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ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 3  |  Page : 276-280

Comparison of chronology of teeth eruption with body mass index among school children at Mangalore: A cross-sectional study


1 Department of Public Health Dentistry, AMEs Dental College and Hospital, Raichur, Karnataka, India
2 Department of Pedodontics and Preventive Dentistry, AMEs Dental College and Hospital, Raichur, Karnataka, India
3 Department of Oral Medicine and Radiology, RKDF Dental College and Hospital, Bhopal, Madhya Pradesh, India
4 Department of Public Health Dentistry, Amritha School of Dentistry, Ernakulum, Kerala, India
5 Department of Public Health Dentistry, Yenopoya Dental College, Mangalore, Karnataka, India
6 Department of Conservative and Endodontics, AMEs Dental College and Hospital, Raichur, Karnataka, India

Date of Web Publication6-Sep-2016

Correspondence Address:
Hemanth Kumar
Department of Pedodontics and Preventive Dentistry, AMEs Dental College and Hospital, Raichur, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.189835

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  Abstract 

Introduction: The development and eruption of the teeth, chronologies of human dentitions, dental age, and tooth formation standards are important aspects applied to dental practice. Body mass index (BMI) gives an indication about the nutritional status of the child. It is relevant to know whether BMI has influenced chronology of tooth eruption pattern. Aim: To determine the eruption age of the different permanent teeth and compare eruption age with BMI in a group of children from selected schools in Mangalore. Materials and Methods: A cross-sectional study was designed in which 2928 children ranging in age from 5.5 to 15 years were included in the study. The children were divided into 20 chronological age groups with half year intervals. All the children were examined by a single examiner with the help of a trained assistant. The teeth were examined under natural light with mouth mirror. The comparison was made between mean eruption ages in males and females using the independent t-test. Results: There were 1526 males constituting 52.1% and 1402 females constituting 47.9% of the total sample of 2928 children. The mean age of eruption of maxillary central incisor, maxillary lateral incisor, maxillary and mandibular canines, maxillary and mandibular premolars, maxillary and mandibular second molars were found to have statistical significant with BMI. The mean age of eruption of the teeth in females was found to be earlier than in males, with the exception of the maxillary first molar which is earlier in males. Conclusion: Different categories of BMI were underweight, normal weight, risk of overweight and overweight, wherein overweight children had early eruption of teeth. Girls had early eruption time compared to boys.

Keywords: Body mass index, children, eruption time, permanent teeth


How to cite this article:
Bagewadi NB, Kumar H, Bagewadi SB, Kumar V, Panchmal GS, Mohnish Z M. Comparison of chronology of teeth eruption with body mass index among school children at Mangalore: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:276-80

How to cite this URL:
Bagewadi NB, Kumar H, Bagewadi SB, Kumar V, Panchmal GS, Mohnish Z M. Comparison of chronology of teeth eruption with body mass index among school children at Mangalore: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Jul 16];14:276-80. Available from: http://www.jiaphd.org/text.asp?2016/14/3/276/189835


  Introduction Top


Evolution of the human race has seen many changes in the living habits, food habits, and oral hygiene habits over a span of thousands of years, which may have influenced the eruption of teeth as well.[1] Studies have also reported differences in the eruption of permanent teeth between ethnic groups, gender socioeconomic and nutritional factors, fluorides congenital abnormalities such as supernumerary teeth, Down's syndrome, cleidocranial dysplasia and environmental and secular trends.[1] The existing eruption schedules for permanent and deciduous dentition are based on studies in the western population. Since Indians differ from westerners racially genetically and environmentally, these studies fail to provide relevant guidance on the eruption schedule in the Indian population.[2]

Knowledge of the development of the teeth and their emergence into the oral cavity is applicable to clinical practice, anthropology, demography, forensic science and palaeontology. The development and eruption of the teeth, chronologies of human dentitions, dental age, and tooth formation standards are important aspects applied to dental practice. It is relevant to know whether this has influenced the chronology of tooth eruption.[3]

Demirjian stated that emergence standards should be derived from the population in which they are to be applied, as factors related to emergence may vary considerably.[4] Very few studies have been published correlating body mass index (BMI) and chronology of tooth eruption among children in India.[5] Children who had lesser height and weight had delayed eruption time than those children who are within standard range. Therefore, the objective of the present study was to determine the mean eruption time of permanent teeth and to compare the relationship of mean eruption time with BMI of school children in Mangalore.


  Materials and Methods Top


A cross-sectional study was carried out in which convenient sampling methodology was used, 2928 children ranging in the age group from 5.5 to 15 years participated from 5 adopted schools of the institution in the study. The study protocol was reviewed and ethical clearance was provided by the institutional ethical committee. Prior permission was obtained from the school authorities. The study was conducted for the period of January 2012–March 2012 in Mangalore, Karnataka.

Children who have completed 5 years of age and are below 15 years of age were included in the study. Only those cases were considered whose records were available for date of birth from school records and birth certificates. Children with growth or congenital anomalies or severe medical conditions and children who were absent on the day of examination were excluded.

The size of the sample was calculated with desired allowable error (L) at 4% risk that the true estimate will not exceed allowable error by 10% or 20% of P 4pq/L2 = 4 × 50 × 50/(4% of 50)2 = 2500. In this study, all the children of adopted schools were observed which comprised 2928 subjects, which was deemed adequate.

The children were divided into 20 chronological age groups with half year intervals. Because more precise variations in eruption pattern may be observed with month interval than 1 year interval. The children were examined by a single examiner with the help of a trained assistant under natural light with mouth mirror. About 30–40 children were examined per day.

The children were informed briefly about the procedure involved, and the examinations were carried out after obtaining their consent. Proforma were assigned to each child individually. The ages of the children were recorded as age at last birthday and were confirmed from school records.

A permanent tooth was diagnosed as erupted under three stages. Stage 0 - the teeth is not visible in the oral cavity. Stage 1 - at least one cusp is visible in the oral cavity. Stage 2 - the entire occlusal surface visible but not reached the occlusal level. Stage 3 - the tooth in occlusion or at the level of the occlusal plane if the antagonistic tooth was not fully erupted.[6]

All the subjects were examined for eruption status of their teeth and charting of teeth was done on Palmer's Notation chart. BMI was calculated where height and weight of the individual child were measured using height chart and weighing machine.

BMI for age percentiles = weight in kilograms/height in meter 2.

Underweight was defined as BMI-for-age <5th percentile.

Normal weight was defined as 5th≤BMI for age <85th percentile.

At the risk of overweight was defined as 85th≤BMI for age <95th percentile.

Overweight was defined as BMI for age ≥95th percentile.

https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html.[7]

The examination commenced from maxillary right quadrant for the presence of permanent teeth followed by the maxillary left, mandibular left and mandibular right quadrant. ANOVA, t-test were used for statistical analysis in SPSS version 17.0 (IBM SPSS Version 17.0, Chicago, USA). P ≤ 0.05 was considered statistical significance.


  Results Top


Distribution of study population among males and females is shown in [Figure 1]. In the 5.5 years of age group only few of permanent teeth had erupted in both males and females and in 14 years of age all the permanent teeth except third molars had erupted. Comparison of mean age in years of the eruption of teeth in males and female was done [Table 1].
Figure 1: Distribution of the study population

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Table 1: Comparison of mean age in years of eruption of teeth in males and females

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In the study population, teeth in the maxillary and mandibular arch erupted earlier in females than in males and it was found that maxillary lateral incisor, canine, and first premolar erupted earlier in females than the males. In mandibular arch, it was found that central incisor, second premolar erupted earlier in males than in females. Mandibular canine, first premolar, first molar, second molar had erupted earlier in females than in males. This shows that the eruption in mandibular arch is earlier than the maxillary arch. The study subjects were categorized according to BMI scores as underweight, normal weight, risk of overweight, and overweight children and the mean age eruption and standard deviation were obtained and compared with different BMI groups of both the arches in anterior and posterior teeth [Table 2] and [Table 3].
Table 2: Comparison of mean age in years of eruption of teeth in different body mass index groups in maxillary and mandibular anterior teeth

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Table 3: Comparison of mean age in years of eruption of teeth in different body mass index groups in maxillary and mandibular posterior teeth

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Underweight children were found to have late eruption of teeth compared to overweight children. Among the various BMI groups, maxillary central, maxillary lateral, maxillary, and mandibular canines were shown to have statistically significant difference in the age of eruption. Eruption ages of all posterior teeth with the exception of maxillary and mandibular first molars and mandibular second molar were found to have statistically significant difference among various BMI categories.


  Discussion Top


When eruption age of males and females were compared, maxillary lateral incisor, canine, and first premolar erupted earlier in females than the males. Mandibular canine, first premolar, first molar, second molar erupted earlier in females than in males, but mandibular central incisor and second premolar erupted earlier in males than females. This shows that mean eruption age is earlier in females than the males. These findings are in agreement with findings of Lee et al.,[4] Pahkala et al.,[6] Knott and Meredith,[8] Leroy et al.,[9] Diamanti and Townsend [10] Hernández et al.[11] Virtanen et al.,[12] Parner et al.,[13] Mugonzibwa et al.,[14] Krumholt et al.[15] In the study by Magnusson, both dental stages DS01 and DS02 set in earlier in the girls, as might be expected considering their earlier emergence of teeth. This finding agrees with the differences in the onset of dental stages of permanent teeth among the Icelandic population, which was significantly earlier in girls.[16]

In this study, the mean age of eruption of maxillary central incisor, maxillary lateral incisor, maxillary and mandibular canines, maxillary and mandibular premolars, maxillary and mandibular second molars were found to have statistical significant difference between underweight, normal, risk of being overweight and overweight children who were categorized according to BMI status.

The findings of the present study were contradictory to that of Khan et al.,[17] in which there was no statistical correlation between BMI and mean age of eruption except mandibular lateral incisor. Observations of the present study were also in contrast to the study by Höffding et al.,[18] who reported only minor changes in tooth emergence with pronounced acceleration in physical development.

In this study, children in underweight category showed delayed eruption pattern. These findings were similar to that done by Chohan et al., in which it was found that children who are below average weight and height showed a delayed eruption time than those children who are within the standard range.[19]

In the present study where overweight children had earlier eruption ages compared with those in lower BMI status. Similar observations were made by Almonaitiene et al., in which there was a positive correlation between body height and weight and teeth emergence. The taller and heavier children are slightly advanced dentally and stunting (retarded linear growth) is more strongly associated with delayed tooth eruption. Research on children obesity and dental development also showed a positive correlation.[20] Obese children mature earlier, and teeth tend to erupt on average 1.2–1.5 year earlier as compared to children with normal BMI.

The findings of the present study were also similar to that of Agarwal et al.[5] in which they observed that eruption of teeth was positively related to somatic growth (height and weight).

Literature regarding chronology of tooth eruption and its correlation with BMI among children in India is less.[5] Indian population differs from western population racially, culturally and environmentally. The standard eruption age based on the western population cannot be applied to the Indian population.[2] Further research among various population groups spreading across various states of the nation needs to be done to standardize the eruption pattern of teeth in Indian population.

The study was conducted in a limited geographical region. Hence, the findings of the present study cannot be extrapolated to the Karnataka state or South Indian population.


  Summary and Conclusion Top


Comparison of different categories of BMI with eruption pattern was studied. Different categories of BMI are underweight, normal weight, risk of overweight and overweight, wherein we found that overweight children had an early eruption. In a correlation between boys and girls, the present study showed girls had early eruption.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Lakshmappa A, Guledgud MV, Patil K. Eruption times and patterns of permanent teeth in school children of India. Indian J Dent Res 2011;22:755-63.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Gupta R, Sivapathasundharam B, Einstein A. Eruption age of permanent mandibular first molars and central incisors in the South Indian population. Indian J Dent Res 2007;18:186-9.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Ash MM, Nelson SJ. Development and Eruption of the teeth. Dental Anatomy, Physiology and Occlusion. 8th ed. St. Louis: Elsevier; 2003. p. 49-51.  Back to cited text no. 3
    
4.
Lee MM, Low WD, Chang KS. Eruption of the permanent dentition of Southern Chinese children in Hong Kong. Arch Oral Biol 1965;10:849-61.  Back to cited text no. 4
    
5.
Agarwal KN, Gupta R, Faridi MM, Kalra N. Permanent dentition in Delhi boys of age 5-14 years. Indian Pediatr 2004;41:1031-5.  Back to cited text no. 5
    
6.
Pahkala R, Pahkala A, Laine T. Eruption pattern of permanent teeth in a rural community in Northeastern Finland. Acta Odontol Scand 1991;49:341-9.  Back to cited text no. 6
    
7.
About Child and Teen BMI. Available from: https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html. [Last accessed on 2015 May 15].  Back to cited text no. 7
    
8.
Knott VB, Meredith HV. Statistics on eruption of the permanent dentition from serial data for North American white children. Angle Orthod 1966;36:68-79.  Back to cited text no. 8
    
9.
Leroy R, Bogaerts K, Lesaffre E, Declerck D. The emergence of permanent teeth in Flemish children. Community Dent Oral Epidemiol 2003;31:30-9.  Back to cited text no. 9
    
10.
Diamanti J, Townsend GC. New standards for permanent tooth emergence in Australian children. Aust Dent J 2003;48:39-42.  Back to cited text no. 10
    
11.
Hernández M, Espasa E, Boj JR. Eruption chronology of the permanent dentition in Spanish children. J Clin Pediatr Dent 2008;32:347-50.  Back to cited text no. 11
    
12.
Virtanen JI, Bloigu RS, Larmas MA. Timing of eruption of permanent teeth: Standard Finnish patient documents. Community Dent Oral Epidemiol 1994;22(5 Pt 1):286-8.  Back to cited text no. 12
    
13.
Parner ET, Heidmann JM, Vaeth M, Poulsen S. A longitudinal study of time trends in the eruption of permanent teeth in Danish children. Arch Oral Biol 2001;46:425-31.  Back to cited text no. 13
    
14.
Mugonzibwa EA, Kuijpers-Jagtman AM, Laine-Alava MT, van't Hof MA. Emergence of permanent teeth in Tanzanian children. Community Dent Oral Epidemiol 2002;30:455-62.  Back to cited text no. 14
    
15.
Krumholt L, Roed-Petersen B, Bindborg JJ. Eruption times of the permanent teeth in 622 Ugandan children. Arch Oral Biol 1971;16:1281-8.  Back to cited text no. 15
    
16.
Magnusson TE. Emergence of permanent teeth and onset of dental stages in the population of Iceland. Community Dent Oral Epidemiol 1976;4:30-7.  Back to cited text no. 16
    
17.
Khan NB, Chohan AN, Al-Mograbi B, Zahid T, Al-Moutairi M. Eruption time of the permanent first molars and incisor among a sample of Saudi male school children. Saudi Dent J 2006;18:18-24.  Back to cited text no. 17
    
18.
Höffding J, Maeda M, Yamaguchi K, Tsuji H, Kuwabara S, Nohara Y, et al. Emergence of permanent teeth and onset of dental stages in Japanese children. Community Dent Oral Epidemiol 1984;12:55-8.  Back to cited text no. 18
    
19.
Chohan AN, Khan NB, Al Nahedh L, Hassan MB, Sufyani AN. Eruption time of the permanent first molars and incisors among female primary school children of Riyadh. JDUHS 2007;1:53-8.  Back to cited text no. 19
    
20.
Almonaitiene R, Balciuniene I, Tutkuviene J. Factors influencing permanent teeth eruption. Part one – General factors. Stomatologija 2010;12:67-72.  Back to cited text no. 20
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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