PREVALENCE OF NAIL BITING AMONG PRESCHOOL CHILDREN IN BITOLA

Гризењето нокти може да има значајна улога во развојот на некои аномалии и штетни последици врз орално-фацијалниот систем. Цел: Целта на студијата беше да се утврди преваленцијата на гризењето нокти кај предучилишните деца во Битола. Методи: Во опсервациона, пресечна, (crosssectional) студија беа опфатени 890 деца, кои дошле на систематски прегледи во периодот од јануари до декември 2009 година. Беа применети следните методи: психолошко тестирање (тестот по Чутуриќ), педијатриски преглед, интервју со родителите и прашалникот: Child Behavior Checklist-Achenbach, 1981. Резултати: Истражувањето опфати 890 деца, од кои 401 на тригодишна, 489 на петгодишна возраст, 51,6% машки и 48,4% женски. Преваленцата на гризењето нокти беше 22,02%. Статистичката анализа покажа дека оваа навика не се јавува значајно почесто (p>0.05) кај децата на 5 годишна возраст и кај машките. Тестираната разлика во фреквенцијата на гризењето на ноктите кај децата од градовите и селата не беше статистички значајна (p>0.05). Децата кои немаат своја соба статистички несигнификантно почесто ја манифестираат оваа навика (p>0.05). Тестираните разлики во зависност од бројот на членови и деца во семејството, беа статистички значајни (p<0.05), но во однос на Nail biting may have a significant role in the development of some anomalies and harmful effects upon the oral-facial system. Objective: The objective of the study was to determine the prevalence of nail biting among preschool children in Bitola. Methods: Through an observational, intersection (cross-sectional) study, 890 children who came to medical checkups during the period from January to December 2009 were included. The following methods were applied: psychological testing (Test of Chuturikj), pediatric examination, interview with parents and the questionnaire: Child Behaviour Checklist-Achenbach, 1981. Results: The study included 890 children, 401 of which were at the age of three, 489 were at the age of five, 51.6% of them were males and 48.4% females. The level of prevalence of nail biting was 22.02%. The statistical analysis showed that the habit is more insignificant (p>0.05) in children at the age of 5 and among the male gender. The tested difference in the frequency of nail biting among children from the cities or villages was not statistically significant (p>0.05). Children who do not have their own room more often manifest this habit statistically insignificantly (p>0.05). Depending on the number of members and children in the family, the tested differences

Objective: The objective of the study was to determine the prevalence of nail biting among preschool children in Bitola.

Methods:
Through an observational, intersection (cross-sectional) study, 890 children who came to medical checkups during the period from January to December 2009 were included.The following methods were applied: psychological testing (Test of Chuturikj), pediatric examination, interview with parents and the questionnaire: Child Behaviour Checklist-Achenbach, 1981.
F 98,8 together with other specified disorders of relationships and emotions that usually appear in the childhood of the adolescence (biting nails, nose picking, thumb sucking).Nail biting, or "onychophagia," is one of the most common oral habits among children and a common and important concern for pediatricians and child dentists (4)(5)(6).Aetiology must be traced back in the family and includes anxiety, stress, loneliness, abandonment, imitation of other family members, adoption of finger sucking as a habit and so on (7,8).In many studies it is noted that nail biting may play a significant role in the development of some anomalies of the oral-facial system or may cause damage of the cuticles and secondary bacterial infection.
(9-12) Onychophagia may damage the structure of the mouth and can enable easier spread of infectious diseases (7,12,13).

Objective
The main purpose of this study was to determine the prevalence of nail biting among preschool children in the municipality of Bitola and to quantify eventual association with their age, sex, family factors and socio-economic conditions in which the children live (number of members and children in the family, birth order of child, city, village, education of parents and family income.)
properly and completely filled out by parents were not analyzed.The following methods were applied during the investigation period: testing by a psychologist using the Test of Chuturikj, a clinical pediatric examination, an interview with the parents, and the questionnaire.Only the information which concerned the presence or absence of a nail biting habit among the children was analyzed from this questionnaire.The obtained results were statistically processed using the following methods: the distribution of qualitative data was presented with absolute and relative numbers.To test the significance of the differences for the presence of a nail biting habit in terms of the analyzed parameters, nonparametrical statistics were used (Pearson chisquare test and Yates chi-square test).The significance was determined for level of p<0.05 and p<0.01.

Results
After the psychological testing, a pediatric review and the questionnaire was completed, a total number of 890 children were analyzed, of whom 401 were three years old and 489 were five years old.In terms of gender distribution, 51.6% of the children were male and 48.4% female.Table 1 shows the results for the presence of nail biting habit in relation to the age and sex of the children.structure demonstrates prevalence of the habit in larger families, i.e. 89% of children were living in families with more than three members and only 11% were living in families with three members.The children who live in larger families more often bite nails (20.7%) compared to children in families with three members.The tested difference for presence and absence of onychophagia related to the number of family members, is statistically significant (p<0.05).

Табела 1. Гризење нокти кај предучилишните деца во однос на возраста и полот
The results of researching the presence of onychophagia related to the number of children in the family and their birth order are shown in Table 3. From the presented results it is concluded that in 63.7% of the examined families there are two children and only 2% of the families have more than three children.Nail biting is more common in families with two children.The tested differences of the frequency of presence or absence of such habit depended on the number of children witch is also confirmed statistically (p<0.05).In terms of birth order, 99 subjects (11.1%) with onychophagia and 348 (39.1%) without onychophagia were firstborn, 80 (9.0%) with and 304 (34.2%) without onychophagia were second born.Fourteen subjects (1.6%) with and 37 (4.2%) without such habits are born as the third child, while 3 children (0.3%) with and only 5 (0.6%) without onychophagia are born fourth, fifth and so on.The cross-tabulation of the frequency of presence and absence of onychophagia and birth order is statistically Во табела 4 се прикажани резултатите за присуството на гризењето нокти во однос на образованието на родителите.

insignificant (p>0.05).
Table 4 shows the results of the presence of nails biting relationship to the education of parents.The distribution presented in Table 4 shows that children often come from families where parents have secondary education (13.4% and 10.7% have nail biting habit).The tested difference of the frequency of presence or absence of nail biting habit and parent's education is statistically significant.The children, whose parents have a high level of education, show significantly less manifestation of onychophagia.That significance has a high statistical significance for the level of p<0.01 and p<0.05, when the distribution relates to the education of the father and the mother.The children in this study were also analyzed for the relationship between the presence of oral habits and the employment of parents and family income.The results are shown in Table 5.

Заклучок Conclusion
Во In this study, we showed that nail biting is at a rate of 22%, a high rate of prevalence among preschool children in Bitola.Also, the existence of a significant correlation between this habit, the family factors and the socio-economical conditions in which children live, was confirmed.The reasons for such children's behaviour should be traced inside the families and there should be constant psychological vigilance over every child concerning the living conditions under which this habit appears.Through this attention, the children's emotional problems can be revealed.
Since the occurrence of this habit increases with the ageing of the child, its early detection and treatment in preschool is becoming more important and significant.Successful treatment is achieved with a multidisciplinary approximation of the basic problem, during which constant cooperation with the child and the family is more than important.It is very important that parents are aware of the existence of this habit, to recognize the causes of its existence and to seek help from appropriate professionals.During the treatment, behavioural techniques and psychoanalytical methods are applied.Nail biting may also affect the development of the orofacial system.Because of this, pediatricians and children's dentists should diagnose this habit as early as possible and, in collaboration with other specialists, implement a timely and appropriate treatment, thereby preventing the development of certain anomalies.Mutual longitudinal studies are needed to research the importance of this habit among children and its influence over the development of the teeth.The American Academy of Child Dentists recommends an initial oral evaluation over a 6 month period for all children after the primary dentition stage,but no later than 12 months of age, and an intensification of oral health education for children and their parents to benefit from the advantages of orthodontial care.

Table 3 .
Nail biting among preschool children and its relationship with the number of children in the family and the child's birth order

Table 4 .
Nail biting among preschool children in relation to parents' education

Table 5 .
Nail biting among preschool children related to the parents' employment and the family's income