Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2019  |  Volume : 37  |  Issue : 2  |  Page : 115--119

Prevalence of early loss of primary molars among children aged 5–10 years in Chennai: A cross-sectional study


Danalakshmi Jayachandar1, Deepa Gurunathan2, Ganesh Jeevanandan2,  
1 Undergraduate Student, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Studies, Saveetha University, Chennai, Tamil Nadu, India
2 Department of Pedodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Studies, Saveetha University, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Deepa Gurunathan
Department of Pedodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, 162 Vellapanchavady, Chennai - 600 077, Tamil Nadu
India

Abstract

Background: The early loss of primary teeth may reduce arch length required for the succeeding permanent tooth and thus result in crowding, rotation, and impaction of permanent teeth. The present study evaluates the prevalence of early loss of molars of primary teeth in children in Chennai, Tamil Nadu, India. Materials and Methods: An experienced examiner performed all clinical examinations under natural light, a total of 1529 children (759 boys and 770 girls) ages between 5 and 10 years were selected for the study. Data including age and missing teeth were collected. The data collected was then subjected to statistical analysis. Statistical Analysis: Microsoft Excel/2000 (Microsoft office XP) data spreadsheet was used and later exported to the Statistical Package for Social Science for Windows (version 10.0, SPSS Inc., Chicago Ill., USA). Results: The results showed that of the sample 34.46% had early loss of primary teeth with boys showing an increased incidence of loss of primary teeth (54.64%) and the greater prevalence was found among the age group of 8–9 years. The most common missing tooth was the first molar (43.8%) followed by second molars (33.2%). Early loss of teeth was common in the mandibular right side (36.81%). It can be concluded that the prevalence of early loss of the lower first primary molar was the most common in the present study. Conclusion: The prevalence of early loss of primary teeth was present in predominantly in male children (54.64%) when compared to female children (43.35%) which was statistically significant (P = 0.03). The most commonly affected were the mandibular teeth (58.63%), the most common tooth being the first molar (44%) followed by second molar (33%).



How to cite this article:
Jayachandar D, Gurunathan D, Jeevanandan G. Prevalence of early loss of primary molars among children aged 5–10 years in Chennai: A cross-sectional study.J Indian Soc Pedod Prev Dent 2019;37:115-119


How to cite this URL:
Jayachandar D, Gurunathan D, Jeevanandan G. Prevalence of early loss of primary molars among children aged 5–10 years in Chennai: A cross-sectional study. J Indian Soc Pedod Prev Dent [serial online] 2019 [cited 2019 Sep 21 ];37:115-119
Available from: http://www.jisppd.com/text.asp?2019/37/2/115/261340


Full Text



 Introduction



The loss of primary teeth before the natural time of its exfoliation is known as premature loss of deciduous teeth. Dental caries, trauma, or early root resorption are the most common causes for premature loss of primary teeth.[1] Traumatic dental injuries to the deciduous teeth will essentially lead to avulsion, premature exfoliation, or extraction due to any complications or poor prognosis.[2] This will ultimately affect the esthetics in case of anterior tooth loss, speech, mastication, eruption, or development of the successor permanent teeth, oral habits, and also the arch integrity.[3] Root resorption of primary teeth is affected by the environmental, hereditary, nutritional, and endocrine factors whereas the root formation of permanent dentition remained undisturbed. Furthermore, the local factors such as decay, pulp necrosis, and pulpotomy increased the rate of root resorption and hastened the exfoliation of the deciduous dentition.[4] Although the periodontally compromised teeth and trauma lead to early loss, the main cause is dental caries. The premature loss of molars can result in lack of space, midline discrepancies, and disturbance in the occlusion of permanent dentition.[5] This is because the premature loss of primary teeth can predispose to rotation, crowding, and impaction of permanent teeth owing to the reduction in the arch length required for the permanent dentition.[6] Malocclusion caused by premature extraction of primary teeth were sagittal, vertical, and transverse malocclusion. Early loss in the maxilla would often lead to the extraction of the permanent teeth and early loss of the primary teeth in mandible would require prolonged orthodontic treatment.[7] The premature loss of deciduous teeth predisposes to the reduction in the dental arch length which is usually greater in the mandibular arch when compared to the maxillary arch, and it is evident when it occurs in an earlier age along with crowded dentition.[8] It is also associated with the migration of the adjacent teeth leading to rotation, crowding, and impaction of the permanent dentition.[9] The premature loss of the deciduous teeth that causes a shortage of arch length generally leads to impaction of the second bicuspids. Eruption sequence can also be disturbed by the early loss of primary teeth.[10] The postextraction site has a space loss in the initial few months, mainly because of the distal movement of the primary cuspid rather than the movement of the permanent molar's mesial movement.[11] Premature extraction of deciduous molars results in an increased incidence of space closure. The rate and amount of closure in maxilla that occurs due to the movement of the teeth posterior to the extraction site in a mesial direction is higher than the mandible in which the closure occurs due to distal movement by the teeth present anterior to the extraction site.[12] It is important to restore the affected tooth, namely by caries or trauma, rather than to extract it because the removal of the tooth will lead to malocclusions by vertical dimension of occlusion loss, tongue thrusting, and mouth breathing habits.[13] The dentists usually prefer to extract a primary tooth rather than restore it many number of times; some reasons are total coronal destruction or a grossly decayed tooth.[11] It could also be attributed to the lack of knowledge among the parents about restoring the primary teeth and the consequences of early loss of deciduous teeth.[14] Early loss of deciduous molars might decrease the rate of eruption or even prevent the eruption of permanent bicuspids. Hence, space maintainers should be provided to prevent the impaction of the permanent bicuspids.[15] This study was aimed at assessing the prevalence of early loss of molars in school children aged 5–10 years.

 Materials and Methods



This study was approved by the Institutional Review Board and was conducted at Saveetha Dental College. The study population comprised of a total of 1529 children of which 759 were boys and 770 girls who were between the 5 and 10 years of age group were selected for the study. The sample size was calculated from a previous study using GPower analysis.[4] All clinical examination was performed under natural light by an experienced single examiner. All the relevant data such as age, gender, and missing teeth were recorded. Alginate impressions were taken after selecting the appropriate tray size of each subject, and diagnostic casts were made using dental stone. The data collected was then subjected to statistical analysis. Microsoft Excel/2000 (Microsoft office XP) data spreadsheet was used and later Chi-square tests were applied to the acquired results at a significance level of 5% (P < 0.05).

 Results



The results revealed that there was a loss of 527 number of teeth among the individuals of which 288 was among boys and 239 was among girls. [Table 1] reveals the distribution of early loss of primary teeth among various age and gender groups. Males had a higher prevalence of early loss of primary teeth than female children, and it was found to be statistically significant (P = 0.03). [Table 2] shows the distribution of early loss of primary teeth according to the dental group. It shows that the most commonly lost tooth was the primary first molar (44%) followed by the second molar (33%). [Table 3] represents the distribution of early loss of primary teeth arch and sides. It is seen that loss of molars was higher in the mandibular right side (26.81%) followed by mandibular left side (21.82%) [Figure 1] and [Figure 2].{Table 1}{Table 2}{Table 3}{Figure 1}{Figure 2}

 Discussion



The prevalence of early loss of primary teeth in children has been previously established in a number of researches around the world. This study comprised of screening a total number of 1529 children of which 759 were boy (49.64%) and 770 were girl (50.35%). Early loss of teeth was present in 527 individuals of which 288 was among male children (54.64%) and 239 was among female children (45.35%).

The study was carried out across all the zones of Chennai, and hence, the results of the study can be generalized. In addition, the children chosen were form various socioeconomic status so that there is a complete distribution of children belonging to various groups of society. It has been established that children belonging to lower socioeconomic status have a higher occurrence of dental caries.[14] Since almost equal number of male and female children were chosen for the study the findings of the study is not biased due to gender difference. The present research has given the insight into the prevalence of early loss of primary molars in Chennai which necessitates the action to be started for the prevention of early childhood caries among children.

These results are in line with studies that were previously conducted in Chidambaram.[4] The prevalence of early loss of deciduous teeth in the children may be due to the fact that many dentists prefer to extract a carious primary teeth rather than restoring it, and it could also be attributed to the parent's attitude regarding the extraction of primary teeth because they know that the teeth will eventually get replaced.

Most of the children are affected by untreated early childhood caries which is the most common cause of loss of primary teeth in children.[16] The higher incidence of early loss of primary teeth can be attributed to the fact that the oral hygiene measures among the mothers of the children are very minimal[17],[18],[19] which is the basic need for oral health.

A higher prevalence was seen among the male children (54.64%) on comparison to female children (45.35%), and the results were statistically significant. Longer feeding period of the male children when compared to the female children due to the preference for sons irrespective of the socioeconomic status might be a contributing faction to the increased decay-filled teeth (dft) scores among male individuals thus leading to increased loss of primary molars in the male individuals.[14] It could also be due to the geographic location, diet, cultural differences due to the male priority prevalent in India.[15],[20] It can also be seen that in the same population that there is a loss of permanent teeth at an earlier age.[21] Although Chennai is a metropolitan city with easy access to dental care the awareness among parents regarding the importance of primary teeth is minimal and dental neglect is significant.[18]

Early loss of teeth is not significantly higher in any age group, and it is almost equally distributed. The right lower first molar is the most common tooth affected by early loss (36.81%) which is in accordance to the study conducted by Alamoudi et al.[11] and Cavalcanti et al.[1] This was followed by lower left first molar (21.82%) and the second most commonly affected teeth were the primary second molar (33%). This finding can be attributed to the chronologic age of eruption of the first and second deciduous molars. Since the primary first molars, having erupted earlier, remain in the oral environment longer, are more prone to dental caries. Furthermore, dentists usually would prefer to restore a second deciduous molar for maintenance of space till the first permanent molar erupts and this is why first primary molars are more commonly extracted in comparison to the second primary molar leading to frequent early loss of the primary first molars.[22]

One of the reasons for the early loss of primary molars can be the colonization of Streptococcus mutans that have an increased acquisition rate at 16–29 months of age and increases with age and also the number of erupted teeth. The increased affinity of Streptococcus mutans toward the primary molars is because of the occlusal surfaces that are fissured in nature and the proximal surfaces that are concave. This will ultimately result in dental caries thus resulting in the extraction of the primary molars and hence early loss of the primary teeth.[23] The mean dft/decayed, missing, and filled teeth of children in the age group of 6–12 years were found to be significantly higher than that of 3–5 years of age group.[24] Similarly, early childhood caries among the monozygotic and dizygotic twins which was found to be 18.7% in a study conducted by Kuppan et al.[25] Maxillary arch had a significantly lesser rate of early loss of primary teeth than the mandibular arch, also seen in Natalie Kelner et al.'s and Cavalcanti et al.'s[1] findings, because the rich saliva supply provides anticarious effect to the upper posteriors whereas the mandibular posteriors are more prone to food getting packed on to the tooth surfaces and hence resulting in plaque accumulation. Hence, the mandibular posteriors have a higher rate of disposal to dental caries. The current study reveals higher loss of teeth in the right side of both jaws, reflects the lack of teeth cleanliness in the said side because a higher attention is paid to the prophylactic methods in the left side than the right. This leads to an increased tendency for plaque accumulation in these less cleaned tooth surfaces due to the lower level of shearing occlusal and tooth brushing forces.[26],[27] A large number of children brush only once during the day according to a study by Thanish Ahamed,[28] which is a sign of poor oral hygiene which can result in early childhood caries. Early childhood caries has disadvantageous effects such as higher risk of new carious lesions development.[29] A study by Prabakar et al. showed caries prevalence of 40.7% among 5-year-old children, 56.2% among 5–10 old children and a decline of 34.5% was seen among 11–15-year-old children.[30] All these varied factors lead to caries of the primary teeth which leads to the unfortunate extraction of the tooth resulting in early loss of primary teeth. Dental caries remains the major cause for early loss of primary teeth followed by trauma.

Studies indicate a decrease in Class I relationship of permanent teeth when there is a premature loss of primary molars.[31],[32] It was observed conducted in a study by Alexander et al. that the relationship between the first permanent molar occlusion and facial form of the child influences the space loss following earlier exfoliation of primary teeth. Average space loss in the maxilla was 1.75 mm, and in the mandible, the average space loss was 1.38 mm. The clinical loss of space in the maxilla was due to mesial migration of both the second primary molar and permanent first molar. During a 9-month observation after the premature loss of the primary first molar, space loss occurs in the maxilla and mandible of patients with a leptoprosopic facial form and Class I or end-on molar occlusion. During a 9-month observation after the loss of the primary first molar in patients with a mesoprosopic/euryprosopic facial form, loss of space occurred only at the mandibular site.[33] Rönnerman had shown that there was a tendency toward less dental changes in children without early tooth loss than with children with early loss of primary molars. It was seen that the second permanent molar erupted earlier in both jaws after the early loss of the second primary molar. Children who had a loss of primary molars before seven and half years developed more crowding than children without loss of primary molars. Tooth loss after 7½ years had little effect on the space.[34]

Although ultimate care was taken in the methodology of the study, confounder such as congenital missing of primary teeth was not recorded which has a very minimal occurrence. Hence, the observations from the study can be considered to be appropriate.

After the screening was completed oral hygiene instructions were given to both the parents and the children and awareness was made regarding the consequences of early extraction and the importance to instead restore primary teeth was stressed. Reduction of early loss of primary molars can be achieved by the prevention of early childhood caries, creating awareness among parents, pediatricians and general dentist regarding the importance of primary teeth, as well as including oral health in school syllabus. These can be achieved by modifications in the government policies regarding the prevention of caries in children and change in attitude toward primary teeth by caregivers to children. It is also mandatory that information regarding the aftermath of the early extraction of primary teeth is given to the parents. Moving a step further it is essential to make parents understand the importance of space maintainers in place of a missing primary tooth to prevent malocclusion.

 Conclusion



From this study, we can conclude that there was a prevalence of early loss of primary teeth presents predominantly in male children when compared to female children. The most commonly affected were the mandibular teeth, and the most common tooth that was missing was the first molar followed by the second molar. Most number of teeth were lost on the right side of both the jaws than the left side.

Recommendation

Early loss of primary molars leads to malocclusion. Hence, it is essential to prevent and treat the dental caries in children rather than to extract them.

Acknowledgment

The author would like to thank the children for their time and patience for participating in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Cavalcanti AL, Barros de Alencar CR, Medeiros Bezzera PK, Granville-Garcia AF. Prevalence of early loss of primary molars in school children in Campina Grande, Brazil. Pak Oral Dent J 2008;28:113-6.
2Holan G, Howard L. Needleman, premature loss of primary anterior teeth due to trauma- potential shit- and long-term sequelae. Dent Traumatol 2014;30l: 100-6.
3Haralabakis NB, Yiagtzis SC, Toutountzakis NM. Premature or delayed exfoliation of deciduous teeth and root resorption and formation. Angle Orthod 1994;64:151-7.
4Ahamed SS, Reddy VN, Krishnakumar R, Mohan MG, Sugumaran DK, Rao AP. Prevalence of early loss of primary teeth in 5-10-year-old school children in Chidambaram town. Contemp Clin Dent 2012;3:27-30.
5Pedersen J, Stensgaard K, Melsen B. Prevalence of malocclusion in relation to premature loss of primary teeth. Community Dent Oral Epidemiol 1978;6:204-9.
6Murshid SA, Al-Labani MA, Aldhorae KA, Rodis OM. Prevalence of prematurely lost primary teeth in 5-10-year-old children in Thamar city, Yemen: A cross-sectional study. J Int Soc Prev Community Dent 2016;6:S126-30.
7Northway WM, Wainright RL, Demirjian A. Effects of premature loss of deciduous molars. Angle Orthod 1984;54:295-329.
8Padma Kumari B, Retnakumari N. Loss of space and changes in the dental arch after premature loss of the lower primary molar: A longitudinal study. J Indian Soc Pedod Prev Dent 2006;24:90-6.
9Owen DG. The incidence and nature of space closure following the premature extraction of deciduous teeth: A literature study. Am J Orthod 1971;59:37-49.
10Mandroli PS. Biological restoration of primary anterior teeth: A case report. J Indian Soc Pedod Prev Dent 2003;21:95-7.
11Alamoudi N, Salako N, Masoud I. Prevalence and distribution of caries n the primary dentition in a cosmopolitan Saudi population. Saudi Dent J 1995,7:23-8.
12Cardoso L, Zembruski C, Fernandes DS, Boff I, Pessin A. Evaluation of pervalence of precocious loss of deciduous molars. Braz Res Pediatr Dent Integr Clin 2005;5:17-22.
13Sleichter GG. The influence of premature loss of deciduous molars and the eruption of their successors. Angle Orthod 196;33:279-83.
14Saravanan S, Kalyani V, Vijayarani MP, Jayakodi P, Felix J, Arunmozhi P, et al. Caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, South India. Indian J Dent Res 2008;19:186-90.
15Mahejabeen R, Sudha P, Kulkarni SS, Anegundi R. Dental caries prevalence among preschool children of Hubli: Dharwad city. J Indian Soc Pedod Prev Dent 2006;24:19-22.
16Moses J, Rangeeth BN, Gurunathan D. Prevalence of dental caries, socio-economic status and treatment needs among 5 to 15 year old school going children of Chidambaram. J Clin Diagn Res 2011;5:156-61.
17Aishwary AS, Gurunathan D. Oral health maintenance in children with self brushing and parents guidence: A pilot study. Int J Pharm Biol Sci 2015;6: 535-43.
18Gurunathan D, Shanmugaavel AK. Dental neglect among children in Chennai. J Indian Soc Pedod Prev Dent 2016;34:364-9.
19Bhatia SK, Maguire SA, Chadwick BL, Hunter ML, Harris JC, Tempest V, et al. Characteristics of child dental neglect: A systematic review. J Dent 2014;42:229-39.
20Qudeimat MA, Sasa IS. Clinical success and longevity of band and loop compared to crown and loop space maintainers. Eur Arch Paediatr Dent 2015;16:391-6.
21George B, John J, Saravanan S, Arumugham IM. Prevelance of permanent tooth loss among children and adults in Chennai. Indian J Dent Res 2011;22:364-7.
22Mansour Ockell N, Bågesund M. Reasons for extractions, and treatment preceding caries-related extractions in 3-8 year-old children. Eur Arch Paediatr Dent 2010;11:122-30.
23Caufield PW, Cutter GR, Dasanayake AP. Initial acquisition of mutans streptococci by infants: Evidence for a discrete window of infectivity. J Dent Res 1993;72:37-45.
24Naziya KB, Pradeep Kumar R, Arumughamm IM, Srisakthi D. Prevalence of dental caries among primary schoolchildren in Chennai – A cross-sectional study. J Adv Pharm Educ Res 2017;7:150-2.
25Kuppan A, Rodrigues S, Samuel V, Ramakrishnan M, Halawany HS, Abraham NB, et al. Prevalence and heritability of early childhood caries among monozygotic and dizygotic twins. Twin Res Hum Genet 2017;20:43-52.
26Loto AO. Relative prevalence of caries in first and second premolars in urban Nigerians. Odontostomatol Trop 1998;21:23-6.
27Park K, Jung DW, Kim JY. Three-dimensional space changes after premature loss of a maxillary primary first molar. Int J Paediatr Dent 2009;19:383-9.
28Thanish Ahamed S. Awareness of oral hygiene among children in Chennai. Res J Pharm Tech 2016;9:1055-8.
29Das B, Muthu MS, Farzan JM. Comparison of the chemical composition of normal enamel from exfoliated primary teeth and teeth affected with early childhood caries: Anin vitro study. Int J Paediatr Dent 2016;26:20-5.
30Prabakar J, John J, Srisakthi D. Prevalence of dental caries and treatment needs among school going children of Chandigarh. Indian J Dent Res 2016;27:547-52.
31Saloom HF. Early loss of deciduous teeth and occlusion. Iraqi Orthod J 2005;1:36-9.
32Terlaje RD, Donly KJ. Treatment planning for space maintenance in the primary and mixed dentition. ASDC J Dent Child 2001;68:109-14, 80.
33Alexander SA, Askari M, Lewis P. The premature loss of primary first molars: Space loss to molar occlusal relationships and facial patterns. Angle Orthod 2015;85:218-23.
34Rönnerman A. The effect of early loss of primary molars on tooth eruption and space conditions. A longitudinal study. Acta Odontol Scand 1977;35:229-39.