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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 12  |  Issue : 3  |  Page : 121-125

Sociodemographic and behavioral factors associated with developmental dental hard-tissue anomalies in children with primary dentition


1 Department of Child Dental Health, Faculty of Dentistry, College of Medicine, University of Nigeria, Ituku, Enugu, Nigeria
2 Department of Child Dental Health, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria

Date of Submission29-Nov-2019
Date of Decision10-Mar-2020
Date of Acceptance17-Jun-2020
Date of Web Publication14-Aug-2020

Correspondence Address:
Nneka Kate Onyejaka
Department of Child Dental Health, Faculty of Dentistry, College of Medicine, University of Nigeria, Ituku
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_127_19

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  Abstract 


Introduction: Developmental dental hard-tissue anomalies include anomalies of number, size, shape, and structure of the teeth. Anomalies in primary dentition are associated with anomalies in the permanent dentition. The present study identified the sociodemographic and behavioral factors associated with developmental dental hard-tissue anomalies in primary dentition. Materials and Methods: This was a cross-sectional study of 433 preschool children aged 5 years and below in Enugu East Local Government Area, Enugu, Nigeria. Data on sociodemographic profile were collected, and clinical examination was conducted on the children to record the presence of double tooth, hypodontia, hyperdontia (supernumerary), microdontia, talons cusp, hypoplasia, and Hutchinson's incisors. Results: The prevalence of developmental dental hard-tissue anomalies was 14 (3.2%). Five-year-old children (28.6%), male children (57.1%), and children belonging to high socioeconomic status (50.0%) had developmental dental hard-tissue anomalies, and there was a statistically significant association between past dental visit (P < 0.001) and developmental dental hard-tissue anomalies. There was no statistically significant association between age (P = 0.80), sex (P = 0.75), socioeconomic status (P = 0.83), and developmental dental hard-tissue anomalies. The most common developmental dental anomaly was double tooth (1.6%), whereas talons cusp (0.2%) and hyperdontia (0.2%) occurred the least. The upper central incisors were affected the most (48.5%). Conclusion: The prevalence of developmental dental hard-tissue anomalies was low, and past dental visit was associated with developmental dental hard-tissue anomalies in this population.

Keywords: Dental anomaly, dentition, primary


How to cite this article:
Onyejaka NK, Amobi EO, Olatosi OO. Sociodemographic and behavioral factors associated with developmental dental hard-tissue anomalies in children with primary dentition. Indian J Dent Sci 2020;12:121-5

How to cite this URL:
Onyejaka NK, Amobi EO, Olatosi OO. Sociodemographic and behavioral factors associated with developmental dental hard-tissue anomalies in children with primary dentition. Indian J Dent Sci [serial online] 2020 [cited 2020 Sep 19];12:121-5. Available from: http://www.ijds.in/text.asp?2020/12/3/121/292270




  Introduction Top


Developmental dental anomalies are marked deviations from the normal color, contour, size, number, and degree of development of teeth. It can arise during the morpho-differentiation of tooth development.[1] These can present as hyperdontia, hypodontia, talon cusp, double teeth, hypoplasia, and protostylid.[2]

The prevalence of dental anomaly ranges from 1.73% in India,[3] 1.8% in Bangladesh,[4] 4.2%–26.6% in Nigeria,[5],[6] and 12% in Iran.[7]

There is a dearth of information on developmental dental anomalies in the primary dentition of children in Enugu, Southeastern Nigeria. This study identified the prevalence of developmental dental hard-tissue anomalies and their association with sociodemographic factors and past dental visit.


  Materials and Methods Top


Ethics

Ethical approval for the study was obtained from the University of Nigeria Health Research and Ethics Committee (IRB00002323). Permission was also obtained from the Ministry of Education and head teachers in Enugu, in addition to obtaining parental consent.

Study area

The study was conducted in Enugu East Local Government Area (LGA) of Enugu State, Nigeria. There are three LGAs that make up Enugu metropolis, and Enugu East LGA is one of them.

The total number of children in both private and public kindergarten/nursery schools was 6094 pupils in the school year, 2009/2010.[8] The inhabitants are mainly traders, farmers, and civil servants.

Study design and study population

This was a cross-sectional study of children attending nursery schools in Enugu, Southeastern Nigeria. Data on demographic profile (age, sex, and socioeconomic status) and history of past dental visit were collected from parents at home, and oral examination was conducted in the school. Children aged 5 years as at the last birthday and below attending private and public kindergarten/nursery schools in the LGA were recruited for the study. Uncooperative children were excluded from the study.

Sample size determination

This was determined using the following sample size formula: P × q (SE) 2 by Akpala,[9] wherePis the prevalence, q is 100 − p), and SE is the standard error tolerated. Based on 4.2% prevalence of developmental dental anomaly from a previous study[8] and a sampling error of 5%, the minimum sample size calculated was 17. The total sample size required to get 17 children with developmental anomalies was 405. To accommodate for 10% nonresponders, the sample size was 405 + 41 = 446 children. The total number of schools visited was 6094/400 pupils = 16 schools.

Pupils were selected from the 16 kindergarten/nursery schools in Enugu East LGA of Enugu State.

Sample selection

Proportionate representation of the sample between private and public schools

The ratio of private to public kindergarten/nursery schools in Enugu East is 1:0.8. Hence, nine private kindergarten/nursery schools and seven public kindergarten/nursery schools were selected from a list of public and private kindergarten/nursery schools in Enugu East LGA obtained from the Ministry of Education. Random sampling technique was used to select the schools.

Selection of pupils from the schools by random sampling

Two hundred and twenty-two children from private kindergarten/nursery schools and 178 from public schools were selected for the study. Twenty-eight children were selected from each school. From each of the four levels (prenursery, nursery 1, 2, and 3), seven children were selected to get 28 children. Pupils picked ballot paper written “yes” or “no,” and each pupil who picked “yes” participated in the study.

Study procedure

Two pediatric dentists were recruited as field workers and trained on the data collection procedure and details of the study collection tool. The data collection tool consisted of the first part (A) which contained questions that elicited information on the sociodemographic profile of the child (age of the study participants as at the last birthday, sex, and parents' occupation and educational status) and past dental visit. The second part elicited information on the status of oral hygiene using the Simplified Oral Hygiene Index by Greene and Vermillion[10] and status of caries using the dmft index and observing the criteria by the World Health Organization[11] and dental anomalies based on the procedure by Temilola.[5]

On the day of the study, the children were given informed consent form, with the first part of the questionnaire attached to it to give to their parents at home. The teachers assisted by reminding the caregivers of the children when they pick them from the school. On the 2nd day of the study, oral examination was conducted on the children with signed informed consent and completely filled questionnaire. They were examined while seated on their school chairs under natural light. Oral hygiene was assessed while cotton wool was used to clean the debris on the teeth before examining for caries and dental anomalies visually. A tongue depressor was also used to enhance visibility of the teeth.

Socioeconomic status of child's family

The socioeconomic status of each child was based on the index used in a previous study.[12] It was calculated using multiple indices obtained from a scoring index that combined the mother's level of education and occupation of the father. Father's occupation was grouped into professional (score 1); civil servants (score 2); unskilled, unemployed, civil servants with primary education (score 3), whereas mother's level of education was categorized into tertiary education (score 0), secondary (score 1), and primary or no school education (score 2). Each child's family social class was obtained by adding the score of the father's occupation to the score of the mother's level of education. A total score of 1 (Class 1) was categorized as upper class, total score of 2 (Class II) was upper middle class, total score of 3 (Class III) middle class, total score of 4 (Class IV) the lower middle class, and a total score of 5 (Class V) was the lower class. This information was collected from the questionnaire sent to the parents along with the consent form.

Developmental anomalies

These were identified using the criteria by Temilola et al.[5] The developmental anomalies diagnosed included double tooth, supernumerary, hypodontia, enamel hypoplasia, talons cusps, and notched incisors.

Standardization of the examiners

Two pediatric dentists were trained on the identification of dental anomalies. They used clinical photographs to train themselves. Intra-examiner and inter-examiner reliability were assessed by using pictures with the developmental anomalies on two separate occasions in 2 weeks' interval. The result was coded and fed into the computer. The data were then subjected to a Cohen's kappa score analysis, to determine the intra-examiner and inter-examiner variability. The intra-examiner variability score was 0.90, whereas the inter-examiner variability score for dental anomalies was 0.88.

Data handling

The age of the children was grouped into <1 year, 1 year, 2 years, 3 years, 4 years, and 5 years. For ease of analysis, the data for socioeconomic status in this study were re-grouped into the following three levels: high (upper and upper middle classes), middle (middle class), and low (lower middle and lower classes). This categorization was used to test associations. This modality of categorization of socioeconomic status was previously used.[13]

Data analysis

The data were analyzed using SPSS version 18 (IBM, Chicago, IL, U.S.A). Exploratory analysis was conducted to ensure data consistency. The results were expressed using frequency tables and percentages. Descriptive analysis was conducted using a wide variety of measures of location (mean). Bivariate analysis was conducted to test the association between the child's age, sex, socioeconomic status, and occurrence of dental anomaly. Chi-square test was used to assess association between variables. The effect of all significant factors on the occurrence of dental hard tissue anomaly was inferred at P < 0.05.


  Results Top


Four hundred and thirty-three (97.1%) out of 446 schoolchildren recruited returned the consent forms and first part of the questionnaire. Many of the study participants were 5 years old 112 (25.6%), males 229 (52.9%) and from high socioeconomic status189(43.6%). Most of the children had fair oral hygiene 374 (86.4%) and had never visited the dental clinic 374 (86.4%). Only 14 (3.2%) study participants had developmental dental hard-tissue anomalies [Table 1].
Table 1: General characteristics of the study participants (n=433)

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[Table 2] shows that 5-year-old children (28.6%), males (57.1%), and children in the high socioeconomic status (50.0%) had developmental dental tissue anomalies the most, and there was no statistically significant association between age (P = 0.80), sex (P = 0.75), socioeconomic status (P = 0.83), and developmental dental hard-tissue anomalies. There was statistically significant association between past dental visit (P< 0.001) and developmental dental hard-tissue anomalies.
Table 2: Association between age, sex, socioeconomic status, oral hygiene status, past dental visit, and developmental dental hard-tissue anomalies

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The most common developmental dental hard-tissue anomaly was double tooth (7 [1.6%]), whereas talon cusp (1 [0.2%]) and hyperdontia (1 [0.2%]) occurred the least. Other anomalies were hypodontia (6 [1.4%]), hypoplasia (5 [1.3%]), and Hutchinson's incisors (4 [0.9%]), as shown in [Table 3].
Table 3: Prevalence of types of dental anomalies in the dentition (n=433)

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[Table 4] shows that developmental dental hard-tissue anomaly was more prevalent in the maxilla (27 [81.8%]) than the mandible (6 [18.1%]). Maxillary central incisors were affected the most (16 [48.5%]) followed by maxillary lateral incisors (10 [30.3%]) and mandibular central incisor (3 [9.1%]), while the mandibular lateral incisor (1 [3.0%]), mandibular canine (1 [3.0%]), maxillary first molar (1 [3.0%]), and mandibular second primary molar (1 [3.0%]) were affected the least.
Table 4: Distribution of teeth with developmental dental hard-tissue anomaly (n=33)

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  Discussion Top


The prevalence of dental anomaly in this study was 3.2%, which is greater than that seen in Bengali (1.8%)[4] and Turkey (2.0%),[14] but less than that seen in India (4.0%)[15] and Southwestern Nigeria.[5],[6] This may be as a result of differences in the age distribution of the study participants and the ethnic and racial variation associated with dental anomalies. Again in this study, there was no significant association between age, sex, socioeconomic status, caries, and developmental dental hard-tissue anomalies in general. This is similar to a prior Nigerian study although significant association was established between sex, socioeconomic status, and a specific anomaly – enamel hypoplasia – in that study.[6] Other studies, however, showed varied association between sex, age, sociodemographic profile, and dental anomalies.[14],[15] Past dental visit was associated with developmental dental hard-tissue anomalies in this study. One-fifth of those with dental anomalies had past dental visit, probably because of the esthetics and other complications associated with it,[16],[17],[18] while only a percent of those without dental anomaly had a history of dental visit. This is not surprising because asymptomatic visit is rarely embarked upon by the populace.[19]

Double tooth which is a developmental anomaly of tooth shape was the most common developmental dental hard-tissue anomaly in this study, similar to a prior study in Turkey.[14] We could not explain the reason for this observation. Furthermore, hypodontia was the second most common anomaly. This was not surprising as double tooth may be associated with hypodontia especially if the double tooth is as a result of tooth–germ fusion.[20] Early identification of double tooth will help to monitor the permanent dentition and institute care on time. Double tooth can lead to caries, poor esthetics, malocclusion, altered dental arch length, and anomalies in the eruption of the permanent successor.[21] Enamel hypoplasia was also seen in the study population. Prior studies in Southwestern Nigeria[5],[22],[23] showed that hypoplasia was the most common anomaly, and the reason may be the scarce resources and malnutrition seen in developing countries.[24] There were also four cases of notched incisors, but getting a history of syphilis from the mothers of the pupils was not possible as it is a school-based study. However, the children did not have any other symptoms of syphilis such as saddle nose and frontal bossing.[25]

Maxillary central and lateral incisors were the teeth commonly affected by dental anomalies. The reason for the common affectation of central incisor cannot be explained, but that of the lateral incisors may be as a result of the small size of lateral incisor tooth germ, which may be directly affected by forces generated by the tooth germs of the central incisor and canine that develop earlier than it.[26],[27] Maxillary incisors are very important for esthetics, hence early diagnosis and treatment of these anomalies is important to avert complications such as esthetics, caries, and occlusal trauma.[28]

Study limitations

Only preschool children who were enrolled in nursery schools participated in the study. Again, radiographs were not taken to identify other anomalies.

It is recommended that a household survey be conducted to include children who are not attending nursery schools so that the result can be more generalizable.


  Conclusion Top


The prevalence of developmental dental hard-tissue anomalies was low in this Population, and double tooth was the most common dental anomaly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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