الفهرس 
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Abstract
Smoking is a complex global public health problem and a major health-risk factor of chronic diseases. Almost half of children are exposed to SHS worldwide, which is associated with the most serious preventable chronic diseases. SHS has a damaging effect on human saliva and increases the risk of oral diseases. SHS is correlated with the increase in childhood dental caries as a result of its damaging effect on human saliva. Saliva is a combination of many components which are similar in many features to other body fluids. Saliva is mainly composed of water in combination with proteins, enzymes, epithelial and immune cells, microorganisms, bronchial products, electrolytes and some other biochemical products such as antioxidants. Saliva could be considered for use as a suitable biomarker for oral diseases besides some systemic diseases.
Green tea has been used for its beneficial effects on human health and improvement of salivary parameters and prevention of oral diseases. The general objective of the study was to study second hand tobacco smoke among primary school children in Alexandria and the effect of green tea varnish on their salivary parameters and the specific objectives were:
1) To estimate the prevalence of second hand tobacco smoke among governmental primary school children aged 10-12 years in Alexandria.
2) To evaluate the impact of green tea varnish on the salivary parameters among governmental primary school children aged 10-12 years exposed to second hand tobacco smoke.
The study was conducted in Alexandria among governmental primary schools’ children aged 10-12 years using a cross sectional study, followed by an intervention study (one group pretest-posttest design). Smokers, children not exposed to smoking, systemically unhealthy children, children taking additional fluoride prophylaxis, other than the use of fluoridated tooth paste, or children had a history of taking antihistaminics or antibiotic therapy within the previous three months were excluded from the study.
Three administrations were randomly selected from the eight educational administrations of Alexandria. They were Middle, Gomrok, and Ajamy directorates. A random selection of one school from the list of schools for each of the three selected administrations was done. They were Al Sory, Abi Eldardaa, and Al Bitash schools for both girls and boys. All grade six students in the selected schools were included in the study, then children exposed to SHS were selected. After selection of the SHS children who fulfilled the criteria, children from each school were numbered sequentially, and then were chosen by a simple random sampling method using a list of random number generated by a computer. The subsample was equally chosen from the selected schools; 20 students were randomly selected from each school to get 60 students from the three directorates.
A predesigned structured interviewing questionnaire was used to collect data from 435 children. The collected data included: sociodemographic data, parents’ smoking history, medical history of the children, oral hygiene practices and dietary habits, frequency of dental clinic visits per year and reasons for these visits.
Stimulated saliva was collected from the 60 children included in the intervention study at the baseline for examination of salivary parameters. These salivary parameters were; salivary flow rate, pH, buffering capacity, total protein, IgA, TAC, cotinine, streptococcus mutans and lactobacilli. Green tea varnish application was done once after baseline assessment of salivary parameters. To assess the effect of green tea varnish on salivary parameters, the assessment was repeated after one, three and six months after green tea varnish application.
The study revealed the following results:
• The majority of governmental primary school children included in the cross sectional study were exposed to SHS (62.3%).
• The proportion of smoking did not differ significantly among participants with different degrees of parents’ education and occupation (p >0.05).
• The odds of smoking increased by 80% among participants with illiterate or read and write fathers compared to university education, 30% among those who had fathers with primary school education, 50% among children who had fathers with preparatory school education and 60% among children who had fathers graduated from secondary school.
• The risk of exposure to SHS smoking increased by 60% among children who had illiterate or read and write mothers compared to mothers graduated from university, 50% among children who had mothers graduated from primary, preparatory, and secondary schools.
• Although, smoking risk increased by 50% among skilled and unskilled workers compared to professionals, mother’s occupation was not a determinant for exposure to SHS.
• Salivary flow rate, pH, buffering capacity and IgA increased after one month and three months of follow up of green tea varnish application. There was a statistically significant difference between baseline versus one and three months’ values (p<0.05), while there was no statistical difference between the flow rate at baseline and after six months of follow up (p > 0.05).
• Concerning TAC, the median value increased after one month. This increase was statistically significant (p = 0.00). TAC decreased at three and six months of follow up after green tea varnish application. There was no statistically significant difference between the baseline level and after three and six months of follow up (p >0.05).
• Regarding cotinine, the median values decreased after green tea varnish application after one, three and six months of follow up, but there was no significant difference.
• Salivary streptococcus mutans median values decreased after one and three months of follow up. The differences between baseline value and after one and three months were statistically significant (p <0.05). After six months of follow up, the value increased and there was no significant difference between baseline median value and after six months of follow up (p >0.05).
• Lactobacilli median values decreased after one, three and six months of follow up. The differences between baseline value and after one, three and six months were statistically significant (p <0.05).
• At baseline, males showed higher median values regarding flow rate, pH and IgA than females. These differences were statistically significant (p <0.05). Then the median values of these parameters increased after one, three and six months of follow up. There were no statistically significant differences between males and females after one, three and six months of follow up after green tea varnish application (p<0.05), except for pH.
• Males showed lower streptococcus mutans and lactobacilli median counts than females at baseline. This difference was statistically significant (p <0.05). After green tea varnish application, the median counts of streptococcus mutans and lactobacilli decreased at one, three and six months of follow up, and there was no statistically significant difference between males and females (p >0.05).
• Children who used to brush their teeth showed higher median values of flow rate, pH and TAC, and less cotinine median value than children who never brushed their teeth at baseline. This difference was statistically significant (p <0.05). Then the median values of flow rate, pH and TAC increased and the median value of cotinine decreased after one, three and six months of follow up. There were no statistically significant differences between children who used to brush their teeth and who never brushed their teeth after one, three and six months of follow up after green tea varnish application (p >0.05), except for pH.
• Children who used to brush their teeth showed lower median values of streptococcus and lactobacilli median counts than children who never brushed their teeth at baseline. This difference was statistically significant (p <0.05). Then the median counts of streptococcus mutans and lactobacilli decreased after one, three and six months of follow up. There were no statistically significant differences between children who used to brush their teeth and those who never brushed their teeth after one, three and six months of follow up after green tea varnish application (p >0.05).
• Regarding types of snacking among the children, children who used to snack sweets showed lower median counts of salivary flow rate and pH than those who used to snack vegetables and fruits at baseline. This difference was statistically significant (p <0.05). After one, three and six months of intervention the median values of these parameters increased and there were no significant differences between the three groups after green tea varnish application (p >0.05).
• Children who used to snack sweets showed higher median counts of salivary streptococcus mutans than children who used to snack vegetables and fruits at baseline and after one and six months of follow up. These differences were statistically significant (p <0.05). After three months of intervention, there was no significant difference between the three groups after green tea varnish application (p >0.05). Regarding lactobacilli, children who used to snack sweets showed higher median counts than children who used to snack vegetables and fruits at baseline and after three and six months of follow up. These differences were statistically significant (p <0.05). After one month of intervention, there were no significant differences between the three groups (p >0.05).
• Children who snacked sweets once or twice had higher salivary pH median values than children snacked sweets three or four times at baseline. The difference was statistically significant (p <0.05). After one, three and six months of follow up, the pH median values of the four groups increased and there was no statistically significant difference between the four groups (p >0.05).
• Children who snacked sweets once or twice had lower salivary streptococcus mutans median values than children snacked sweets three or four times at baseline. The difference was statistically significant (p <0.05). After one, three and six months of follow up, the bacterial median values of the four groups decreased and there was no statistically significant difference between the four groups (p >0.05). Regarding lactobacilli, children who snacked sweets once or twice had lower median values than children who snacked sweets three times or more at baseline, after three and six months of follow up. The differences were statistically significant (p <0.05). After one month of follow up, lactobacilli median values of the four groups decreased and there was no statistically significant difference between the four groups (p >0.05).
• The median values of salivary flow rate, pH, protein, IgA and TAC were higher and cotinine values were lower in children exposed to less than 10 cigarettes daily than in the two other groups at baseline. These differences were statistically significant (p <0.05). After one, three and six months of follow up, there were no significant difference for these parameters between the three groups, except for flow rate and cotinine median values (p >0.05).
• The median values of salivary streptococcus mutans and lactobacilli were lower in children exposed to less than 10 cigarettes daily than the two other groups at baseline. These differences were statistically significant (p <0.05). After one, three and six months of follow up, there were no significant differences between the three groups (p >0.05), except for streptococcus mutans median values.