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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 29
| Issue : 2 | Page : 167-172 |
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Pattern and prevalence of dental anomalies among a paediatric population in Lagos, Nigeria
Olubukola O Olatosi1, Afolabi Oyapero2, Kehinde O Akinwande3, Oladipupo Solomon Ayedun1, Emmanuel Temitope Aladenika1, Olorunfemi I Obe1
1 Department of Child Dental Health, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
2 Department of Preventive Dentistry, Faculty of Dentistry, College of Medicine, Lagos State University, Lagos, Nigeria
3 Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| Date of Submission | 25-Jan-2022 |
| Date of Decision | 16-Mar-2022 |
| Date of Acceptance | 11-Apr-2022 |
| Date of Web Publication | 23-Apr-2022 |
Correspondence Address:
Olubukola O Olatosi
Department of Child Dental Health, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/npmj.npmj_23_22
Background: Dental anomalies are craniofacial abnormalities in the size, structure or number of the teeth. This study was conducted to assess the prevalence of dental anomalies among children aged 0–16 years attending the Paediatric Dental Clinic at the Lagos University Teaching Hospital, Lagos, Nigeria. Methods: A cross-sectional design was used and data were obtained from the dental records of the Dental Clinic from January 2014 to August 2019 by two calibrated examiners, who are co-authors of the manuscript. To test for statistical differences, Chi-squared test was utilised for the categorical variables. The prevalence of the different dental anomalies was estimated and presented with frequencies. P < 0.05 was considered statistically significant. Results: Among the 6175 patients' dental records reviewed, 50.85% (n = 3150) were male and the highest proportion of 45.4% (n = 2807) were aged between 6 and 10 years, with a mean age of 8.62 ± 3.85 years. A total of 1090 (17.52%) had dental anomalies; 465 (7.53) anomalies were in the maxilla, 263 (4.6) were in the mandible while 360 (5.83) were in both. The most common anomaly was hypoplasia 550 (9.06%), followed by retained primary tooth 546 (8.84%) and hypodontia 84 (1.36%). Dentinogenesis imperfecta 1 (0.02) and transposition 1 (0.02) were the least prevalent anomalies. Retained primary teeth (5.8%) and the cusp of Carabelli (0.4%) were slightly more prevalent among males. However, females had a higher prevalence of natal/neonatal teeth (0.4%), fusion/germination (0.4%), hypodontia (1.5%) and peg-shaped lateral incisors (0.9%). Conclusion: Dental anomalies' prevalence in this study was 17.52%, with a higher occurrence of anomalies in the maxilla. Hypoplasia was the most prevalent anomaly, after which was retained primary tooth, then hypodontia. Prompt diagnosis and preventive interventions are crucial for the appropriate management of these dental anomalies.
Keywords: Anomalies, dental defects, developmental, hypoplasia, supernumerary teeth
How to cite this article:
Olatosi OO, Oyapero A, Akinwande KO, Ayedun OS, Aladenika ET, Obe OI. Pattern and prevalence of dental anomalies among a paediatric population in Lagos, Nigeria. Niger Postgrad Med J 2022;29:167-72 |
How to cite this URL:
Olatosi OO, Oyapero A, Akinwande KO, Ayedun OS, Aladenika ET, Obe OI. Pattern and prevalence of dental anomalies among a paediatric population in Lagos, Nigeria. Niger Postgrad Med J [serial online] 2022 [cited 2022 May 22];29:167-72. Available from: https://www.npmj.org/text.asp?2022/29/2/167/343732 |
| Introduction | |  |
Dental anomalies are craniofacial abnormalities in the size, structure or number of the teeth.[1] They result from abnormal events in embryonic development caused by genetic mutations and environmental influences during odontogenesis.[2] Dental development is an incredibly complex process that is regulated by a series of molecular and cellular interactions. Disruptions and alterations during the phases of initiation, morphogenesis and histodifferentiation can lead to the occurrence of dental anomalies.[2] Most mutations that have been identified as causing abnormalities in tooth number and/or shape affect molecules of the signalling networks regulating early tooth morphogenesis.[1] The environmental causes include diets, affecting the gum, extended use of tetracycline in young children, fluorosis and poor nutrition.[2]
The anomalies can present in a wide variety and can be classified into several categories such as anomalies in number, size, shape, root formation and matrix deposition and mineralisation. Developmental dental anomalies (DDAs) of the permanent dentition, unlike in the deciduous, can result in complications and afterwards cause long-lasting damage.[3] The incidence and degree of expression of DDA in the various populations can be explored in phylogenic and genetic studies, to provide an understanding about the various possible variations.[3] Such studies can provide vital information, making a prompt diagnosis, optimal patient management and treatment planning possible, thus reducing the complexity associated with delayed treatment. Dental anomalies range from missing teeth, supernumerary teeth, microdontia, macrodontia and aberrations in the structure, such as odontoma, dens invaginatus, germination, fusion, hypoplasia, taurodontism and inherited defects.[1] These anomalies can be diagnosed clinically on inspection and by the use of intraoral radiographs. They often result in delayed eruption, tooth wear, poor aesthetics, cusp fracture, occlusal interference, speech and mastication disturbances. They can also result in occlusal disharmony, occlusal trauma as well as periodontal disease due to the enhancement of plaque accumulation, increased caries risk and tooth breakdown.[4],[5]
The prevalence of these anomalies varies depending on the population being studied. For instance, some researchers in European and the Middle East countries found that congenitally missing teeth were the most prevalent anomaly among children.[3],[6],[7],[8],[9] In Saudi Arabia, a dental clinic-based study reported a prevalence of 25.39%.[10] The prevalence was reported to be higher in boys than girls (27.42% vs. 23.28%), while hypodontia was the most common anomaly (9.7%).[3] Furthermore, a study of the Turkish population reported a prevalence of 5.56% and hypodontia was the most prevalent anomaly.[8] However, the study conducted in Egypt had a higher prevalence of 32.6%, with impaction and ectopic eruption being the most common, and females (32.1%) having a lower prevalence than males (33.5%).[11]
Data on dental anomalies in the African populations are however limited, and only a few of these studies were conducted in Nigeria. Moreover, some of the Nigerian studies included only some of the developmental defects[12],[13] in their criteria, while many other defects were unaccounted for.[12],[13] A lower prevalence of anomalies was reported in the study conducted in Ile-Ife,[13] but higher than the study done in the schools at Lagos, Nigeria, both in the South-western part of Nigeria.[12] Furthermore, the predominant dental anomaly differed in each of these locations and these differences may be due to variances in environmental factors and genetic pre-disposition. For example, in the study conducted in a school in Ile Ife, enamel hypoplasia was highly prevalent while hypodontia was very rare.[13] Similarly, in the Lagos school-based study, the prevalence of dental anomaly was 11.2%, with chronological enamel hypoplasia accounting for 7.5% of anomalies seen.[12]
These few Nigerian studies provided some information on the pattern of dental anomalies, but there were still gaps with regard to the external validity of the data since some anomalies were unaccounted for. Furthermore, even though the study settings were in schools where more representative data for the community could be obtained, a large hospital-based data could provide some critical information about trends in treatment intervention. This study was therefore undertaken to fill this gap in evidence, to understand the prevalence of dental anomalies and population-specific interventions for patients attending tertiary hospitals, where most dental cases are referred to in Nigeria. Hence, this study aimed to assess the prevalence of dental anomalies among children aged 0–16 years at the Paediatric Dental clinic of the Lagos University Teaching Hospital, Lagos (LUTH), Nigeria.
| Methods | | |
Ethical consideration
The procedure for this study was presented to the Health Research and Ethics Committee, LUTH, and written approval was acquired on 9th October 2019 (ADM/DCST/HREC/APP/3240). A formal written request, which was approved, was also obtained from the medical records department of LUTH. Written informed consent was not obtained because the data were collected anonymously from the patients' records.
Study design
A cross-sectional study was performed to ascertain the prevalence of dental anomalies among children aged 0–16 years attending the Paediatric Dental clinic at the LUTH, Lagos, Nigeria.
Data source
The data used for this study were obtained from the dental records of the Department of Child Dental Health of the Dental Clinic of LUTH, Lagos, Nigeria, from January 2014 to August 2019. The study population included all children aged 1 day − 16 years. The treatment book provided data, consisting of patient's name, gender, age and presenting complaints, diagnosis and treatment performed.
Outcome variables
The inclusion criteria were (1) male and female participants between 0 and 16 years with dental anomalies in deciduous or permanent dentition and (2) participants with good quality radiographs. The exclusion criteria included: (1) case files with incomplete information with respect to age and gender of the participants and the presenting complaint or clear diagnosis and (2) incomplete information with regard to treatment planning and (3) participants with syndromic and craniofacial defects (e.g., cleft lip/palate). All children whose case histories meet the inclusion criteria were enrolled to participate in the study. All dental anomalies that were clinically documented were recorded. The dental anomalies were classified as: anomalies in tooth structure: hypoplasia, dentinogenesis imperfecta, amelogenesis imperfecta and anomalies in tooth position: rotation, ectopic eruption; anomalies in tooth number: supernumerary tooth (ST), congenitally missing teeth; anomalies in tooth shape: taurodontism, talons cusp and fusion.
A clinical impression made of hypodontia and supernumerary was confirmed by radiographs. Variations in size that were established by clinical judgement and anomalies such as the talon's cusp were confirmed when it extends 1 mm beyond the cementoenamel junction (CEJ) or half the distance from CEJ to the incisal edge.[14] Fusion was recorded as teeth with separate pulp chambers merging at the dentin level, which is confirmed by radiological evaluation. Taurodontism was determined by the criteria established by Shifman and Chanannel[15] where the tooth structure and/or its pulp chamber are vertically enlarged and the pulp chamber has a rectangular outline. ST was diagnosed when another tooth series was present along with the normal dentition. Odontomas (Os) were diagnosed with a radiopaque mass consisting of normal dental tissue in an irregular pattern.
Data preparation
The principal investigator and a second examiner were calibrated for data collection using some randomly selected dental records of patients at the Paediatric dentistry unit of the Child Dental Health Department. Inter-examiner reliability for both examiners was 0.91, whereas the inter-examiner reliability was 0.92 and 0.88 for the two examiners, respectively. The paper dental records of the patients were then extracted by the dental record officers after the written permission obtained from the medical records department was presented to them. The principal investigator obtained the date of birth, gender, the presenting complaint, the diagnosis of dental anomaly, pattern and distribution of the anomaly in the mandible and maxilla, treatment plan and the treatment details such as restorations and/or extractions. The chart review process was repeated by the other calibrated examiner and the data were equated for reproducibility and consistency. Other variables such as socio-economic status, religion and occupation were not considered during the review of the patients' case files, due to the fact that some of these entries were incomplete in the records. The collected data were then entered into a spreadsheet (Excel 2013; Microsoft Office)
Statistical analysis
The data were analysed with the IBM Statistical Package for the Social Sciences (SPSS) software version 24.0 (IBM Corp, Armonk, NY, USA). Descriptive statistical analysis was done to describe the demographic characteristics of the study population. The characteristics included the child's age and sex. Normally distributed continuous variables were presented as means and standard deviation, whereas numbers and percentages were reported for proportions. To test for statistical differences, Chi-squared test was utilised for the categorical variables. The prevalence of the different dental anomalies was estimated and presented with frequencies. Statistical significance was set at a P ≤ 0.05.
| Results | | |
Among the 6175 children' dental records reviewed, 50.85% (n = 3150) were male and the highest proportion of 45.4% (n = 2807) were aged between 6 and 10 years, and a mean age of 8.62 ± 3.85 years. A total of 1090 (17.52%) had dental anomalies; 465 (7.53) anomalies were in the maxilla, 263 (4.6) were in the mandible while 360 (5.83) were in both. The most common anomaly was hypoplasia 550 (9.06%), followed by retained primary tooth 546 (8.84%) and hypodontia 84 (1.36%). Dentinogenesis Imperfecta 1 (0.02) and transposition 1 (0.02) were the least prevalent anomalies [Table 1].
There was an equal distribution of hypoplasia among males and females, representing 8.9% of both sexes. Retained primary teeth (5.8%) and the cusp of Carabelli (0.4%) were slightly more prevalent among males. However, females had a higher prevalence of natal/neonatal teeth (0.4%), fusion/germination (0.4%), hypodontia (1.5%) and peg-shaped lateral incisors (0.9%). Supranumerary teeth (0.6%), peg-shaped lateral incisors (1.6%), microdontia (0.3%) and hypoplasia (9.2%) were more prevalent among those aged 11–16 years. The gender of the children was significantly associated with the occurrence of macrodontia, fusion/germination, supranumerary teeth, peg-shaped lateral incisors, microdontia, taurodonts and retained primary teeth (≤0.05) [Table 2].
Hypoplasia, the most prevalent anomaly in the study, was equally distributed among males and females, representing 4.45% each in the sample. Hypoplasia in the mandible had a prevalence of 2.80% compared to a maxillary prevalence of 1.40% in the total sample; while retained primary teeth had a maxillary prevalence of 2.40% compared to 1.90% in the mandible in the total sample. Furthermore, supranumerary teeth 14 (0.20%), hypodontia 49 (0.80%), peg-shaped lateral incisor 42 (0.70), microdontia 5 (0.10%) and the cusp of Carabelli 15 (0.20%) were more prevalent in the maxilla in the total sample while natal/neonatal tooth was more prevalent in the mandible 10 (0.20%) [Table 3]. | Table 3: Prevalence (percentage of sample total) of all dental anomaly types identified in the study sample
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| Discussion | | |
Past bodies of the research reported a wide range of prevalence (from 4.7% to 74.8%) of specific DDA types in various patient cohorts.[16],[17],[18],[19],[20] These studies have been conducted in diverse two ethnic and patient groups and have adopted different designs. Many of the studies also looked at the specific subsets of populations. In this study, slightly over half of the children were male and the highest proportion was aged between 6 and 10 years. The prevalence of dental anomalies in this study was 17.52%, of which a higher proportion was in the maxilla. A similar study that conducted in Ile Ife, Nigeria, reported a prevalence of 26.6% for paediatric dental anomalies.[13]
The most prevalent anomaly in the present study was hypoplasia (550; 9.06%). There was an equal distribution of hypoplasia among males and females, each representing 4.45% in the sample. Hypoplasia was also more prevalent in the mandible (2.8%) as compared to a maxillary prevalence of 1.40% in the total sample. Our findings are similar to those made in previous Nigerian studies,[12],[21] that observed a prevalence of 7.5% and 6.7% for enamel hypoplasia, respectively. A high occurrence of enamel hypoplasia has been documented in paediatric populations in developing countries, especially among those in whom malnutrition and very low birth weights are common.[22]
Retained primary tooth was the next most prevalent finding (546; 8.84%) while retained primary teeth had a maxillary prevalence of 2.40% as compared to 1.90% in the mandible in the total sample. This is in contrast to a study conducted in Turkey that had a higher prevalence of retained primary teeth in the right side of the dentition and in the mandible.[23] The developmental absence of the permanent successor is the most common reason for the retention of primary teeth,[24] but it can also occur due to tooth impaction, late eruption of successor teeth or an abnormal eruption pattern. The sequelae of primary tooth retention include dental caries, periodontitis and ankylosis of the deciduous tooth.
Hypodontia is the congenital absence of deciduous or permanent teeth due to the absence of tooth buds from genetic factors, spacing, infectious and traumatic influences or the use of certain drugs. The prevalence of hypodontia in this study was 1.36% and a slightly higher proportion was observed among females (1.5%), a higher occurrence in the mandible and a slightly higher prevalence in children in mixed dentition. This contrasts with previous research that observed that the permanent dentition was more frequently affected (3%–7.5%), even though there was an agreement that it is seen in females more than males.[25] A higher prevalence of hypodontia in females could be due to the smaller size of their mandible and maxilla, resulting in interference with tooth bud development. The prevalence of microdontia in this study was 0.13% and it occurred only in the maxillary permanent dentition of males. This prevalence was lower than in previous studies that reported an overall prevalence range in the permanent dentition of 1.5%–2.5%.[25] Microdontia is a condition in which a tooth has a reduced size compared to the average norm, and the maxillary lateral incisors and third molars are frequently involved.[26]
Natal/neonatal teeth had a prevalence of 0.27% in this study, with a higher occurrence in females and in the mandible. From the literature, neonatal teeth rarely occur, and incidence rates vary between 1:2000 and 1:3500, with one or two teeth involved.[27] Majority of researchers report that there is no gender predilection, even though some document a higher occurrence among females.[28],[29] The mandibular central incisors area is the most affected region (85%),[30] and factors such as a superficial location for developing tooth germs, bone resorption around the tooth germs, hormonal stimulation, febrile illnesses and certain syndromes and systemic diseases have been implicated in its aetiology.[31]
The observed occurrence of supranumerary teeth was 0.6%, and this falls within the prevalence described in previous studies, that varied from 0.04% to 2.29%.[32],[33],[34] Different evaluation methods or populations sampled may be responsible for this pattern. The present study observed a higher occurrence in the maxillary permanent dentition of females. This contrasts with previous literature that observed a higher prevalence among males,[35],[36] but similar to the findings that it is more prevalent in the permanent dentition (0.04%–2.29%), than the deciduous dentition (0.3%–0.6%)[32] and in the pre-maxillary and maxillary region.[37]
A limitation of this study was that certain socio-economic variables such as religion and socio-economic status were not recorded during the data collection, due to the fact that some of these entries were incomplete in the records. A prospective study can be conducted as a follow-up to this research to determine if any association exists between these anomalies and socio-demographic characteristics.
| Conclusion | | |
The prevalence of dental anomalies was 17.52% and they occurred more commonly in the maxilla, while the most prevalent anomaly was hypoplasia, then retained primary tooth and hypodontia. Dentinogenesis imperfecta and transposition were the least prevalent anomalies.
Recommendations
Prompt diagnosis and appropriate preventive interventions are critical for the successful management of DDA. Hence, children with these anomalies in deciduous dentition should have their permanent dentition assessed as soon as eruption commences. When both dentitions are involved, a genetic cause may be implicated, and such children should be promptly referred to paediatricians and paediatric dentists for diagnosis, and further specialist care and possibly for genetic testing and counselling.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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