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Community Dent Oral Epidemiol 1998; 26:166–9 Copyright C Munksgaard 1998

Printed in Denmark. All rights reserved

ISSN 0301-5661

Angel Alvarez-Arenal1 ,
DMFT, dmft and treatment Jose Antonio Alvarez-Riesgo2,
Jose Miguel Pen˜ a-Lopez3 and
Jose Pedro Fernandez-Vazquez1
requirements of schoolchildren in 1
Department of Prosthodontics, School of
Dentistry, University of Oviedo, 2Department
of Public Health, Regional Administration of
Public Health of Asturias and 3Department of
Asturias, Spain Dental Pathology and Therapy, School of
Dentistry, University of Oviedo, Spain

Alvarez-Arenal A, Alvarez-Riesgo JA, Pen˜a-Lopez JM, Fernandez-Vazquez JP:

DMFT, dmft and treatment requirements of schoolchildren in Asturias, Spain.
Community Dent Oral Epidemiol 1998; 26: 166–9. C Munksgaard, 1998

Abstract – An epidemiological survey was carried out in 1992 to study the dental
health status of schoolchildren aged 6, 9 and 12 in Asturias, Spain. It focused on
the caries prevalence, dmtf, DMFT, restoration indices and dental treatment
needs of this population. A representative sample of 1839 subjects, randomly read
and proportionally assigned by age group (6, 9 and 12) with the classroom
as the sample unit, was examined. Analysis of the data showed that in 6-year-old
children the caries prevalence in primary teeth was 45.8%. The mean caries indices were
Key words: dental treatment needs; DMFT
2.10 dmft and 0.25 DMFT. At 9 years old the prevalence of caries in primary teeth was and dmft index; epidemiological survey;
62.8% and in the permanent teeth 49.1%. The mean level of caries was 2.38 dmft and schoolchildren.
1.50 DMFT. At 12 years old the caries prevalence in permanent teeth was 71% and in Angel Alvarez-Arenal, C/Cardenal
first molars 64.2%. The mean caries experienced Cienfuegos 10-6æA, 33007 Oviedo, Spain
was 3.30 DMFT. In all groups the D-component constituted the major part of the Tel: ÿ34-98-5276832
caries index. The results for girls were higher than for boys in almost all ages E-mail: arenal/sci.cpd.uniovi.es
groups. Surface fillings were the treatment most required in all age groups. Accepted for publication August 26, 1997

Oral disease, particularly dental caries, is an important
problem in oral public health. This has meant
that most of the public administrations of developing
countries and other international organizations
have designed and conducted specific programs
to prevent oral diseases and to promote and restore
oral health within the population.
In our country, information concerning the oral
health of schoolchildren is scarce, although a national
study (1) of oral disease in 1984 and several
epidemiological surveys (2–6) undertaken in recent
years mean that we now have more knowledge of
the problem. In Asturias, Spain, however, up-to-date oral
health data on children is not available.
The present survey was conducted to observe the
caries prevalence, dmft and DMFT indices, restorative
index and treatment needs of schoolchildren in
the Asturias region. The data were collected to provide
information and a basic knowledge about den
such cavities and their treatment needs; they are also to be
used for planning preventive and restorative oral
health programs in the population studied and to
provide information to the health authorities to enable
them to establish appropriate priorities.
Materials and methods
The study was carried out in 1992 in Asturias, a
region situated in the north-west of Spain. The
study population was taken from the school-age
population aged 6, 9 and 12 of Asturias, which on
December 31, 1991 numbered 38,588 children. TO
random sample was chosen by proportional stratification.
The constructed strata were the ages 6, 9,
and 12. The procedure for obtaining the sample
was as follows: schools were chosen randomly and
these schools selected the classrooms.
The non-existence of previous studies of samples

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Dental caries in Spanish children

representative of school-age populations means performed on the same schoolchildren 15 days

that caries prevalence and dmft/DMFT indices are
not known in our region. In other regions of Spain,
oral health investigations on representative samples
of schoolchildren are scarce, and often the
questionnaire methodology and conditions under
which they are done differ, which was the reason
for our decision not to employ them as references
for the process.
The sample size was calculated by qualitative
variables assuming the most unfavorable situation,
Pÿqÿ0.50, which led us to a sample of 2222 school
children with a confidence interval of 95% assuming
a sampling error of 0.03. The sampling size was
re-adjusted because of the need to complete the
ep ideological survey by the end of the school year
(June 30, 1992). The sample consisted of a total of
1839 children (587 6-year-olds, 635 9-year-olds and
617 12-year-olds) assuming a sampling error of the
0.035 for a confidence interval of 95%. The initial
drop-out proportion was 2%, which was replaced
by others from the same school.
The dental examination was carried out by five
work teams each consisting of two final year stu
dents from the dental school of Oviedo University
(Asturias). The examiners were trained and
monitored by the principal investigator. The consistency higher in girls than boys but this difference is
of the examination criteria was measured by a pre
test done on a sample of 27 schoolchildren. Intraex
aminer and interexaminer agreement were
measured with the Cohen kappa index.
Intraexaminer re producibility was evaluated by two examinations
apart, aiming to avoid a recall bias. The results
obtained ranged between 0.75 and 0.84, for the worst
and best agreement respectively. Interexaminer
vari ability in assessing dental caries and treatment
needs reached Cohen kappa values between 0.70
and 0.75, for the worst and best agreement
respectively. Dental examinations were performed by
teams working in a ''dentobus'' at each of the se
lected schools. The dentobus is a bus equipped with
two dental chairs and full dental equipment. The
WHO (7) method and criteria were used for the
recording of data collection. The caries prevalence,
dmft, DMFT, restoration indices and treatment
needs for primary teeth as well as for permanent
teeth were calculated. The restoration index is the
filling teeth/dmft or DMFT ratio. The following
statistical techniques were used for data
differentiation: the chi-square test and the Student t-test.
Results
The prevalence proportion of dental caries in the
primary dentition as well as in the permanent teeth
and the first permanent molar can be seen from
Table 1. Caries prevalence in permanent teeth is
significant only in the 12-year-old age group.
Table 2 represents the dmft and DMFT indices
according to the age and sex of the children. De
cayed teeth was the main component of both
the dmft index and the DMFT index.

Table 1. Caries prevalence in primary teeth, permanent teeth, first permanent molar and second permanent molar, by age and
gender

sample primary teeth Permanent teeth 1st molars 2nd molars

Age and gender
nÿ1839 n % n % n % n % n %

6 years
318 54.2 139 43.7 34 10.7 31 9.7 – –
Boys
Girls 269 45.8 130 48.3 42 15.6 41 15.2 – –
Total 587 100.0 269 45.8 76 12.9 72 12.3* – –

9 years
337 53.1 214 63.5 159 47.2 154 45.7 – –
Boys
Girls 298 46.9 185 62.1 153 51.3 150 50.3 – –
Total 635 100.0 399 62.8 312 49.1 304 47.8 – –

12 years
Boys 338 54.8 75 22.2 229 67.7 206 60.9 62 18.3
Girls 297 45.2 52 18.6 209 74.9 190 68.1 84 30.1
Total 617 100.0 127 20.6 438 71.0*** 396 64.2* 146 23.7***

* Pÿ0.05.
** Pÿ0.01.
*** Pÿ0.001.

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Alvarez-Arenal et al.

Table 2. dmft and DMFT indices and their respective individual components, by age and gender

6 years 9 years 12 years

Boys Girls Total Boys Girls Total Boys Girls Total

Indices x¯ÿsd x¯ÿsd x¯ÿsd x¯ÿsd x¯ÿsd x¯ÿsd x¯ÿsd x¯ÿsd x¯ÿsd

d 1.79ÿ2.96 2.02ÿ3.04 1.90ÿ3.00 2.07ÿ2.26 1.96ÿ2.23 2.02ÿ2.25 0.42ÿ0.98 0.35ÿ0.84 0.39ÿ0.92

m 0.05ÿ0.37 0.03ÿ0.22 0.04ÿ0.31 0.15ÿ0.60 0.06ÿ0.32 0.07ÿ0.36 0.06ÿ0.34 0.34ÿ0.38 0.00ÿ0.00 0.00ÿ0.00 0.00ÿ0.00
F 0.18ÿ0.72 0.16ÿ0.66 0.25ÿ0.24 0.30ÿ0.32 0.06ÿ0.34 0.04ÿ0.34 0.05ÿ0.35
dmft 1.99ÿ3.20 2.23ÿ3.16 2.10ÿ3.18 2.47ÿ2.41 2.28ÿ2.38 2.38ÿ2.39 0.48ÿ1.09 0.39ÿ0.90 0.44ÿ1.01
d 0.18ÿ0.63 0.28ÿ0.74 0.23ÿ0.70 0.00ÿ0.06 1.11ÿ1.45 1.31ÿ1.58 1.20ÿ1.51 0.02ÿ0.18 2.01ÿ2.13 2.66ÿ2.69 2.31ÿ2.42
M 0.00ÿ0.00 0.00ÿ0.04 0.03ÿ0.17 0.02ÿ0.18 0.05ÿ0.28 0.10ÿ0.42 0.07ÿ0.35
F 0.02ÿ0.16 0.01ÿ0.14 0.02ÿ0.15 DMFT 0.20ÿ0.66 0.28ÿ0.47 0.30ÿ0.55 0.28ÿ0.51 0.89ÿ1.64 0.94ÿ1.90 0.92ÿ1.76
0.29ÿ0.77 0.25ÿ0.71 1.41ÿ1.59 1.64ÿ1.75 1.50ÿ1.67 2.95ÿ2.30 3.70ÿ2.99 3.30ÿ2.67*

x¯ÿmean; sdÿstandard deviation; *ÿPÿ0.001.

Table 3 shows the results for dental treatment
needs and the restoration index. At all ages girls
have more treatment needs than boys. The filling
of one surface is the most frequent treatment
required in any of the age groups and it increases
slowly with age. The restoration index level is very
low for primary dentition. The restoration index
for permanent dentition is slightly higher.
Discussion
In 1984 the WHO Regional Office for Europe
carried out a national health pathfinder survey in
Spain which showed an overall level of 4.20 DMFT
and 90% of dental caries prevalence in 12-year-old
children (1). The present survey revealed a lower
prevalence of dental caries and DMFT index and
this could indicate a decreasing trend in disease in
Asturias compared to the national level. The current
rent level is considerably higher than the European
goal of less than 2 DMFT in 12-year-olds, for
modulated by the WHO (8), and is close to the world
goal of 3 DMFT by the year 2000.
On a regional level, the caries prevalence and
DMFT index in Asturias 12-year-olds would seem
slightly higher than in other Spanish regions (2–6).
Compared to other countries and regions, our data
showed that Asturian children have higher DMFT
scores than children from industrialized countries
such as the USA (DMFTÿ3) (9), Switzerland
(DMFTÿ2.4), Finland (DMFTÿ2.8), Sweden
(DMFTÿ2.7) (10) and Denmark (DMFTÿ1.3) (11),
and regions of the United Kingdom and Ireland with
scores lower than 3 (12, 13), although a similar
mod erate or high level of caries has been reported in
other developing and neighboring countries (14,

Table 3. Needs for dental treatment, restoration index for primary and permanent teeth (in percentages), by age and gender

Treatment needs Restoration index

Age No Filling 1 Filling

and gender treatment surface 2 surfaces Pulpal care Extraction Primary permanent

6 years
Boys 48.6 36.1 21.9 6.9 8.8 7.5 10.0
Girls 39.9 44.4 22.0 8.6 7.8 8.1 3.4
Total 44.6* 39.9* 22.0 7.7 8.3 7.6 8.0**

9 years
Boys 18.4 38.3 38.3 10.1 12.5 13.7 19.8
Girls 16.4 31.5 31.5 12.1 14.8 10.9 18.3
Total 17.5 35.1 35.1 11.0 13.5 12.6 18.6

12 years
Boys 14.2 63.0 24.3 8.0 8.6 12.5 30.2
Girls 11.8 73.1 22.9 11.8 11.4 10.2 25.4
Total 13.1 67.6** 23.7 9.7 9.8 11.3 27.9

*ÿPÿ0.05.
**ÿPÿ0.01.

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fifteen). A comparison is not possible because these data
may have been gathered in quite different ways.
Girls in the 6-year-old age group had a higher
caries prevalence and DMFT than boys in the same
age group as is shown in national (1) and others
regional Spanish surveys (2–6). These results are
unexplained; furthermore other surveys have revealed
no difference in the caries figures between
genders (16), whereas a multiple regression anal ysis
showed sex to be a significant factor (17).
Our study shows that caries prevalence is lower
than the world target of 50% caries-free 6-year olds, as
formulated by the WHO. However, the
present study reported that the D-component constituted
the major part of the caries index in the
primary as well as the permanent dentition. It also
showed a low restoration index and high dental
treatment needs.
In summary, the high need for dental treatment,
especially in the permanent dentition, reflects the
current economic and practical difficulties within
the Asturian oral health service system and indicates the
need for preventive as well as restorative
programs. Adequate public dental health pro grammes
including school-based oral health edu cation and
primary oral care, revitalization of existing oral health
services, increasing the number of
dentists and oral hygienists, and decreasing the pa
tient:dentist ratio can all be recommended to the
Asturian oral health authorities. These recommendations
mendations combined with our present data can
serve as a platform to implement preventive and
restorative dental health programs that meet the
needs of Asturian children.
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