Maria-Antonela Beldiman, A.

Maxim, Adriana Blan Biomaterials

ON THE ETIOLOGY AND TIPOLOGY OF PREMATURE LOSSES OF TEMPORARY TEETH IN PRE-SCHOOL CHILDREN

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: mariabeldiman@yahoo.com

Abstract

Maria-Antonela Beldiman1, A. Maxim2, Adriana Blan3

INTRODUCTION

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.

(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.

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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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.
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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.

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

RESULTS

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%

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. 1. Distribution of cases as a function of the integrity of dental arches

children w ith com plete dental arches 58.4%

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 Blan

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)

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).

Fig. 3. Number of premature losses as a function of localization on arch and group of age

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. 5. Number of premature losses as a function of localization on arch and group of age

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).
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Fig. 4. Frequency of premature losses as a function of localization on the arch

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)
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Fig. 6. Distribution of cases with carious lesions on groups of age

Table III. Frequency of arch affection through carious lesions of temporary teeth

ON THE ETIOLOGY AND TIPOLOGY OF PREMATURE LOSSES OF TEMPORARY TEETH IN PRE-SCHOOL CHILDREN

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. 7. Distribution on number of arches with carious lesions, on groups of age

The premature losses caused by extractions showed no statistically significant differences on groups of age (c2 = 4.42; GL = 3; p = 0.220).

Fig. 9. Distribution of cases as a function of premature losses: with/without space narrowing Table V. Premature losses through dental extractions, on groups of age

Fig. 8. Weight of carious lesions on groups of age Table IV. Aetiology of premature losses in temporary teeth

DISCUSSION

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,
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Maria-Antonela Beldiman, A. Maxim, Adriana Blan

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

Menezes, J.V., Uliana, G., Profilul copilului cu din]ii temporari pierdu]i prematur, J Bras Odontopediatr, Curitiba 2003, 6(31): 196-200. 2. Nogueira, J.A.S. et al., Pierderile precoce ale din]ilor temporari [i consecin]ele asupra viitoarei denti]ii [i elaborarea unor propuneri de prevenire a acestor pierderi, Rev. ABO Nacional So Paulo 1998, 6(4): 228-233. 3. Varela Morales M., Atitudinea privind erup]ia dentar [i cre[terea asociat dizarmoniilor dento-faciale, n Curs de Actualit]i Pediatrice, Madrid, Ed. Edxlibris, 2005, pp. 301-308. 4. Medrano Luna, J.E., Cedillo Galindo, L., Pruneda, J.F., Prevalen]a factorilor de risc pentru deficien]ele ocluzale, Revista Asocia]iei Dentare Mexicane, 2002, Vol. 59, nr. 5. 5. Martinez, N.S. et al., Pierderea prematur a din]ilor temporari [i malocluzia la copii [colari. Policlnica Pedro Daz Coello, 2003. Disponbil la: http: www. cocmed.sld.cu/no93/Acces din: 10 Dec 2005. 6. Cardoso, L. et al., Aspecte ale prevalen]ei pierderilor premature ale molarilor temporari, Pesq Bras Odontoped Clin Integr, Joo Pessoa 2005, 5(1): 17-22. 7. Batista, A.M.R., Prevalen]a [i etiologia pierderilor premature ale din]ilor temporari la pacien]ii urmri]i n Clinica de Odontopediatrie a Universit]ii Santa Catarina, 2006, Tez de doctorat. 8. Medina-Solis C.E., H.M. del Socorro, Rosado-Vila G., Minaya-Sanchez, Vallejos-Sanchez A.A. Perdida dental y patrones de caries en preescolares de una comunidad suburbana de Campeche Acta Odontol. Venez Caracas, sept. 2004., Vol. 42, no. 3. 9. Barros de Alencarr C.R., Cavalcanti A.L., Bezerrai Medeiros P.K. Early loss of primary teeth: etiology, epidemiology and orthodontic consequences Publ. UEPG Ci. Biol. Sade, Ponta Grossa, mar./jun. 2007, 13 (1/2): 29-37. 10. Irigoyen M.E., Zepeda M.A., Snchez L., Molina N. Prevalencia e incidencia de caries dental y hbitos de higiene bucal en un grupo de escolares del sur de la Ciudad de Mxico: Estudio de seguimiento longitudinal. Rev. ADM 2001; 53(3): 98-104. 1.

References

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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