|Year : 2020 | Volume
| Issue : 1 | Page : 11-15
The prevalence of dental anomalies among the Maharashtrian population: A radiographic study
Devashish Kumar, Sanjeev Datana, Abhijeet Kadu, Shiv Shankar Agarwal, SK Bhandari
Department of Dental Surgery and Oral Health Sciences, AFMC, Pune, Maharashtra, India
|Date of Submission||17-Dec-2019|
|Date of Acceptance||19-Dec-2019|
|Date of Web Publication||31-Jan-2020|
Department of Dental Surgery and Oral Health Sciences, AFMC, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Developmental anomalies are frequently observed in the routine oral health examination. Only clinical examination without radiographic study tends to underestimate the prevalence of these anomalies.
Aim: The aim of the study was to estimate the frequency of occurrence of three commonly occurring dental anomalies (hypodontia, hyperdontia, and dental impaction) using orthopantomogram (OPG) in the young population seeking orthodontic treatment in Pune, Maharashtra.
Materials and Methods: This cross-sectional study included pretreatment OPGs and the dental records of patients in permanent dentition selected from the achieves of the patients coming for treatment at the Division of Orthodontics and Dentofacial Orthopedics, Department of Dental Surgery and Oral Health Sciences, Armed Forces Medical College, Pune, from January 1, 2015, to December 1, 2018. These records were then evaluated and analyzed by a trained pediatric dentist for the occurrence of hypodontia, hyperdontia, and impacted teeth. One thousand and one hundred OPGs were examined and the data were recorded in MS Excel sheets and were subjected to statistical analysis.
Results: The most recorded developmental anomaly was hypodontia (11.6%), followed by impacted teeth (5.5%) and hyperdontia (1.1%). Statistically significant difference was noted in the distribution of hypodontia and impacted teeth between males and females (P < 0.001), whereas no statistically significant difference was noted in the distribution of hyperdontia between the males and females (P > 0.05).
Conclusions: Dental anomalies can be commonly observed in OPG. Hypodontia and dental impaction were the most common dental anomalies observed in the present study. The early recognition of these dental anomalies is very important to offer preventive modality of management. The findings of the present study may be considered representative of the Maharastrian population. Multicentric studies with a larger sample size are recommended to be representative of the larger regions of the country.
Keywords: Developmental anomalies, hyperdontia, hypodontia, impacted teeth
|How to cite this article:|
Kumar D, Datana S, Kadu A, Agarwal SS, Bhandari S K. The prevalence of dental anomalies among the Maharashtrian population: A radiographic study. J Dent Def Sect. 2020;14:11-5
|How to cite this URL:|
Kumar D, Datana S, Kadu A, Agarwal SS, Bhandari S K. The prevalence of dental anomalies among the Maharashtrian population: A radiographic study. J Dent Def Sect. [serial online] 2020 [cited 2020 Apr 6];14:11-5. Available from: http://www.journaldds.org/text.asp?2020/14/1/11/276408
| Introduction|| |
Developmental anomalies are frequently encountered in the routine oral health examination. Children with developmental anomalies are not only vulnerable to malocclusion and functional problems but also vulnerable to a poor oral health-related quality of life. When dental anomalies are associated with the anterior teeth, self-esteem-related psychological issues are also involved.
The nature of these developmental anomalies generally is asymptomatic, but they can lead to multiple complications involving eruption of teeth, malocclusions, periodontal problems, interference in speech and mastication, compromise in the esthetics, and temporomandibular joint dysfunction., Thus, many times, these anomalies require interdisciplinary management. It is therefore imperative to understand the epidemiological aspects of these problems, which provide for containing the disease approach that can help in preventing morbidities. Moreover, it provides insights about the nature of these developmental anomalies, their prevalence, and etiology, which helps in timely treatment planning and management.
The epidemiology of hypodontia, hyperdontia, and impacted teeth is highly variable, and literature shows inconsistent results when reported intra- and interpopulation. These differences may have been due to racial variations, different methods of sampling used, age group selected, and diagnostic criteria used.,, These variations can also have genetic attributes having a polygenic model of inheritance. For example, nonsyndromic tooth agenesis has been found to be associated with a mutation in MSX1, PAX9, and transforming growth factor-alpha genes.,
Literature on the developmental anomalies has showed studies with a large population being mostly relied only on clinical examination without radiographic evaluation, which may lead to the under-recording of these anomalies.
The present study was conducted to evaluate the prevalence of three commonly occurring dental anomalies (hypodontia, hyperdontia, and dental impaction) using orthopantomogram (OPGs) in the young population seeking orthodontic treatment in Pune, Maharashtra.
| Materials and Methods|| |
This cross-sectional study was conducted at the Division of Orthodontics and Dentofacial Orthopedics, Department of Dental Surgery and Oral Health Sciences, Armed Forces Medical College, Pune, Maharashtra. The sample consisted of pretreatment OPGs along with other dental records selected from the archives of patients coming for treatment to the department from January 1, 2015 to December 31, 2018. OPGs of patients in permanent dentition were included in the study. Third molars were not considered for the evaluation. OPGs of patients having a history of extraction of any teeth for any reason except for third molars and having a history of previous orthodontic treatment were excluded from the study. Patients with syndromes such as Down's, Crouzon, Gorlin, Ectodermal dysplasia, Cleft lip and palate and Ehlers–Danlos were also excluded from the study. Finally, 1100 OPGs were examined and the data were recorded. These records were then evaluated and analyzed by a trained pediatric dentist for hypodontia, hyperdontia, and impacted teeth.
The collected data were recorded in MS Excel sheets and were subjected to statistical analysis. The entire data were analyzed for statistics using SPSS software for windows (version 22.0;IBM, Armonk, NY). The intergroup statistical comparison of the distribution of categorical variables was tested using the Chi-square test.
| Results|| |
Distribution of the study sample
The sample included 1100 OPGs of patients in the age range of 12–30 years. Gender distribution of the sample population revealed 520 (47.3%) males and 580 (52.7%) females [Table 1]. The mean ± standard deviation (SD) of age among males was 17.8 ± 4.5 years and the age range was 12–28 years. The mean ± SD of age among females was 17.5 ± 3.7 years, with an age range of 12–30 years.
Overall prevalence and distribution of dental anomalies
Of total of 1100 OPGs examined, dental anomalies were recorded in 16.7% of the OPGs. About 19.2% of the male OPGs showed development anomalies in comparison of 14.5% females. The difference between them was statistically not significant (P = 0.136) [Table 2]. Some OPGs studied showed more than one developmental anomalies, but for the purpose of statistical calculation, the OPGs were counted as one. For example, OPGs showing hypo- or hyperdontia also showed the impacted teeth. The overall prevalence (males + females) of three selected dental anomalies in decreasing order was hypodontia (11.6%), followed by impacted teeth (5.5%) and hyperdontia (1.1%) [Graph 1]. Males and females showed similar distribution for all three developmental anomalies with no statistical significant difference (P > 0.05) between them [Table 2] and [Graph 1].
Tooth-wise distribution of hypodontia
Overall, 188 teeth were affected by hypodontia. Maxillary lateral incisors (tooth no 12 and 22) followed by mandibular central incisors (tooth no 31 and 41), and mandibular second premolars (tooth no 35 and 45) were the most commonly affected teeth by hypodontia. The difference in the prevalence of hypodontia between males and females was statistically significant (P < 0.001) [Table 3].
Prevalence and distribution of hyperdontia
Mesiodens was the only tooth observed in hyperdontia, with an overall prevalence of 1.1%. The difference in the distribution of mesiodens between males and females was statistically not significant (P = 0.429) [Table 4].
Tooth-wise distribution of impacted teeth
Overall, 88 teeth were impacted. The most commonly observed impacted teeth were the maxillary canines (13 and 23) followed by mandibular canines (33, 43). Least common impacted teeth were maxillary lateral incisors and mandibular first premolars. The difference in the distribution of impacted teeth between males and females was statistically significant (P < 0.001) [Table 5].
| Discussion|| |
Developmental dental anomalies are not an uncommon finding both clinically and radiographically. Only clinical examination not supported by radiographic evaluation tends to underestimate the prevalence of these developmental anomalies. As per the definition, clinically missing teeth are those that are not visible in the oral cavity as well on the radiograph. Therefore, the present study was conducted taking patients' radiograph and dental records into consideration.
A wide range of the prevalence of developmental anomalies have been reported in the literature. This variation may be due to different diagnostic criteria used for the diagnosis of dental anomalies, age range selected, and racial and genetic factors.
The prevalence of all the developmental anomalies evaluated from OPGs in the present study was 16.7%. Shokri et al. (sample size: 1649, age range: [7–35 years]) in their study on panoramic radiographs recorded a prevalence of 29% dental anomalies, Gupta et al. – 34.28% (sample size – 1123), Ezoddini (Iran) – 40.8% (sample size – 900), and Guttal et al. – 1.73% (sample size 20182).
This may be attributed to variations in the number of developmental anomalies selected for the study, the age range selected, the inclusion and exclusion criteria of the studies, methodology and recording criteria, and racial variations.
There has been a large variation reported in the literature for the prevalence of hypodontia ranging from 0.15% to 26.1%., Hypodontia in the present study was observed in 11.6% of the cases. Similar results were reported by Nordgarden et al. (11%) from Norway (sample size 1100) and Chung et al. (11%) from Korea (sample size 1622). This may be attributed to a similar sample size in these studies. Diab (15.4%) and Shokri et al. (16%) have reported a higher prevalence. This may be due to the higher the age range selected (7–35 years). Goya et al. reported a lower prevalence of 9.4%. Medina reported a much lower prevalence (4%). Lower prevalence may be due to the lower age of the sample selected (3–17 years – Goya et al. and 5–11 years – Medina), which poses chances of underestimating the hypodontia. The most commonly missing teeth in the present study were the maxillary lateral incisors (12 and 22). These findings were in consonance to that reported by Medina Nordgarden et al., Chung et al., and Shokri et al, while Goya et al. and Thilander et al. have reported mandibular second premolar to be the most common tooth involved in hypodontia.
Hyperdontia in the present study was recorded in 1.1% of the cases. Literature reports depict the prevalence of hyperdontia in the range of 0.1%–3.8%. The results of the present study were in consonance with Anitha et al., Fardi et al., and Gupta et al.who reported hyperdontia in 1.12%, 1.8%, and 0.89 of the cases, respectively. Lower prevalence has been reported in the Indian population by Guttal et al. (0.43%). This may be due to different age groups selected in the study (<14 years of children excluded). Higher prevalence has been reported in radiographic studies by Shokri et al. from Iran (2.43%) and Diab from Saudi Arabia (5.4%). Mesiodens was the only type of hyperdontia observed in the present. This is in consonance with the data reported by Gupta et al. who also did not report any other type of hypodontia than mesiodens. Fardi et al. (Greece) and Shokri et al. (Iran) have reported fourth molars followed by mesiodens as the most commonly affected tooth by hyperdontia. These differences may be attributed to racial variation.
Third molars were not included in the present study because of high variation in the age of eruption. Teeth impaction was recorded in 5.5% of the OPGs examined in the present study. Literature reports the incidence of impacted teeth excluding third molars in the range of 5.6%–18.8%. The most commonly impacted teeth in the present study were the maxillary canines followed by mandibular canines. This is in consonance with the published literature where the third molars were not taken into consideration., The prevalence of impaction noted among the maxillary canines in the present study was found to be 2%, which is in agreement with the past studies that show it in the range of 1%–3% for various populations.,,,, Fardi et al. has shown much higher prevalence of impaction of maxillary canine (8.4%); this difference may be due to the racial and methodological differences.
| Conclusions|| |
Hypodontia and dental impaction were the most common dental anomalies recorded in the present study. The early recognition of these dental anomalies is very important to offer preventive modality of management. These developmental anomalies can result in multiple complications, and their early detection is imperative to prevent permanent changes in the dentition and stomatognathic system. The maxillary lateral incisors were the most common teeth involved in hypodontia, while mesiodens was the most common supernumerary tooth. Maxillary canines were the most common teeth to be impacted. The findings of the present study may be considered representative of the mixed Indian population. Multicentric studies with a larger sample size are recommended to be representative of larger regions of the country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Polder BJ, Van't Hof MA, Van der Linden FP, Kuijpers-Jagtman AM. A meta-analysis of the prevalence of dental agenesis of permanent teeth. Community Dent Oral Epidemiol 2004;32:217-26.
Locker D, Jokovic A, Prakash P, Tompson B. Oral health-related quality of life of children with oligodontia. Int J Paediatr Dent 2010;20:8-14.
Nunn JH, Carter NE, Gillgrass TJ, Hobson RS, Jepson NJ, Meechan JG, et al
. The interdisciplinary management of hypodontia: Background and role of paediatric dentistry. Br Dent J 2003;194:245-51.
Akkaya N, Kiremitçi A, Kansu O. Treatment of a patient with oligodontia: A case report. J Contemp Dent Pract 2008;9:121-7.
Ranta R. Numeric anomalies of teeth in concomitant hypodontia and hyperdontia. J Craniofac Genet Dev Biol 1988;8:245-51.
al-Emran S. Prevalence of hypodontia and developmental malformation of permanent teeth in Saudi Arabian schoolchildren. Br J Orthod 1990;17:115-8.
Ooshima T, Ishida R, Mishima K, Sobue S. The prevalence of developmental anomalies of teeth and their association with tooth size in the primary and permanent dentitions of 1650 Japanese children. Int J Paediatr Dent 1996;6:87-94.
Thongudomporn U, Freer TJ. Prevalence of dental anomalies in orthodontic patients. Aust Dent J 1998;43:395-8.
Bailit HL. Dental variation among populations. An anthropologic view. Dent Clin North Am 1975;19:125-39.
De Coster PJ, Marks LA, Martens LC, Huysseune A. Dental agenesis: Genetic and clinical perspectives. J Oral Pathol Med 2009;38:1-7.
Frazier-Bowers SA, Pham KY, Le EV, Cavender AC, Kapadia H, King TM, et al
. A unique form of hypodontia seen in Vietnamese patients: Clinical and molecular analysis. J Med Genet 2003;40:e79.
Medina AC. Radiographic study of prevalence and distribution of hypodontia in a pediatric orthodontic population in Venezuela. Pediatr Dent 2012;34:113-6.
Bergström K. An orthopantomographic study of hypodontia, supernumeraries and other anomalies in school children between the ages of 8-9 years. An epidemiological study. Swed Dent J 1977;1:145-57.
Pemberton TJ, Das P, Patel PI. Hypodontia: Genetics and future hypodontia: Genetics and future perspectives. Braz J Oral Sci 2005;4:695-706.
Guttal KS, Naikmasur VG, Bhargava P, Bathi RJ. Frequency of developmental dental anomalies in the Indian population. Eur J Dent 2010;4:263-9.
Kositbowornchai S, Keinprasit C, Poomat N. Prevalence and distribution of dental anomalies in pretreatment orthodontic Thai patients. Korean Dent J 2010;13:92-100.
Nordgarden H, Jensen JL, Storhaug K. Reported prevalence of congenitally missing teeth in two Norwegian counties. Community Dent Health 2002;19:258-61.
Chung CJ, Han JH, Kim KH. The pattern and prevalence of hypodontia in Koreans. Oral Dis 2008;14:620-5.
Diab H. The prevalence of some dental anomalies on panoramic radiographs in Saudi population in Alkharj city. Egypt Dent J 2013;59:2243-47.
Shokri A, Poorolajal J, Khajeh S, Faramarzi F, Kahnamoui HM. Prevalence of dental anomalies among 7- to 35-year-old people in Hamadan, Iran in 2012-2013 as observed using panoramic radiographs. Imaging Sci Dent 2014;44:7-13.
Goya HA, Tanaka S, Maeda T, Akimoto Y. An orthopantomographic study of hypodontia in permanent teeth of Japanese pediatric patients. J Oral Sci 2008;50:143-50.
Thilander B, Pena L, Infante C, Parada SS, de Mayorga C. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development. Eur J Orthod 2001;23:153-67.
Salcido-García JF, Ledesma-Montes C, Hernández-Flores F, Pérez D, Garcés-Ortíz M. Frequency of supernumerary teeth in Mexican population. Med Oral Patol Oral Cir Bucal 2004;9:407-9.
Anitha S, Roopashri G, David MP. Prevalence of developmental dental anomalies – A clinical study. Int J Contemp Med Res 2018;5:22-4.
Fardi A, Kondylidou-Sidira A, Bachour Z, Parisis N, Tsirlis A. Incidence of impacted and supernumerary teeth-a radiographic study in a North Greek population. Med Oral Patol Oral Cir Bucal 2011;16:e56-61.
Gupta SK, Saxena P, Jain S, Jain D. Prevalence and distribution of selected developmental dental anomalies in an Indian population. J Oral Sci 2011;53:231-8.
Grover PS, Lorton L. The incidence of unerupted permanent teeth and related clinical cases. Oral Surg Oral Med Oral Pathol 1985;59:420-5.
Kramer RM, Williams AC. The incidence of impacted teeth. A survey at Harlem hospital. Oral Surg Oral Med Oral Pathol 1970;29:237-41.
Dachi SF, Howell FV. A survey of 3, 874 routine full-month radiographs. II. A study of impacted teeth. Oral Surg Oral Med Oral Pathol 1961;14:1165-9.
Rohrer A. Displaced and impacted canines. Int J Orthod Oral Surg 1929;15:1002-4.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]