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ORIGINAL ARTICLE
Year : 2013  |  Volume : 2  |  Issue : 3  |  Page : 185-188

Prevalence of developmental defects of enamel in mixed and permanent dentition of 9 and 12 year old children of Himachal Pradesh, India: A cross sectional study


1 Department of Pedodontics and Preventive Dentistry, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
2 Department of Community Medicine, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India

Date of Web Publication25-Oct-2013

Correspondence Address:
Deepak Chauhan
Department of Pedodontics and Preventive Dentistry, H.P. Government Dental College, Shimla 171 001, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.120587

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  Abstract 

Objective: The purpose of this study was to determine and compare the prevalence and presentation of developmental defects of the enamel (DDE) in the mixed and permanent dentition of healthy school children residing in hills. Materials and Methods: A total of 1188 healthy school children were examined using modified DDE criteria for recording enamel defects. Results: The overall prevalence of DDE of any type was (51.3%) in both mixed and permanent dentition. Diffuse opacity was (25.3%) the most common defect and demarcated opacity was (23.1%) and whereas, enamel hypoplasia was the least prevalent defect with prevalence of (2.9%). Conclusion: The study population showed a high prevalence of DDE in primary as well as in the permanent dentition, reflecting the current increasing trend of this condition, which should be considered as a significant public health problem.

Keywords: Demarcated opacity, developmental enamel defects, diffuse opacity, enamel hypoplasia


How to cite this article:
Chauhan D, Chauhan T. Prevalence of developmental defects of enamel in mixed and permanent dentition of 9 and 12 year old children of Himachal Pradesh, India: A cross sectional study . Int J Health Allied Sci 2013;2:185-8

How to cite this URL:
Chauhan D, Chauhan T. Prevalence of developmental defects of enamel in mixed and permanent dentition of 9 and 12 year old children of Himachal Pradesh, India: A cross sectional study . Int J Health Allied Sci [serial online] 2013 [cited 2021 Sep 27];2:185-8. Available from: https://www.ijhas.in/text.asp?2013/2/3/185/120587


  Introduction Top


Developmental defects in the enamel (DDE) present important clinical significance since they are responsible for esthetic problems, dental sensitivity, dentofacial anomalies and predisposes to dental caries by serving as a platform for retention of dental plaque. [1] Populations affected by these changes require as a priority preventive intervention and early treatment. A few epidemiological studies reported on the prevalence of developmental defects of teeth in deciduous dentition when compared with the permanent dentition. [2],[3],[4],[5] Furthermore, great variation is seen in the prevalence rate.

The objective of this study was to estimate the prevalence of DDE i.e. demarcated opacity, diffuse opacity and hypoplasia in the age group of 9 and 12-year-old children of Himachal Pradesh.


  Materials and methods Top


A total of 1188 school children in age groups of 9 and 12 years, from classes 5 th to 8 th were selected as World Health Organization (WHO) oral health survey guidelines clearly state to record age at last birthday (i.e., a child in the 10 th year of life is nine and a child in the 13 th year of life is 12). Out of which 650 were males and 538 females. The sample size was calculated with a 95% confidence interval and the precision was fixed at 0.05. Simple random technique was adopted so that every student had same possibility to be chosen to avoid any bias. All the subjects were allotted a number (0 to N-1); random numbers were generated from a table to select both public and private schools from rural and urban areas of 6 districts out of total 12 districts of Himachal Pradesh, which were selected so as to represent different geographical conditions and all four directions of the state as well as the central region:

  • Chamba (North)
  • Sirmour (South)
  • Lahaul-Spiti (East)
  • Una (West)
  • Mandi (Central)
  • Shimla (Capital of the state).


Inclusion criteria

All the students present on the day of examination in the age group of 9 and 12 years who represented mixed and permanent dentition stage respectively and of hill origin were included as study subjects. This study was cross-sectional in design and was approved by the institutional committee for ethical considerations for research work. The examination was carried out by two examiners. Inter- and intra-examiners calibration and standardization were performed prior to the commencement of the study. Using Cohen's Kappa statistics, the reliability tests were 0.90 and 0.94, respectively. The examination of the students was carried out in the schools under proper lighting without prior drying and dental prophylaxis of their teeth, but when necessary for improved visualization their teeth were cleaned and dried using gauze piece with the help of intraoral mouth mirrors and periodontal probes. Demographic information was recorded for each subject prior to the clinical examination.

The Modified Developmental Defects of Enamel Index [6] was used to classify and diagnose the changes in the enamel of the teeth examined. Buccal, occlusal or incisal and lingual or palatal surfaces of all teeth were examined and enamel defects were assessed according to three indicators such as hypoplasia of the enamel diffused and demarcated opacities.

Other diagnostic criteria included were:

  1. A tooth was considered present when any portion of the crown had erupted through the mucosa
  2. When an enamel defect was present in the erupted portion, it was recorded
  3. In the case of doubt regarding the presence of an abnormality, the dental surface was classified as "normal"
  4. A surface with a single abnormality less than 1 mm in diameter was classified as "normal"
  5. The dental surfaces that presented marked fractures, caries and very extensive restorations or impacting on more than 2/3 of the tooth surface were excluded from the analysis and classified as "excluded"
  6. All the deciduous teeth extracted or exfoliated were considered "excluded." For the process of calibration, a theoretical study of the criteria for the diagnosis of the index of DDE was carried out, with the help of colored photographs of typical examples of hypoplasia, demarcated and diffuse opacities in permanent teeth, contained in the manual of basic presentations in oral health of the WHO. Statistical analysis was carried out by using the statistical package for the social sciences 15.0 and differences between proportions were assessed using the Chi-square test. The level of significance was set at P ≤ 0.05.



  Results Top


[Table 1] and [Figure 1] illustrate the demographic profile of the study population. A total of 1188 children were examined, of these 650 (54.8%) were males and 538 (45.2%) were females. 564 belonged to the 9 and 624 to 12 years age group. In 9 years age group from the rural area, there were 139 males and 136 females as compared with 165 males and 124 females from the urban area. However, in the age group of 12 years, 176 males and 136 females belonged to a rural area and from the urban area, 170 were males and 142 were females.
Figure 1: Distribution of subjects according to age, gender, and location

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Table 1: Distribution of study subjects according to age and gender


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In the [Table 2] age-wise comparison showed that in 9 year age group 367 (65.0%) of the children were found to be normal whereas 98 (17.4%) with demarcated opacity, 90 (16.0) diffuse opacity and 9 (1.6) were having enamel hypoplasia. Similarly, in 12 year age group 211 (33.8%) were found to be free from any developmental defect of enamel, whereas 203 (32.5%) were having demarcated opacity, 185 (29.6%) diffuse opacity and 25 (4.1) were having enamel hypoplasia. Distribution according to age showed an age wise increase in the prevalence of enamel opacities and hypoplasia (EOH) and statistically significant differences were observed P < 0.0000001.
Table 2: Prevalence of opacities and other enamel disorders in the study subjects according to age


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In the [Table 3] prevalence and distribution of developmental enamel defects i.e., EOH according to gender showed that out of total 650 males 288 (44.3%) were found to be normal, whereas 203 (31.2%) were having demarcated opacity, 145 (22.3%) were observed with diffuse opacity and only 14 (2.2%) with enamel hypoplasia. Whereas in girls out of 538, 290 (53.9%) were observed without any signs of enamel defect. Whereas 98 (18.2%) were having demarcated opacity, 130 (24.2%) were observed with diffuse opacity and only 20 (3.7%) were having enamel hypoplasia. Distribution according to gender showed that females were affected more than males P < 0.000003292.
Table 3: Prevalence of opacities and other enamel disorders in the study subjects according to gender


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In the [Table 4] prevalence and distribution of developmental enamel defects i.e., EOH according to location showed that out of total 601 urban children 253 (42.1%) were found to be normal, whereas 160 (26.6%) were having demarcated opacity, 169 (28.1%) were observed with diffuse opacity and only 19 (3.2%) with enamel hypoplasia. Whereas, among rural children out of 587, 325 (55.4%) were observed without any signs of enamel defects. Whereas 141 (24.0%) were having demarcated opacity, 106 (18.0%) were observed with diffuse opacity and only 15 (2.6%) were having enamel hypoplasia. There were no major rural and urban differentials in the pattern of distribution of enamel defects by type P < 0.00001612. The overall prevalence of developmental defects of the enamel of any type was (51.3%) in both mixed and permanent dentition. Diffuse opacity was (25.3%) the most common defect and demarcated opacity was (23.1%). Whereas, enamel hypoplasia was the least prevalent defect with a prevalence of (2.9%) [Figure 2].
Figure 2: Prevalence of opacities and other enamel disorders in study subjects.Pie diagram shows the overallprevalence of developmental defects of the enamelof any type was (51.3%) in both mixed and permanent dentition. Diffuse opacity was (25.3%) the most common defect and demarcated opacity was (23.1%). Whereas, enamel hypoplasia was the least prevalent defect with a prevalence of (2.9%).

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Table 4: Prevalence of opacities and other enamel disorders subjects according to location


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  Discussion Top


Present study was first of its own kind in Himachal Pradesh. Which was conducted on a large sample population from both rural and urban school children with the aim of to evaluate the prevalence of enamel opacities and hypoplasia through clinical examination and data obtained was compared with the findings of other national and international studies and to establish a baseline for comparison with future studies.

Epidemiological studies on the prevalence of DDE exhibit a wide variability in prevalence rate. This diversity may be; by and large, explained by specific characteristics of the population and by methodological methods adopted in the studies, such as the index and criteria used in the examination. For example, whether only hypoplasia was considered as a defect of the enamel or whether enamel opacities were also considered; whether only the front teeth, only the canines or the whole dentition were examined; the type of illumination employed for the examination and whether, prior to the examination, brushing, prophylaxis and drying of the teeth were carried out or not.

The present study reports the overall prevalence of enamel disorders to be 51.3%. 301 (25.3%) with demarcated opacity, 275 (23.1%) with diffuse opacity and 34 (2.9%) were having enamel hypoplasia. The findings did not corroborate with the results of the studies, conducted in other countries like Brazil, where in diffuse opacities were the defects most frequently found in the children (17.9%), followed by hypoplasia (11.1%) and demarcated opacities (6.1%) which is lesser than our results. [7]

The reason may be because the study was conducted among the preschoolers. Similarly, the study conducted among the children of age group, 6-36 months to assess the frequency of enamel defects in the primary dentition in Tanzania shows that the prevalence of enamel defects was 33.3%. The most common defects found was diffuse opacities (23.1%), followed by hypoplasia (7.6%) and demarcated opacities (5.0%). [8]

Another study by Seow et al., conducted among Australian children compared DDE in the primary and permanent dentitions. They found that DDE were twice as common in the permanent dentition versus the primary dentition. In the primary dentition, the predominant defects were demarcated opacities and missing enamel while in the permanent dentition, the defects were more variable. [9] Whereas, a study conducted in 12 year age group children reports that 16.0% had enamel opacities, 7.0% had enamel hypoplasia and 2.5% presented with enamel mutilation. [10] Another study reported enamel hypoplasia Of the 698 children examined, 44 (6%) had enamel hypoplasia on at least one primary tooth, 3% had one tooth affected, 2% had two teeth affected, <1% had three teeth affected, <1% 4 teeth affected and only one individual had more than four affected teeth. [4]


  Conclusion Top


This study has primarily been a description of the clinical signs and symptoms of enamel opacities and hypoplasia in children with special reference to age, gender and location differences. Approximately, half of the school children (51.34%) presented with some kind of DDE. Increasing age, dental caries, low birth weight, avitaminosis, general ill-health, rubella and other congenital diseases are associated with increased incidence of EOH in children. These disorders are indicative of a high level of childhood diseases. It is expedient that immunization against childhood diseases as well as health education and promotion efforts should be intensified while restorative dental care is made available to the children to treat the enamel disorders.


  Acknowledgments Top


I am thankful to all children, their parents and school authorities for participating and providing support during this endeavor. My special thanks to Dr. Tripti Chauhan (Assistant Professor, Department of Community Medicine) for her critical evaluation of the manuscript, valuable suggestions and helping out with statistical analysis.

 
  References Top

1.Seow WK. Enamel hypoplasia in the primary dentition: A review. ASDC J Dent Child 1991;58:441-52.  Back to cited text no. 1
    
2.Grahnén H, Sjölin S, Stenström A. Mineralization defects of primary teeth in children born pre-term. Scand J Dent Res 1974;82:396-400.  Back to cited text no. 2
    
3.Murray JJ, Shaw L. Classification and prevalence of enamel opacities in the human deciduous and permanent dentitions. Arch Oral Biol 1979;24:7-13.  Back to cited text no. 3
    
4.Slayton RL, Warren JJ, Kanellis MJ, Levy SM, Islam M. Prevalence of enamel hypoplasia and isolated opacities in the primary dentition. Pediatr Dent 2001;23:32-6.  Back to cited text no. 4
    
5.Weeks KJ, Milsom KM, Lennon MA. Enamel defects in 4- to 5-year-old children in fluoridated and non-fluoridated parts of Cheshire, UK. Caries Res 1993;27:317-20.  Back to cited text no. 5
    
6.A review of the developmental defects of enamel index (DDE Index). Commission on oral health, research and epidemiology. Report of an FDI working group. Int Dent J 1992;42:411-26.  Back to cited text no. 6
    
7.Lunardelli SE, Peres MA. Prevalence and distribution of developmental enamel defects in the primary dentition of pre-school children. Braz Oral Res 2005;19:144-9.  Back to cited text no. 7
    
8.Masumo R, Bårdsen A, Astrøm AN. Developmental defects of enamel in primary teeth and association with early life course events: A study of 6-36 month old children in Manyara, Tanzania. BMC Oral Health 2013;13:21.  Back to cited text no. 8
    
9.Seow WK, Ford D, Kazoullis S, Newman B, Holcombe T. Comparison of enamel defects in the primary and permanent dentitions of children from a low-fluoride District in Australia. Pediatr Dent 2011;33:207-12.  Back to cited text no. 9
    
10.Koleoso DC. Dental fluorosis and other enamel disorders in 12-year-old Nigerian children. J Community Med Prim Health Care 2004;16:25-8  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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