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ORIGINAL ARTICLE
Year : 2020  |  Volume : 38  |  Issue : 1  |  Page : 26-33
 

Prevalence and pattern of caries in primary anterior teeth of preschool children: An observational study


Departement of Pedodontic and Preventive Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India

Date of Submission06-Feb-2020
Date of Acceptance11-Feb-2020
Date of Web Publication12-Mar-2020

Correspondence Address:
Prof. Vinay Kumar Srivastava
Faculty of Dental Sciences, Institute of Medical Sciences, BHU, Varanasi - 221 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_62_20

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   Abstract 


Introduction: Primary teeth are prone to caries. Consequences of caries may hamper eruption and function of the succedaneous teeth. The aim of the study is to find the prevalence and patterns of dental caries in maxillary and mandibular primary anterior teeth of preschool children. The study design adopted was an analytical observational study. Methodology: Caries examination was done using the WHO caries detection criteria. Anterior carious tooth surfaces were examined under optimal light source by a single qualified examiner to minimize visual error. The age of children was measured in years. Obtained data were subjected to statistical analysis using SPSS 16 software. A test for significance was done with the help of the Chi-square test. Results: Right maxillary and mandibular canines had more caries prevalence and patterns as compared to their left counterpart of the same arch. Maxillary canines had more prevalence of caries as compared to mandibular canines. Mandibular lateral incisors had about eight times less chance to develop caries as compared to maxillary lateral incisors. Maxillary and mandibular right central incisors had equal caries prevalence and patterns of their counterparts of the same arch, but maxillary central incisors had four times more caries prevalence as compared to mandibular central incisors. Conclusions: Right maxillary and mandibular anterior teeth had more prevalence of caries as compared to their left counterparts. Maxillary anterior teeth had more prevalence of caries as compared to mandibular anterior teeth.


Keywords: Caries patterns, caries prevalence, primary anterior teeth


How to cite this article:
Srivastava VK. Prevalence and pattern of caries in primary anterior teeth of preschool children: An observational study. J Indian Soc Pedod Prev Dent 2020;38:26-33

How to cite this URL:
Srivastava VK. Prevalence and pattern of caries in primary anterior teeth of preschool children: An observational study. J Indian Soc Pedod Prev Dent [serial online] 2020 [cited 2020 Apr 2];38:26-33. Available from: http://www.jisppd.com/text.asp?2020/38/1/26/280519





   Introduction Top


Anterior teeth of preschool children are more susceptible to dental caries due to increased consumption of sugars and reduced exposure of fluoride.[1] It has been testified that caries follow a typical pattern on each tooth surface. All the surfaces of primary tooth are not equally susceptible to caries; therefore, it is important to know the relative tooth susceptibility of maxillary and mandibular anterior teeth. High susceptibility to caries may be due to dental tissue-level deficiency, hygiene, or cariogenic food habits. Anatomy/positions of tooth in the arch also play an important role in plaque accumulation like inaccessible tooth surfaces to hygiene or due to tooth mineralization defect/matrix formation defects; tooth becomes more sensitive to demineralization. Children are unaware of the consequences of unhygienic oral conditions and have a tendency of consuming more cariogenic diet. Parental ignorance and unawareness of the importance of oral hygiene worsens the oral conditions of children. Dental caries is recognized as a serious community health problem due to its potential for increasing risk of caries in succedaneous tooth.[2] Each primary anterior tooth surface has a specific pinpoint area of caries initiation which has a higher susceptibility to caries as compared to the same surface of the tooth and other tooth surface/surfaces. These caries form a specific pattern on each tooth surface with distinctive caries prevalence and patterns. Most of the prevalence studies are based on the total prevalence of caries at specific age.[3],[4] None of the studies of primary teeth regarding caries prevalence were based on the individual tooth assessment. This study revealed the prevalence and patterns of dental caries of each primary anterior maxillary and mandibular tooth.


   Methodology Top


Children (n = 900) participating in the study were 56.7% of males and 43.3% of females. The present study was done to know the prevalence and pattern of dental caries in primary anterior tooth of preschool children. Caries examination was conducted under optimal light source using the WHO caries detection criteria.[5] Exclusion criteria of the study were children suffering from any systemic disease, special care need children, and erupted permanent teeth. Ethical clearance was taken from the institute, and signed written consent was obtained from children's parents. Caries prevalence and patterns of preschool children, who visited the Faculty of Dental Sciences for caries or other oral/tooth ailments, were examined, and data were recorded. The children were examined under standardized environment by a single qualified examiner under optimal light source to reduce error of observation. Children's age was measured in years, and ages in years and months was merged with the nearest round off number. Each tooth surface was scored independently. No radiographic examination was done. The Chi-square test was done to compare the study population to age and gender. Student's t-test was used to compare the data between males and females.


   Results Top


Prevalence and caries pattern in maxillary right primary canines [Table 1]
Table 1: Age and Gender wise Prevalence & Pattern of Caries in Maxillary Right Primary Canine

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In preschool children, 90% of maxillary right primary canine had no caries. Only 10% prevalence of caries was detected in maxillary right primary canines with 11 patterns of caries. Mesial caries was seen 4% of maxillary right canines. The incidence of mesial caries was observed to be highest at the age of 4 years, followed by 3, 6, and 5 years. Another common pattern of caries in maxillary right canines was distal caries which were observed in only 1.3%. Other common caries patterns were buccal caries, incisal caries, mesio-buccal caries, and mesio-disto-buccal caries which occupied 0.7% each. Preschool children's maxillary right canines also showed mesio-bucco-incisal, mesio-linguo-disto-buccal, and disto-buccal caries patterns which occupied 0.3% each. Mesio-distal caries patterns occupied 1%. No significant difference of carious prevalence and pattern was observed among different ages and genders (P = 0.585 and P = 0.196, respectively).

Prevalence and caries pattern in maxillary right primary lateral incisors [Table 2]
Table 2: Age and Gender wise Prevalence &Pattern of Caries in Maxillary Right Primary lateral incisor

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In preschool children, 68% of maxillary right primary lateral incisors had no caries. 32% prevalence of caries was observed in maxillary right primary lateral incisors with 9 patterns of caries. The highest incidence of mesio-linguo-disto-buccal caries pattern was observed in maxillary lateral incisors, followed by mesial caries, mesio-buccal caries, buccal caries, and mesio-disto-buccal caries. Other common caries prevalence and patterns were mesio-distal caries, mesio-linguo-buccal caries, and disto-buccal caries which occupied 1.7%, 0.7%, and 0.3%, respectively. The percentage of caries prevalence in maxillary right primary lateral incisors was in decreasing order as age increased from 3 to 6 years. A significant correlation was observed between age and prevalence and caries patterns (P = 0.001). However, no significant difference was observed between prevalence and caries pattern of males and females (P = 0.498).

Prevalence and caries pattern in maxillary right primary central incisors [Table 3]
Table 3: Age and Gender wise Prevalence & Pattern of Caries in Maxillary Right Primary central incisor

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In preschool children, 59.7% of maxillary right primary central incisors had no caries. 40.3% prevalence of caries was observed in maxillary right primary central incisors with 8 patterns of caries. The percentage of caries prevalence in maxillary right primary central incisors was in decreasing order as age increased from 3 to 6 years. The highest incidence of caries pattern in maxillary right central incisors was observed as mesio-linguo-disto-buccal, followed by mesio-disto-buccal, mesial, mesio-distal, mesio-buccal, buccal, and mesio-incisal caries. A significant correlation was observed between age and caries prevalence and patterns (P = 0.000). No significant difference was observed between prevalence and caries pattern of males and females (P = 0.852).

Prevalence and caries pattern in maxillary left primary central incisors [Table 4]
Table 4: Age and Gender wise Prevalence% Pattern of Caries in Maxillary left Primary central incisor

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In preschool children, 59.3% of maxillary left primary central incisors had no caries. 40.7% prevalence of caries was observed in maxillary left primary central incisors with 9 caries patterns. The percentage of caries prevalence in maxillary left primary central incisors was in decreasing order as age increased from 3 to 6 years. The highest prevalence and pattern of caries in maxillary left central incisors was exhibited by mesio-linguo-disto-buccal caries, followed by mesio-disto-buccal, mesial, mesio-distal, buccal, mesio-buccal, mesio-incisal, and mesio-linguo-buccal caries. A significant correlation was observed between age and percentage of caries prevalence and patterns (P = 0.000). No significant difference was observed between prevalence and caries patterns of males and females (P = 0.677).

Prevalence and caries pattern in maxillary left primary lateral incisors [Table 5]
Table 5: Age and Gender wise Prevalence & Pattern of Caries in Maxillary left Primary lateral incisor

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In preschool children, 68.7% of maxillary left primary lateral incisors had no caries. 31.3% prevalence of caries was observed in maxillary left primary lateral incisors with 9 patterns of caries. The percentage of caries prevalence in maxillary left primary lateral incisors was in decreasing order as age increased from 3 to 6 years. The highest caries prevalence and pattern was exhibited by mesio-linguo-disto-buccal caries, followed by mesial, buccal, mesio-buccal, mesio-disto-buccal, mesio-distal, and disto-buccal caries patterns. A significant correlation was observed between age and percentage of prevalence and caries patterns (P = 0.000). No significant difference was observed between caries prevalence and patterns of males and females (P = 0.312).

Prevalence and caries pattern in maxillary left primary canines [Table 6]
Table 6: Age and Gender wise Prevalence & Pattern of Caries in Maxillary Left Primary Canine

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In preschool children, 92.7% of maxillary left primary canines had no caries. 7.3% prevalence of caries was observed in maxillary left primary canines with 9 patterns of caries. The percentage of mesial caries was observed to be the highest, followed by buccal caries and mesio-distal caries which had equal incidences (1.3% each). In maxillary left primary canines, distal caries and mesio-buccal caries had prevalence and patterns of 0.7% each, followed by incisal, mesio-lingual-disto-buccal, and mesio-disto-buccal caries, with an incidence of 0.3% each. Caries prevalence in maxillary left primary canines was highest at the age of 3 years which reduced to about half at 4 and 5 years and about 6 times less caries at 6 years. No significant correlation was observed between ages, genders, and percentage of prevalence and caries patterns (P = 0.260 and P = 0.931, respectively).

Prevalence and caries pattern in mandibular left primary canines [Table 7]
Table 7: Age and Gender wise Prevalence & Pattern of Caries in Mandibular Left Primary Canine

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In preschool children, 98.3 of mandibular left primary canines had no caries. 1.7% prevalence of caries was detected in mandibular left primary canines with 4 patterns of caries. Here, the highest percentage of caries observed was distal caries, which constituted 1% of the total incidence. Mesial caries and mesio-disto-buccal caries patterns had an equal incidence, i.e., 0.3% each. No significant correlation was observed between age, gender, and percentage of caries prevalence and patterns (P = 0.375 and P = 0.533, respectively).

Prevalence and caries pattern in mandibular left primary lateral incisors [Table 8]
Table 8: Age and Gender wise Prevalence & Pattern of Caries in Mandibular Left primary lateral incisor

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In preschool children, 96.3% of mandibular left primary canines had no caries. Nearly 3.7% prevalence of caries was observed in mandibular left primary lateral incisors with four patterns of caries. In this context, the highest percentage of caries prevalence and pattern was exhibited by mesial caries, which occupied 2% of the total caries incidence. Other common patterns were mesio-distal (1.3%) and buccal caries (0.3%). The incidence of mesial caries was observed to be highest at the age of 4 years followed by 5, 3 and 6 years. The other caries pattern observed was mesio-distal caries whose incidence was highest at the age of 3 years, followed by 5 years. No significant correlation was observed between ages, genders, and percentage of caries prevalence and patterns in mandibular left primary lateral incisors (P = 0.143 and P = 0.659, respectively).

Prevalence and caries pattern in mandibular left primary central incisors [Table 9]
Table 9: Age and Gender wise Prevalence & Pattern of Caries in Mandibular left primary central incisor

Click here to view


In preschool children, 90.7% of mandibular left primary central incisors had no caries. 9.3% prevalence of caries was observed in mandibular left primary central incisors with 8 patterns of caries. The highest percentage of prevalence and patterns was exhibited by mesial caries and mesio-distal caries, which occupied 6% and 1.3%, respectively. Other patterns of caries were distal, buccal, disto-buccal, and mesio-disto-buccal caries, which occupied 0.3% each, and mesio-buccal caries pattern, which occupied 0.7%. The highest incidence of mesial caries occurred at the age of 3 years, followed by 4, 5, and 6 years. No significant correlation was observed between ages, genders, and percentage of caries prevalence and patterns in mandibular left primary central incisors (P = 0.185 and P = 0.464, respectively).

Prevalence and caries pattern in mandibular right primary central incisors [Table 10]
Table 10: Age and Gender wise Prevalence & Pattern of Caries in Mandibular Right Primary central incisor

Click here to view


In preschool children, 91% of mandibular right primary central incisors had no caries. 9% prevalence of caries was observed in mandibular right primary central incisors with 6 patterns of caries. The highest percentage of caries pattern was exhibited by mesial caries, followed by mesio-distal caries and mesio-buccal caries, which occupied 5%, 2.3%, and 1%, respectively. Other common caries pattern was buccal and mesio-distal caries which occupied 0.3% each. The highest incidence of mesial caries was observed at the age of 3 years, followed by 4, 5, and 6 years. The percentage of caries prevalence in mandibular right primary central incisors was in decreasing order as age increased from 3 to 6 years. No significant correlation was observed between ages, genders, and percentage of caries prevalence and patterns in mandibular right primary central incisors (P = 0.129 and P = 0.321, respectively).

Prevalence and caries pattern in mandibular right primary lateral incisors [Table 11]
Table 11: Age and Gender wise Prevalence & Pattern of Caries in Mandibular Right primary lateral incisor

Click here to view


In preschool children, 96.7% of mandibular right primary lateral incisors had no caries. 3.3% caries prevalence was observed in mandibular right primary lateral incisors with 5 patterns of caries. The highest incidence of caries patterns was exhibited by mesial caries and mesio-distal caries, which occupied 2% and 0.7%, respectively. Other caries patterns frequently seen were buccal caries and mesio-buccal caries, which occupied 0.3% each. The percentage of caries prevalence in mandibular right primary lateral incisors was in decreasing order as age increased from 3 to 6 years. No significant correlation was observed between ages, genders, and percentage of caries prevalence and patterns in mandibular right primary lateral incisors (P = 0.223 and P = 0.496, respectively).

Prevalence and caries pattern in mandibular right primary canines [Table 12]
Table 12: Age and Gender wise Prevalence & Pattern of Caries in Mandibular Right Primary Canine

Click here to view


In preschool children, 98%of mandibular right primary canines had no caries. 2% prevalence of caries was observed in mandibular right primary canines with 6 patterns of caries. The highest incidence of caries pattern was observed in distal caries, which occupied 0.7%. Other common patterns were mesial, buccal, mesio-distal, and mesio-disto-buccal caries which occupied 0.3% each. No significant correlation was observed between ages, genders, and percentage of caries prevalence and patterns in mandibular right primary canines (P = 0.497 and P = 0.396, respectively).


   Discussion Top


Primary teeth are prone to dental caries. Caries in primary teeth may hamper eruption and tooth structure formation of succedaneous permanent teeth and oral health status of children. This study was done to know the caries prevalence and patterns in primary anterior teeth which would help us to make a preventive and interceptive program at society level by advising government to make a policy for oral health of children. The present study was done to know each individual anterior tooth's caries prevalence and caries patterns, and obtained results were compared with their opposite counterpart tooth in the same arch and the opposite arch.

In our study, caries prevalence and patterns were slightly more in primary anterior of males as compared to primary anterior teeth of females. This means that caries have some predilection for sex. The same findings were reported by other authors.[6],[7],[8] The WHO/FDI goals for 2000 revealed that 50% of children in the age group of 5–6 years should be caries free.[9] Our study results were in close accordance with the WHO goals. Other studies regarding the prevalence of caries in primary teeth by renowned researchers[3],[4] describe the prevalence of caries in preschool children without individual tooth caries prevalence and caries patterns.

Primary anterior teeth of the right side were slightly more prone to caries development in our study as compared to the left counterparts. It may be due to the fact that many individuals are right handed and find it easy to brush their teeth on the left side of teeth as compared to the right side. Our study also revealed that mandibular anterior teeth are less prone to caries development as compared to maxillary anterior teeth because submandibular salivary duct opens just behind the mandibular anterior teeth, and excess salivary flow on the mandibular tooth surfaces helps in less deposition of plaque, and more chances of salivary remineralization.

In the present study, the prevalence of caries in anterior teeth was observed to be ranging from 2% to 40.7%. The maximum percentage of caries prevalence was in accordance with other researcher's studies who reported caries prevalence ranging from 17% to 42% in India as well as other countries.[10],[11],[12],[13],[14] However, lower percentage was not in accordance with the mentioned study because they find out total caries prevalence, while in our study, we considered only anterior teeth. Mandibular incisors are least affected by caries in our study which is in accordance with the previous studies.[10],[15] Maxillary anterior teeth have more prevalence of caries than mandibular anterior teeth. Among all anterior teeth, left mandibular primary canines is least affected by caries in preschool children.


   Conclusions Top


  1. Caries prevalence and patterns were slightly more in maxillary right canines than left maxillary canines. Left mandibular canines had less caries prevalence than mandibular right canines. As compared to maxillary and mandibular canines regarding caries prevalence and patterns, maxillary canines were more prone to caries development as compared to mandibular canines. Mandibular canines had about five times less chances of caries development as compared to maxillary canines
  2. Maxillary right and left lateral incisors had about equal caries prevalence, approximately 32% and 9 carious patterns. Mandibular right lateral incisors (3.3%) and mandibular left lateral incisors (3.7%) had about equal caries prevalence with 5 and 4 caries patterns, respectively. Mandibular lateral incisors had about eight times less chance to develop caries as compared to maxillary lateral incisors
  3. Maxillary right and left central incisors had about equal caries prevalence (40%) with equal number of caries patterns. Mandibular right and left central incisors also had equal caries prevalence (about 9%) with 6 and 8 caries patterns, respectively. Mandibular central incisors had four times less chances of caries development as compared to maxillary central incisors
  4. Maxillary right and left central and lateral incisors had a significant correlation in caries prevalence and ages, but no gender association was reported in the caries prevalence.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Hiremath A, Murugaboopathy V, Ankola AV, Hebbal M, Mohandoss S, Pastay P. Prevalence of dental caries among primary school children of India-A cross-sectional study. J Clin Diagn Res 2016;10:ZC47-50.  Back to cited text no. 1
    
2.
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Vacher BR. Dental survey of school children in Amritsar (Punjab). J. Indian Dent Assoc 1952;24:13.  Back to cited text no. 6
    
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Jose B, King NM. Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent 2003;25:594-600.  Back to cited text no. 12
    
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Raj S, Goel S, Sharma VL, Goel NK. Short-term impact of oral hygiene training package to Anganwadi workers on improving oral hygiene of preschool children in North Indian City. BMC Oral Health 2013;13:67.  Back to cited text no. 13
    
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Halappa M, Bharatesh JV, Liveiro HK, Rameeza P, Basheer SM, James LT. Oral health of Anganwadi children in Tumkur city: A field study. CHISMED J Health Res 2016;3:119-22.  Back to cited text no. 14
    
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Masiga MA, Holt RD. The prevalence of dental caries and gingivitis and their relationship to social class amongst nursery-school children in Nairobi, Kenya. Int J Paediatr Dent 1993;3:135-40.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12]



 

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