or -] 19.46 and buccal pockets, 8.74% [+ or -] 15.56.

The total mean percentage of sites with pocket depth from 2 mm to 7 mm in mothers' sample was 2mm, 43.59%; 3mm, 30.71%; 4mm, 9.2%; 5mm, 6.7%; 6-7 mm, 21.40%.

The mean total buccal pocket depth was 2.29 mm[+ or -] 0.45, the mean total mesial pocket depth was 2.63 mm[+ or -] 0.60.

The percent prevalence of women with at least 1 site with 1 bleeding point was 63%. The calculus prevalence in women sample was 25% no calculus, 56.7% supra gingival calculus, 2.2% sub gingival calculus and 16% supra and sub gingival calculus.

Also the children's sample presented a history of prevalence of LBW of 14.3% and pre term babies accounted for the 8.2% of the sample.

A significant association was found between the oral health status of the mother and having a child with LBW (p = 0.03).

Significant association between DMFS/T and dmfs/t of children was found (p < 0.001). A significant association between signs of periodontal disease, such as bleeding gums and buccal pockets, and reports of having birthed a LBW (p = 0.007) were also found. In addition, we found a significant association between DMFS/T and bleeding, a sign of periodontal disease (p = 0.02). Finally, we found a significant association between bleeding gums and pocket depth (p < 0.001).


Children in this study showed a high rate of caries with a mean of 1.96 teeth with carious lesions and a mean dmfs of 4.32. Prevalence of caries in this group of children was 36%. Also studies of the oral health of Hispanic children report (51-57) high indices of dental disease, with a prevalence of ECC ranging from 30% to 50%. This Puerto Rican group of children was not an exception to the high rate of dental caries in minority ethnic pre school children.

Mothers were, on average, of young age and also presented high rates of dental disease. This group of mothers showed a mean of at least 3 missing and decayed teeth representing a high need for dental services. Presence of signs of periodontal disease was high for this group of mothers showing a 63% prevalence of bleeding points, which implies the presence of an active inflammation process at the time of dental examination. The total mean percent of sites with pocket depth in the group of mothers studied showed that almost 22% of the group studied presented pocket depth greater than 6 mm which represents a severe sign of periodontal disease.

Most interestingly, was the high prevalence of children with history of LBW (14.3%) and pre term babies (8.2%) and its possible association to the poor oral health of their mothers. Previous studies 15-30 have also shown that the oral health status of mothers is related to their children's oral health. This study shows evidence of a significant association between the oral health of mothers and oral health of their children (p < 0.001).


Significant levels of treated and untreated caries and gingival disease were observed in this sample. The importance for primary and secondary prevention, as well as treatment of periodontal and other dental disease in rural Puerto Rican communities, is evident from this investigation.


This research study was supported by NIDR Grant No. RO1 DE 12628.


(1.) Irigoyen-Camacho ME, Sanchez-Perez L, Garcia-Perez A, Zepeda-Zepeda MA. Relationship between severe early childhood caries, mother's oral health and mutans streptococci in low income group: changes from 1996 to 2007. J Clin Pediatr Dent 2009;33:241-246.

(2.) Traebert J, Guimaraes Ldo A, Durante EZ, Serratine AC. Low maternal schooling and severity of dental caries in Brazilian pre school children. Oral Health Prev Dent 2009;7:39-45.

(3.) Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM. Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm. Community Dent Oral Epidemiol 2008;36:363-369.

(4.) Okada M, Kawamura M, Hayashi Y, Takase N, Kozai K. Simultaneous interrelationship between the oral health behavior and oral health status of mothers and their children. J Oral Sci 2008;50:447-452.

(5.) Dasanayake AP, Gennaro S, Hendricks-Munoz KD, Chhun N. Maternal periodontal disease, pregnancy and neonatal outcomes. MCN Am J Matern Child Nurs 2008;33:45-49.

(6.) Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics 2007;120:944-952.

(7.) Medina-Solis CE, Segovia-Villanueva A, Estrella-Rodriguez R, Maupome G, Avila-Burgos L, Perez-Nunez R. Association between socioeconomic status and oral hygiene among preschoolers enrolled in the IMSS preventive dental program in Campeche. Gac Med Mex 2006;142:363-368.

(8.) Ramos-Gomez FJ. Clinical considerations for an infant oral health care program. Compend Contin Educ Dent 2005;26(5 Suppl 1):17-23.

(9.) Brandao IM, Arcieri RM, Sundefeld ML, Moimaz SA. Early childhood caries: the influence of socio-behavioral variables and health locus of control in a group of children from Araraquara, Sao Paulo, Brazil. Cad Saude Publica 2006;22:1247-1256.

(10.) Riche EL, Boggess KA, Lieff S, Murtha AP, Auten RL, Beck JD, Offenbacher S. Periodontal disease increases the risk ofpreterm delivery among preeclamptic women. Ann Periodontol 2002;7:95-101.

(11.) Scheutz F, Baelum V, Matee MI, Mwangosi I. Motherhood and dental disease. Community Dent Health 2002;19:67-72.

(12.) Dini EL, Holt RD, Bedi R. Caries and its association with infant feeding and oral health-related behaviours in 3-4-year-old Brazilian children. Community Dent Oral Epidemiol 2000;28:241-248.

(13.) Goldie MP. Oral health care for pregnant and postpartum women. Int J Dent Hyg 2003;1:174-176.

(14.) Brambilla E, Felloni A, Gagliani M, Malerba A, Garcia-Godoy F, Strohmenger L. Caries prevention during pregnancy: results of a 30-month study. J Am Dent Assoc 1998;129:871-877.

(15.) Lapirattanakul J, Nakano K, Nomura R, Hamada S, Nakagawa I, Ooshima T. Demonstration of mother-to-child transmission of Streptococcus mutans using multilocus sequence typing. Caries Res 2008;42:466-474.

(16.) Law V, Seow WK, Townsend G. Factors influencing oral colonization of mutans streptococci in young children. Aust Dent J 2007;52:93-100.

(17.) Ercan E, Dulgergil CT, Yildirim I, Dalli M. Prevention of maternal bacterial transmission on children's dental-caries-development: 4-year results of a pilot study in a rural-child population. Arch Oral Biol 2007;52:748-752.

(18.) Al Shukairy H, Alamoudi N, Farsi N, Al Mushayt A, Masoud I. A comparative study of Streptococcus mutans and lactobacilli in mothers and children with severe early childhood caries (SECC) versus a caries free group of children and their corresponding mothers. J Clin Pediatr Dent 2006;31:80-85.

(19.) Caufield PW, Li Y, Dasanayake A. Dental caries: an infectious and transmissible disease. Compend Contin Educ Dent 2005;26(5 Suppl 1):10-16.

(20.) Berkowitz RJ. Mutans streptococci: acquisition and transmission. Pediatr Dent 2006;28:106-109.

(21.) Carletto Korber FP, Cornejo LS, Gimenez MG. Early acquisition of Streptococcus mutans for children. Acta Odontol Latinoam 2005;18:69-74.

(22.) Li Y, Caufield PW, Dasanayake AP, Wiener HW, Vermund SH. Mode of delivery and other maternal factors influence the acquisition of Streptococcus mutans in infants. J Dent Res 2005;84:806-811.

(23.) Thorild I, Lindau B, Twetman S. Salivary mutans streptococci and dental caries in three-year-old children after maternal exposure to chewing gums containing combinations of xylitol, sorbitol, chlorhexidine, and fluoride. Acta Odontol Scand 2004;62:245-250.

(24.) Li S, Liu TJ, Xiao XR, Ye WW. Acquisition of Mutans streptococci by children of 3-4 years with possible source of the pathogen from their mothers. Sichuan Da Xue Xue Bao Yi Xue Ban 2004;35:818-820.

(25.) Lindquist B, Emilson CG. Colonization of Streptococcus mutans and Streptococcus sobrinus genotypes and caries development in children to mothers harboring both species. Caries Res 2004;38:95-103.

(26.) Berkowitz RJ. Causes, treatment and prevention of early childhood caries: a microbiologic perspective. J Can Dent Assoc 2003; 69:304-307.

(27.) Berkowitz RJ. Acquisition and transmission of mutans streptococci. J Calif Dent Assoc 2003;31:135-138.

(28.) Liu Y, Liu Z, Feng X, Zhu M, Pan Y. A study on transmission of pathogenic bacteria of rampant caries from mothers to children. Hua Xi Kou Qiang Yi Xue Za Zhi 2001;19:89-92.

(28.) Tanner AC, Milgrom PM, Kent R Jr, Mokeem SA, Page RC, Liao SI, Riedy CA, Bruss JB. Similarity ofthe oral microbiota ofpre-school children with that of their caregivers in a population-based study. Oral Microbiol Immunol 2002;17:379-387.

(29.) Thorild I, Lindau-Jonson B, Twetman S. Prevalence of salivary Streptococcus mutans in mothers and in their preschool children. Int J Paediatr Dent 2002;12:2-7.

(30.) Slavkin HC. First encounters: transmission of infectious oral diseases from mother to child. J Am Dent Assoc 1997;128:773-778.

(31.) Lohsoonthorn V, Kungsadalpipob K, Chanchareonsook P, Limpongsanurak S, Vanichjakvong O, Sutdhibhisal S, Wongkittikraiwan N, Sookprome C, Kamolpornwijit W, Jantarasaengaram S, Manotaya S, Siwawej V, Barlow WE, Fitzpatrick AL, Williams MA. Is maternal periodontal disease a risk factor for preterm delivery? Am J Epidemiol 2009;169:731-739.

(32.) Novak MJ, Novak KF, Hodges JS, Kirakodu S, Govindaswami M, Diangelis A, Buchanan W, Papapanou PN, Michalowicz BS. Periodontal bacterial profiles in pregnant women: response to treatment and associations with birth outcomes in the obstetrics and periodontal therapy (OPT) study. J Periodontol 2008;79:1870-1879.

(33.) Wimmer G, Pihlstrom BL. A critical assessment of adverse pregnancy outcome and periodontal disease. J Clin Periodontol 2008;35(8 Suppl):380-397.

(34.) Clothier B, Stringer M, Jeffcoat MK. Periodontal disease and pregnancy outcomes: exposure, risk and intervention. Best Pract Res Clin Obstet Gynaecol 2007;21:451-466.

(35.) Jeffcoat MK, Hauth JC, Geurs NC, Reddy MS, Cliver SP, Hodgkins PM, Goldenberg RL. Periodontal disease and preterm birth: results of a pilot intervention study. J Periodontol 2003;74:1214-1218.

(36.) Jeffcoat MK, Geurs NC, Reddy MS, Goldenberg RL, Hauth JC. Current evidence regarding periodontal disease as a risk factor in preterm birth. Ann Periodontol 2001;6:183-188.

(37.) Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth: results of a prospective study. J Am Dent Assoc 2001;132:875-880.

(38.) Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc 2006;137:7S-13S.

(39.) Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG 2006;113:135-143.

(40.) Champagne CM, Madianos PN, Lieff S, Murtha AP, Beck JD, Offenbacher S. Periodontal medicine: emerging concepts in pregnancy outcomes. J Int Acad Periodontol 2000;2:9-13.

(41.) Dasanayake AP, Gennaro S, Hendricks-Munoz KD, Chhun N. Maternal periodontal disease, pregnancy, and neonatal outcomes. MCN Am J Matern Child Nurs 2008;33:45-49.

(42.) Rajapakse PS, Nagarathne M, Chandrasekra KB, Dasanayake AP. Periodontal disease and prematurity among non-smoking Sri Lankan women. J Dent Res 2005;84:274-277.

(43.) Lopez L, Berkowitz R, Spiekerman C, Weinstein P. Topical antimicrobial therapy in the prevention of early childhood caries: a follow-up report. Pediatr Dent 2002;24:204-206.

(44.) Lopez L, Berkowitz R, Zlotnik H, Moss M, Weinstein P. Topical antimicrobial therapy in the prevention of early childhood caries. Pediatr Dent 1999;21:9-11.

(45.) Lopez Del Valle LM, Singh GD, Feliciano N, Machuca Mdel C. Associations between a history of breast feeding, malocclusion and parafunction al habits in Puerto Rican children. P R Health Sci J 2006;25:31-34.

(46.) Lopez del Valle LM, Riedy CA, Weinstein P. Rural Puerto Rican women's views on children's oral health: a qualitative community-based study. J Dent Child 2005;72:61-66.

(47.) Lopez Del Valle L, Velazquez-Quintana Y, Weinstein P, Domoto P, Leroux B. Early childhood caries and risk factors in rural Puerto Rican children. ASDC J Dent Child 1998;65:132-135.

(48.) Gudino S, Rojas N, Castro C, Rodriguez M, Vega M, Lopez LM. Colonization of mutans streptococci in Costa Rican children from a high-risk population.. J Dent Child 2007;74:36-40.

(49.) Lopez L, Berkowitz RJ, Moss ME, Weinstein P. Mutans streptococci prevalence in Puerto Rican babies with cariogenic feeding behaviors. Pediatr Dent 2000;22:299-301.

(50.) Lopez L. The Association of Early Childhood Caries, Caries Risk and History of Prematurity in Puerto Rican Children. P R Health Sci J 2010; 29:36-39.

(51.) Kopycka-Kedzierawski DT, Bell CH, Billings RJ. Prevalence of dental caries in Early Head Start children as diagnosed using teledentistry. Pediatr Dent 2008;30:329-333.

(52.) Psoter WJ, Pendrys DG, Morse DE, Zhang H, Mayne ST. Associations of ethnicity/race and socioeconomic status with early childhood caries patterns. J Public Health Dent 2006;66:23-29.

(53.) Shiboski CH, Gansky SA, Ramos-Gomez F, Ngo L, Isman R, Pollick HF. The association of early childhood caries and race/ethnicity among California preschool children. J Public Health Dent 2003;63:38-46.

(54.) Huntington NL, Kim IJ, Hughes CV. Caries-risk factors for Hispanic children affected by early childhood caries. Pediatr Dent 2002;24:536-542.

(55.) Albert DA, Park K, Findley S, Mitchell DA, McManus JM. Pediatr Dent 2002;24:229-233.

(56.) Ramos-Gomez FJ, Tomar SL, Ellison J, Artiga N, Sintes J, Vicuna G. Assessment of early childhood caries and dietary habits in a population of migrant Hispanic children in Stockton, California. ASDC J Dent Child 1999;66:395-403.

(57.) Kaste LM, Drury TF, Horowitz AM, Beltran E. An evaluation of NHANES III estimates of early childhood caries. J Public Health Dent 1999;59: 198-200.

Lydia M. Lopez Del Valle, DMD, MPH

Address correspondence to: Lydia M. Lopez, Professor, UPR School of Dental Medicine, P.O. Box 365067, San Juan, Puerto Rico 00936. E-mail: lydia.lopez1@
Table 1. Oral indices for children

Oral indices       Means

dmfs *             4.32 [+ or -] 9.75
dmft **            2.30 [+ or -] 1.94
decalcifications   1.36 [+ or -] 1.94
fillings           0.22 [+ or -] 0.83
missing            0.04 [+ or -] 0.41
decay              1.96 [+ or -] 3.30

* dmfs: decay, missing for caries and filled surfaces of primary teeth

** dmft: decay, missing for caries and filled teeth of primary teeth

Table 2. Oral indices for Mothers

Oral Indices    Means

DMFS *          16.51 [+ or -] 9.02
DMFT **         12.20 [+ or -] 6.76
DECAY TEETH      2.73 [+ or -] 2.86
FILLED TEETH     7.07 [+ or -] 8.76
MISSING TEETH     2.9 [+ or -] 4.53

* DMFS: decay, missing for caries and filled surfaces of permanent

** DMFT: decay, missing for caries and filled teeth of permanent
Gale Copyright: Copyright 2010 Gale, Cengage Learning. All rights reserved.