Does nutrition have an effect on the timing of tooth formation?

BACKGROUND: The effect of nutritional status on the timing of permanent tooth formation is not well understood, despite clear evidence that systemic stresses result in enamel defects during tooth formation. AIM: This study investigated the effect of nutritional status (measured as BMI, height, weight, mid-upper arm circumference, and head circumference) on permanent tooth formation. METHOD: This was a prospective cross-sectional study involving 642 (270 males, 372 females) healthy Black South African participants aged 5-20 years. The height and BMI were converted to z-scores using WHO z-score for age tables. The participants were grouped into underweight/short for age (<-2), normal (≥ - 2 to 2.0) and overweight/obese/tall for age (>2). Panoramic radiographs of the children were assessed using Demirjian's eight stages of permanent tooth formation and age was estimated using Demirjian's method. Probit regression analysis was used to calculate the mean age of attainment of the developmental stages for the left mandibular teeth (I2-M2). RESULTS: There was significant advancement in the age of attainment of the final (H) stage for the majority of permanent teeth in the overweight (mean male BMI 22.9; female 27.94) group compared to the underweight (p < .05). Negative binomial regression indicated that age, height, and BMI were significant predictors of the dental maturity score for males (p < .05), while age, height, weight, BMI and HC were significant predictors for females (p < .05). CONCLUSION: Nutritional status had a significant effect on the timing of tooth formation in males and females in the study population. The effect was mainly noticeable for children in the extremes of the spectrum of BMI z-scores.

The timing of permanent tooth development in a Black Southern African population using the Demirjian method.

BACKGROUND: Many aspects of growth have been documented for Black Southern African children, yet their dental development has not been comprehensively investigated. AIM: The present study was designed to provide information on age of attainment of dental development stages in Southern African children and to compare the findings with other populations. METHOD: This was a community-based cross-sectional study of 642 children (270 males and 372 females). Panoramic radiographs of children aged 5 to 20 years were assessed using Demirjian's eight stages of permanent tooth formation and age was estimated using Demirjian's method. Resulting dental ages were compared to the chronological ages. Probit regression analysis was employed to calculate the mean age of attainment of the developmental stages for the seven left mandibular teeth. Maturity scores and age of attainment were compared by sex and with published data on other populations. RESULTS: Females show significantly advanced dental maturity and dental ages, as well as earlier attainment of all stages of mineralization, compared to males (p < 0.05). The Demirjian method overestimated dental age in both males (0.8 ± 1.02 years) and females (1.0 ± 0.98 years). Cross-population comparisons illustrate that Black Southern African children are generally advanced in dental maturity compared to children of European and Asian ancestry. CONCLUSION: The Demirjian method significantly overestimated the chronological ages of Black Southern African males and females. Southern Africans attain dental maturity earlier than South Korean, Canadian, and Belgian children. These differences in dental maturity clearly illustrate the need for population-specific, rather than global, dental maturity standards.

Permanent tooth emergence: Timing and sequence in a sample of Black Southern African children.

OBJECTIVES: This study investigates mean age, sequence, and temporal trends of permanent tooth emergence in Black Southern African children and compares the findings with other population samples. MATERIALS AND METHODS: This community-based cross-sectional study involved 639 Black Southern African children between 5 and 20 years of age. Probit analysis was used to derive the mean age at emergence of the permanent teeth. Sex and cross-population comparisons were undertaken to determine similarities and differences in emergence timing and sequence. RESULTS: Females emerged all teeth earlier except for M3s (p < .05). Black Southern Africans have earlier mean ages of emergence compared to population samples from the USA, Europe, Australia, and Asia. Sexual dimorphism was detected in the mandibular I1/M1 emergence sequence (females, M1 I1 ; males, I1 M1 ). The sequence in males is similar in both jaws to males from other sub-Saharan African, USA, and European samples. Females show a similar sequence pattern in the maxilla with other sub-Saharan African, and also Australian and US females of European ancestry. There is a high frequency of polymorphism in the P1P2C1 emergence sequence, with significantly more P2P1C1 maxillary sequences seen among males. Polymorphic variation was common for the I1 M1 sequence in both males and females. DISCUSSION: Mean age of tooth emergence among Black Southern African children is similar to children from most other sub-Saharan African populations. No temporal change was seen in the mean age of emergence. Earlier permanent tooth emergence in Black Southern Africans is part of a general sub-Saharan pattern that is distinct from European and Asian populations.

The WITS Atlas: A Black Southern African dental atlas for permanent tooth formation and emergence.

Current dental maturity charts, such as the widely applied London atlas, do not take into consideration advanced tooth emergence and formation patterns observed in children of African ancestry. The result is inaccurate age estimation in Southern Africa, a region where there is great forensic and anthropological need for reliable age estimation. OBJECTIVES: To develop a population-specific atlas of permanent tooth emergence and formation for age estimation of Black Southern Africans. MATERIALS AND METHODS: Using data from a cross-sectional study of 642 school children aged 5-20 years, panoramic radiographs taken during routine dental examination in a mobile treatment van were analyzed using the Demirjian method of eight (A-H) tooth formation stages. Tables of the stages of tooth development for each tooth, including the third molars, were generated separately for age cohorts and by sex. The most frequently occurring (modal) stage of tooth formation was considered the signature developmental stage for the age. The relationship of the third molar occlusal surfaces with occlusal tables on the radiographs were checked and compared with the findings recorded during intra oral examination. RESULTS: Comparison with the London atlas shows that at age 9.5 years, the canine and premolar emergence are at least one year ahead and the third molar formation completes four years earlier in the WITS Atlas. DISCUSSION: Similarities in advancement in tooth formation and emergence across sub-Saharan Africa suggest that the WITS Atlas can be used for those populations as well.

Accuracy of the Demirjian and Willems methods of age estimation in a Black Southern African population.

The accuracies of the original Demirjian, modified Demirjian and Willems dental age estimation methods were compared for a Black Southern African population to determine their usefulness for forensic and anthropological purposes. Data were collected using a community-based prospective study design. Panoramic radiographs of seven left mandibular teeth from 540 children aged 5-15.99 years were scored using the three methods. Obtained estimates were compared to the chronological ages and mean absolute errors were calculated. The original Demirjian method significantly overestimated ages (males 0.85 years, female 1.0 years; mean absolute errors of 1.1 years for both sexes), as did the modified Demirjian method (males 0.90 years, females 1.21 years; mean absolute errors of males 1.1 years, females 1.4 years). The Willems method was the most accurate for Black Southern Africans, with the lowest significant mean difference (males 0.2 years, females 0.3 years) between dental and chronological age, with the least mean absolute errors (males 0.70 years, females 0.68 years).

Efficacy of Three In-Office Dentin Hypersensitivity Treatments.

PURPOSE: This study assessed the comparative efficacy of three in-office treatment agents in patients presenting with dentin hypersensitivity (DH) at a university teaching hospital. MATERIALS AND METHODS: A randomised, controlled study was conducted to compare the efficacy of Gluma desensitiser, Pro-Relief and Copal F in relieving the pain of DH. In 68 subjects with 508 hypersensitive teeth, the agents and placebo (distilled water) were applied to 127 hypersensitive teeth each. At baseline, the pain of DH to tactile and evaporative stimuli was measured using the visual analogue scale (VAS) and verbal rating scale (VRS). Post-application assessment was carried out at 10 min, 1 week, 2 and 4 weeks. RESULTS: The mean difference in VAS between baseline and post-treatment periods significantly increased for all the desensitising agents (p < 0.05) with both tactile and air-blast stimuli, except for the placebo. Gluma desensitiser had the highest mean difference at 10 min (3.7 ±â€¯1.8) and 4 weeks (5.4 ±â€¯2.3) for tactile and air-blast stimuli, respectively. However, using the VAS, no statistical significance was noted in the mean differences between the agents. With the application of Gluma desensitiser, a significantly higher number of teeth had no pain at 4 weeks using the VRS. CONCLUSION: Gluma desensitiser can be suggested as an appropriate desensitising agent for in-office treatment of DH.

Brief communication: Emergence chronology of permanent teeth in Nigerian children.

This study measured the mean age, duration, and sequence of the emergence of permanent dentition in Nigerian children and compared the findings with other population groups. The cross-sectional study involved 1,078 Nigerian children, aged 4-16 years old, from selected primary and secondary schools in the Ife Central local government area in Ile-Ife, Osun State. In general, compared to boys, girls had an earlier mean age of emergence of all the permanent teeth. Children from high socioeconomic class had an earlier mean age of emergence for the maxillary incisors (6.43 and 7.58 years) and mandibular incisors (5.28 and 6.44 years) compared to children from middle and low socioeconomic classes, although socioeconomic effects were more mixed for premolars and molars. Compared to their counterparts in the USA, Australia, Belgium, and Iran, Nigerian children showed an earlier mean age of emergence of all the permanent teeth studied except for Pakistani boys, who had an earlier mean age of emergence of the maxillary premolars and second molar. Poorer economic status has been associated with delayed dental development; however, when compared to other populations, the Nigerian children in this study have earlier mean emergence ages than children from wealthier countries such as the USA and Australia.

Impact of oral conditions on the quality of life of secondary schoolchildren in Nigeria.

PURPOSE: Oral health problems have been increasingly recognized as important factors causing a negative impact on daily performance and quality of life. The purpose of this study was to assess the impact of tooth extraction with no replacement, untreated fractured anterior teeth, malocclusion, dental restorations, and orthodontic braces on the quality of life in Nigerian schoolchildren. METHODS: A total of 197 9- to 17-year-old schoolchildren completed the Oral Health Impact Profile (OHIP) index/questionnaire. RESULTS: Students who had tooth extraction with no replacement and untreated fractured incisors had significantly higher mean OHIP scores for functional limitations, physical pain, psychological discomfort, physical, psychological, and social disabilities, and handicaps (P<.001) when compared to other groups and the control. The mean OHIP scores of students with features of malocclusion were significantly higher for functional limitations, psychological discomfort, and psychological disability compared to the control group (P<.001). CONCLUSIONS: Untreated dental problems had some negative impact on the quality of life on the 7 subscales of the OHIP.

Tooth loss among Nigerians treated in teaching hospitals: a national pilot study.

AIM: The aim of this study was to identify the causes and patterns of tooth loss among Nigerian adults. BACKGROUND: Tooth loss continues to be a major problem in clinical dentistry and has received significant attention in everyday dental practice. In Nigeria there is a discernible lack of current data that would explain the reasons and patterns of tooth loss from its different geopolitical zones. METHODS AND MATERIALS: The reasons for tooth extractions during a period of 12 months were obtained from the hospital records of teaching and specialist hospitals in Nigeria's six geopolitical zones and the Federal Capital Territory (FCT). Data were analyzed using Statistical Package for the Social Sciences for Windows (SPSS) version 9.0. RESULTS: A total of 4,204 teeth were extracted from 3,431 patients. Of these teeth 52.4 percent were lost due to dental caries while 30.2 percent were removed because of periodontal disease, 5.0 percent were missing as a result of trauma, and 3.9 percent were impacted and required extraction. The remaining 8.5 percent were extracted for a variety of reasons such as orthodontic treatment, overeruption, neoplasms, supernumerary teeth, attrition, a cystic lesion, and hypoplasia. Dental caries was the most common diagnosis given for tooth loss in the South-South (79 percent), South-East (68 percent), North-East (47 percent), North-West (69 percent), and North-Central (35 percent) zones followed by periodontal disease. In contrast, periodontal disease was the most common cause of tooth loss in the South-West zone (65 percent) and in the FCT (55 percent), followed by dental caries at 22 percent and 33 percent, respectively. CONCLUSION: Although teeth were extracted based on a variety of diagnoses, dental caries was identified as the common reason cited for tooth loss in Nigeria and to a lesser extent periodontal disease. Also different reasons were given for tooth loss among the various geographical zones. CLINICAL SIGNIFICANCE: Tooth loss among Nigerians was attributed largely to dental caries and secondarily to periodontal disease. Both conditions can be prevented if diagnosed early enough and treatment is instituted in a timely manner.

Teething problems and parental beliefs in Nigeria.

AIM: To determine signs and symptoms associated with teething, parental beliefs about teething, and the effects of socioeconomic status on teething in Nigerian children. METHODS AND MATERIALS: A cross-sectional study consisting of 1,013 mothers of children between the ages four to 36 months who visited the immunization clinics at the Community Health Centres in Ife Central and Ife East Local Government Areas. Data was analyzed using STATA (Intercooled release 9) for Windows. RESULTS: A total of 765 mothers (75.5%) reported systemic signs and symptoms in their children. Fever (51.8%), diarrhea (12.5%), and vomiting (2.9%) were the most prevalent symptoms and signs reported. Teething problems were reported by 60% of mothers from a high socioeconomic class, as well as 76.7% and 77.9% from middle and low socioeconomic classes, respectively. Interestingly, 65.5% of mothers believed teething should be accompanied with systemic signs and symptoms such as fever (42.1%), diarrhea (13.9%), and vomiting (0.6%). No significant difference was noted between breastfeeding status, gender of the child, and reported systemic signs and symptoms noticed by the mothers. CONCLUSION: Most mothers in the study reported signs and symptoms adduced to teething in their children irrespective of their beliefs. Fever ranked highest of the signs and symptoms reported. Mothers of children from the high socioeconomic class reported fewer teething symptoms. Breastfeeding status and gender of the child had no effect on teething problems in the children studied. CLINICAL SIGNIFICANCE: Most signs and symptoms adduced to teething by parents may actually be due to underlying infections. Thus, there is a need to rule out occult infection during the tooth eruption period.

Factors influencing tooth shade selection for completely edentulous patients.

AIM: There is limited scientific information on the relationship between tooth shade, age, gender, and skin color in black Africans. This lack of knowledge may impact the ability of the prosthodontist to select artificial teeth for completely edentulous patients. This study explores the possibility of a relationship between tooth shade, gender, age, and skin color in a black African population. METHODS AND MATERIALS: A total of 212 individuals aged 15 to 79 years participated in this study. One investigator, calibrated for examining tooth shade, performed all examinations. A Vita-Lumin shade guide was used to examine either the maxillary right or left central incisor. One had to be sound for inclusion in the study. Tooth shades were divided into two categories according to value, and skin tones were divided into two categories (light, and dark). Chi-square analysis and Fisher's exact tests were used to analyze the data (P< 05). RESULTS: No statistically significant difference was found between tooth shade and skin color and the subjects' perception of their tooth shade. However, a statistically significant difference was found between age and tooth shade (P<.001). There was also a statistically significant difference in tooth shade between men and women. CONCLUSION: Within the limitations of this study, tooth shade value and skin color were not related. However, older adults and men are more likely to have darker teeth.

Pattern of dental extraction in children in a Nigerian tertiary hospital.

Changes that occurred in the pattern of tooth extraction in the last 13 years among a population of children in Nigerian were studied. The result of this study was then compared to that of a past study done in the same institution 13 years earlier. Information on age, gender, and indication of tooth extraction was collected prospectively from 379 consecutive patients who visited the outpatient Pediatric Dental Clinic for the first time during the year 2002. Results showed tooth extraction due to caries decreased, while there was an increase in tooth extraction from an apparent increase in orthodontic treatment needs. Acute necrotizing ulcerative gingivitis (ANUG), a significant cause of tooth loss in the last decade, decreased significantly. The pattern of deciduous tooth loss also changed as more anterior teeth were lost for orthodontic reasons in this present study. The pattern of tooth loss in the permanent dentition remains very similar to that of the past study, though more premolars were lost in the present study. There appears to be an increasing need for tooth extractions in orthodontic treatment for this population of children. The focus of planned dental health care provisions, treatment policies, and training emphasis in child dental care may need to shift to addressing orthodontic needs.