Investigating prevalence of dental anomalies in Eastern Province of Saudi Arabia through digital orthopantomogram

Prevalence of Dental Anomalies in Pediatric Patients at King Saud University Dental Hospital, Riyadh, Saudi Arabia-A Radiographic Analysis

OBJECTIVES

To record the prevalence of dental anomalies in children visiting King Saud Dental Hospital, Riyadh, Saudi Arabia.

MATERIALS AND METHODS

This cross-sectional study involved radiographic examination of children aged 6 to 14 years who visited King Saud Dental Hospital, Riyadh, Saudi Arabia, in the past five years. Four dental interns were trained in three consecutive sessions by a pediatric dentist and evaluated the orthopantomograms of the children. The recorded anomalies were divided into four categories: tooth number, size, position, and general. Descriptive statistics were derived and chi-square tests performed to report prevalence and significance among genders, medical histories, and dental anomalies. The significance level was set at p < 0.05.

RESULTS

Of the 1987 radiographs studied, 268 (13.48%) children had dental anomalies. The sample consisted of 51.1% female and 48.5% male children, with a mean age of 11.87 ± 2.1 years. Most study participants had mixed dentition and were healthy. The prevalence of dental anomalies reported in this study was as follows: 4.6% hypodontia, 2.7% ectopic eruption, 1.63% taurodontism, 1.2% infra-occluded molars, 1.1% impacted teeth, 0.75% root dilaceration, and 0.65% supernumerary teeth. Significant correlations were found between gender and ectopic eruption (p = 0.02) and between medical history and hypodontia (p = 0.00), ectopic eruption (p = 0.048), and root dilaceration (p = 0.03).

CONCLUSIONS

This study showed that hypodontia was the most common dental anomaly, followed by ectopic eruption and taurodontism. The findings of this study may guide dentists in better understanding, diagnosing, and treating dental anomalies in children in Riyadh, Saudi Arabia.

The prevalence of dental anomalies among Saudi Population in Makkah, Saudi Arabia

BACKGROUND

Morphological and structural abnormalities are common dental anomalies. Identifying DA and determining their prevalence can play an important role in reducing the risk of surgical intervention and improving occlusion, leading to successful dental treatments. Thus, this study aimed to determine the prevalence of DA using panoramic radiographs (OPG) in Makkah, Saudi Arabia according to gender.

MATERIALS AND METHODS

A retrospective radiographic investigation was performed, and the digital OPG of 923 patients (age range, 8-27 years) were collected. Records were collected from patients admitted at a government hospital in Makkah between January 2020 and DA in terms of tooth shape (microdontia, macrodontia, gemination, and fusion), number (supernumerary and congenitally missing teeth), and position (impaction and ectopic eruption). Several other abnormalities, such as ankyloses, dens in dents, dilacerations, and taurodontism, have also been reported. Digital radiographs from patients were systematically evaluated to diagnose each radiograph with consistent screen brightness and resolution.

RESULTS

The most prevalent DA were impaction (53.8%), hypodontia (13.6%), microdontia (8.2%), and ectopic eruption (6.7%). Taurodontism was observed more frequently in male compared to female (7.5% and 2.2%, respectively). However, there was no significant difference between gender in the distribution of other DA.

CONCLUSION

This study found that 27.8% of the Saudi population of Makkah city have DA. Clinical examination and radiographic evaluation are crucial for providing the proper treatment for patients seeking dental treatment.

Dental Anomalies in Saudi Arabia: A Systematic Review

BACKGROUND

Epidemiological studies have shown varying prevalence rates of dental anomalies worldwide, ranging from 5.2% to 56.9%, with a higher rate of 90.4% in patients with cleft lip and palate. In Saudi Arabia, studies have also reported varied prevalence rates, likely due to genetic differences or sampling variations. However, no research has yet evaluated the quality of these studies or provided an overall prevalence estimate, which is the aim of the present study. This systematic review aims to assess the prevalence and types of dental anomalies across various regions of the Kingdom of Saudi Arabia (KSA).

METHODS

A comprehensive literature search identified 10 relevant studies on different dental anomalies in Saudi Arabia. The quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale (NOS), showing variability in the methodological quality of the included cohort studies, with several studies demonstrating a moderate to high risk of bias.

RESULTS

Common anomalies included hypodontia, hyperdontia, microdontia, and impacted teeth. This study highlights the varying prevalence of dental anomalies in different regions of Saudi Arabia, ranging from 2.6% to 45.1%.

CONCLUSIONS

This review highlights the need for early diagnosis and tailored treatment approaches to mitigate the clinical challenges posed by these anomalies, underscoring the importance of standardized diagnostic criteria and further research to understand regional and demographic differences in the prevalence of dental anomalies in Saudi Arabia.

Prevalence, Occurrence, and Characteristics of Supernumerary Teeth Among the Saudi Arabian Population Using Panoramic Radiographs

BACKGROUND

Supernumerary teeth numerical anomalies and the early diagnosis of supernumerary teeth is very important to avoid potential complications. The study aim was to determine the prevalence, occurrence, and characteristics of supernumerary teeth among the Arabian population.

METHODS

A retrospective radiographic study was performed using panoramic radiographs of patients attending a teaching hospital from January 2018 to December 2020. Only healthy patients with clear radiographs were included in the study, and patients with syndromes, cleft lip, and palate, and unclear radiographs were excluded from the study. The details include the patient's age and gender, supernumerary tooth number, location, orientation, and position. Only a single examiner was involved in the data collection and analysis.

RESULTS

Overall, 38 (2%) patients were observed with 47 supernumerary teeth. Among them, 76% were males and 24% were females, with a mean age of 16.1 ± 9.7 years. Mesiodens (87%) are the common type of supernumerary tooth, and the majority of the supernumerary teeth were impacted (66%). The majority of the patients presented with a single supernumerary tooth, while 24% of the patients presented with two supernumerary teeth. Sixty percent of the supernumerary teeth were conical in morphology, followed by a tuberculate morphology. In the study population, most of the supernumerary teeth were normal in orientation.

CONCLUSIONS

The prevalence of supernumerary teeth was 2%. Among them, the majority were observed at the anterior region of the maxillary arch with a conical shape of normal orientation. The gender-based comparison of location, orientation, morphology, eruption, and number of supernumerary teeth showed male predilection.

What could be the role of genetic tests and machine learning of AXIN2 variant dominance in non-syndromic hypodontia? A case-control study in orthodontically treated patients

BACKGROUND

Hypodontia is the most prevalent dental anomaly in humans, and is primarily attributed to genetic factors. Although genome-wide association studies (GWAS) have identified single-nucleotide polymorphisms (SNP) associated with hypodontia, genetic risk assessment remains challenging due to population-specific SNP variants. Therefore, we aimed to conducted a genetic analysis and developed a machine-learning-based predictive model to examine the association between previously reported SNPs and hypodontia in the Saudi Arabian population. Our case-control study included 106 participants (aged 8-50 years; 64 females and 42 males), comprising 54 hypodontia cases and 52 controls. We utilized TaqManTM Real-Time Polymerase Chain Reaction and allelic genotyping to analyze three selected SNPs (AXIN2: rs2240308, PAX9: rs61754301, and MSX1: rs12532) in unstimulated whole saliva samples. The chi-square test, multinomial logistic regression, and machine-learning techniques were used to assess genetic risk by using odds ratios (ORs) for multiple target variables.

RESULTS

Multivariate logistic regression indicated a significant association between homozygous AXIN2 rs2240308 and the hypodontia phenotype (ORs [95% confidence interval] 2.893 [1.28-6.53]). Machine-learning algorithms revealed that the AXIN2 homozygous (A/A) genotype is a genetic risk factor for hypodontia of teeth #12, #22, and #35, whereas the AXIN2 homozygous (G/G) genotype increases the risk for hypodontia of teeth #22, #35, and #45. The PAX9 homozygous (C/C) genotype is associated with an increased risk for hypodontia of teeth #22 and #35.

CONCLUSIONS

Our study confirms a link between AXIN2 and hypodontia in Saudi orthodontic patients and suggests that combining machine-learning models with SNP analysis of saliva samples can effectively identify individuals with non-syndromic hypodontia.

Treatment and genetic analysis of multiple supernumerary and impacted teeth in an adolescent patient

BACKGROUND

Multiple supernumerary teeth, combined with numerous impacted teeth, can lead to various malocclusions, posing significant treatment challenges. While certain genes associated with syndromic cases of multiple supernumerary and impacted teeth have been identified, the etiologies of non-syndromic cases still largely remain elusive.

CASE PRESENTATION

Here, we report a treatment of a 12-year-old boy who presented with 10 supernumerary teeth and 6 impacted teeth, accompanied by a genetic analysis to explore the underlying etiology. During the treatment, fifteen teeth were extracted, and various skilled techniques, including the closed-eruption technique and the application of by-pass arches, were utilized. Post-treatment, traction was successful for all the impacted teeth, without any tooth mobility or reduction in gingival height. Space closure, well-aligned teeth, and excellent functional occlusion were achieved. Furthermore, comprehensive genetic analysis was conducted through whole-exome sequencing on the patient and his parents, which revealed a potential link between the patient's numerous supernumerary teeth and abnormal mineralization. Notably, the p.Ser496Pro variant in the TCF7L2 gene was identified as a potential candidate variant in this patient.

CONCLUSIONS

Overall, our findings not only report the treatment of a rare case involving multiple supernumerary and impacted teeth but also offer valuable insights into the molecular basis of supernumerary teeth.

Assessment of the Absorbed Dose Variations in the Thyroid Gland Exposed to Orthopantomography (OPG) while Swallowing: A Novel Approach to Radiation Protection

Background

The reliance on specialized diagnostic techniques is on the rise across various medical fields, including dentistry. While orthopantomogram (OPG), offers many advantages in terms of dental diagnosis, it also poses potential risks to sensitive organs, notably the thyroid gland.

Objective

This study aimed to evaluate the fluctuations in the absorbed dose within the thyroid gland during swallowing while undergoing an OPG procedure.

Material and Methods

In this computational simulation study, the BEAMnrc Monte Carlo code was employed to model an OPG machine, using 700 million particles across the energy range of 60-75 keV, which is standard for OPG procedures. The Monte Carlo (MC) model was cross-verified by comparing the derived spectra with those in the IPEM Report 78. A head and neck phantom was constructed using CT scan images with a slice thickness of 5 mm. This phantom underwent simulated beam exposure under two conditions: pre-swallow and post-swallow. Subsequently, the percentage depth dose was measured and contrasted across different depths.

Results

After swallowing, there was an increase in the absorbed dose across all three regions of the thyroid (right, left, and center). Notably, regions near the hyoid bone exhibited a particularly significant increase in dose. In certain areas, the absorbed dose even tripled when compared to the pre-swallowing state.

Conclusion

The findings indicate that during OPG imaging, swallowing can lead to an increased radiation dose to the thyroid gland. Given the thyroid's heightened sensitivity to radiation, such an increase in dosage is noteworthy.

Endodontic Treatment of a Dilacerated Maxillary Second Premolar With a Severely Curved Root Canal: A Case Report and Literature Review

Dilaceration is a developmental anomaly characterized by a sharp change in the axial inclination between the crown and the root of a tooth. Severe root curvature in a dilacerated tooth can greatly complicate root canal treatment. This case report details the successful endodontic treatment of a dilacerated maxillary second premolar with significant root curvature. It highlights the importance of a thorough understanding of root canal anatomy and demonstrates the effectiveness of using pre-curved hand files along with heat-treated nickel-titanium rotary instruments in navigating complex root structures to achieve successful treatment outcomes.

Dental Anomalies in Primary Dentition among Arabian Children: A Hospital-Based Study

An observational study was carried out in a teaching hospital in Saudi Arabia to determine the occurrence of dental anomalies among Arabian children. The study included children of Saudi nationality with primary teeth. The study assessed the prevalence of dental anomalies in their primary dentition. The assessment and data collection were conducted by a single examiner, utilizing clinical examination and intra-oral radiographs. A comparative analysis was conducted to examine dental anomalies in relation to gender (boys and girls) and arch type (maxillary and mandibular). In addition, the study explored the occurrence of gender-specific dental anomalies depending on arch type. The data analysis was conducted using IBM Statistics (version 21.0) with a significance level of p < 0.05. In total, there were 245 children included in the final analysis. The study population consisted of boys (66%) and girls (34%), with an average age of 4.87 ± 0.9 years. Taurodontism was the most prevalent dental abnormality, occurring in 2.8% of the individuals in the study sample. The study sample exhibited hypodontia in 2%, supernumerary teeth in 2.4%, double teeth in 2%, and microdontia in 1.2%. Talon cusp and macrodontia have a relatively low incidence of 0.4%. Boys exhibit supernumerary teeth, microdontia, macrodontia, talon cusp, and taurodontism, whereas hypodontia and double teeth were more frequent in girls.

Prevalence of Dental Anomalies Among Orthodontic Patients: A Retrospective Study in Saudi Arabia

BACKGROUND

Odontogenic anomalies encompass deviations in dental morphology, orientation, or spatial positioning within the mandibular structures. This study probed the frequency of such dental malformations among orthodontic patients receiving treatment in Riyadh City, Saudi Arabia. Furthermore, the study sought to discern variations in the manifestation of these dental anomalies related to gender and nationality.

MATERIALS AND METHODS

A retrospective analysis was conducted on 384 panoramic radiographs belonging to orthodontic patients (comprising 222 males and 162 females) who sought treatment at orthodontic clinics of a privately owned university hospital in Riyadh City between 2017 and 2019. The patient records were scrutinized for various dental abnormalities, including but not limited to dilacerated teeth, supernumerary teeth, congenital absence of teeth, impactions, hyperdontia, hypodontia, taurodontism, tooth rotation, and amelogenesis imperfecta. The Chi-square test was employed to assess the correlation between the prevalence of dental anomalies and variables such as gender and nationality. A p-value of less than 0.05 was deemed statistically significant for all tests.

RESULTS

Among the assessed sample size of orthodontic patients, dental impactions emerged as the most prevalent dental anomaly, affecting 246 patients (64.1%). This was followed by the occurrence of supernumerary teeth in 31 patients (8.1%), hyperdontia in 29 patients (7.6%), and congenital absence of teeth in 28 patients (7.3%). Other less frequently observed dental irregularities included dilacerated teeth in 23 patients (6%), amelogenesis imperfecta in 12 patients (3.1%), taurodontism in 12 patients (3.1%), and tooth rotations in five patients (1.3%). A statistically significant gender-based disparity was observed, with dental impactions being more prevalent among males (n=154; 69.4%) than females (n=92; 56.8%). Conversely, supernumerary teeth were more prevalent among females (n=24; 14.8%) than males (n=7; 3.2%). No significant variation in the prevalence of dental anomalies was discernible across different nationalities.

CONCLUSION

Impactions and the presence of supernumerary teeth were the predominant dental anomalies detected among the studied orthodontic patient population. The prevalence of dental anomalies exhibited discernible variations based on gender but not nationality. These disparities could potentially influence orthodontic outcomes, underscoring the necessity for meticulous examination and tailored orthodontic treatment planning.

Odontoma and other congenital dental anomalies: Implications for forensic identification

Forensic odontology plays a crucial role in establishing the identity in mass disasters and criminal cases with high accuracy. Dental anomalies and features help in such situations. Congenital and developmental dental anomalies can be easily documented to establish distinctive and individualistic characteristics of an individual. The location, number of teeth involved, and the type of anomaly vary between individuals. Similarly, dental malformations also assist greatly in the identification process. Many types of dental anomalies have been studied in the past for their individualistic characteristics in forensic examinations. One such dental anomaly is odontoma, which is a benign odontogenic malformation. This malformation may also help in the identification of the deceased, when recorded and examined accurately. An odontome is a malformed teeth-like structures consisting of enamel, dentin, and pulpal tissue, formed due to the growth of completely differentiated epithelial and mesenchymal cells. If antemortem (AM) dental records incorporate information regarding odontomes and other dental anomalies, including in radiographs, orthopantomograms or microradiographs, positive identification may be established by comparison of these records with postmortem (PM) records. In the present communication, a rare case of compound composite odontoma in the anterior mandible with multiple denticles has been discussed with a brief overview of congenital and developmental dental anomalies. The authors emphasize the importance of such rare dental anomalies and malformations which may be used for identifying the deceased in mass disasters and forensic identification.

Prevalence of Dental Anomalies and Its Role in Sex Estimation among Children of Jazan Region, Saudi Arabia

BACKGROUND

This study aimed to ascertain the prevalence of dental anomalies and their ability to estimate sex status.

MATERIAL AND METHODS

This cross-sectional radiographic study was based on the evaluation of dental anomalies of Saudi children aged between 5 and 17 years. A total of 1940 orthopantomograms (OPG) were screened, of which 1442 were included. All the OPGs were digitally evaluated with ImageJ software. The demographic variables and dental anomaly findings were subjected to descriptive and comparative statistical analysis. Discriminant function analysis was conducted for sex estimation. p value < 0.05 was considered as significant.

RESULTS

The mean age of the children in this study was 11.35 ± 0.28 years. At least one dental anomaly was detected in 161 children (11.17%), including 71 males and 90 females. Only 13 children (8.07%) presented with more than one anomaly. The most common dental anomaly detected was root dilaceration (47.83%) followed by hypodontia (31.68%). The least common dental anomaly was infraocclusion (1.86%). The sex prediction accuracy using discriminant function analysis was 62.9% (p < 0.01).

CONCLUSION

The prevalence of dental anomalies was 11.17% with root dilaceration and hypodontia being the most common. The role of dental anomalies in sex estimation was found to be ineffective.

Prevalence of mesio-distal dilaceration in patients presenting for initial orthodontic care: A retrospective study

OBJECTIVE

To determine the prevalence of dilaceration in a sample of patients presenting for initial orthodontic care.

METHODS

Examining radiographs from a random sample of orthopantomogram images was used to acquire the data. In all, 2,801 dental records were evaluated at Oman Dental College (ODC), Oman. A dental X-ray processing software was utilized to view the images. A tooth was classified as having a mesial/distal dilaceration if its long axis exhibited an angle of 90 degrees or greater. Dilacerated roots in the buccal/lingual direction were diagnosed by observing the appearance of a spherical opaque area with a dark shadow in its central region, projected by the apical foramen, which gave the root canal a "bull's-eye" appearance.

RESULTS

Dilacerations were found in 17.32% of the records examined. The maxillary second molars (22.71%) were the most commonly affected, followed by the mandibular third molars and mandibular lateral incisors (21.90% and 17.23%, respectively). The central incisors and canines were the least affected, with dilaceration affecting less than 0.2% of the teeth. The mandible was found to have more dilacerations than the maxilla (53.78% and 46.22%, respectively). 61.03% of dilacerations occurred in molars, 43.12% of which occurred in third molars.

CONCLUSION

Dilaceration is a notable dental anomaly that can affect any tooth, with some teeth being more affected than others. Dilaceration in maxillary second molars and mandibular lateral incisors is more common in the population of this study than in other populations reported in the literature. Recognizing the condition will allow for more effective orthodontic treatment.

Concrescence of maxillary second molar and impacted third molar: A case report

BACKGROUND

Morphological anomalies of teeth, including talon cusp, dens evaginatus, gemination, fusion, concrescence, root dilaceration, and taurodontism, always involve changes in the enamel, cementum and dentin. Diagnosing concrescent teeth through routine clinical examination alone is difficult, and most cases of concrescence are found accidentally during extraction. A definite preoperative diagnosis of concrescence would contribute to a better treatment plan and fewer undesirable complications

CASE SUMMARY

A 47-year-old woman who complained of left maxillary first molar loss for half a year presented to our department seeking treatment by dental implant restoration. Panoramic radiography and cone-beam computed tomography (CBCT) showed an unclear boundary between the distal root of the second molar and the mesial root of the third molar. The teeth were extracted under local anesthesia, and a definite diagnosis of concrescence was made by histopathological examination.

CONCLUSION

CBCT is a useful tool for diagnosing and planning the management of tooth concrescence and may be beneficial for reducing unnecessary complications.

Prevalence of dens invaginatus and palatogingival groove in North India: A cone-beam computed tomography-based study

Aim

The aim of this study was to study the prevalence of dens invaginatus (DI) and palatogingival groove (PGG) in maxillary lateral incisors, and the occurrence of apical periodontitis in association with these anomalies in North Indian population.

Methodology

Maxillary lateral incisors in 163 cone-beam computed tomography scans were assessed to determine the presence of DI and PGG. Anomalies identified were then classified as per Oehler's and Gu's classification, respectively. Their side and gender predilection and association with apical and lateral radiolucency was also studied.

Statistical Analysis

Descriptive data were reported as percentages. Chi-square analysis was used to determine the association with gender and side predilection.

Results

DI was present in 13.5% of the scans, while PGG was present in 7.3% of the scans. No significant gender and side predilection was observed. 6.67% of lateral incisors with DI and 25% of lateral incisors with PGG had an associated apical radiolucency. 33.33% of lateral incisors with PGG had an associated lateral radiolucency.

Conclusions

There is a high prevalence of DI and PGG in maxillary lateral incisors.

Prevalence and Distribution of Nonsyndromic Dental Anomalies in Children in Eastern Saudi Arabia: A Radiographic Study

OBJECTIVES

To report the prevalence and distribution of nonsyndromic dental anomalies in children in eastern Saudi Arabia.

METHODS

This retrospective records review study involved radiographic examination of 6-18 years old pediatric patients who attended the Dental Hospital of the College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Four calibrated examiners recorded nonsyndromic dental anomalies from patients' digital orthopantomograms (OPG). The anomalies recorded were related to tooth number, shape, and location. Descriptive statistics, chi-square test, and Fisher exact tests were used to report prevalence and differences by gender, nationality, and medical history at the 5% significance level.

RESULTS

Of 2226 reviewed patients' records, 1897 met the inclusion criteria and were included in the study. The study sample had equal distribution of males (52.6%) and females (47.4%) and comprised 81.2% Saudi children with a mean age of 8.8 ± 1.84 years. Most study subjects (97.8%) were in mixed dentition and 88.7% were healthy. The prevalence of dental anomalies was as follows: teeth rotations (24.5%), ectopically erupted teeth (6%), congenitally missing permanent teeth (5.4%), peg lateral (1.1%), supernumerary (0.5%), gemination (0.3%), and fusion (0.1%). No statistically significant differences were found in the distribution of dental anomalies by patients' gender, medical history, and nationality (p value ≥0.05).

CONCLUSION

This study showed that teeth rotations were the most common dental anomalies followed by ectopic eruptions and congenitally missing teeth. The study findings may guide dental practitioners to better diagnose and manage children with dental anomalies in eastern Saudi Arabia.