|Year : 2017 | Volume
| Issue : 2 | Page : 83-89
Developmental and eruption disturbances of teeth and associated complications in Indian children from birth to 12 years of age: A cross-sectional survey
Parul Singhal1, Ritu Namdev1, Garima Kalia2, Ayushi Jindal1, Priyanka Grewal1, Samir Dutta1
1 Department of Pedodontics and Preventive Dentistry, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
2 Department of Pedodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
|Date of Web Publication||25-Jul-2017|
H. No. 114/19, Scheme No. 19, Vivekanand Nagar, Jind - 126 102, Haryana
Source of Support: None, Conflict of Interest: None
Introduction: This study evaluated the prevalence of developmental and eruption disturbances of teeth in both primary and mixed dentition of the patients along with the associations between the variables such as child's age, gender, jaw, and teeth.
Materials and Methods: A total of 9235 children visiting the Outpatient Department of Pedodontics and Preventive Dentistry, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India, were examined during a period of 1 year from January 2014 to January 2015. Clinical examination was carried out to identify the presence of developmental and eruption disturbances. Data management and statistical analysis were carried out using software Statistical Package for Social Sciences version 19.
Results: A total of 223 (2.41%) patients were affected by the developmental dental and eruption disturbances. The prevalence of developmental dental anomalies was 1.62 and of eruption disturbances was 1.06. Enamel hypoplasia was the most prevalent anomaly (0.77) whereas the most prevalent eruption disturbance was ectopic eruption (0.80).
Conclusion: The early detection and diagnosis of dental anomalies is important to prevent further disturbances and related complications.
Keywords: Developmental disturbances, eruption disturbances, supernumerary teeth
|How to cite this article:|
Singhal P, Namdev R, Kalia G, Jindal A, Grewal P, Dutta S. Developmental and eruption disturbances of teeth and associated complications in Indian children from birth to 12 years of age: A cross-sectional survey. Saudi J Oral Sci 2017;4:83-9
|How to cite this URL:|
Singhal P, Namdev R, Kalia G, Jindal A, Grewal P, Dutta S. Developmental and eruption disturbances of teeth and associated complications in Indian children from birth to 12 years of age: A cross-sectional survey. Saudi J Oral Sci [serial online] 2017 [cited 2020 Aug 14];4:83-9. Available from: http://www.saudijos.org/text.asp?2017/4/2/83/211560
| Introduction|| |
The tooth is a specialized part of the human body and understanding its development is quiet enigmatic and challenging. The development of tooth is a complex reciprocal interaction between the dental epithelium and underlying ectomesenchyme which involves a series of molecular signals, receptors, and transcription control systems.
Deviation from normal is regarded as anomaly. Developmental anomalies are result of disturbances of the epithelium and mesenchymal interactions of teeth. Developmental dental anomalies are marked deviations from the normal color, contour, size, number, and degree of the development of teeth. These can be congenital (inherited genetically) or acquired (teeth alterations during normal formation).
Many epidemiological studies have been conducted in different populations of the world to evaluate the prevalence of dental anomalies, but the results are conflicting. In literature, the prevalence of dental anomalies in different populations has ranged from 5.6% to 74%.,, Ooshima et al. showed the prevalence of tooth anomalies in Japanese children as low as 21% whereas Nayak and Nayak  and Gupta et al. reported 1.2% and 29.1% prevalence in Jodhpur and Panchkula regions of India, respectively. Differences in these results may be related to racial and regional variations, variable sampling techniques, and different diagnostic criteria used.
Eruption disturbances of teeth are deviation from the normal eruption sequence and position of teeth. The normal eruption, position, and morphology of teeth are paramount to facial esthetics and phonetics. Racial, ethnic, sexual, and individual factors can influence eruption and are usually considered in determining the standards of normal eruption.
It has been claimed that early diagnosis of developmental and eruption disturbances is important to start treatment at the optimal time so as to minimize the complications. Moreover, the knowledge of common dental anomalies can prove to be a useful tool for forensic dentistry. Many studies have documented the prevalence of dental anomalies and eruption disturbances in the permanent dentition, but there is a paucity of such studies in primary dentition in Indian scenario. Hence, the present study was conducted to gather baseline data regarding the prevalence of developmental and eruption disturbances of teeth in both primary and mixed dentition of the patients along with the associations between the variables such as child's age, gender, jaw, and teeth affected.
| Materials and Methods|| |
Study design and study setting
The present cross-sectional study was conducted on patients visiting the Outpatient Department of Pedodontics and Preventive Dentistry, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India, during a period of 1 year from January 2014 to January 2015. A total of 9235 children were examined, of which 5212 were male and 4023 were female. The study sample was broadly divided into two age groups depending on the dentition involved. Group I (<6 years, i.e., involving the deciduous dentition) included 3548 children and Group II (6–12 years i.e., involving the mixed dentition) included 5687 children.
Patients having cleft lip and palate, history of extraction for orthodontic purpose or because of caries and trauma, medical problems, and syndromes were excluded from the study.
A specially designed pro forma was used to record the demographic details of a patient along with the medical and dental history, clinical findings, and complications. It was filled by the same examiner to ensure the uniformity of data.
A comprehensive clinical examination was carried out to identify the presence of developmental and eruption disturbances. Intraoral periapical radiographs, occlusal radiographs, and orthopantomograms were taken in clinically suspected patients after taking their verbal consent. Sterilized instruments and separate gloves were used for each patient.
Patients were evaluated for the following developmental and eruption disturbances:
- Size anomalies (microdontia and macrodontia)
- Shape anomalies (germination, fusion, concrescence, talon cusp, dens invaginatus, dens evaginatus, taurodontism, peg laterals, and dilaceration)
- Number anomalies (anodontia, hypoodontia, and hyperdontia)
- Structure anomalies (dentinogenesis imperfecta and enamel hypoplasia)
- Positional anomaly (transposition)
- Eruption disturbances such as premature eruption, delayed eruption, and ectopic eruption.
Data management and statistical analysis were carried out using software Statistical Package for Social sciences version 19, IBM corporation, Armonk, New York, USA to derive the results and draw out the conclusion. Descriptive statistics were used to summarize the sample, and Pearson's Chi-square test was used to assess the relationship between different variables. Statistical significance was set at P < 0.05.
| Observations and Results|| |
The study sample included a total of 9235 patients, of which 223 (2.41%) patients were affected. Developmental dental and eruption disturbances accounted to be 248 in number. Out of the total patients affected by developmental and eruption disturbances, 199 (89.24%) patients had one, 23 (10.31%) patients had two, and one patient (0.45%) had more than two anomalies or eruption disturbances which explains why the number of anomalies and eruption disturbances was more than the number of patients affected.
The distribution of study sample according to different variables such as age, gender, and jaw affected is listed in [Table 1]. Group I consisted of 18 (0.194%) patients and Group II consisted of 205 (2.219%) patients. Males were 131 (1.418%) and females were 92 (0.996%). Maxilla was affected in 93 (1.201%), mandible in 66 (0.833%), and both jaws in 64 (0.649%) patients.
The prevalence of various developmental dental anomalies was 1.62 and of eruption disturbances was 1.06. Enamel hypoplasia was the most prevalent anomaly (0.77) followed by hypodontia (0.35), hyperdontia (0.28) whereas microdontia (0), macrodontia (0), anodontia (0), dens evaginatus (0), and taurodontism (0) were not reported in any patient. The most prevalent eruption disturbance was ectopic eruption (0.80) followed by delayed eruption (0.21) whereas least prevalent was premature eruption (0.054).
[Table 2] depicts the association of developmental and eruption disturbances of teeth with age.
|Table 2: Association of teeth having developmental and eruption disturbances (248) with age|
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Talon cusp, hypodontia, hyperdontia, enamel hypoplasia, ectopic eruption, and delayed eruption were maximally found in mixed dentition period than deciduous dentition and the result was statistically significant (P = 0.037, 0.003, 0.001, <0.001, <0.001, and 0.003, respectively) whereas fusion and premature eruption were present more in deciduous dentition and the result was statistically significant (P = 0.011 and 0.005, respectively).
[Table 3] shows the association of developmental and eruption disturbances according to gender and jaws involved in the patients. Hyperdontia and delayed eruption were found maximum in males as compared to females and the result was statistically significant (P = 0.0002 and 0.0477, respectively). Talon cusp, hyperdontia, and delayed eruption were present maximum in maxilla as compared to mandible and both jaws and the result was statistically significant (P = 0.001, <0.001, and 0.001, respectively) whereas hypodontia and ectopic eruption were significantly present in mandible as compared to maxilla and both jaws (P ≤ 0.001 and <0.001, respectively). Enamel hypoplasia was present in both jaw and the association was statistically significant as compared to maxilla and mandible (P < 0.001).
|Table 3: Association of teeth having developmental and eruption disturbances (248) with gender and jaw involved|
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The location and distribution of teeth affected by developmental and eruption disturbances are enlisted in [Table 4], and [Table 5] shows the complications associated with the developmental and eruption disturbance.
|Table 4: Location and distribution of teeth affected by developmental and eruption disturbances (248)|
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|Table 5: Complications associated with developmental and eruption disturbances|
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| Discussion|| |
Of total 9235 children screened, 223 (2.41%) patients had developmental and eruption disturbances with developmental anomalies accounting for 1.62% and eruption disturbances for 1.06%. Males predominance over females was in accordance with Nayak and Nayak  whereas in contrast to Najm and Younis  maxillary predominance (1.201%) as compared to mandibular (0.833%) and both jaws (0.649%) involvement was found which was in agreement with Temilola et al. and Shokri et al.
Several studies have reported the frequency of various dental anomalies in different populations, but the results are conflicting. In literature, the prevalence of dental anomalies in different populations has ranged from 5.6% to 74%.,, In the present study, the prevalence of developmental dental anomalies came out to be 1.62% which was in close association with the study conducted by Guttal et al. in Dharwad region of India. However, a significant difference was observed in the studies conducted by Kathariya et al., Nayak and Nayak  in Maharashtra and Jodhpur regions of India, respectively. Similarly, Garib  and Najm and Younis  reported a variable range in prevalence as 40% and 33.9% in Thamar and Iraq, respectively. These conflicting results could be explained primarily by racial differences, local environmental influences and nutrition, differences in sampling techniques, differences in the age of the patients, inclusion criteria, and study design.
In the present study, enamel hypoplasia (0.77%) was the most common developmental anomaly. Fluorosis came out to be the most common cause of enamel hypoplasia as the areas in and around Rohtak have high levels of fluoride in drinking water and most of the patients who reported with this anomaly were the residents of these areas. In India, 19 states have been identified having fluoride concentration in groundwater more than the permissible limit. Haryana is one of the states where problem of fluorosis is widespread. Fourteen districts in Haryana, namely, Bhiwani, Faridabad, Gurgaon, Hissar, Jhajjar, Jind, Kaithal, Kurushetra, Mahendragarh, Panipat, Rewari, Rohtak, Sirsa, and Sonepat, have fluoride concentration more than 1.5 mg/L permissible limit prescribed by the Bureau of Indian Standards in groundwater wells (Central Ground Water Board, 2010). Primary dentition is thought to be less affected by fluorosis. This was also reflected in our study as the occurrence was statistically significant in mixed dentition as compared to deciduous dentition (P < 0.001).
Hypodontia is generally defined as the developmental absence of one or more teeth, excluding the third molars, either in primary or permanent dentition. Large differences in the prevalence of tooth agenesis have been reported, varying from 0.3% to 36.5%. However, in our study, hypodontia was found to be prevalent only in 0.35% population. Davis found that in Asian population, the mandibular lateral incisors were the most affected. Similar results were found in our study also.
Supernumerary teeth (ST) or hyperdontia refers to a developmental dental anomaly where any tooth or odontogenic structure is formed from tooth germ in excess of usual number for any given region of the dental arch. The prevalence of ST in the general population has been reported to be between 0.15% and 3.8% with males showing a higher predominance. The frequency is 3.8% in permanent dentition which is higher as compared to 1.8% for primary dentition. Higher prevalence in males may be due to the association of the ST with the autosomal recessive gene, which has a greater penetration in males, as was suggested by Niswander et al.
Talon cusp has been defined as an accessory talon-shaped cusp arising from the lingual (or facial surface) of the crown of a tooth and extending at least half of the distance from the cementoenamel junction to the incisal edge of the tooth. Mitchell first reported this dental anomaly on the palatal surface of the maxillary central incisor, in his 1982 article. Mellor et al. (1970) first mentioned the term “talon cusp,” since the cusp resembled an eagle's talon. The prevalence of talon cusp varies among different ethnic and religious groups. In our study, the prevalence of talon cusp was 0.076% which was lower than the prevalence of 0.2% reported by Kaur et al. in Indian population. The high incidence of occurrence in lateral incisor may be due to compression of the tooth germ during the morphodifferentiation stage between the central incisors and canine. The sequel of compression can either result in an outward folding or an infolding of the dental lamina.
Different terminologies have been used to describe the anomaly of double teeth such as fusion, gemination, and twinning. The frequency of double teeth varied from 0.1% to 1.6% despite the variation in the age and region of the group examined. In the present study, fusion and germination were reported in 0.043% and 0.032% sample, respectively, and the result was in contrast to studies conducted by Guttal et al. and Vibhute et al.
Peg laterals accounted for 0.03% in our study which was much lesser than 0.4% as reported by Nayak and Nayak  in Jodhpur region of India.
The prevalence of eruption disturbances in our study was 1.06%, which was in contrast to studies conducted by Bondemark and Tsiopa  and Noda et al. who reported the overall prevalence of eruption disturbances to be 2.3% and 4% in Sweden and Japan, respectively.
The eruption of a tooth in an abnormal position is known as ectopic eruption. The findings in our study were in close association with the study conducted by Patil et al. and were in contrast with by Kaur et al. and Gupta et al. who showed higher prevalence in Ghaziabad and Indore, respectively.
Among other eruption disturbances, delayed eruption was accounted to be the second most common eruption disturbance with the prevalence of 0.021%. Our results were in coincidence with the findings by Javali and Meti  who reported the prevalence of 0.20% in North Karnataka population but greater than a study conducted by Kayal andJayachandran  reporting a prevalence of 0.08%. Maxilla was frequently affected than mandible, also showing a significant association (P = 0.001). Noda et al. also supported the finding that maxilla is more affected than mandible.
According to the definition presented by Massler and Savara (1950) taking only the time of eruption as reference, natal teeth are those observable in the oral cavity at birth and neonatal teeth are those that erupt during the first 30 days of life. The prevalence ranges from 1:716 births (0.139%) to 1:30,000 births (0.003%). In our study, the prevalence of premature eruption was 0.054% and it was significantly associated with deciduous dentition (P = 0.005).
In our study, altered esthetics was the most common complication. Impaction, malocclusion, early pulpal involvement, diastema, rotation, alteration in the path of eruption, displacement, mobility, and feeding problems were also seen. Treatment for these anomalies and eruption disturbances varies according to the particular case and depends on severity and the pattern of these.
| Conclusion|| |
This study concluded that enamel hypoplasia was the most prevalent anomaly followed by hypodontia and hyperdontia whereas microdontia, macrodontia, anodontia, dens invaginatus, and taurodontism were least common. Ectopic eruption was the most prevalent eruption disturbance followed by delayed eruption and premature eruption.
Fluorosis came out to be the major cause of enamel hypoplasia in this study as the areas in and around Rohtak have high levels of fluoride in drinking water. Hence, this study endorses fluoride mitigation programs to be instituted in the study area. It also advocates regular dental check up to be done so that the anomalies which might go unnoticed can be detected at an earlier stage and treatment can be instituted accordingly and therefore further unseen complications can be prevented.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]