|Year : 2019 | Volume
| Issue : 5 | Page : 309-317
Prevalence and distribution of dental anomalies among a sample of orthodontic and non-orthodontic patients: A retrospective study
Khalid A Aldhorae1, Zainab M Altawili2, Ali Assiry3, Basema Alqadasi4, Khalid A Al-Jawfi5, Hisham Hwaiti6
1 Department of Orthodontics, College of Dentistry, Thamar University, Thamar, Yemen
2 Yemen Medical Tower, Sana’a, Yemen
3 Department of Preventive Dental Sciences, Najran University, Najran, Kingdom of Saudi Arabia
4 Orthodontic department hospital of Stomatology, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
5 Department of Biological and Preventive Science, College of Dentistry, University of Science and Technology, Sana’a, Yemen
6 College of dentistry University of Science and Technology, Sana’a, Yemen
|Date of Web Publication||24-Sep-2019|
Khalid A Aldhorae
Department of Orthodontics, College of Dentistry, Thamar University, 00967777889904, Thamar
Source of Support: None, Conflict of Interest: None
Aims and Objectives: Dental anomalies are clinically evident abnormalities, which can lead to functional, aesthetic, and occlusal problems, which may complicate orthodontic treatment planning. The purpose of the study was to address the prevalence and distribution of dental anomalies in a group of Yemeni dental patients and to compare the presence of dental anomalies in patients seeking dental and orthodontic treatment. Materials and Methods: This retrospective study was conducted on 1675 digital panoramic radiographs for dental patients aged between 9 and 52 years, who visited orthodontic specialty centers in Sana’a, Yemen, from January 2018 to February 2019. The digital panoramic radiographs were evaluated for the prevalence and distribution of dental anomalies, such as supernumerary, hypodontia, microdontia, macrodontia, taurodontism, dens evaginatus, dens invaginatus, impaction, and dilacerations. Results: The distribution of anomalies was 30.61% among the orthodontic patients and 22.96% through non-orthodontic patients. The most frequent anomaly among the subjects was impaction (14%–47%), macrodontia (11.8%), microdontia (9.23%), hypodontia (7.48%), dilaceration (5.07%), dens evaginatus (1.91%), dens invaginatus (1.58%), hyperdontia (0.99%), and taurodontism (0.91%). Among the individuals who had dental anomalies, 57.9% of subjects showed one type of anomaly, 30.5% had two types of anomalies, whereas 11,49% had more than two types of anomalies. The selected dental anomalies in this study showed high prevalence rate among the orthodontic patients. Conclusion: Variations in data and results among different studies suggest the impact of racial, genetic, and environmental factors. The high frequency of dental anomalies emphasizes the need of early detection and diagnosis, which can be achieved through radiographic imaging, this would avoid potential orthodontic, functional, and aesthetic problems, and further emphasizes awareness to minimize any means of complexity of orthodontic and other dental problems.
Keywords: Dental anomalies, Hypodontia, Non-orthodontic, Orthodontic, Panoramic radiograph
|How to cite this article:|
Aldhorae KA, Altawili ZM, Assiry A, Alqadasi B, Al-Jawfi KA, Hwaiti H. Prevalence and distribution of dental anomalies among a sample of orthodontic and non-orthodontic patients: A retrospective study. J Int Oral Health 2019;11:309-17
|How to cite this URL:|
Aldhorae KA, Altawili ZM, Assiry A, Alqadasi B, Al-Jawfi KA, Hwaiti H. Prevalence and distribution of dental anomalies among a sample of orthodontic and non-orthodontic patients: A retrospective study. J Int Oral Health [serial online] 2019 [cited 2021 Oct 18];11:309-17. Available from: https://www.jioh.org/text.asp?2019/11/5/309/267708
| Introduction|| |
Dental anomalies are one of the anomalies of the dental structures that result from disturbance during tooth formation. Genetics are the most influential factors, in addition to some etiological events in the prenatal and postnatal during teeth morphogenesis that may lead to anomalies in tooth size, shape, position, number, and structure.,,, Worldwide, the prevalence of dental anomalies is ranged between 12% and 45% among the different populations.,,, Teeth anomalies are more frequent in orthodontic patients than other dental patients, and are usually associated with certain malocclusions.,, Anomalies affect dental occlusion, length of the dental arch, and skeletal patterns.,, Knowledge of the presence of such anomalies in orthodontic patients is extremely important in the aesthetics and orthodontic treatment planning to anticipate the malocclusion and other challenges when dealing with orthodontic diagnosis and treatment.,, The incidence and degree of expression of dental anomalies can provide important information for the phylogenic and genetic studies and help to achieve an understanding of variations within and between populations. Numerous published studies and research have discussed the prevalence of developmental anomalies; however, the outcome of every single study has been heterogamous and inconsistent due to the variety of ethnic and racial groups.
This study was conducted to address the prevalence and distribution of dental anomalies in a group of Yemeni subjects, with the possible existence of gender-based associations with these anomalies and to compare the presence of dental anomalies in dental patients and orthodontic patients to detect the occurrence of dental anomalies in patients seeking orthodontic treatment. Furthermore, the study aimed to compare dental anomalies in Yemeni patients with published data from other population groups.
| Materials and Methods|| |
This retrospective study was conducted on 1675 dental patients aged between 9 and 52 years, who visited orthodontic specialty centers in Sana’a City from January 2015 to February 2019. Medical, dental, and family histories and demographic details were obtained.
The radiographs were evaluated in the department of orthodontics and dentofacial orthopedics at College of Dentistry, Thamar University.
The inclusion criteria consisted of the subjects of 9–52 years of age, with no significant medical history (such as trauma to the teeth, jaw bone fractures that affect the natural eruption, syndromes or metabolic disorders that affect the tooth formation and/or bone metabolism, craniofacial anomalies, and skeletal defects that could affect head and neck region), complete formation of all teeth except third molar as they show several variables, no crowns or large restorations that would interfere with the detection of some dental anomalies such as taurodontism, and a history of previous orthodontic treatment. The inclusion criteria for the anomalies were based on the descriptions presented by White and Pharoah.
Exclusion criteria included patients with maxillofacial trauma, evidence of syndrome, and those radiographic images presenting deformations were excluded from this study.
After applying the exclusion criteria, the final sample obtained was of 1202 (497 males [M] and 705 females [F]) subjects with a mean age of 19.29 (standard deviation [SD] = 7.75) years.
Dental anomalies assessed and recorded the presence of supernumerary teeth (mesiodens, supplemental incisor, supplemental premolar, supplemental molar, and paramolar), hypodontia, microdontia, macrodontia, taurodontism, dens invaginatus, dens evaginatus, impaction, and dilacerations. Different anomalies were evaluated according to the following criteria:
Supernumerary teeth: Teeth that develop in addition to the normal complement, may be erupted or impacted, and may resemble or differ from the normal tooth morphology.
Hypodontia: An aplasia of a tooth germ leads to failure to develop at the optimal time.
Microdontia: The affected tooth is smaller than normal, and it may be altered morphologically.
Macrodontia: The affected tooth appears larger than normal.
Taurodontism: The body of taurodont teeth appears elongated and the roots short.
Dens invaginatus: It is the infolding of the enamel surface into the interior of a tooth.
Dens evaginatus: It is the result of an outpouching of the enamel organ.
Impaction: It is the presence of tooth below cementoenamel junctions of the adjacent tooth or teeth, which fails to erupt.
Dilacerations: It is a disturbance in tooth formation that produces a sharp bend or curve in the tooth anywhere in the crown or the root.
Digital dental panoramic radiographs were acquired with the same radiographic equipment (PaX-i3D Green [model: PHT-60CFO] panorama scanner, VATECH, Gyeonggi-do, Korea) operating at 73kV and 14 mA, with an exposure time of 7.2s, 1.052 dGy·cm2 [dose area product] Panorama standard).
Images were stored in a digital database. Density and contrast enhancement tools adjusted these digital radiographs. The panoramic images were reviewed under good lightening conditions with a standard screen resolution. Images were evaluated independently by two different calibrated operators (orthodontist and general dentist). To estimate the reproducibility of diagnosis, 100 radiographs selected randomly were examined once again separately by the two operators. The agreement between the operators was almost perfect agreement (κ, 0.89–0.99). A singular examiner conducted evaluation to avoid variation in examination criteria due to difference in personal interpretation.
To ensure acceptable intra-examiner reliability, the same examiner analyzed a random sample of 10 sets of radiographs twice, with evaluations separated at two weeks’ interval. Errors of identification were evaluated by testing reliability using Kappa statistics, which reflect the reproducibility of results of the measurement procedure results.
Methodological error was assessed using Kappa statistics [Table 1].
|Table 1: Inter and intra-examiner reliability analysis. Kappa Coefficient test|
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Statistical analysis: Demographic details were obtained, and collected information was analyzed using the Statistical Package for the Social Sciences (SPSS) program, (version 24; Inc., Chicago. IL) USA. Standard chi-squared test was used for all comparisons of dental anomalies, in addition to specific dental anomalies in relation to gender except when the number of observations was five or fewer, in which case Fisher exact test was used. P < 0.05 was considered to be significant.
| Results|| |
Intra-examiner Kappa value ranged from 0.890 to 0.995, which indicates perfect agreement between the first and the second evaluations. The result revealed very high inter-examiner reliability, ranging from 0.891 to 0.993. The results were considered to be valid according to interpretation Viera and Garrett.
The study sample consisted of 1202 subjects. The mean age of subjects was 19.29 (range from 9 to 56) years; 497 (41.34%) were male and 705 (58.65%) were female (male/female ratio, 1:1.4). Among them, 601 (50%) were orthodontic patients, 18.63% (224) were males and 31.36 (377) were females. A total of 601 (50%) were non-orthodontic patients. Of them, 273 (22.71%) were males and 328 (27.28%) were females. From the overall 1202 panoramic radiographs, 644 (53.57%) had dental anomalies.
The distribution of anomalies was 30.61% among the orthodontic patients and 22.96% among non-orthodontic patients. A significant difference existed among the studied subjects regarding group of the patient and gender distribution (P = 0.004). The prevalence rate of selected anomalies in the final sample, distribution in patient’s groups, sex sets, and statistical differences are shown in [Table 2].
The most frequent anomaly among the subjects was impaction (14.47%), followed by macrodontia (11.81%), microdontia (9.23%), hypodontia (7.48%), dilaceration (5.07%), dens evaginatus (1.91%), dens invaginatus (1.58%), hyperdontia (0.99%), and taurodontism (0.91%).
High statistical difference was shown in dens evaginatus (P < 0.001) among studied subjects as shown in [Table 2]. Of the subjects, dens evaginatus was most commonly encountered in orthodontic samples (3.32%) and maxillary left canine (1.33%) was the most frequently affected, whereas dens invaginatus was mostly seen in maxillary left lateral incisor (0.99%). Dens invaginatus showed no significant difference between studied subjects regarding group of the patient and sex distribution (P > 0.05) as shown in [Table 2].
[Table 2] shows taurodontism was the least common dental anomaly among the sample subjects (0.11%) with high frequency in both maxillary left first and second molar (0.33%). No significant difference exists among studied subjects regarding patients’ group and gender (P > 0.05).
Among the individuals who had dental anomalies, 57.91% of the subjects showed one type of anomaly, 30.59% had two types of anomalies, whereas 11.49% had more than two types of anomalies as shown in [Figure 1].
Impaction was the most common anomaly in this study. It was highly prevalent in orthodontic patients (9.73%) with higher frequency in females (6.32%) than in males (3.41%), the maxillary left canine was the most frequently impacted tooth (8.23%) [Figure 2].
|Figure 2: Distribution pattern of impacted teeth among orthodontic and non-orthodontic patients|
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Impaction showed no statistical difference among the patients’ groups and gender variation (P > 0.05) [Table 2],[Table 3],[Table 4].
|Table 3: Distribution of dental anomalies in relation to group and gender|
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|Table 4: Distribution of dental anomalies in relation to gender among orthodontic patients|
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Following impaction of teeth, macrodontia (11.81%) was the second most common anomaly among subjects with more predominance in non-orthodontic subjects, especially females (4.32%). The most frequently reported macrodontic tooth was the maxillary right central incisor (0.91%). [Table 2],[Table 3],[Table 4] show higher significant difference between the subjects’ sample (P < 0.001). Also, statistical difference was observed among orthodontic group; females were highly affected (P < 0.05).
Microdontia and hypodontia were more prevalent in orthodontic patients (10.31% and 9.65%, respectively). The maxillary left lateral incisor was the most commonly microdontic and congenitally missing tooth (3.91% and 3.07%, respectively). No statistical difference was found in macrodontia regarding patients’ group and gender (P > 0.05), whereas hypodontia reported significant difference among sample subjects’ (P < 0.01). No significance difference was observed on both groups and genders regarding microdontia P > 0.05 [Table 2],[Table 3],[Table 4].
Dilacerations were significant and highly prevalent in orthodontic patients than in non-orthodontic patients and in females (2.74%) more than in males (1.08%) (P < 0.05). And it was significant among non-orthodontic patients with higher prevalence in female (0.99%) (P < 0.05) [Table 2],[Table 3],[Table 4]. The most highly affected tooth was equally both the mandibular left first and second molars (1.41%).
Approximately 0.21% of anomalies in this study were supernumerary teeth and were found to be equal in both patients’ groups (orthodontic and non-orthodontic, P > 0.05). Mesiodens was the most frequented type (0.66%) with more prevalence in males (0.49%) than in females (0.16%) as shown in [Table 5]. No significant difference exists between the type of supernumerary, group of patient, and gender (P > 0.05) [Table 2],[Table 3],[Table 4],[Table 5].
|Table 5: Distribution and frequencies of supernumerary teeth among study subjects|
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Among the selected dental anomalies in this study, impaction, microdontia, hypodontia, taurodontism, dens invaginatus, dens evaginatus, and dilaceration were highly predominant among orthodontic patients (30.61%). Overall, this study revealed some convergence to other populations, especially Arabian residents and Indian population in the prevalence of some selected dental anomalies [Table 6].
| Discussion|| |
Dental anomalies may be expressed with mild developmental delay to the most severe tooth agenesis, as microdontia, changes in dental shape, structure, and octopi’s. The etiology of dental anomalies of number, size, and position, as well as timing of development has been suggested to be genetic and hereditary, as derived from studies in families, monozygotic twins, and from the frequent observations of associations of certain abuttal anomalies, the dental anomalies can complicate orthodontic treatment not considered, therefore, their presence should be thoroughly investigated during diagnosis and carefully considered during treatment planning.
Many epidemiological surveys have been carried out over the past recent years in different parts of the world to determine the prevalence of dental anomalies. Even though dental anomalies are the most observed causative factor in malocclusion, no reported study has been conducted to compare the prevalence of dental anomalies among orthodontic patients and dental patients. The prevalence of some abnormalities such as hypodontia and supernumeraries may be underestimated in few studies. The studies were conducted without any radiographic assessments. To the best of our knowledge, this study was the only one to use panoramic radiography of the patients as accurate diagnostic aids in diagnosing dental anomalies. The results of this study showed a gender predilection of dental anomalies in both orthodontic and non-orthodontic patients, with higher prevalence in females than that in males.
The most common abnormality found in this study was impaction (14.47%), which was consistent with the findings by Bilge et al., which was in near to that found in the Indian population (15.5%). These results were higher than the findings of 3.41% in Iran and 3.9% in Italy., In western Saudi population, a higher prevalence of impacted teeth (21.2%) was reported. The reason may be related to the dental arch dimension in Arabic population, which are smaller than those in the other populations.
The second most common anomaly in this study was macrodontia. Larger teeth or macrodontia were observed in 11.81% of our study population, and all were in localized form. Talon’s cusp is a well-delineated additional cusp on the surface of an anterior tooth and extends half the distance from cementoenamel junction to incisal edge. Thus, it might be the most prevailing racial marker in Indian races. The most frequent macrodontic tooth was the maxillary right central incisor, whereas the maxillary left lateral incisor was the most common microdontic tooth.
The prevalence of isolated microdontia in literature was between 1% and 8%, and 9.23% was noticed in this study. Maxillary lateral incisors were reduced mesiodistally and were most frequently involved in this anomaly. It was found to be common in >1% of general population and was 6.5% in our study [Table 2]. Microdontia are inherited as autosomal-dominant trait.
Hypodontia was observed in 7.48% of study sample, which was in agreement with the findings in Swedish and Italian population, which were 7.4% and 7.1%, respectively., However, this was higher than the findings of 2.6% in Egypt and 4.19% in India., Also, it was less than the reported findings of Zakaria et al., which was 19%. This can be related to sample size, hereditary, or genetic etiology.
The maxillary lateral incisors were the most frequently observed absent teeth and were found to be more common in females, these results were in agreement with previous studies such as Johannsdottir et al. and Pinho et al., the reason for this was related to gender differences.
The prevalence of dilacerations in this study was 5.07%, which was in agreement to that in the Iranian population, which was found to be 5.1%. However, it was significantly less than 18.67% in Brazil and more than 0.02% in Turkey., Owing to the limitation of panoramic radiograph, there may be an underestimation to the prevalence of dilaceration.
The prevalence of dens evaginatus was found to be 1.91%, which was higher than the results of Dravidian and Nigerian population, which were 0.4% and 0.5%, respectively., However, it was less than the prevalence in India (2.4%).
The prevalence of dens invaginatus was found to be 1.58%, which was in agreement with the prevalence of Turkish population, which was 1.3%. These findings were much higher than the findings of Nigerian population (0.004%), but much less than that of American population (5%).,
In this study, supernumerary teeth were observed in 0.99% of our subjects, which was in agreement with the Turkish population, which was 0.98%, but it was significantly less than what was found in the French population (15.06%) and the Indian population (8%).,
Supernumerary teeth were more frequently observed in males than in females, these results were in agreement with previous studies., They were more frequently reported in the permanent dentition, more so in the anterior region as mesiodens than any part of either dental arch., This concurred with this study that found 0.66% of supernumerary teeth to be mesiodens.
This can be related to hypergenesis of the epithelial cord, hereditary, and splinting of permanent tooth germ.
The prevalence of taurodontism was found to be 0.91%, which was in agreement with the findings in Iran, which was 0.7%. Patients with syndrome are more predictable to predominantly have teeth with taurodontism. However, due to the inclusion criteria in this study, patients with syndrome were excluded. Therefore, low prevalence was recorded.
Significant difference in gender was found in this study. This was in line with majority of previous studies that reported sex-significant relation to anomalies.,, Furthermore, a wide range of studies reported higher prevalence of specific anomalies in orthodontic patients., This was in line with this study that found anomalies more predominantly in orthodontic patients [Table 2]. Ethnicity was also reported to be associated with some anomalies. However, the general tendency of dental anomaly prevalence was similar throughout a number of studies conducted in a variety of ethnical groups in different geographic settings [Table 6].
- The most frequent anomaly among the subjects was impaction followed by hypodontia, dilacerations, dens invaginatus, dens invaginatus, hypodontia, and taurodontism.
- Among the individuals who had dental anomalies, half of the them showed one type of anomaly, one-third of them had two types of anomalies. Impaction was the most common anomaly in this study.
- The high level of occurrence of these anomalies suggest to find the etiological factors and earlier treatment of the dental anomalies, several variations in data were noted between this study and other studies in the same region, as well as in other regions of the world, which give us a clear idea about compact of racial, genetic, and environmental factors on the prevalence of dental anomalies.
- Dental anomalies can be diagnosed as early detection is very vital as it would prevent the occurrence of further complication, epically for orthodontic problems, and the earlier the diagnosis of a particular anomaly, the less complexity a treatment plan would be.
Further research into etiological factors for dental anomaly present in Yemeni patients can create awareness and guide preventive strategies to minimize the dental and orthodontic complexities.
Ethical policy and institutional review board statement
The study project was approved by the ethics committee at the University of Thamar (0025 DEC-2017).
Data availability statement
The data set used in this study is available on request from Khalid Aldhorae (e-mail: [email protected]).
We would like to thank Dr. Yanoof Al-Rawnah and Dr. Mohammed Al-Rashidi for their assistance in data acquisition, and Mrs. Somya Al-Ansi and Mrs. Fatima Al-Ansi for all help and support during the course of the research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]