on the etiology and tipology of premature losses of temporary teeth

Maria-Antonela Beldiman, A. Maxim, Adriana Bălan
Biomaterials
ON THE ETIOLOGY AND TIPOLOGY OF PREMATURE LOSSES
OF TEMPORARY TEETH IN PRE-SCHOOL CHILDREN
Maria-Antonela Beldiman1, A. Maxim2, Adriana Bălan3
1. Univ. Assist. Dr., Technology of Dental Prostheses, Mobile Prostheses Dept., Faculty of Dental Medicine,
“Gr.T. Popa” UMPh Iasi, Romania
2. Prof. Univ. Dr., Paedondontics, Paedodontics – Orthodontics, Faculty of Dental Medicine, “Gr.T. Popa” UMPh Iasi, Romania
3. Assist. Prof. Dr., Paedondontics, Paedodontics – Orthodontics, Faculty of Dental Medicine, “Gr.T. Popa” UMPh Iasi, Romania
Contact person: Antonela Beldiman, e-mail: [email protected]
Abstract
Premature loss of temporary teeth is particularly
important during growth and development periods, if considering the negative effects generated by the pattern of
prematurely lost teeth, a special feature being the aetiology
implications of these losses. The purpose of this study was
to evaluate the aetiology of premature loss of temporary
teeth in children of preschool age, and the localization of
these temporary losses: upper/lower arches or anterior/
lateral area of the dental arch.
The study clinically evaluated a group of 274 children,
with ages between 4-8 years, from three kindergartens in
Iasi, divided, according to sex, into four age groups. The
observation was made that, aetiologically, deciduous teeth
are most frequently affected by simple/complicated caries,
leading to premature loss, with extractions performed
before the time of permanent teeth eruption; such early
losses occur more frequently in the mandibular arch than
in the upper arch, and in the lateral area, comparatively
with the anterior one, regardless of age group. The prevalence of a premature loss of temporary teeth, determined
by the increased number of transitional edentulous dental
arches and by the location pattern of losses in the dental
arches, supports the data obtained in the present study.
Keywords: premature loss, dental pattern, caries, dental
trauma, temporary tooth extractions.
INTRODUCTION
Premature loss of temporary teeth may have
either general or local causes. In temporary and
mixed dentition, such losses have severe negative consequences, being especially important
during growth and development periods, if considering the prematurely lost pattern and its
implications in the existing and subsequent
intermaxillary relations. In this respect, several
clinical studies have been reported in the literature of the field; for example, Menez and Uliana
[1] observed more numerous losses towards the
age of 7 years (29.1%), the most frequently
involved here being the prime temporary molar
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(45.8%); Nogueira et al. [2] related on the consequencies of the premature losses of temporary
teeth caused by the precocious eruption of permanent teeth, and on a possible installation of a
false IInd or IIIrd Angle class, as evidenced by the
anterior study on the prevalence of prime and
secondary temporary molar losses; the recent
studies of Varela Morales M. [3] showed that
about 59% of the examined patients having suffered dental losses through traumatisms were
boys, and also that the traumatic lesions of teeth
caused premature dental losses in 46% of cases.
According to the study of Medrano Luna et al.
[4], 3.6% of preschool children showed carious
lesions and /or premature losses of temporary
teeth, no dependence of these variables on either
age (H = 0.0928341, p = 0.937691) and sex
(U = 0.04867, p = 0.0973127) being recorded.
The scope of the study was clinical evaluation, evidencing of the aetiological factors, and
registering of the prevalence of premature losses
of temporary teeth in preschool age children,
and the typology of such losses: the upper/lower
arch or the frontal/lateral area of the dental arch.
MATERIALS AND METHOD
The development of the study involved information of parents and educators, for obtaining
their consent and support. The clinical examination was performed by the paedodontist, with the
usual dental instruments (mouth mirrors, tweezers,
explorers), special attention being given to the
absent dental structures.
volume 2 • issue 4 October / December 2012 • pp. 260-264
ON THE ETIOLOGY AND TIPOLOGY OF PREMATURE LOSSES
OF TEMPORARY TEETH IN PRE-SCHOOL CHILDREN
Epidemiological characteristics of the experimental group. The group was formed of 274
patients from 3 kindergartens of the urban area
of the Ia[i city, the prevalence of premature losses
of temporary dentition in preschool population
being followed. The group included 151 girls and
123 boys, in a F/M ratio = 1.23/1. Distribution
on sexes evidences a slightly higher ratio of the
cases of premature losses of temporary teeth in
girls (55.1%)
The data were loaded and processed by means
of the EPIINFO and EXCEL statistical functions,
being analyzed with statistical methods, so that
the t-Student test – known as considering the
measurement of variability and the importance
of observations – w as applied for calculating
the significant difference. Test c2, a non-parametric test comparing 2 or more frequency distributions, was also applied, and the relative risk (RR)
and the Pearson correlation coefficient were interpreted.
RESULTS
differences on groups of age, the frequency of
premature losses being approximately the same
in both girls and boys from the same group of
age (p = 0.789).
Table I. Distribution of cases with premature losses
of temporary teeth according to gender and
groups of age
According to the localization of the premature
losses of temporary teeth, at the level of the
whole group, more numerous losses are observed
on the lower arch, comparatively with the upper
one, however, the difference is not statistically
significant (c2 = 1.77; GL = 1; p = 0.183) (Fig. 2,
Table II).
In the cases under study, 114 of the 274 children of the experimental group (41.6%) showed
premature losses of temporary teeth, while 125
of the 548 arches evidenced premature losses
(22.8% of the total number of arches) (Fig. 1).
children w ith
prem ature
losses in
dental arches
41.6%
children w ith
com plete
dental arches
58.4%
Fig. 1. Distribution of cases as a function of the
integrity of dental arches
On groups of age and gender, the distribution
of the cases with premature losses in temporary/
mixed dentition, comparatively with the whole
group under investigation, is slightly higher in
boys, the highest frequency being registered in
the 7-8 year group (15%), for both girls and boys
(Table I). Test c2 evidences no significant
International Journal of Medical Dentistry
Fig. 2. Frequency of premature losses as a function of
localization on the arch
Table II. Localization of premature losses of
temporary teeth on groups of age
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Maria-Antonela Beldiman, A. Maxim, Adriana Bălan
A higher number of lower arches with premature losses of temporary teeth is also registered
on groups of age, yet the distribution shows no
statistically significant differences (c2 = 2.57;
GL = 3; p = 0.462). (Fig. 3)
Fig. 5. Number of premature losses as a function of
localization on arch and group of age
Fig. 3. Number of premature losses as a function of
localization on arch and group of age
According to the localization of premature
losses of temporary teeth, significantly higher
losses were registered on the lateral arch,
comparatively with the frontal one (c2 = 34.71;
GL = 1; p < 0.001), at the level of the whole group
(Fig. 4).
Appearing as a risk factor for the premature
loss of the temporary teeth, carious lesions
appear, in ratios exceeding 50%, in all groups
of age here under study, which explains
the absence of statistically significant differences
on groups of age (c2 = 6.39; GL = 3; p = 0.094)
(Fig. 6).
Fig. 6. Distribution of cases with carious lesions on
groups of age
Fig. 4. Frequency of premature losses as a function of
localization on the arch
On groups of age, several losses may be
observed on the lateral arch, comparatively with
the frontal one, according to the localization
of the premature losses of temporary teeth,
howeverthe difference is not statistically significant (c2 = 1.09; GL = 1; p = 0.780) (Fig. 5).
262
From the view point of arches’ affection, carious lesions with ratios between 30 and 47%,
representing statistically significant distributions (c2 = 8.78 GL = 3; p = 0.032) may be observed
in all 4 groups of age. (Fig. 7, Table III)
The complications of the carious lesions characterize the 5-6 year group of age (80%), traumatisms being observed most frequently at the age
of 4-5 years (15%), while precocious extractions
appear of majority at ages of 7-8 years (30%)
(Fig. 8, Table IV)
volume 2 • issue 4 October / December 2012 • pp. 260-264
ON THE ETIOLOGY AND TIPOLOGY OF PREMATURE LOSSES
OF TEMPORARY TEETH IN PRE-SCHOOL CHILDREN
Table III. Frequency of arch affection through
carious lesions of temporary teeth
The most frequent cases of premature losses
through dental extraction were registered in the
7-8 year (7.3%) and 6-7 year (5.8%) groups of age
(Fig. 9).
Fig. 9. Distribution of cases as a function of
premature losses: with/without space narrowing
The premature losses caused by extractions
showed no statistically significant differences on
groups of age (c2 = 4.42; GL = 3; p = 0.220).
Table V. Premature losses through dental
extractions, on groups of age
Fig. 7. Distribution on number of arches with
carious lesions, on groups of age
DISCUSSION
Fig. 8. Weight of carious lesions on groups of age
Table IV. Aetiology of premature losses
in temporary teeth
International Journal of Medical Dentistry
Corroboration of the data provided by the
present study showed that they agree with those
of the medical literature of the field.
Thus, mention should be made here of
Martinez et al. [5] who, in a transversal study,
observed that premature losses appear mainly in
the prime temporary molar, usually associated
with malocclusions.
The same result was reported by Cardoso
et al. [6], while Batista [7] recorded a higher
prevalence for the premature loss of the right
secondary lower molar.
According to the studies of Medina-Solis et al.
[8], and Barros de Alencarr et al. [9], the relation
between the presence of carious lesions and the
existence of premature dental losses may induce,
263
Maria-Antonela Beldiman, A. Maxim, Adriana Bălan
to a certain extent, dental disharmonies and
malocclusions.
As to the affection, through carious lesions, of
the temporary teeth in preschool children, the
study of Irigoyen et al. [10] evidenced a reduction
of up to 30% of the index for carious lesions, so
that a statistically significant reduction in the
number of caries at the level of the temporary
teeth corresponding to this group of age was also
observed.
CONCLUSIONS
1. The distribution of cases with premature
losses in temporary/mixed dentition, on
groups of age and gender, versus the whole
group of study, is slightly higher in boys, the
highest frequency being recorded in the 7-8
year group of age (15%), in both girls and
boys.
2. As a risk factor for the premature loss of temporary teeth, carious lesions appear, in ratios
exceeding 50%, in all groups of age here
under study, which explains the absence of
statistically significant differences on groups
of age.
3. The study revealed that complications of the
carious lesions appear in the 5-6 year group
of age (80%), traumatisms occurring most frequently in the 4-5 year group (15%), while
precocious extractions – in the 7-8 year group
(30%).
4. According to the localization of the premature loss of temporary teeth, globally, significantly more numerous losses were
evidenced at the level of the lateral arch, comparatively with those of the frontal one.
5. Premature losses are more frequent in the
secondary temporary molar, as well as in the
first temporary one, the association with
malocclusions being quite possible.
6. If considering the importance of temporary
dentition in the development of the permanent one, for the realization of the masticator
264
and phonetic functions, in correlation with
the individual occlusal and for joint relations,
preservation of the decidual teeth up to the
exfoliation and natural loss of the temporary
teeth from the dental arches is especially
important.
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