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 : 2009  |  Volume : 27  |  Issue : 4  |  Page : 197--201

Molluscum contagiosum and dental caries: A pertinent combination


S Dixit1, M Chaudhary2, A Singh3,  
1 Department of Pedodontics and Preventive Dentistry, New Horizon Dental College and Research Center, Sakri, Bilaspur, Chhattisgarh, India
2 Department of Oral Pathology and Microbiology, New Horizon Dental College and Research Center, Sakri, Bilaspur, Chhattisgarh, India
3 Department of Pedodontics and Preventive Dentistry, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, Maharashatra, India

Correspondence Address:
S Dixit
Department of Pedodontics and Preventive Dentistry, New Horizon Dental College and Research Center, Sakri, Bilaspur, Chhattisgarh - 495 001
India

Abstract

Background: In recent decades, there has been a tremendous surge of interest in issues related to child health. The present study was carried out to reveal the DMFT/deft status of children in the age group of 1-12 years, residing in orphanages from Pune, India. Aims and Objectives: To explore the DMFT/deft status in various orphanages from Pune (India). To find out differences, if any, between the DMFT/deft status in orphanages from Pune, India, and the general population of children below 12 years of age in Maharashtra state, India as well as all over India. Results: DMFT/deft of the orphanages was found to be 2.58 in the age group 1-5 years and 2.5 in the age group 6-12 years with caries prevalence in 70.27% of the children. An incidental finding of Molluscum contagiosum was observed in a significant percentage of children. The total percentage of children afflicted by Molluscum contagiosum was found to be 24.32%. Conclusion: The higher incidence of Molluscum contagiosum in children residing in orphanages as compared to the normal population of the same age group was reflected in the higher incidence of DMFT/deft in orphanages as compared to the normal population.



How to cite this article:
Dixit S, Chaudhary M, Singh A. Molluscum contagiosum and dental caries: A pertinent combination.J Indian Soc Pedod Prev Dent 2009;27:197-201


How to cite this URL:
Dixit S, Chaudhary M, Singh A. Molluscum contagiosum and dental caries: A pertinent combination. J Indian Soc Pedod Prev Dent [serial online] 2009 [cited 2021 Jan 21 ];27:197-201
Available from: https://www.jisppd.com/text.asp?2009/27/4/197/57652


Full Text

 Introduction



In recent decades, there has been a tremendous surge of interest in issues related to child health. Researches are being undertaken exploring unheard of possibilities. Epidemiological surveys aid in exploring various aspects of dental caries. Schools are most often targeted for surveys as they form a convenient cohort group. The present study was carried out to reveal the DMFT/deft (decayed missing filled teeth/decayed extracted filled teeth) status of children in the age group of 1-12 years, residing in orphanages from Pune, India. It was our endeavor to highlight the status of the oral cavity in these institutionalized children.

Aims and Objectives

To explore the DMFT/deft status in various orphanages from Pune, India.

To find out differences, if any, between the DMFT/deft status in orphanages from Pune, India and the general population of children below 12 years of age in Maharashtra state, India as well as all over India.

 Materials and Methods



The study included 207 children selected from three orphanages from Pune, India. Informed consent was taken from the Managing Directors and the consulting pediatricians of the orphanages selected for the study. Children of the age range 1-12 years were selected, which included 132 children of the age group 1-5 years and 57 children of the age group 6-12 years. DMFT/deft status of the children was determined using WHO criteria. An incidental finding of Molluscum contagiosum was encountered in a large percentage of the children [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5]. Diagnosis was made on the basis of clinical appearance. Excisional biopsy was taken from a patient and histopathological examination was done to confirm the clinical finding [Figure 6]. Enumeration of the cases of Molluscum contagiosum was done.

 Results



DMFT/deft of the orphanages was found to be 2.58 in the age group 1-5 years and 2.5 in the age group 6-12 years with caries prevalence in 70.27% of the children [Table 1].

Clinical examination of Molluscum contagiosum revealed dome-shaped, flesh-colored papules, usually multiple, measuring 2-5 mm in diameter. Histopathologic section under low power microscopy of the biopsy revealed inverted lobules of hyperplastic, acanthotic squamous epithelium arranged in lobulated pattern. The centers of these bulbous structures are filled with enlarged, altered keratinocytes with eosinophilic viral inclusions referred to as Henderson and Paterson inclusion bodies. The inclusion bodies are the result of a virally induced transformation process. Initially, the small virion particle is formed in the cytoplasm of the epithelial cells above the basal layer. These eosinophilic particles grow in size as they progress towards the granular cell layer causing compression of the nucleus to the periphery of the infected epithelial cells. Histopathologic section under high power microscopy revealed the inclusion bodies compressing the nuclei of the infected epithelial cells towards the periphery giving itself a crescent-shaped appearance. The total percentage of children afflicted by Molluscum contagiosum was found to be 24.32% [Table 2].

 Discussion



Dental caries is an important dental public health problem and is the most prevalent oral disease among children in the world. The prevalence of dental caries has been of great interest for long and is a principal subject of many epidemiological researches carried out in India and abroad. [1]

High risk group children with primary teeth decay should be identified and categorized, which in turn is useful to determine needs for restorations and to implement primary preventive procedures in the targeted group. [2]

Dental services in India are predominantly provided by private dentists since the government diverts limited resources to finance dental services. [3]

According to the National Oral Health Survey, 2002-2003, the mean DMFT/deft is 1.9 in the 1-5 and 1.8 in the 6-12 years of age groups in Maharashtra, India. [4] Likewise, the mean DMFT/deft is 2.0 in the 1-5 and 1.8 in the 6-12 years of age groups in India. [4] These index values are similar to the ones found elsewhere in India. However, the mean DMFT/deft was found to be 2.58 and 2.5 in the orphanages in the 1-5 and 6-12 years age groups, respectively, which is significantly higher than the index values in the general population.

Since caries is a multifactorial disease of bacterial etiology, the factors responsible for an increase in the incidence of dental caries are usually a cariogenic diet, poor oral hygiene and cariogenic microbiota. In institutionalized children, overcrowding, inadequate number of staff (caretakers), poor sanitation may contribute to poor oral hygiene, which may be one of the factors for an increased caries incidence in these children as compared to the general population.

Poor living conditions also warrant the discussion of another common entity i.e. Molluscum contagiosum. Molluscum contagiosum (MC) is a common, self-limiting viral disease of the skin and mucous membranes. It was first described by Bateman in 1817. [5] It is caused by molluscipoxvirus, which belongs to unclassified genus of poxvirus species. [6] The mature virion is a brick-shaped particle measuring 150 Χ 350 nm. [7]

Molluscum contagiosum has a usual incubation period of 14 to 50 days, [8] although there are reports of newborns having lesions as early as 7 days postpartum. [9] The lesions may persist for weeks to months suggesting that the virus provokes a minimal cell-mediated immunity. It occurs predominantly in preadolescent children, sexually active adults, participants in sports with skin to skin contact and in individuals with impaired cellular immunity. [10]

Although Molluscum contagiosum as a clinical entity is well-defined and commonly observed, few data regarding its epidemiology in the pediatric population exist. [11]

According to one survey, incidence of Molluscum contagiosum in India in children less than 14 years of age was found to be 2.5%. [12] Immunocompromised individuals act as the ideal hosts for this lesion. Transmission factors in children are accounted by a warm and humid environment, overcrowding, poor hygiene, sharing towels, clothes, etc. These are conditions that are usually seen in orphanages and other institutions where children reside together. In adults, Molluscum contagiosum is usually sexually transmitted. Signs of sexual abuse should always be looked for when lesions on genitalia are present in children.

Management

Molluscum contagiosum is a self-limiting disease, which, left untreated, will eventually resolve in immunocompetent hosts but may be protracted in atopic and immunocompromised individuals. One of the most common, quick, efficient methods of treatment is cryotherapy. [13]

An easy method to remove the lesions is eviscerating the core with an instrument such as a scalpel, sharp tooth pick, edge of a glass slide or any other instrument capable of removing the umbilicated core. Because of its simplicity, patients, parents and caregivers may be taught this method so that new lesions can be treated at home. [14]

Curettage, use of adhesive tape, 0.05 ml of 5% podofilox in lactate-buffered ethanol, Cantharidin (0.9% solution of collodion and acetone), Tretinoin 0.1% cream, oral cimetidine, 10% potassium hydroxide, Imiquimod 5% cream, Cidofovir either topically or intralesional injection have also been used for the management of Molluscum contagiosum with varying success.

Correlation

Karthikeyan et al, reported an incidence of 2.5%, of Molluscum contagiosum in India in children less than 14 years of age. [12]

The present study, however, shows a significantly increased incidence of 24.32% in children residing in orphanages. There is a possibility of difference in the incidence related to a variation in the living conditions of children in orphanages as compared to those who are a part of the normal population. A positive correlation was found between the incidence of Molluscum contagiosum in children and poor living conditions. [15]

Naidoo and Chikte have also found a higher prevalence of Molluscum contagiosum in institutionalized children (21%) as compared to hospital outpatients (0%). [16]

The higher incidence of Molluscum contagiosum in children residing in orphanages was also reflected in the incidence of DMFT/deft in orphanages. A higher incidence of 2.58 and 2.5 in the age groups 1-5 and 6-12 years was found in the orphanages as compared to 1.9 and 1.8 in the respective age groups in the normal population.

This sets the path for the obvious line of thinking that, "could there be a common connection somewhere? could a lack of basic facilities be responsible for these skewed incidences?"

Caries and Molluscum contagiosum differ significantly from each other mainly etiologically. However, since the factors responsible for increased incidence of caries and molluscum appear to be similar, the present study points towards common underlying conditions present in some institutions resulting in an increased incidence of both dental caries as well as Molluscum contagiosum as compared with the general population.

A few guidelines would go a long way towards reducing the increased incidence of both Molluscum contagiosum as well as DMFT/deft. Better facilities for orphanages should be made available by the government. Hospitals and medical institutions should adopt orphanages. Knowledge about common diseases should be made available to the caretakers.

 Conclusion



This article intends to provide an insight into a possibility that has never been reported in literature before. However, further research is required in this context.

References

1Saravanan S, Madivanan I, Subashini B, Felix JW. Prevalence pattern of dental caries in the primary dentition among school children. Indian J Dent Res 2005;16:140-6.
2Mahejabeen R, Sudha P, Kulkarni SS, Anegundi R. Dental caries prevalence among preschool children of Hubli: Dharwad city. 2006;24:19-22.
3David J, Wang NJ, Εstrψm AN, Kuriakose S. Dental caries and associated factors in 12-year-old schoolchildren in Thiruvananthapuram, Kerala, India. Int J Paediatr Dent 2005;15:420-8.
4National Oral Health Survey and Fluoride Mapping; 2002-2003. India. Dental Council of India, New Delhi, India: 2004.
5Bateman F. Molluscum contagiosum. In: Shelley WB, Crissey JT, editors. Classics in dermatology. Springfield (IL): Charles C Thomas; 1953. p. 20.
6Parr RP, Burnett JW, Garon CF. Structural characterization of the Molluscum contagiosum virus genome. Virology 1977;81:247-56.
7Fenner F. Poxviruses. In: Fields BN, Knipe DM, editors. Virology. 2 nd ed. New York: Raven Press; 1990.
8Moss B. Poxviridae and their replication. In: Fields BN, Knipe DM, Melnick JL, et al, editors. Virology. 2 nd ed. New York: Raven Press; 1990.
9Brown ST, Nalley JF, Kraus SJ. Molluscum contagiosum. Sex Transm Dis 1981;8:227-34.
10Smith KJ, Skelton H. Molluscum contagiosum: Recent advances in pathogenic mechanisms, and new therapies. Am J Clin Dermatol 2002;3:535-45.
11Dohil MA, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF. The epidemiology of Molluscum contagiosum in children. J Am Acad Dermatol 2006;54:47-54.
12Karthikeyan K, Thappa DM, Jeevan K. Pattern of pediatric dermatoses in a referral center in South India. Indian Pediatr 2004;41:373-7.
13Janniger CK, Schwartz RA. Molluscum contagiosum in children. Cutis 1993;52:194-6.
14Epstein WL. Molluscum contagiosum. Semin Dermatol 1992;11:184-9.
15Chandrashekar L, Devinder MT, Telanseri JJ. Clinical profile of Molluscum contagiosum in children versus adults. Dermatol Online J ;9:1.
16Naidoo S, Chikte U. Oro-facial manifestations in paediatric HIV: A comparative study of institutionalized and hospital outpatients. Oral Dis 2004;10:13-8.