|Year : 2018 | Volume
| Issue : 5 | Page : 250-255
Incidence of endodontically treated first permanent molar teeth among Saudi children subpopulation
Abdulaziz Saad Abumelha1, Atheer Ahmad Alhammadi1, Eman Abdulrahman Alshahrani1, Zahra Abdullah Alsafi1, Tasneem S Ain2
1 Department of Restorative Dental Sciences, King Khalid University College of Dentistry, Abha, Saudi Arabia
2 Department of Preventive Dentistry, King Khalid University College of Dentistry, Abha, Saudi Arabia
|Date of Web Publication||24-Oct-2018|
Dr. Abdulaziz Saad Abumelha
Department of Restorative Dental Sciences, King Khalid University College of Dentistry, Abha
Source of Support: None, Conflict of Interest: None
Aim and Objectives: A study was carried out among children to assess the incidence of endodontically treated first permanent molar (FPM) teeth during 4 years in Abha, Saudi Arabia. Materials and Methods: A convenient sample of 65 children, willing to participate was included in the study. Sixty-five children were selected for the study of age 6 years old, having erupted FPM teeth in all quadrants. The panoramic radiographs of the subjects were evaluated for sound, decayed, missing, filled teeth (DMFT), or endodontically treated FPM teeth. The same subjects were followed for 4 years and their orthopantomograms (OPGs) were taken at the age of 10 years. Their OPGs were again examined for sound, DMFT, and endodontically treated teeth. The mothers of these children were asked one question about their awareness regarding the importance of FPM teeth of their children. Data were put to statistical analysis. Results: It was found that all subjects at 6 years of age were having sound FPM teeth in all the 4 quadrants of their oral cavity. The overall incidence of endodontically treated FPMs was found to be 1.2% at age 10 years of the subjects. Conclusion: It was concluded that the incidence of endodontically treated FPM teeth was 1.2%. The incidence of root canal treatment was found to be more in the children whose mothers were not aware about the importance of FPM teeth.
Keywords: Awareness, children, endodontic treatment, first permanent molar teeth
|How to cite this article:|
Abumelha AS, Alhammadi AA, Alshahrani EA, Alsafi ZA, Ain TS. Incidence of endodontically treated first permanent molar teeth among Saudi children subpopulation. J Int Oral Health 2018;10:250-5
|How to cite this URL:|
Abumelha AS, Alhammadi AA, Alshahrani EA, Alsafi ZA, Ain TS. Incidence of endodontically treated first permanent molar teeth among Saudi children subpopulation. J Int Oral Health [serial online] 2018 [cited 2020 Apr 5];10:250-5. Available from: http://www.jioh.org/text.asp?2018/10/5/250/243855
| Introduction|| |
It is a universally accepted fact that the first permanent molars (FPMs) hold an utmost importance for the development of proper occlusion and it is an essential part of masticatory unit. The FPMs are considered as the teeth most prone to dental caries since these are the first permanent teeth which erupt in the oral cavity. The other reasons that have been documented in previous studies for the increased caries susceptibility of FPM teeth are their deep pit and fissures, lack of knowledge of parents regarding the importance of these teeth and lack of maintaining oral hygiene at the time of its eruption.,
There exists a wide variation among a different population of the world in respect to the prevalence of dental caries in FPMs. In China (2008), the prevalence of decayed, missing, filled, teeth (DMFT) was found to be 41%; in Brazil, it was 40% and in the United States 45%–48%., In Nigeria, it was established that carious FPM teeth accounted for 42% of all the extractions. In a study conducted in Sri Lanka, it was found that 11% of subjects suffered from dental caries of all 4 permanent first molar teeth. In Saudi Arabia, the previous studies depict that the point prevalence of dental caries was found to be 66.4% and that the frequency of dental caries increased with the advancement of age.,
Prevention and treatment of dental caries especially that of FPM teeth is a matter of major concern which bothers one and all. The study was aimed to serve as a cornerstone in chalking out the future course of action needed to be taken in the direction of enhancing both knowledge and providence of corrective treatment of the dental caries of FPM teeth among the young populace.
There having been no previous study conducted in Saudi Arabia about the incidence of endodontic treatment of FPM teeth among children, a prospective cohort study was conducted to assess the incidence of endodontically treated FPM teeth at 6 years and 10 years of age of the study samples, so as to achieve the target of supplementing the pertinent literature and also enriching insight into the much needed knowledge of population who desire to go for conservative treatment of their FPM teeth.
- To find the incidence of endodontically treated FPM teeth among subjects
- To find the frequency of mothers who were aware and those who were unaware of the importance of FPMs of their children
- To find the association of awareness of mothers and incidence of dental caries, filled, endodontically treated and extracted FPM teeth among the subjects.
| Materials and Methods|| |
A prospective study was conducted in the Department of Pediatric Dentistry King Khalid University, Abha, to assess the incidence of endodontically treated teeth among children for 4 years (2013–2017). Before the conduct of the study, ethical approval was taken from Scientific Research Committee King Khalid University, College of Dentistry (SRC/REG/2016-2017/146). A convenient sample of 65 children, willing to participate was included in the study. A cohort of 65 children (both girls and boys) was selected for the study of age 6 years old, having erupted FPM teeth in all quadrants. Permission for their participation in the study was taken from their parents. Those subjects who were mentally unhealthy and uncooperative were excluded from the study. The panoramic radiographs of the subjects were evaluated for sound, DMFT or endodontically treated FPM teeth. The same subjects were followed for 4 years, and their Orthopantomograms (OPGs) were taken at the age of 10 years. Their OPGs were again examined for sound, DMFT and endodontically treated teeth. The evaluation of OPGs was done by two examiners whose inter- and intra-examiner reliability was assessed using kappa statistics. Both inter- and intra-examiner reliability was found to be satisfactory. In addition to the OPG evaluation, the mothers of these children were asked one question about their awareness regarding the importance of FPM teeth of their children, for which they had to answer as yes or no. Their responses were entered in a recording pro forma. The baseline data as well as the final data were entered into the Microsoft Excel sheet and subjected to statistical analysis.
The children requiring treatment or pit and fissure sealants were referred for the same. Oral hygiene instructions were given to the children and their mothers.
Sample size estimation
The following formula was used:
n = sample size
Z = z statistics for given level of confidence = 1.96 (for 95% confidence interval).
p = expected incidence = 1.05% (from literature review).
d = Precision = 2.5%.
The sample size was estimated to be 64; so we took the sample of 65 subjects to round off the figure.
| Results|| |
In the present study, it was found that out of the total 65 subjects, 43 (66.15%) were girls and 22 (33.84%) were boys. It was found that all subjects at 6 years of age were having sound FPM teeth in all the 4 quadrants of their oral cavity. At the age of 10 years, it was found that 84.6% of subjects had sound FPM teeth in 1st quadrant while 10.8% had carious teeth and none of the subjects had undergone endodontic treatment in 1st quadrant. While considering the situation in 2nd quadrant of the oral cavity of the subjects, it was found that 83.1% subjects had sound FPMs, 15.4% had carious FPMS, 1.5% of subjects had undergone restoration of FPMs while none of the subjects possessed endodontically treated or extracted teeth. In 3rd quadrant of the subjects, it was observed that 83.1% of subjects had sound FPMs, 9.2% of subjects had carious FPMs, 3.1% had filled teeth, and 4.6% had endodontically treated teeth. In the 4th quadrant, 13.8% of subjects had carious FPMs and none of the subjects had undergone root canal treatment (RCT) of FPM teeth [Table 1]. The overall incidence of endodontically treated FPMs was found to be 1.2% [Table 1] and [Graph 1].
When mothers were asked about their awareness regarding importance of FPM teeth in their children, majority (75.38%) of mothers were aware about it while 24.62% of the mothers were unaware about the importance of FPM teeth in children [Graph 2].
The incidence of endodontically treated FPM teeth in the 3rd quadrant of the study sample was 18.8% among those children whose mothers were unaware about the importance of FPM teeth of their children while no endodontically treated FPM tooth was found among those children whose mothers were aware about the same. The difference was found to be statistically significant (P = 0.000) [Table 2].
|Table 2: Frequency distribution of sound, decayed, filled, missing, endodontically treated FPM teeth according to the mothers response about its importance|
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| Discussion|| |
The importance of FPM in the development of occlusion during the transition stage of permanent dentition is well highlighted in the previous research works., If a child loses his FPM at early stage of his life, he is at a great loss throughout his life in terms of the change in occlusion, drifting of teeth, impaired function, and supraeruption of opposing teeth. The presence of FPM tooth holds importance not only in having balanced occlusion and function, but it also plays an essential part in orthodontic and maxillofacial trauma diagnosis and treatment planning. These molars are multi-rooted teeth with three roots in the maxillary (upper) and two roots in the mandibular (lower) of FPMs. This gives them enough surface area for a powerful bone grip which is utilized for anchorage in orthodontic tooth movements. Therefore, the presence of the healthy FPMs makes treatments pertaining to tooth movements much easier.
With taking a holistic view of the above facts borne in mind, a study was planned for assessing the incidence of endodontically treated FPM teeth in children and its association with mother's awareness about the importance of FPMs in their children.
In the study under reference, it was found that incidence of carious first permanent teeth of subjects at the age 10 of years was 12.3%. It was observed that there were no carious FPM teeth among subjects at 6 years of their age, but at 10 years of age the new cases of dental caries in FPM teeth were seen, thus indicating that frequency of dental caries increases as the age advances. This finding is in accordance with previous studies wherein it was found that increase in dental caries occurs with increasing age. At the age of 10 years, the prevalence of dental caries was 12.3% which was lower than that found in the previous study conducted by Al-Samadani and Ahmad among 9–12-year-old subjects.
Through our study, when mothers were asked about their awareness regarding the importance of FPM teeth in their children, majority (75.38%) of them were aware about it while 24.62% of were unaware about the significance of FPM teeth in children. These findings are similar to those found in the previous studies conducted in Kerman, Iran wherein 18.5% of the parents were known to be unaware about presence of FPM teeth in their children. In a yet another study conducted on Romanian mothers, it was observed that Only one fifth of the mothers knew the right age of eruption of first permanent molar teeth. The percentage of mothers who were unaware about importance of FPM teeth of their children, as per the present study, was less than those found in a previous study conducted by Zouashkiani and Mirzakhan (2006) who found 34.7% of mothers had been unaware about importance of FPM teeth of their children.
The findings of the present study showed that there was no incidence of extracted FPM teeth in the study population at the age of 10 years; the reason whereof might be attributable to the fact that all FPM teeth were sound when the subjects were 6 years old. As it is mentioned in the previous study conducted by Chukwu et al.(2004), majority of the FPM teeth were found to have been extracted due to dental caries at subjects' early stage of the life. Moreover, in our study, it is established that the incidence of filled and endodontically restored teeth increased at the age of 10 years of subjects thereby indicating that most of the parents were aware about the importance of FPM teeth due to which they opted for curative services so as to save FPM teeth of their children.
The results of the present study show that children of those mothers who were aware about the importance of the FPM teeth of their children had less carious FPMs in all their quadrants at the of age 10 years as compared to the incidence of caries among those children whose parents were unaware about its prominence. The parent's/mother's role in preventive measures for maintaining the oral health of their children is indispensably needed. It is mentioned in previous studies that most of the parents are unaware about the eruption of FPM teeth of their children as these erupt at 6–7 years of age when most of the parents do not notice it which thus takes toll on much-needed care and consequently adds to the susceptibility to its dental caries., The other predisposing factors that make the FPM teeth most vulnerable to dental caries are high intake of sugary snacks in between meals, lack of supervised oral hygiene measures needed to be adopted by parents at teeth erupting stage and specific morphological shapes of the upcoming teeth.
The overall incidence of endodontically treated FPM teeth among subjects is found to be around 1.2%. Further, the results of the study depict that incidence of endodontically treated FPM teeth in 3rd quadrant of the study sample is observed to be 18.8% among those children whose mothers were unaware about the importance of FPM teeth of their children. A 0% incidence of endodontically treated teeth among children of those mothers who were aware about importance of FPM teeth was observed while the filled cases showed an incidence of 2% in first quadrant and 6.1% in fourth quadrant of the subjects whose mothers were aware about importance of FPM teeth. These findings indicate that the mothers who were aware of the importance of FPM teeth underwent the treatment of their children at earlier stages of the tooth decay. The conservative method (filling) should be the first treatment choices for carious FPM teeth; however the endodontic treatment (RCT) is opted when the caries reach the pulp.
In the present study, a significant correlation was found between the health status of FPM teeth of children and the awareness of their mothers regarding the importance of FPM teeth. The parents who are aware about the eruption of FPM teeth would dispense meticulous care of oral hygiene practices of their children particularly the supervised tooth brushing, preventive measures such as pit and fissure sealant placement, fluoride application, and regular dental examinations, all for targeting the goal of curing the dental problems of their children at early stages so as to prevent the loss of their teeth especially the FPMs. These may be taken as the most probable reasons for 0% incidence of missing FPM teeth in all quadrants of children sampled in the present study. On the contrary, a previous study shows no statistically significant difference between the parents' awareness and the mean of DMFT of subjects' FPM tooth. The variation in the findings might be attributed to the difference in study design, study sample, sample size, and study population and study setting.
A decrease in the prevalence of dental caries was observed in a number of previous studies, and the reason for the same was associated to the application of preventive measures at the appropriate age of 6–7 years of children.,, Good oral hygiene habits taught by parents to their children at home get inculcated in them throughout their life resulting in good oral health status which ultimately has a positive impact on the quality of life of the populace as a whole.
The FPM teeth are often mistaken as a primary tooth and hence the parents' thinking that it has to shed anyways or would be replaced by a permanent one, unfortunately, do neglect their care. Thus, the tooth eruption ends up in irreversible pulpitis which if detected in time could be saved by endodontic treatment or otherwise the child loses the tooth forever affecting his quality of life in various aspects. Therefore, parent's awareness and knowledge are of utmost importance to prevent the dental caries occurrence in FPM teeth; otherwise, once the caries occurs, the parental vigilance and timely restorative or endodontic treatment might save their child's important tooth thus would lead to children's healthy oral health status.
The primary outcome of the present study shows that the overall incidence of endodontically treated FPM teeth among subjects is found to be around 1.2%. The secondary outcome measures depict that incidence of carious first permanent teeth of subjects at the age of 10 years was 12.3%. It was observed that there were no carious FPM teeth among subjects at 6 years of their age, but at 10 years of age, the new cases of dental caries in FPM teeth were seen. The incidence of extracted FPM teeth in the study population at the age of 10 years was found to be 0%. Majority (75.38%) of mothers were aware about the importance of FPM teeth of their children while 24.62% of were unaware about the significance of FPM teeth.
Strengths and limitations of the study
The researchers have adopted a good study design involving a cohort and following the same group for 4 years thereby reducing the effect of confounding factors on the outcome measures. The incidence of the endodontically treated FPM has been taken as the aim of the study which was rarely being conducted earlier. The awareness of mothers was evaluated which has a great impact on the oral health of children.
The limitation of the study was that the other related factors such as dietary habits, oral hygiene measures, and socioeconomic status of the subjects could not be taken into consideration.
| Conclusion|| |
It was concluded that the incidence of endodontically treated FPM teeth was 1.2%. The incidence of endodontically treated FPM teeth in 3rd quadrant of the study sample was found as 18.8% among those children whose mothers were unaware about the importance of FPM teeth of their children while there were no endodontically treated teeth among the children whose mothers were aware about importance of FPM teeth of their children. Hence, the awareness of parents especially mothers is quite important for saving the FPM tooth-loss of children and also for ensuring their good oral health status.
- The dentist bears responsibility in educating parents about the eruption time of FPM and its importance
- The parents are needed to be made aware about the various preventive measures such as pit and fissure sealant placement, fluoride application, healthy diet, and supervised tooth brushing of their children so that the occurrence of dental caries is averted at its initial stage especially in the most vulnerable permanent tooth that is the FPM teeth
- Parents are required to be guided to supervise the tooth-brushing of their children up to 12 years of age though they can brush alone from the age of 6 years
- The parents have to be motivated to undergo regularly the 6-month oral check-ups of their children with dental specialists so as to reduce the caries progression of their child's FPM teeth
- Parents have to be educated that in case the FPM tooth of their child is having pain and decay they should invariably opt for restorative/endodontic treatment with the dental specialist for the same instead of going for its extraction
- A good counseling of parents against the myths about the failure of endodontic treatment would be beneficial.
- The FPMs hold an utmost importance for the development of proper occlusion, and it is an essential part of masticatory unit. The FPMs are considered as the teeth most prone to dental caries since these are the first permanent teeth which erupt in the oral cavity
- The study was aimed to serve as a cornerstone in chalking out future course of action needed to be taken in the direction of enhancing both knowledge and providence of corrective treatment of the dental caries of FPM teeth among the young populace.
Areas of future research
The future research may involve larger sample size so as to obtain broader external validity of the study. The success of endodontically treated teeth could be evaluated in future similar studies. Factors such as diet, routine dental examinations, and socioeconomic status may be taken into the study to find any correlations with the incidence of endodontically treated teeth among children.
The authors would like to express gratitude to King Khalid University, Abha, for its constant support in the accomplishment of this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]