An ideal substitute for missing J Bagh College Dentistry Vol. 29(1), March 2017 Dental anomalies in Pedodontics, Orthodontics and Preventive Dentistry 148 Dental anomalies in permanent teeth and the associated etiological factors among fifteen years-old students in Basrah city\Iraq Nadia Azzam Al-Sheraydah B.D.S.(1) Zainb Al-Dahan B.D.S., M.Sc.(2) ABSTRACT Background: Dental anomalies of teeth are major issue that contributes to dental problems encountered in general practice. The aim of this study is to measure the prevalence of dental anomalies and the associated etiological factors among 15 years old students in Basrah city –Iraq. Materials and methods: The total sample composed of 1000 students (435 males and 565 females) from urban area selected randomly from different high schools in the city. Diagnosis of dental anomalies were recorded by present or absent, diagnosis and recording of enamel defects were done according to the criteria of WHO (1997). Results: The prevalence of hypodontia was 4.6%, Females have higher prevalence than males (5.8% females and 3.0% males), talon cusp prevalence was 37.0% (males 38.6% and females 35.8%), the prevalence of microdontia was 1.4% (males were equal to females 1.4%), the prevalence of supernumerary teeth, fusion, macrodontia and gemination was 0.8%, 0.7%, 0.1% and 0.1% respectively. The prevalence of enamel defects was 30.5%, demarcated opacities prevalence was 23.8%, it is the most prevalent type of enamel defects (males 20.5% and females 26.4%) followed by diffuse opacities 9.1% then enamel hypoplasia 0.4%. Conclusion: This study revealed that secondary school students have dental anomalies, some of them with high prevalence, while other has very low prevalence. Keywords: Dental anomalies, etiological factors, Basrah city. (J Bagh Coll Dentistry 2017; 29(1):148-152) INTRODUCTION Dental anomalies of teeth are not uncommon problem, anomalies of teeth number, shape and structure occur due to abnormal events in the embryological development of teeth that may be resulted from environmental and genetic factors during the morphodifferentiation or histodifferentiation stages of tooth development (1). Anomalies of teeth shape include: fusion that can be defined as joining of two developing teeth germs, resulting in a single large tooth structure (2). Gemination defined as the attempt of tooth bud to divide, that will resulted in the formation of tooth with a bifid crown and common root with root canal (3). Talon cusp is a well-defined accessory cusp project from the cingulum or cemento-enamel junction to the incisal ridge of the upper or lower anterior teeth in both the deciduous and permanent dentitions (4). Microdontia defined as a tooth that is much smaller than normal average size while macrodontia defined as a tooth that is much larger than normal average size (5). Anomalies of the number of teeth include: hypodontia and supernumerary teeth, hypodontia defined as congenital lack of teeth that results from (1) Master Student. Department of pediodontic, College of Dentistry, University of Baghdad (2) Professor, Department of pediodontic, College of Dentistry, University of Baghdad. disturbances during tooth development in early stages (6). Supernumerary teeth can be defined as extra teeth occurring in dental arch, more than twenty in deciduous dentition or more than thirty-two in the permanent dentition (3). Enamel defects can be defined as any alteration that results from wide disturbances during the process of odontogenesis, these defects include diffuse opacities, demarcated opacities and enamel hypoplasia (7). The etiological factors for the development of dental anomalies that had been studied include tooth trauma, deciduous tooth extraction, previous surgery in the jaw, low birth weight and systemic diseases (8) (9). The aim of this study was to measure the prevalence of dental anomalies and find an association with the etiological factors. MATERIALS AND METHODS This study was conducted among high school students during the period from the middle of November 2014 till the beginning of April 2015 in Basrah city, Iraq. In this study the sample consist of 1000 students aged 15 years old, the schools were randomly selected, and they were distributed in different geographical location in Basrah city. J Bagh College Dentistry Vol. 29(1), March 2017 Dental anomalies in Pedodontics, Orthodontics and Preventive Dentistry 149 Diagnosis of dental anomalies were recorded by present or absent, diagnosis and recording of enamel anomalies were done according to criteria of WHO 1997, questionnaire papers were distributed to the students to answer questions related to the etiological factors, these questions include if the students had exposed previously to tooth trauma, deciduous tooth extraction, previous surgery in the jaw and also were asked to try to locate the tooth or if they had low birth weight and any systemic disease . Data entering and analysis was performed using SPSS version 21 computer software (Statistical Package for Social Science) in association with Microsoft Excel. The tests that were used in this study include: 1. t-test. 2. Chi-square test. 3. Odds ratio. RESULTS Table (1) illustrates the distribution of the sample by gender, the sample consist of 435 males (43.5%) and 565 females (56.5%). Table (2) demonstrates the total prevalence of the selected anomalies among the sample. The prevalence of talon cusp was 37.0 %, demarcated opacities was 23.8 %, diffused opacities was 9.1 %, hypodontia was 4.6 %, microdontia was 1.4 %, supernumerary teeth was 0.8 %, fusion was 0.7 %, enamel hypoplasia was 0.4 %, macrodontia was 0.1 %, gemination was 0.1 % and any type of enamel defect was 30.5 %. Table (3) shows the relationship between tooth trauma and dental anomalies which was non- significant statistically. Table (4) illustrates the relationship between deciduous tooth extraction and dental anomalies by using Chi-square test, the results were non- significant statistically except the relationship between deciduous tooth extraction with demarcated opacities and any type of enamel defects which was significant statistically (p <0.001, p =0.022). Table (5) shows the relationship between previous oral surgery and dental anomalies which was non-significant statistically. Table (6) demonstrates that there is no significant relationship between low birth weight and dental anomalies. Table (7) demonstrates that there is no significant relationship between systemic disease and dental anomalies. Table 1: The distribution of the sample by gender Gender N % Males 435 43.5 Females 565 56.5 Total 1000 100.0 Table 2: The prevalence of the selected anomalies among the sample Anomalies (total N=1000) N % 95% confidence interval At least one tooth with Talon cusp 370 37.0 (34%to40.1%) At least one tooth with Demarcated opacity 238 23.8 (21.2%to26.6%) At least one tooth with Diffuse opacity 91 9.1 (7.4%to11.1%) At least one tooth with Hypodontia 46 4.6 (3.4%to6.1%) At least one tooth with Microdontia 14 1.4 (0.8%to2.4%) At least one tooth with Supernumerary 8 0.8 (0.4%to1.6%) At least one tooth with Fusion 7 0.7 (0.3%to1.4%) At least one tooth with Enamel hypoplasia 4 0.4 (0.1%to1.0%) At least one tooth with Macrodontia 1 0.1 (0.003%to0.6%) At least one tooth with Gemination 1 0.1 (0.003%to0.6%) At least one tooth with any type of enamel defect 305 30.5 (27.7%to33.5) Pedodontics, Orthodontics and Preventive Dentistry 150 Table 3: The relationship between tooth trauma and dental anomalies Tooth trauma Negative (n=963) Positive (n=37) Anomalies N % N % P OR 95% CI for OR At least one tooth with Hypodontia 44 4.6 2 5.4 0.69[NS] 1.19 (0.28 to 5.12) At least one tooth with Microdontia 14 1.5 0 0.0 1[NS] ** ** At least one tooth with Talon cusp 354 36.8 16 43.2 0.42[NS] 1.31 (0.68 to 2.54) At least one tooth with Diffuse opacity 86 8.9 5 13.5 0.37[NS] 1.59 (0.61 to 4.2) At least one tooth with Demarcated opacity 229 23.8 9 24.3 0.94[NS] 1.03 (0.48 to 2.22) At least one tooth with any type of enamel defect 291 30.2 14 37.8 0.36[NS] 1.41 (0.71 to 2.77) Note: The (**) means cannot be calculated. Table 4: The relationship between deciduous tooth extraction and dental anomalies Tooth extraction Negative (n=829) Positive (n=171) Anomalies N % N % P OR 95% CI for OR At least one tooth with Hypodontia 37 4.5 9 5.3 0.65[NS] 1.19 (0.56 to 2.51) At least one tooth with Microdontia 12 1.4 2 1.2 1[NS] 0.81 (0.18 to 3.63) At least one tooth with Talon cusp 306 36.9 64 37.4 0.9[NS] 1.02 (0.73 to 1.44) At least one tooth with Diffuse opacity 77 9.3 14 8.2 0.65[NS] 0.87 (0.48 to 1.58) At least one tooth with Demarcated opacity 180 21.7 58 33.9 0.001 1.85 (1.29 to 2.64) At least one tooth with any type of enamel defect 240 29.0 65 38.0 0.022 1.5 (1.07 to 2.12) Table 5: The relationship between previous oral surgery and dental anomalies Oral surgery Negative (n=992) Positive (n=8) Anomalies N % N % P OR 95% CI for OR At least one tooth with Hypodontia 46 4.6 0 0.0 1[NS] ** ** At least one tooth with Microdontia 13 1.3 1 12.5 0.11[NS] 10.76 (1.23 to 93.81) At least one tooth with Talon cusp 366 36.9 4 50.0 0.48[NS] 1.71 (0.43 to 6.88) At least one tooth with Diffuse opacity 89 9.0 2 25.0 0.16[NS] 3.38 (0.67 to 17.01) At least one tooth with Demarcated opacity 234 23.6 4 50.0 0.1[NS] 3.24 (0.8 to 13.05) At least one tooth with any type of enamel defect 300 30.2 5 62.5 0.06[NS] 3.84 (0.91 to 16.19) Note: The (**) means cannot be calculated. Table 6: The relationship between low birth weight and dental anomalies LowBirth weight(10) (<2Kg) Negative (n=608) Positive (n=17) Anomalies N % N % P OR 95% CI for OR At least one tooth with Hypodontia 35 5.8 0 0.0 0.62[NS] ** ** At least one tooth with Microdontia 8 1.3 0 0.0 1[NS] ** ** At least one tooth with Talon cusp 222 36.5 4 23.5 0.27[NS] 0.53 (0.17 to 1.66) At least one tooth with Diffuse opacity 50 8.2 1 5.9 1[NS] 0.7 (0.09 to 5.37) At least one tooth with Demarcated opacity 145 23.8 3 17.6 0.77[NS] 0.68 (0.19 to 2.41) At least one tooth with any type of enamel defect 179 29.4 4 23.5 0.79[NS] 0.74 (0.24 to 2.29) Note: The (**) means cannot be calculated. Pedodontics, Orthodontics and Preventive Dentistry 151 Table 7: The relationship between systemic diseases and dental anomalies Systemic disease Negative (n=974) Positive (n=26) Anomalies N % N % P OR 95% CI for OR At least one tooth with Hypodontia 46 4.7 0 0.0 0.63[NS] ** ** At least one tooth with Microdontia 13 1.3 1 3.8 0.31 [NS] 2.96 (0.37 to 23.49) At least one tooth with Talon cusp 364 37.4 6 23.1 0.14 [NS] 0.5 (0.2 to 1.26) At least one tooth with Diffuse opacity 89 9.1 2 7.7 1[NS] 0.83 (0.19 to 3.56) At least one tooth with Demarcated opacity 230 23.6 8 30.8 0.4[NS] 1.44 (0.62 to 3.35) At least one tooth with any type of enamel defect 295 30.3 10 38.5 0.39[NS] 1.44 (0.65 to 3.21) Note: The (**) means cannot be calculated. DISCUSSION This study was designed to investigate the prevalence of dental anomalies among high school students aged 15 years old and study their relationship to the possible etiological factors. The prevalence of hypodontia was 4.6% and this is lower than AL-Jourane(11) and Chung et al (12). There was no statistically significant difference between hypodontia and the studied factors, in order to find an association between hypodontia and the studied factors a larger sample size should be taken or a follow up study about the patients that have the etiological factors to determine the presence of this anomaly. Talon cusp prevalence was 37.0% and this is higher than Danker et al(13) .This difference in the prevalence of talon cusp may be due to the fact that diagnosis of this dental anomaly in other study was based on radiographs solely without clinical examination and this might produce a false positive or negative diagnosis because talon cusps are easily discovered on radiograph as they present as V-shaped structure superimposed on the tooth but there is an exception to that which is a type 3 trace talon cusp that cannot be detected during radiographic examination (14). In this study the prevalence of supernumerary teeth was 0.8% and this is lower than Thilander et al(15), it was difficult to study the relationship between supernumerary teeth and the studied factors due to the small number of this anomaly detected in the study and this may be attributed to the fact that most supernumerary teeth are impacted, asymptomatic and diagnosed incidentally during radiographic examinations, so panoramic radiograph is essential for detection of supernumerary teeth (16). In this study the prevalence of fusion was 0.7% and this is higher than Al-Ani (17) and this is may be due to larger sample size that had been taken in this study than other studies. In this study the prevalence of gemination was 0.1% and this is equal to the results of Neville et al(18). The etiology of double teeth may be attributed to trauma, hereditary and environmental factors, the cause may be attributed to the force of physical pressure that are generated during growth resulted in contact between adjacent teeth germs and union before calcification (19). In this study the prevalence of macrodontia and microdontia was 0.1% and 1.4% respectively, macrodontia and microdontia may be due to complex multifactorial interactions that include genetic and environmental factors occur during the long process of dental development (20). The prevalence of enamel defects was 30.5% and this finding was lower than (21) demarcated opacities which appear the most prevalent type of enamel defect 23.8% (males 20.5% and females 26.4%) followed by diffuse opacities 9.1% then by enamel hypoplasia 0.4%. There was no statistically significant relationship between enamel defects and the studied factors but there was significant relationship between tooth extraction, enamel defects and demarcated opacities, this is may be due to trauma that result from tooth extraction and cause disturbance in the process of matrix degradation which occur during matrix formation stage to provide suitable condition for the commencement of maturation (22). REFERENCES 1. Elizabeth A. Multiple dental anomalies in young patients: a case report. Int. J of paedia. Dent. 2000; 10:63-66. Pedodontics, Orthodontics and Preventive Dentistry 152 2. Velasco LF, de Araujo FB, Ferreira ES, Velasco LE. Esthetic and functional treatment of a fused permanent tooth: a case report. Quintessence Int 1997; 28: 677-680. 3. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology, 2nd ed. Saunders, Elsevier 2002. 4. Gündüz K, Celenk P, Zengin Z, Sümer P. Mesiodens: a radiographic study in children. J Oral Sci. 2008; 50:287-91. 5. D ҆ Souza RN, Kapadia H, Vieira AR, et al. Human malformations and related anomalies. New York: Oxford University press 2006. 446 p. 6. Butler PM: Ontogenetic aspects of dental evolution. Int J Dev Biol; 1995, 39:25-34. 7. Wong HM, McGrath C, King NM. Dental practitioners' views on the need to treat developmental defects of enamel. Community Dent Oral Epidemiol. 2007; 35: 130-139. 8. Nunn JH, Carter NE, Gillgrass TJ, Hobson RS, Jepson NJ, Meechan JG, et al. The interdisciplinary management of hypodontia: Background and role of paediatric dentistry. Br Dent J 2003; 194:245-51. 9. Seow WK. A study of the development of the permanent dentition in very low birthweight children. Pediatr Dent. 1996; 18: 379-384. 10. Seow WK. A study of the development of the permanent dentition in very low birth weight children. Pediatr Dent. 1996; 18: 379-384. 11. AL- Jourane TS. Hypodontia of Permanent Teeth in a Sample of Student in Baghdad City. A master thesis, College of Dentistry, University of Baghdad 2001.19:26. 12. Chung CJ, Han JH, Kim KH: The Pattern and prevalence of hypodontia in Koreans. Oral Dis 2008; 14:620-5. 13. Danker E, Harari D, Rotstein I. Dens evaginatus of anterior teeth. Literature review and radiographic survey of 15,000 teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 81:472-5. 14. Abed Al-Hadi, M Hamasha and Rima A Safadi. Prevalence of talon cusps in Jordanian permenant teeth: a radiographic study. BMC Oral Health, 2010. 15. Thilander B, Pena L, Infante C, Parada SS, de Mayorga C. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development. Eur J Orthod 2001; 23(2): 153- 167. 16. Gábris K, Fábián G, Kaán M, Rózsa N, Tarján I. Prevalence of hypodontia and hyperdontia in paedodontic and orthodontic patients in Budapest. Community Dent Health. 2006; 23:80–2. 17. Al-Ani N. oral health status, treatment needs and dental anomalies in relation to nutritional status among 12 years old school children in Heet city\Al- Anbar governorate\Iraq. A master thesis, College of Dentistry, University of Baghdad, 2013. 18. Neville BW, Damm D, Allen C, Bouquot J. 2nd ed. New Delhi: Elsevier; 2004. Oral and Maxillofacial Pathology; p. 78. 19. Kjaer I. Daugaard-Jensen J. Interrelation between fusions in the primary dentition and agencies in the succedaneous permanent dentition seen from an embryological point of view. J Craniofac Genet Dev Biol 2000, 20: 193-97. 20. Brook AH (2009) Multilevel complex interactions between genetic, epigenetic and environmental factors in the aetiology of anomalies of dental development. Arch Oral Biol 54 Suppl 1: S3-17. 21. Al-Nori A, Al-Talabani N. Developmental anomalies of teeth and oral soft tissue among 14-15 years school children in Baghdad city with refer to enamel defects. Jorden .Dent.J.1993, 8:5-14. 22. Suga S. Enamel hypomineralization viewed from the pattern of progressive mineralization of human and monkey developing enamel. Adv Dent Res. 1989; 3: 188-198. الخالصة الهدف من هذه .تواجه خالل الممارسة العامة ان االشكال الشاذة التي تصیب االسنان تعتبر قضیة رئیسیة تساهم في حدوث مشاكل في األسنان والتي :الخلفیة .العراق-البصرة محافظة في سنة ١۵ في عمر الطالب بینهو معرفه نسبه انتشار االشكال الشاذة لألسنان وعالقتها بالعوامل المسببة لها الدراسة من عشوائیا العینة اختیرت وقدجمعت العینات من المناطق الحضرية )من اإلناث ۵٦۵من الذكور و ٤۵۵) طالب ١١١١ة من الكلی العینة تكونت :والطرق المواد . تم تسجیل التشخیص في شذوذ األسنان من خالل وجود أو عدم وجود هذه االشكال الشاذة, تم التشخیص وتسجیل محافظة البصرة في المختلفة الثانوية المدارس (.١٩٩١تشوهات المیناء وفقا لمعايیر منظمة الصحة العالمیة ) في ٪ ۵ ,في االناث و . ٪۸,١۵وان معدل االنتشار في االناث أعلى من الذكور ) ,٪ ٦,٤ان هذه الدراسة بینت ان انتشار نقص األسنان الدائمیة كان بنسبة :النتائج ١ ,٤كانت نسبه انتشار صغر حجم االسنان ان ),٪ ٦,۵۸ وفي الذكور ٪ ۸,۵۵اإلناث ) كانت النسبه في ٪ ۵١ان انتشار تالون أعتاب كان بنسبه , )الذكور ١,١ ,٪ ١,١ ,٪۸,١ضخامة األسنان وتضاعف االسنان كان ,االنصهار ,كما ان معدل انتشاراالسنان الزائده ,(١ ,٤)كانت النسبه في الذكور ذاتها في االناث لقد كانت العتمه البیضاء هي ,٪ ۸,۳۵ان نسبه انتشار العتمه البیضاء ,٪ ۵,۵١ء لقد اظهرت الدراسه ان معدل انتشار تشوهات المینا .بالتتابع ٪ ١,١ و ٪ نقص تصنع المیناء بنسبه تلیها ٪ ١,٩بنسبه العتمة المنتشرة ( تلیها٪٤,۳٦بینما في االناث ٪ ۵,۳١النوع االكثر انتشارا في تشوهات المیناء )نسبتها في الذكور ٤,١ ٪. في حین ان بعض ,وان بعض هذه الحاالت منتشرة بصوره واسعه ,ذه الدراسة أن الطالب في المدارس الثانوية لديهم شذوذ في األسناناظهرت ه :الخاتمة الحاالت الشاذة االخرى منتشرة بصورة منخفضة جدا. .البصرة مدينه ,العوامل المسببة ,االسنان شذوذ :الدلیلیة الكلمات 4 http://www.ncbi.nlm.nih.gov/pubmed/17331154 http://www.ncbi.nlm.nih.gov/pubmed/17331154 http://www.ncbi.nlm.nih.gov/pubmed/17331154 http://www.ncbi.nlm.nih.gov/pubmed/17331154 http://www.ncbi.nlm.nih.gov/pubmed/8897530 http://www.ncbi.nlm.nih.gov/pubmed/8897530 http://www.ncbi.nlm.nih.gov/pubmed/8897530 http://www.ncbi.nlm.nih.gov/pubmed/8897530 http://www.ncbi.nlm.nih.gov/pubmed/8897530 http://www.ncbi.nlm.nih.gov/pubmed/8897530 http://www.ncbi.nlm.nih.gov/pubmed/2640430 http://www.ncbi.nlm.nih.gov/pubmed/2640430 http://www.ncbi.nlm.nih.gov/pubmed/2640430 http://www.ncbi.nlm.nih.gov/pubmed/2640430