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INTRODUCTION - Fiji National University

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INTRODUCTION - Fiji National University Powered By Docstoc
					ERUPTION AGES AND SEQUENCE
OF FIRST MOLARS AND CENTRAL
INCISORS OF FIJIAN CHILDREN.




RESEARCHER: WILLIAM OXUS WAURA
          : BDS 5 – STUDENT
          : FINAL RESEARCH REPORT

SUPERVISOR: DR SHIRLEY SCOLA
           : ORTHODONTIST
           : SENIOR LECTURER, DOH, FSM




                            Page 1 of 15
        TABLE OF CONTENTS

1. ABSTRACT……………………………………….3


2. INTRODUCTION and METHODS.....………….4


3. RESULTS …………..………………………………6


4. DISCUSSION…………………………………….. 10


5. RECOMMENDATIONS ……..…………………..11


6. ACKNOWLEDGEMENTS ……………………12


7. REFERENCES……...…..………………………...13


8. APENNDIX ………………..……………………..14




               Page 2 of 15
                                      Abstract
Background: There are no data available of the eruption dates and sequence of
permanent teeth of Fijian children. The current knowledge of eruptions is based on
studies of different countries and populations. However this information is important
particularly for Fijian dental professionals when planning preventive treatments for Fijian
children. This study is aimed at establishing the eruption dates and sequence of first
molars and central incisors of Fijian children particularly the two dominant ethnic groups
and comparing with other studies.
Methods: Data collection is collect by actually carrying out oral examination on
participants with a small torch illuminating in their mouth. A total of 80 children aged
between 5 - 8 years old were part of this study. Participants were from 3 Primary Schools
selected randomly from list of schools in and around Suva area. Data analysis in
Microsoft Excel with graphs of percentage against age in months plotted. The mean age
of each tooth is drawn against the 50 % mark on each graph. Comparison in this study is
between Indigenous Fijian population and Indo – Fijian population, boys and girls and
what other studies report of the eruption timing and sequence.
Results: The first permanent teeth to erupt in Fijian population were the mandibular
first molars at an average age of 71.25 months. It is 4 -5 months earlier than what other
studies report. The pattern of eruption follows the; first molar and then central incisor
sequence in both the mandible and maxilla. These mandibular first molars and central
incisors erupt earlier than their maxillary counterpart in both sexes and ethnic groups.
The mandibular first molars erupt earlier by an average 1.65 months with Indigenous
Fijians and 3.6 months with Indo – Fijians while the mandibular central incisors precede
the maxillary central incisors by 3.75 and 4.45 months respectively. Eruption is earlier in
girls than boys by an average age of 1.8 months but similar eruption timing recorded for
left and right sides. In general the eruption timing is late with Indo – Fijians population
by 6.13 months to those of Indigenous Fijians.
Conclusion: These study findings gives resourceful information to dental
professionals when planning preventive treatments for children such as fissure sealants.
The earlier eruptions of first molars compared to other studies should dictates Fijian
children to attend dental clinics 4-5 months earlier. The results also form the baseline
data for future studies.




                                       Page 3 of 15
                                    INTRODUCTION

The understanding of when permanent teeth erupt and the sequence of eruption is
resourceful information to dental professionals. This information can be used to plan how
to prevent or manage dental problems in growing children. Dentists, dental therapist,
dental hygienist and other trained dental workers can be informed of the correct timing
for preventive practices such as fissure sealing the erupting molars and other fluoride
applications only if they have the knowledge of when these permanent teeth erupt.

A few studies1, 2, 3 have been undertaken in different parts of the world to provide data on
permanent teeth eruption timing and sequence. As Diamanti J, Townsend G C (2003)1
and Agarwal K, Gupta R, Faridi M and Kalra N (2004) 2 reports, this eruption data needs
to be updated because community compositions are changing, there is better nutrition and
healthcare for some children, and because of variations in genetic and hormonal factors,
gender and ethnic differences, economic status and growth parameters.

In most Pacific Island countries, this basic data of the timing and sequence of permanent
teeth eruption are not available. The current understandings of patterns of eruption of
permanent teeth and attempted preventive treatment planning are based on data from
studies of other countries. Therefore this study is aimed to identify the mean eruption
ages and sequence of eruption of first molars and central incisors of Fijian children.
Fijian children in this study will referred to the two dominant ethnic groups in Fiji, the
Indigenous Fijian population and the Indo Fijian population. This study will test the
hypothesis that permanent first molars of Fijian population erupt earlier than 6 years of
age and also to compare the eruption patterns between boys and girls.

                             MATERIALS AND METHODS

The data collections in this study involve actual visiting and examining of participants in
their respective schools. A list of primary schools in and around Suva was obtained from
the Dental Mobile Team 4 and names were randomly drawn from a container. 4 primary
schools were randomly selected to participate in this study, however only 3 were part of
this study. The fourth primary school did not participate in the study because consent
letters for parents’ approval for their children to be part of the study were not given to the
correct age group.

After receiving approval from the Ministry of Education (MOE), head teachers of the
randomly selected schools were made aware of the study. A visiting schedule to each
primary school was drawn and respective participants in each primary school were given
consent letters for the parents’ approval for them to be part of the study a week earlier
than the actual examinations. The children with returned signed consent forms to be part
of this study were the only research participants.

The oral examination was carried out by using a small torch to illuminate the mouth and
with direct vision. Consistent with other studies a tooth is recorded erupt if any part of it
is piercing the gingivae.1-3, 5 A data collection form, formulated and approved by research



                                        Page 4 of 15
committee, was used for recording and data collection was done over three separate visits
to the participating primary schools (Appendix 1).

With each data collection session a 10 percent recheck of participants was done to check
for reliability of results..

The data collected was analyzed in Microsoft Excel.

Participants’ ages were calculated in a formula, formulated in Excel which calculates age
from their date of birth (D.O.B) to the date of examination and converts years to months.
The results of erupted and not erupted were tallied under age group intervals of 5 months.
The results were then converted to percentage and graphs of percentage (y-axis) and age
in months (x-axis) were constructed in Excel. The mean eruption of each tooth was
obtained from the 50 % mark (y-axis) where the erupted curve dissects the not erupted
curve and the age in months (x-axis) was recorded. Similar tables and graphs were
generated for all the teeth for:
     each tooth in the total population
     for each ethnic group
     and for females and males within each group

Picture 1: Shows the small torch and oral examination mirror in use




                                      Page 5 of 15
                                                 RESULTS

Analyzing the 10 percent recheck for reliability of results a kappa value was calculated
and was found to be 0.86 which means that there was a good level of intra examiner
reliability.

A total sample of 195 children was examined.

Of the 195 children:
     91 were Indigenous Fijian males
     60 were Indigenous Fijian females
     20 were Indo Fijian males
     20 were Indo Fijian females
     4 other
 4 children were neither Indigenous Fijians nor Indo Fijians and were not included in the
study.

In order to compare the data for ethnic group and males / females it was necessary to
balance the population numbers.

The result analysis uses 80 participants for equal comparison between ethnic groups and
gender. The total Indo Fijian population was used and the Indigenous Fijian matched
population was selected using random sampling tables. The analysis population
comprises of indigenous Fijians’ 20 males and 20 females as well as Indo Fijians 20
females and 20 males.

The age of the participants was converted to months and the results of erupted and not
erupted were tally under age group interval with the youngest of 66 months and the oldest
96 months with intervals of 5 months. These results were then converted to percentage
and graphs of percentage (y-axis) and age in months (x-axis) were constructed in Excel.
The mean eruption of each tooth is drawn from the 50 % mark (y-axis) where eruption
curve dissects the not erupted curve and age in months (x-axis) is recorded.
                                         Fijians total population - 46


                   120



                   100


                   80
      Percentage




                   60


                   40



                   20


                    0
                         66-70   71-75   76-80        81-85       86-90   91-95   96-100
                                                         of 15
                                                 Pagein6m onths
                                                  Age
The results of the Fijians total population data for tooth 16 is in table 1. It shows the
number of participants in each age group and whether the tooth is erupted or not and their
conversion to percentage. These percentage figures are then plotted on the graph to figure
out the mean age of eruption. In addition, an example of graph of tooth 46 is used to
show how age is been figured; Graph 1: Fijian total population – 46.


                              Table 1: Fijians total population – 46

       Age in           66-70      71-75    76-80 81-85 86-90 91-95 96-100
       months
       Not erupt        2          8        4       1      0       0     0
       Erupt            0          18       16      8      11      9     3

       Percentage
       Not erupt        100        31       20      11     0       0     0
       Erupt            0          69       80      80     89      100   100

Similar tables and graphs were generated for all the teeth for:
    each tooth in the total population
    for each ethnic group
    and for females and males within each group

   The eruption sequence for each of the groups was established and compared

Results for Indigenous Fijians
                            Table 2: Indigenous Fijian Eruption Age

                Tooth         Male (M)      Female (F)      M&F
                            (Age – months) (Age-months) (Age – months)
                   11            79.0          74.0          75.0
                   21            77.5          74.8          75.0
                   31            71.0          70.8          71.0
                   41            71.0          70.5          71.5
                   16            71.5          70.8          71.8
                   26            71.5          70.8          72.0
                   36            70.0          67.8          70.5
                   46            70.0          67.6          70.0



With Indigenous Fijians’ eruption patterns, the mandibular first molar is the first
permanent tooth to erupt. It erupts at 70 months average.
When comparing gender, female mandibular first molar erupts 3.0 months earlier than
male, which is a significant difference.


                                           Page 7 of 15
The mandibular central incisors are second to erupt but about an average of 1 months
after the eruption of the mandibular first molars.

In general, for Indigenous Fijians, eruption patterns is found in this study to be earlier in
females than males with an average difference of 1.8 months, with the most eruption
difference between genders seen in the upper central incisors.

The eruption of sides is similar on left to right with maxillary molars the only pair
showing slight delay of left side by 1.2 months. It is also evident in this study that
mandibular first molars and central incisors precede the maxillary counterparts in
eruption by 1.65 months in molars and 3.75 months with incisors.



Results for Indo Fijians

                            Table 3: Indo Fijian Eruption Age



                Tooth Male (M)              Female (F)       M&F
                      (Age – months)        (Age-months)     (Age – months)
                11    83.5                  79.9             82.5
                21    83.5                  79.8             82.4
                31    80.0                  75.5             78.0
                41    80.0                  76.5             78.0
                16    81.5                  79.4             78.5
                26    81.0                  75.5             78.7
                36    80.0                  71.5             73.5
                46    80.0                  71.2             74.2

Considering the Indo Fijian population (table 3), generally the eruption is delayed by an
average of 6.13 months significant difference in comparison to Indigenous Fijians
eruptions. However eruption patterns again shows eruption earlier in female than male.
This ethnic group shows much difference in eruption between genders as well as the
mandibular and maxillary teeth. The obvious and greatest difference is seen with Indo
Fijians females’ mandibular first molars which erupt 8.65 months earlier than males’
mandibular first molars.

In comparing the Indo Fijians total population eruption between mandibular first molars
and central incisors, the mandibular first molars erupts 3.6 months earlier than their
maxillary counterparts while mandibular central incisors erupt 4.45 months earlier than
the maxillary central incisors.




                                        Page 8 of 15
Comparing the two ethnic groups

               Table 4: Indigenous Fijian and Indo Fijian Eruption Age


          Tooth Indigenous Fijians Indo Fijians TOTAL POPULATION
                (Age – months)     (Age-months)    (Age – months)
           11          75.0            82.5             77.5
           21          75.0            82.4             80.0
           31          71.0            78.0             71.0
           41          71.5            78.0             72.5
           16          71.8            78.5             72.5
           26          72.0            78.7             73.5
           36          70.5            73.5             71.5
           46          70.0            74.2             71.0

Table 4 shows the comparison of eruption between ethnic groups’ total population.
 In this table it is evident that there is a significant difference of eruption of mandibular
first molars between the two ethnic groups by an average of 3.6 months. The mandibular
first molars erupt at age 71.25 months for the Fijians combined population.

 There is an even greater difference when comparing the both mandibular and maxillary
central incisors which show differences of eruption at 6.5 - 7.5 months between the two
ethnic groups. With the Fijians combined population, the eruption is again similar with
left and right sides except for maxillary central incisors which shows the right central
incisor erupting 2.5 months earlier than left central incisor which is the latest tooth to
erupt in the timing and sequence of eruptions.

                                Eruption Sequence.
Eruption Tooth        Indigenous          Indo-               TOTAL
order    No             Fijians          Fijians           POPULATION
                     Age - months      Age - months         Age - months
    1         46         70.0              74.2                 71.0
    2         36         70.5              73.5                 71.5
    3         31         71.0              78.0                 72.0
    4         41         71.5              78.0                 72.5
    5         16         71.8              78.5                 72.5
    6         26         72.0              78.7                 73.5
    7         11         75.0              82.5                 77.5
    8         21         75.0              82.4                 80.0




                                        Page 9 of 15
                                       DISCUSSION

The small number of participants may act as a limitation in this study. However, since
this data are the first in Fiji Islands, they may act as baseline information for future
research in this topic with larger population sample. It is also possible as limitation or
error in this study to record a tooth as not erupted when it had been extracted for other
reasons such as due to caries or less likely orthodontic reasons 1, 6. With these,
participants were usually questioned whenever suspicion arises of missing tooth
especially mandibular first molars. Another likely source of argument maybe due to
different analysis method used in this study since other studies uses various versions of
SPSS; however our findings are very much comparable to those studies.

Our findings show that the earliest permanent tooth to erupt is the mandibular first
molars. Their mean eruption age is 4 -5 months earlier than what other studies report1, 2, 6,
7
  . The pattern of eruption is; first molar and then central incisor which is different to what
is reported in Tehran – Iran 3 and Finland 6 but similar to that of Australians1. It was also
found that the eruption is similar on the left and right sides which is similar to what
Diamanti and Townsend report in their findings of Australian children.1

The mandibular first molars and central incisors erupt earlier than their maxillary
counterparts and girls tend to be advanced in eruption timing compared to boys which
also reflect previous findings from different populations and ethnic backgrounds.1, 8,-10.
This study also clearly proves the ethnic factor in eruption timing, which shows
Indigenous Fijian children eruptions earlier than Indo-Fijian children. The mean age of
eruption of first molars and central incisors of Fijian children are found in this study to be
earlier than other studies reports by 4 – 5 months1, 2.


                                      CONCLUSION

The results of our study provide dentists and other dental professions in Fiji Islands the
resource for planning their treatment approach when faced with child patient especially
between the ages 5 - 8 years old. Preventive treatments such as fissure sealing molars can
now be well timed. These results also form the baseline information for future studies
with larger population sample if a need to verify our findings arises. As our study shows,
the first molars and central incisors of Fijian children erupt earlier than what other studies
found showing that the first molars can be considered as 5 year old molars rather than 6
year old molars in Fiji.

These findings should indicate Fijian children to attend dental clinics earlier than
previously thought. Their attendance should correspond to the appearance of their lower
central incisors for effective fissure sealant of first molars, which erupt at around the
same time, and also obtain professional advice on how to care for their erupting
permanent teeth.




                                        Page 10 of 15
                    RECOMMENDATIONS
 Health care providers need to be informed of the earlier eruption age
  of permanent teeth in the Fijian population compared to previously
  published studies.

 Fijian children should be advised to attend dental clinics at the
  appearance of the lower incisors for effective fissure sealant of first
  molars

 The study should be conducted with a larger population to verify these
  results and a younger population group (kindergarten) should be
  included as their were a significant number of first molars already
  erupted in the 66 month age group

 A National survey should be carried out to document the eruption
  dates and sequence of the permanent dentition as this would give a
  larger population sample.




                              Page 11 of 15
                        ACKNOWLEDGEMENTS


I would like to say ‘thank you’ to the following people who in one way
or another help make this research a reality.


1. Dr Shirley Scola (Research supervisor; Senior Orthodontist
   Lecturer –SOH)

2. School of Oral Health Research Committee (SOHRC)

3. School Dental Mobile Team – Miss Waga

4. Ministry of Education (MOE)

5. Dr Linton Winder (Statistician – USP)

6. 4 H/Teachers & Staff of the participated Primary Schools

7. Participants (children) and their parents

8. Colleagues/ Classmates especially Praneet Sundar (BDS 5)




                            Page 12 of 15
                                    REFERENCES

 1    Diamanti J, Townsend G C. New standards for permanent tooth emergence in
      Australian children. Australian Dental Journal 2003; 48:39-42
 2 Agarwal K N, Gupta R, Faridi M M A Kaira N. Permanent Dentition in Delhi
      boys of age 5-14 years. Indian Pediatrics 2004; 41:1031-1
 3 Moslemi M An epidemiological survey of the time and sequence of eruption of
      permanent teeth in 4-15 years olds in Tehran, Iran. Inter J Paediatric Dent 2004;
      14:432-441
 4 Mobile School Dental Team. Ministry of Health, Suva Fiji Islands. 2006
 5 Pahkala R, Pahkala A, Laine T. Eruption pattern of permanent teeth in a rural
      community in North Eastern Finland. Acta Odontologica Scandinavica 1991;
      49:341-349
 6 Carlson J P, Gittelshn A M. Longitudinal studies of the natural history of caries. I.
      Eruption patterns of the permanent teeth. Journal of Dental Research 1965; 44:
      509-516
 7 Halikis SE. The variability of eruption of permanent teeth and loss of deciduous
      teeth in Western Australian children. I. Times of eruption the permanent teeth.
      Australian Dent. J 1961;6137-140
 8 Carr LM. Eruption ages of permanent teeth. Australian dent j 1962; 7:367-373.
 9 Eskeli R, Laine-Alava MT, Hausen H, Pahkala R. Standards for
      permanent tooth emergence in Finnish children. Angle Orthodontics
       1999;69:529-533
 9. Hägg U, Taranger J. Timing of tooth emergence. A prospective
     longitudinal study of Swedish urban children from birth to 18
     years. Swed Dent J 1986;10:195-206.
10. Krumholdt L, Roed-Petersen B, Pindborg JJ. Eruption times of
    the permanent teeth in 622 Ugandan children. Archs Oral Biol
   1971;16:1281-1288.




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