Krupnyk: Incidence of Small Bounded Edentulous Spaces in Children and Adolescents Living in Lviv



Problem statement and analysis of the recent research

The absence of even one tooth is known to cause irreversible deformations of the dentofacial system in individuals of all age groups. However, they are the most significant in childhood and adolescence. This is principally caused by the active development of dentofacial complex [4]. The loss of permanent teeth in children, especially first molars, has been proven to lead inevitably to deformity of dentitions and changes in musculo-articular complex at the age of 18-20 [9, 10, 12]. Despite a large number of different modern methods of treatment and prevention of major dental diseases, the incidence of dentitions deformity caused by teeth extraction or their considerable destruction is significant [2, 3, 5] and the emergence of morphological and functional changes in dentofacial complex due to premature loss of permanent teeth is the most severe at a young age [7, 11].

According to literary sources, the incidence of small bounded edentulous spaces in growing individuals differs depending on the geographical area of residence, the level of region urbanization, the state of dental care, the quality of the planned sanation and periodic health examination of the population [5, 6] and ranges from 6.4 – 7.1% [2] to 25% [3] in 15-year-old individuals. The latter determines the need to study the incidence of small bounded edentulous spaces in different age groups in a particular region in order to plan and optimize providing of various options for orthopedic care to children and adolescents.

The objective of the research was to study the incidence and causes for small bounded edentulous spaces in children and adolescents living in Lviv.

Materials and methods

2360 children living in Lviv at the age of 9 to 17 (1158 boys and 1202 girls constituting 49.1% and 50.9% respectively) were the study subject. Dental examinations were performed in schools during the annual routine dental examinations together with the dentists of school dental offices. Administrations of schools and pupils’ parents were informed about the examinations. The results of the dental examination were recorded in “Examination record” which was specially developed at the Department of Prosthetic Dentistry at Danylo Halytsky Lviv National Medical University. Study object involved determination of the incidence of small bounded edentulous spaces depending on age and gender and analysis of the main reasons for their occurrence. The selection and grouping of dental examination materials was conducted according to the WHO recommendations [8] in three age groups: 9-12 years, 13-15 years and 16-17 years. The extent of examinations was determined on the base of the WHO methodical recommendations [8]. According to these recommendations each age group must include at least 30 people during epidemiological surveys in order to obtain statistically significant data.

The study and analysis of the causes of permanent teeth premature loss was conducted according to the archival data of case histories of 9-18-year-old patients treated at Dental Medical Center of Danylo Halytsky Lviv National Medical University and the Department of Maxillofacial Surgery of Lviv Regional Clinical Hospital.

The results of the research were statistically processed. Microsoft Excel and Statistica programs were applied for the statistical analysis of the obtained primary data. Analysis of mean values was provided as arithmetic mean and mean error M ± m. Student’s t-test was used to make comparisons between groups.

Results of the research and their discussions

Comparative analysis of the data obtained after epidemiological survey of schoolchildren in Lviv showed that the prevalence of small bounded edentulous spaces ranged on average from 8.90% in girls to 10.53% in boys. According to the data in Fig. 1, a clear trend towards an increase in the numbers of pupils with small bounded edentulous spaces with age in both gender groups was detected.

Fig. 1.

The prevalence of small bounded edentulous spaces in schoolchildren in Lviv.

gmj-24-E201712-g1.jpg

The number of girls with small bounded edentulous spaces at the age of 9 to 17 gradually increased from 3.14±1.26% to 13.46±1.47%, (р<0.001). The number of boys increased from 6.29±1.03% to 14.4±2.17%, (р<0.001). High indices were observed in boys in all age groups in comparison with girls. However, the difference was insignificant in the age groups of 13-15-year-old and 16-17-year-old pupils, and the incidence of detected defects in 9-12-year-old boys was twice higher compared to girls constituting 6.29±1.03% versus 3.14±1.16% (р<0.05), respectively.

Comparison of the data of our epidemiological studies in 2016 with the same materials [1] conducted in the age groups of 13-17, the trend towards decrease in the number of adolescents with small bounded edentulous spaces from 24.9 % to 12.23% in the time range of 10-15 years was observed. We consider this to be caused by active detection and treatment of dental caries and its complications and preventive measures in school age.

The study of small bounded edentulous spaces incidence depending on the site showed that the number of pupils with the studied pathology was variable and depended on age and gender (Tables 1 and 2).

Table 1

Small bounded edentulous spaces in boys depending on the site

Age, years Total number of the examined patients Upper jaw Lower jaw
Lateral area Frontal area Lateral area Frontal area
abs. % abs. % abs. % abs. %
9 152 0 0 3 1.97±1.51 2 1.31±0.75 0 0
10 143 0 0 3 2.09±1.23 4 2.79±1.08 0 0
11 102 2 1.96±1.21 3 2.94±1.51 3 2.94±1.15 0 0
12 159 5 3.14±1.50 3 1.89±2.01 7 4.40±0.51 0 0
13 122 4 3.27±0.83 3 2.45±1.42 7 4.91±1.43 0 0
14 135 6 4.44±1.27 4 2.96±1.03 7 5.73±0.77 0 0
15 109 5 4.58±1.07* 3 2.75±1.27 8 7.33±0.88 0 0
16 115 5 4.34±1.09* 5 4.34±0.65 8 6.95±0.75 0 0
17 121 5 4.51±0.53* 4 3.32±2.53 8 6.61±0.87 0 0
Total 1158 32 2.91±1.37* 31 2.74±1.17 51 4.77±1.61 0 0

Note.

* - a significant difference (р<0.05) between similar groups of both subgroups

Table 2

Small bounded edentulous spaces in girls depending on the site

Age, years Total number of the examined patients Upper jaw Lower jaw
Lateral area Frontal area Lateral area Frontal area
abs. % abs. % abs. % abs. %
9 160 1 0.62±1.35 0 0 0 0 0 0
10 168 1 0.59±1.57 2 1.19±0.75 0 0 0 0
11 100 2 2.00±1.09 0 0 3 3.00±1.71 0 0
12 145 2 1.37±0.79* 2 1.37±0.73 6 4.14±1.15 0 0
13 109 2 1.83±0.53* 3 2.75±1.41 4 3.67±0.78 0 0
14 149 7 4.69±1.21 4 2.68±1.57 8 5.37±1.15 0 0
15 126 6 4.76±1.11 5 3.97±1.23 7 5.15±0.56 0 0
16 122 6 4.91±1.08 4 3.27±1.78 8 6.55±1.13 0 0
17 123 7 4.87±0.84 4 3.25±1.17 8 6.50±1.07 0 0
Total 1202 34 2.83±1.10* 24 2.05±1.27 44 3.86±1.65 0 0

Note.

* - a significant difference (р<0.05) between similar groups of both subgroups

Denture defects were established to be diagnosed with almost the same frequency on both the upper and lower jaws constituting 9.73±0.74% and 8.16±0.63% respectively. An increase in the number of individuals with small bounded edentulous spaces on both upper and lower jaws was observed with age in both gender groups. However, for the first time this pathology was diagnosed on the upper jaw in 9-year-old girls and on the lower jaw in 11-year-old girls. Small bounded edentulous spaces occur in 9-year-old boys on the lower jaw and in 11-year-old boys on the upper jaw.

Small bounded edentulous spaces in both gender groups were established to be diagnosed 2.5 times more often in the lateral areas than in the frontal ones. These indices constituted 7.68±1.03% versus 2.74±1.12%, (р<0.01) in boys and 6.69±1.05% and 2.74±1.17%, (р<0.02) in girls.

Dentition defects in lateral areas were detected in 161 patients. They were caused by the extraction of first permanent molars in the vast majority of cases (93.17%). The most prevalence of male adolescents with lost first molars versus female adolescents was detected by 2.5 times at the age of 13 (71.79% of male adolescents versus 28.21% of female adolescents) and by 2 times at the age of 15 (65.90% versus 34.10%, respectively) (Fig. 2). The distribution of the examined patients according to the loss of the first molars was almost identical in the age groups of 14 and 16 years of age. The indices were about 1.2 times higher in boys than in girls constituting 55.18% in boys versus 44.82% in girls at the age of 14 and 56.52% and 43.48% respectively at the age of 16. However, the considerable prevalence of female adolescents with lost first molars versus male adolescents at the age of 17 by 2.7 times (73.10% in girls versus 26.90% in boys) was detected.

Fig. 2.

Distribution of examined patients with lost first molars of both jaws.

gmj-24-E201712-g2.jpg

We consider premature loss of first permanent molars which are the “key of occlusion” and responsible for the formation of the permanent dentition to be a complex pathology. It may lead to significant morphological and functional abnormalities of the dentofacial complex and requires timely, integrated approach to their replacement.

Children with dentition defects in the frontal areas of the lower jaw were not detected among all the examined patients. Small bounded edentulous spaces were localized in one area of the jaws in 77.0% of pupils. They were detected in two or more areas of the jaws in 23.0% of children.

A detailed analysis of the causes of premature teeth extraction (Fig. 3) found that permanent teeth (the vast majority included first molars constituting 83% of cases, premolars or incisors constituted 17%) were most often prematurely extracted in 73.0% of the examined patients. This was due to the ineffectiveness of conservative treatment or late visiting a doctor caused by fear of dental intervention that caused the development of inflammatory processes of maxillofacial area. The second most frequent cause was dental traumas (tooth root fractures, complete dislocations) and jawbone traumas constituting 13.0 %. Removal of tumors or tumor-like formations of jawbones in 5.0% of cases was followed by the extraction of one or more permanent teeth.

Fig. 3.
gmj-24-E201712-g3.jpg

Conclusions

The incidence of small bounded edentulous spaces among schoolchildren in Lviv is in the range of 10% and tends to increase with age, has the high probability of influence on the development of dentofacial deformities and abnormalities. Therefore, prosthetic rehabilitation of children is reasonable and necessary at school age.

Prospects for further research

The prospect of further research is to study the morphometric changes in the areas of small bounded edentulous spaces and to develop an algorithm of examination and prosthetic rehabilitation of growing patients.

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Copyright (c) 2017 Anna Sofia Krupnyk

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