Variations in Primary Molar Contact and Approximal Caries in Children: A Three-Year Prospective Cohort Study

Purpose: To evaluate the association between the contact areas of primary molar teeth and approximal caries after three years of observation. Methods: This prospective cohort study included 1,119 caries-free children, aged three to four years, from Puducherry, India. At base- line, 4,476 contacts were assessed using the OXIS criteria, which denotes O for open contact and X, I, and S for closed contacts. X contact represents a point contact, I is a straight contact, and S is a curved contact. Two calibrated dentists measured dental caries at one-year intervals following the International Caries Detection and Assessment System for three years. Poisson regression analysis with a multilevel approach was used to determine the association between contact type and approximal caries. Results: Of 3,848 contacts observed at the end of three years, 499 (13 percent) were carious. The adjusted analysis revealed a significant association between contact type and approximal caries (P<0.05). The risk ratios for the development of approximal caries were 2.3 for X-type contacts (0.5 to 11.4, P=0.307), 12.7 for I-type (4.1 to 39.6, P<0.05), and 22.5 for S-type (7.2 to 70.6, P<0.05) when compared with O-type. Conclusions: Compelling evidence suggests that variations in contacts between teeth are significant in the development of approximal caries. The S-type contact is the most susceptible to approximal caries, followed by the I-type.

Assessment of OXIS contacts-a comparison of three methods

PURPOSE

To compare OXIS contacts by means of Replication using Sectional die Models (RSM) and Photographs of the Models (PM) with Direct Clinical Examination (DCE) in a sample of preschool children aged 3-4 years.

METHODS

A retrospective cross-sectional study was performed using existing records of sectional die models and their photographs among 4257 contacts of 1104 caries-free pre-school children. Two calibrated examiners scored the contacts between the distal surface of the primary first molar and mesial surface of the primary second molar using OXIS criteria from the occlusal view using the RSM & PM methods. These were compared to the OXIS scores from DCE method which was available from previous records. Kappa agreement was used to compare results obtained RSM and PM methods with DCE.

RESULTS

The kappa agreement between the RSM and DCE methods was 98.48%; and between the PM and DCE methods was 99.42%, both of which indicated perfect agreement.

CONCLUSION

The RSM and PM methods were found to have an excellent agreement in scoring OXIS contacts when compared to the DCE method. PM was found to be slightly more accurate than the RSM method for scoring OXIS contacts.

OXIS contacts and approximal caries in preschool children- A prospective cohort study

The present prospective cohort study was conducted to evaluate the susceptibility of OXIS contact areas namely O (open type), X (point type), I (straight type) and S (curved type) in the development of approximal caries. We conducted this study among 953 school children with 3812 contacts in Puducherry, India. At baseline, the contacts were assessed in accordance with OXIS criteria. At the end of 12 months, two calibrated dentists measured dental caries following the International Caries Detection and Assessment (ICDAS) criteria. Information about feeding practices, diet, and oral hygiene was collected by means of a structured questionnaire from each child's parent. Data were analyzed by unadjusted and adjusted Poisson regression analysis with a multilevel approach. The two levels of analysis were tooth and child. Of 3,812 contacts observed during the follow-up, 127 (3.3%) were observed as carious. Poisson regression analysis revealed a significant association between type of contact and caries prevalence (p < 0.05). The risk ratios for the development of approximal caries in X contacts were 2.4 (0.3-17.2), p value 0.38; in I contacts - 4.9 (1.2-19.9), p value 0.027; and in S contacts 8.2 (1.9-34.2), p value 0.004, when compared with the O contacts. Among the child variables, male gender (RR=2.1; 95%CI-1.3,3.5), parental supervision while toothbrushing (RR=1.6; 95%CI-1.1,2.4) and the use of toothpaste (RR=1.9; 95%CI-1.3,3.1) were found to be associated with approximal caries after adjustment for the other variables. Among the OXIS contacts, the S type was most susceptible to approximal caries due to its complex morphology, followed by I, X, and O.

Modified OXIS classification for primary canines

Background: A new classification called OXIS was proposed for categorising the interproximal contacts of primary molars, and its prevalence was established. The aim of this study was to establish the variations in interproximal contacts of primary canines and thereby modify the OXIS classification of primary molars to primary canines. Additionally, we aimed to estimate the applicability of modifications to primary anterior teeth.

Methods: A retrospective study was conducted with sectional die models obtained from a previous study of 1,090 caries-free children. Two calibrated examiners evaluated a total of 4,674 contacts from the occlusal aspect. The contacts were scored according to the former OXIS classification, with two modifications incorporated to encompass the morphological differences and rotations of primary canines and other primary anterior teeth.

Results: The most prevalent contact was O (62.1%), followed by X (19.6%), I (12.6%), S type I (4.1%), and S type II (1.6%). Inter-arch comparison by means of the Chi-square test revealed significant differences for all types of contacts ( P < .001).

Conclusions: The interproximal contacts of canines were categorised as O, X, I, S I, and S II. The OXIS classification of primary molars was modified to befit the variations in primary canines. This study showed the presence of different types of contacts in primary canines. Identification of these contacts and their complexity has warranted a need for this to be studied as an inherent risk factor for caries risk assessment.

Modified OXIS classification for primary canines

Background: A new classification called OXIS was proposed for categorising the interproximal contacts of primary molars, and its prevalence was established. The aim of this study was to establish the variations in interproximal contacts of primary canines and thereby modify the OXIS classification of primary molars to primary canines. Additionally, we aimed to estimate the applicability of modifications to primary anterior teeth. Methods: A retrospective study was conducted with sectional die models obtained from a previous study of 1,090 caries-free children. Two calibrated examiners evaluated a total of 4,674 contacts from the occlusal aspect. The contacts were scored according to the former OXIS classification, with two modifications incorporated to encompass the morphological differences and rotations of primary canines and other primary anterior teeth. Results: The most prevalent contact was O (62.1%), followed by X (19.6%), I (12.6%), S type I (4.1%), and S type II (1.6%). Inter-arch comparison by means of the Chi-square test revealed significant differences for all types of contacts (P < .001). Conclusions: The interproximal contacts of canines were categorised as O, X, I, S I, and S II. The OXIS classification of primary molars was modified to befit the variations in primary canines. This study showed the presence of different types of contacts in primary canines. Identification of these contacts and their complexity has warranted a need for this to be studied as an inherent risk factor for caries risk assessment.

OXIS Contacts as a Risk Factor for Approximal Caries: A Retrospective Cohort Study

Purpose: The purpose of the present study was to evaluate the individual susceptibility of four different types of OXIS contact areas (open [O], point [X], straight [I], and curved [S]) to approximal caries in children. Methods: A retrospective cohort study was performed using clinical photographs and cone-beam computed tomography images of children, available from January 1, 2014, to August 31, 2015, showing the presence of at least one caries-free contact area between the primary molars. A single calibrated examiner scored 1,102 selected contacts using OXIS criteria from the occlusal view and subsequently evaluated the same contacts with a minimum follow-up period of one year for the presence of approximal caries. Results: Of the 1,102 contacts, 259 (23.5 percent) were found to be carious or restored due to approximal caries. Multivariate logistic regression analysis showed that only the type of contact played a significant role in caries prevalence (P<0.05). The odds ratios of OXIS contacts for the development of approximal caries were: S contact-147.4 (95 percent confidence interval [95% CI] equals 19.7 to 1101.7); I contact-24.5 (95% CI equals 3.4 to 177.9); X contact-1.1 (95% CI equals 1.0 to 12.5); and O contact-1.00 (reference). Conclusions: Among the OXIS contacts, the S type was most susceptible to approximal caries due to its complex morphology. The broad contact areas, namely, I and S types, are at greater risk for approximal caries in primary molars than O and X contacts.

Prevalence and correlation of OXIS contacts using Cone Beam Computed Tomography (CBCT) images and photographs

BACKGROUND

The contact areas in between primary teeth are broader, flatter, and located further cervically when compared with the contact areas of permanent molars.

AIM

We investigated the prevalence of interproximal contact area types of primary molars using CBCT images in children aged 3-10 years. Our second objective was to correlate OXIS contact areas when observed with CBCT images and clinical photographs.

DESIGN

A retrospective cross-sectional study was performed with 367 CBCT images of children, aged 3-10 years, obtained from Children's Dental Centre, South Korea. The type of contacts in between primary molars was scored at various levels, specifically, occlusal, middle, and cervical thirds, according to OXIS criteria. Following this, the same patient's records were checked for the presence of clinical photographs and scored according to the same criteria. Prevalence was stated as percentages along with numbers. Chi-square test was applied to determine association of contact areas across genders and arches. The correlation between the two methods was done by Cohen's Kappa correlation test.

RESULTS

The prevalence of the OXIS contacts obtained from CBCT images was as follows: I (79.7%), followed by X (10.0%), S (6.6%), and, finally, O (3.7%). The overall score of all the 1343 contact areas matched with the score observed at the occlusal third. All included contacts were of O (open) type at cervical third, and 1,231 contacts were of O (open) type at the middle third. Significant results were observed with respect to arches (P < .001). The correlation between the two methods was found to be 0.958.

CONCLUSIONS

The contact area observed at the occlusal level determined the overall type of contact based on OXIS criteria. Thus, reports in the literature concluded that contact areas are broad, flat, and extend further gingivally should be revised. The study also concluded almost perfect agreement between CBCT images and clinical photographs.

Morphological variations and prevalence of aberrant traits of primary molars

BACKGROUND

Morphological variations in tooth structure exhibit as metric and non-metric traits which play an important role in dental anthropology.

AIM

The purpose of this study was to determine the prevalence of morphometric traits and mean crown dimensions of primary molars in children.

SUBJECTS AND METHODS

This cross-sectional study was carried out in 4256 sectional dye casts of caries-free children aged 2.5-4 years from Puducherry. Two calibrated examiners graded the non-metric traits utilising the Arizona State University Dental Anthropological System classification and measured the crown dimensions in primary molars. The results are expressed in the form of numbers and percentages.

RESULTS

Of the eight non-metric traits studied, metaconule (30.17%), Cusp of Carabelli (90.6%), and deflecting wrinkle (87.41%) in second primary molars, and distal trigonid crest (93.06%) and parastyle (3.48%) in first primary molars, seemed to have higher prevalence, and the overall crown dimensions were found to be smaller in comparison with those in other populations.

CONCLUSION

This study highlights the prevalence of aberrant dental traits in primary molars in a population. The study describes, for the first time, the existence of these traits in first primary molars, adding anthropological significance of primary dentition in various other populations.

Interproximal contact areas of primary molars based on OXIS classification - a two centre cross sectional study

Background: Contact areas in primary teeth are known to be broader, flatter and situated farther gingivally than permanent teeth. The purpose of this study was to assess the prevalence of OXIS contact areas between primary molars using die models of children from two different ethnic populations. The research question of the present study is "What is the prevalence OXIS contact areas of primary molars in the populations studied?". Methods: A cross-sectional study was planned in a representative sample of 200 caries-free contact areas among children aged 3-6 years in two centers, Ajman and Puducherry. Data collection was performed from sectional or full-arch die stone models. The contacts were assessed according to OXIS classification by a single calibrated examiner at Center 2. Prevalence was expressed as numbers and percentages. The Chi-square test was applied to determine the association of OXIS contacts across genders and arches. Results: The prevalence of O, X, I, and S contacts were 19%, 22.5%, 53%, and 5.5% in Center 1 and 6%, 1.5%, 75.5%, and 17% in Center 2, respectively. Significant results (p=0.005) were obtained in Center 1 when inter-arch comparison was performed and between the centers with respect to type of contact. No significant difference was obtained with respect to gender and OXIS contact areas. Conclusions: The present study confirmed OXIS contacts in both the centers. The 'O' and 'X' types of contacts were observed more in Center 1, whereas 'I' and 'S' contacts were observed more in Center 2.

OXIS contact areas of primary molars - a two center cross-sectional study

Background: Contact areas in primary teeth are known to be broader, flatter and situated farther gingivally than permanent teeth. The purpose of this study was to assess the prevalence of OXIS contact areas between primary molars using die models of children from two different ethnic populations. The research question of the present study is "What is the prevalence OXIS contact areas of primary molars in the populations studied?". Methods: A cross-sectional study was planned in a representative sample of 200 caries-free contact areas among children aged 3-6 years in two centers, Ajman and Puducherry. Data collection was performed from sectional or full-arch die stone models. The contacts were assessed according to OXIS classification by a single calibrated examiner at Center 2. Prevalence was expressed as numbers and percentages. The Chi-square test was applied to determine the association of OXIS contacts across genders and arches. Results: The prevalence of O, X, I, and S contacts were 19%, 22.5%, 53%, and 5.5% in Center 1 and 6%, 1.5%, 75.5%, and 17% in Center 2, respectively. Significant results (p=0.005) were obtained in Center 1 when inter-arch comparison was performed and between the centers with respect to type of contact. No significant difference was obtained with respect to gender and OXIS contact areas. Conclusions: The present study confirmed OXIS contacts in both the centers. The 'O' and 'X' types of contacts were observed more in Center 1, whereas 'I' and 'S' contacts were observed more in Center 2.

OXIS Classification of Interproximal Contacts of Primary Molars and Its Prevalence in Three- to Four-Year-Olds

Purpose: The purpose of this study was to investigate the prevalence of different interproximal contact areas of primary molars, as described in the OXIS classification, in a group of three- to four-year-old caries-free children. Methods: This cross-sectional study was carried out with a representative sample of 4,476 contact areas of 1,119 caries-free school children. A single calibrated examiner performed a type III examination to assess the type of contact area between primary molars, as seen from the occlusal view. The contacts were scored as O (open contact), X (point contact), I (straight contact), and S (curved contact) using OXIS classification. The prevalence of the types was expressed in the form of numbers and percentages. The findings were subjected to chi-square and McNemar's tests. Results: The most common contact type was I (75.5 percent), followed by S (15.3 percent), O (5.8 percent), and X (3.3 percent). Significant differences were obtained (P<0.001) when the inter- arch comparison was performed for all except the X type of contact. Further, 401 (35.8 percent) children had more than one type of contact in dif- ferent quadrants. Conclusions: The present study highlights the existence of four different types of interproximal contact areas, O, X, I, and S, in caries-free three- to four-year-olds.

Risk Factors for Early Childhood Caries: A Systematic Review and Meta-Analysis of Case Control and Cohort Studies

Purpose: The purpose of this study was to perform a systematic review to assess current evidence for association between various risk factors and the prevalence or incidence of early childhood caries (ECC). Methods: Two reviewers searched various databases until January 2019. The Newcastle-Ottawa scale was used to perform risk of bias assessment. The included studies were categorized according to the World Bank classification. Data were summarized in a meta-analysis using fixed and random effects inverse-generic meta-analyses. Results: A total of 7,034 records involving 89 studies that evaluated 1,352,097 individuals were included; 23 were high, 46 were moderate, and 20 were of low quality. A total of 123 risk factors were found. Meta-analysis revealed that the strongest risk factors found in the high-income countries were presence of dentinal caries (dmft greater than zero; odds ratio [OR] equals 4.21 [2.18 to 8.16]) and high levels of mutans streptococci (OR equals 3.83 [1.81 to 8.09]). In upper-middle-income countries, presence of enamel defects (OR equals 14.62 [6.10 to 35.03]) was found to be the strongest risk factor. Conclusion: The strongest risk factors associated with early childhood caries was the presence of enamel defects, presence of dentinal caries and high levels of mutans streptococci.

Proposed classification for interproximal contacts of primary molars using CBCT: a pilot study

Background: Interproximal contact areas in primary teeth are known to be broader, flatter, and situated more gingivally than in permanent teeth. The objective of the present study was to evaluate the different types of intact interproximal contact areas in primary teeth using cone beam computed tomography (CBCT) among children. Methods: A cross-sectional study was designed with 74 contacts from 28 existing CBCT images of children aged between 3 and 14 years, obtained from the Indian Dental Education Academy, Chennai, India. The shape of the contact area was observed at three levels, the coronal, middle, and apical thirds, in three different sections of CBCT. Prevalence of the types of contact areas was expressed in the form of numbers and percentages. Results: The weighted Cohen's kappa values for inter-examiner reliability was 0.893 at baseline. Results exhibited four different types of contact areas between the primary molars, namely, O type, X type, I type, and S type, based on the shapes observed; hence, the proposed classification is referred to as OXIS. The most common pattern seen was I (66.2%), followed by X (21.6%), O (9.4%) and the least common was S (2.7%). Conclusion: The three-dimensional evaluation of intact interproximal contact areas between primary molars are of four types, O,X, I and S.

Proposed classification for interproximal contacts of primary molars using CBCT: a pilot study

Background: Contact areas in primary teeth are known to be broader, flatter, and situated more gingivally than in permanent teeth. The objective of the present study was to evaluate the different types of intact contact areas in primary teeth using cone beam computed tomography (CBCT) among children. Methods: A cross-sectional study was designed with 74 contacts from 28 existing CBCT images of patients aged between 3 and 14 years, obtained from the Indian Dental Education Academy, Chennai, India. The shape of the contact area was observed at three levels, the coronal, middle, and apical thirds, in three different sections of CBCT. The weighted Cohen's kappa values for inter-examiner reliability was 0.893 at baseline. Prevalence of the types of contact areas was expressed in the form of numbers and percentages. Results: Results exhibited four different types of contact areas between the primary molars, namely, O type, X type, I type, and S type, based on the shapes observed; hence, the proposed classification is referred to as OXIS. The most common pattern seen was I (66.2%), followed by X (21.6%), O (9.4%) and the least common was S (2.7%). Conclusion: The three-dimensional evaluation of intact interproximal contact areas between primary molars are of four types.

Comparative evaluation of a low-level laser and topical desensitizing agent for treating dentinal hypersensitivity: A randomized controlled trial

Aim

The aim of this randomized, controlled, double-blinded, clinical study is to evaluate and compare the clinical effectiveness of low-level diode GaAlAs laser and glutaraldehyde-based topical desensitizing agent on cervical dentin hypersensitivity with the help of visual analog scale (VAS).

Materials and Methods

Fifty teeth of patients aged between 20 and 50 years were included, and VAS was used to assess the dentin hypersensitivity. The teeth were randomly allocated to either Group 1 or 2 using flip coin technique. Group 1 received glutaraldehyde desensitizer and Group 2 received 905 nm low-level laser. The sensitivity scores were recorded, immediately, after1 week and 3 months after therapy. Data was analyzed using Mann-Whitney U test for intergroup comparison and Friedman's test for intragroup comparison.

Results

There was a significant reduction in pain in both the groups at 3 months evaluation (P = 0.001).However, Group 2 showed a significant decrease in mean VAS scores when compared with Group 1 at both the one week and three month follow ups (P = 0.04, P = 0.03, respectively).

Conclusion

Although topical desensitizer and Low Level Laser are both effective in reducing dentinal hypersensitivity, Low Level Lasers are comparatively more effective at the studied time intervals.

Ethnic Association of Cusp of Carabelli Trait and Shoveling Trait in an Indian Population

INTRODUCTION

Variations in the structure of teeth have always been of great interest to the dentist from the scientific as well as practical point of view. Additionally, ever since decades inter trait relationships have been a useful means to categorize populations to which an individual belongs.

AIM

To determine the association between Cusp of Carabelli and Shoveling Trait in a selected Indian population native of Bangalore city, Karnataka, India.

MATERIALS AND METHODS

A cross-sectional study was carried out in 1885 children aged between 7-10 years. Casts of the study subjects were made to study the presence of Cusp of Carabelli of right maxillary permanent molar and shoveling trait of right maxillary permanent central incisor using the Dahlberg's classification and Hrdliucka's classification respectively. Linear regression was used to assess the association of cusp of carabelli trait with the tooth dimensions and logistic regression was used to evaluate the association of the carabelli trait with gender and presence/absence of shoveling.

RESULTS

A 40.5% of subjects had Cusp of Carabelli on first molar and 68.2% had shoveling on upper central incisor. The study revealed positive association between the two traits studied in the population. A significant difference was also found with presence of Cusp of Carabelli and the buccolingual tooth dimension of the maxillary molar (p<0.05).

CONCLUSION

There is an association between the Cusp of Carabelli and the shoveling trait in the present study population, and this will be valuable in the determination of ethnic origin of an individual.

Prevalence of a few variant dental features in children aged 11-16 years in Davangere, a city in Karnataka

CONTEXT

Variations in morphology of shape of teeth have always been of interest to dentists from ancient times. But to our surprise, till date, no studies related to the prevalence of dental features have been conducted in any part of the world.

AIMS

To evaluate the prevalence of a few variant dental features in a group of children aged from 11 to 16 years in the city of Davangere that belongs to the state of Karnataka, India.

MATERIALS AND METHODS

A cross-sectional survey was conducted where children aged 11-16 years were selected (both girls and boys) and type III clinical examination was done. They were checked for the following features - Carabelli's cusp, 3-cusped maxillary 2(nd) molar, 5-cusped maxillary 1(st) molar, 4-cusped mandibular 1(st) molar, 5-cusped mandibular 2(nd) molar, cusp 6 present in mandibular 1(st) molar, and 7-cusped mandibular 1(st) molar.

STATISTICAL ANALYSIS USED

The Chi-square test was used to analyze the categorical data. P value of 0.05 or less was considered for statistical significance.

RESULTS

Around 99.3% of the school children examined had at least one of the dental variations that were examined in relation to the shape of teeth.

CONCLUSIONS

This study definitely provides us with baseline data, but further epidemiological studies are required to determine the prevalence of the above mentioned dental anomalies.

Prevalence of aberrant dental morphological details in 6-10 year old school children in an Indian population

Background:

Variations in the structure of teeth have always been a great curiosity to the dentist from the scientific and practical point of view.

Aim:

To evaluate the prevalence of a few aberrant morphological features namely, cusp of Carabelli in primary maxillary second molar and in permanent first molar, five cusp in primary maxillary second molar and permanent first molar, shoveling and double shoveling with respect to permanent maxillary central incisors, four cusped primary mandibular second molar and permanent first molar, six cusped primary mandibular second molar and permanent first molar and seven cusped primary mandibular second molar and permanent first molar in 6–10 year old children belonging to the East Bengaluru, a City in India.

Design:

A cross-sectional survey was conducted among 2111 children by two stage sampling method. Type III examination was performed. The findings were subjected to Chi-square test.

Results:

83.8% of the studied population had one or more of the variations checked for, as mentioned above. The variation most commonly seen was double shoveling (66.6%) followed by shoveling (65.7%). No significant results were observed in any trait with respect to gender.

Conclusion:

This study is the first of its kind, providing a baseline data of the prevalence of morphological details in the pediatric Indian population.

The radiculous' premolars: Case reports of a maxillary and mandibular premolar with three canals

Successful root canal therapy requires an accurate diagnosis and management of complex root canal morphology. Although the occurrence of three root canals in maxillary and mandibular premolars is very rare, the clinician must be able to identify it clinically and radiographically to make the necessary changes in his shaping and obturation techniques. We present the endodontic management of a maxillary first premolar with three separate roots and canals, which was diagnosed with the aberrant anatomy only after the access preparation. Then, a mandibular premolar with three root canals and fused roots, which were diagnosed radiographically, is presented. The necessary modifications of the routine clinical steps and the application of dental operating microscope for successful management of the complex anatomy, with emphasis on access modifications and radiographic interpretations are also explained. Teeth with extra roots and/or canals pose a challenge in clinical management. Identifying them early is necessary to facilitate appropriate modifications in treatment protocol, armamentarium to be used and plan optimal number of treatment sittings.

Prevalence and severity of molar incisor hypomineralization in children aged 11-16 years of a city in Karnataka, Davangere

INTRODUCTION

Molar incisor hypomineralization (MIH) describes the clinical picture of hypomineralization of systemic origin affecting one or more first permanent molar. There is a rarity of prevalence studies in Indian population.

OBJECTIVES

The main aim of this study was to investigate the prevalence of MIH in a population of South Indian children.

SETTINGS AND DESIGN

A cross-sectional epidemiological survey, included 2000 children aged 11-16 years chosen by stratified random sampling from government and private schools of Davangere, a city in South India.

MATERIALS AND METHODS

Evaluation of MIH and decayed, missing and filled teeth was carried out in these children by a calibrated examiner. The severity of hypomineralization was recorded according to the Wetzel and Reckel scale.

STATISTICAL ANALYSIS

Chi-square test was used to analyze the categorical data. P ≤ 0.05 was considered for statistical significance.

RESULTS

About 8.9% of all examined children showed at least one ill-structured first permanent molar in terms of MIH. The male and female ratio was found to be 1:1.1. The decreasing order of occurrence of MIH affected teeth were permanent maxillary molars, maxillaryincisors, mandibular molars and the mandibular incisors.

CONCLUSION

The prevalence of MIH in the permanent dentition of south Indian children was 8.9%. There is a need for a proper planned preventive and restorative program with regard to the increasing prevalence of MIH.