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DENTAL SCIENCE - ORIGINAL ARTICLE
Year : 2015  |  Volume : 7  |  Issue : 6  |  Page : 572-575  

Evaluation of caries in deciduous second molar and adjacent permanent molar in mixed dentition


Department of Pedodontia and Preventive Dentistry, Chettinad Dental College and Hospital, Padur, Kelambakkam, Chennai, Tamil Nadu, India

Date of Submission28-Apr-2015
Date of Decision28-Apr-2015
Date of Acceptance22-May-2015
Date of Web Publication1-Sep-2015

Correspondence Address:
Dr. Daya Srinivasan
Department of Pedodontia and Preventive Dentistry, Chettinad Dental College and Hospital, Padur, Kelambakkam, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.163544

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   Abstract 

Aim: This study was done to evaluate association of caries in deciduous second molar and adjacent permanent first molar, tooth surface more involved in permanent first molar and to assess the parental awareness regarding the eruption of permanent first molar. Subjects and Methods: Three hundred and ten children (160 boys, 150 girls) of mixed dentition aged between 6 and 11 years were included. Presence or absence of paired association of caries in primary second molar and adjacent permanent first molar, of both the jaws, were noted. Parental awareness regarding the child's dentition was asked by pointing the maxillary and mandibular permanent first molar. Results: Pearson Chi-square test was used. Significance was noted in both sexes between paired nonassociation of caries in mandibular primary second molar and mandibular permanent molar (P =0.01) and paired nonassociation of caries in primary maxillary second molar and maxillary permanent first molar in girls only (P =0.04). Parental awareness that permanent first molar has erupted was 24.83% and not to be exfoliated and replaced was 22.9% for both the sexes. In permanent teeth of both the sexes, the occlusal surface was more involved with caries in maxillary teeth; the buccal surface was more involved in mandibular teeth. About 10% of the sample did not have caries in both maxillary and mandibular permanent first molar. Conclusions: Paired association of caries of primary second molar and permanent first molar though found in large number of cases was not significant. It is clear that parental awareness is less regarding the child's oral health. Thus, community-based awareness program has to be conducted to emphasize on pediatric oral health status and care.

Keywords: Caries, parental awareness, permanent first molar, primary second molar


How to cite this article:
Srinivasan D, Louis C J. Evaluation of caries in deciduous second molar and adjacent permanent molar in mixed dentition. J Pharm Bioall Sci 2015;7, Suppl S2:572-5

How to cite this URL:
Srinivasan D, Louis C J. Evaluation of caries in deciduous second molar and adjacent permanent molar in mixed dentition. J Pharm Bioall Sci [serial online] 2015 [cited 2019 Aug 17];7, Suppl S2:572-5. Available from: http://www.jpbsonline.org/text.asp?2015/7/6/572/163544

Caries affecting the primary teeth is an important indicator for the occurrence of caries in the permanent tooth in later age. The factors, which cause to caries in primary molars, are the same for permanent first molars and hence the risk of affecting the latter is higher. Parents most often bring the child to the dentist only when the child complaints. This study was designed to find out the existing correlation between caries experience in primary second molar and that of adjacent permanent first molar in both the sexes.

The aim of the present study is

  • To assess the association and nonassociation of caries between deciduous second molar and adjacent permanent first molar
  • To assess the parental awareness regarding the eruption of permanent first molar
  • To evaluate the surface of the tooth involved with caries in permanent first molar in a mixed dentition.



   Subjects and Methods Top


This study was conducted on 310 children of mixed dentition. The age the study population was between 6 and 11 years and those children attending the Pedodontic Department were included in this study. This population had 160 boys and 150 girls out of the total 310 children.

Inclusion and exclusion criterion

  • Study population should be in mixed dentition period with permanent first molar clinically erupted
  • Those children whose permanent first molar had been extracted previously were not taken into the study sample
  • Children with special health needs, metabolic disorders, and anomalous condition were not considered.


Plaque index by Silness and Loe (1964) was carried out. Plaque and gingival scores were taken depending on teeth present such as 16, 52, 64, 36, 32, 84. If a tooth was absent, the tooth distal to missing tooth was taken or only five teeth were considered. Caries presence was detected by both visual and tactile examination. Teeth were cleaned, dried, and viewed in the illuminated light. A ball ended explorer was used to checking for surface cavitations. Status of caries in primary teeth was assessed using decay, extraction, filling of primary teeth (deft) index. Caries in permanent first molar was scored based on each surface of the tooth as buccal surface, lingual/palatal, mesial, distal, occlusal, and no caries as nil. Proximal lesion, which were not conclusive a bite-wing radiograph was taken for confirmation.

The presence or absence of paired association between caries of primary second molar and adjacent permanent first molar of both maxillary and mandibular teeth were noted.

Parental dental awareness regarding the child's dentition was asked by pointing to the maxillary and mandibular permanent first molar and by putting forward these questions:

  • Do you know that permanent first molar has erupted into the mouth?
  • Do you know that permanent first molar is not to be exfoliated and not replaced by another tooth?



   Results Top


A total of 310 children participated in the study, out of which 160 were boys and 150 were girls. The data obtained by conducting the study as described in materials and methods section were analyzed using Statistical Package for the Social Science for Microsoft Windows, version 16.0, IBM (Chicago, USA). There was no significance in the paired association of caries between primary second molar and permanent first molar of both sexes in maxillary and mandibular teeth. There was statistical significance in both sexes between, paired nonassociation of caries of mandibular primary second molar and mandibular permanent first molar (P =0.01) [Table 1] and [Table 2]. Significant results were also found with paired nonassociation of caries of maxillary primary second molar and maxillary permanent molar in girls only (P =0.04) and not in boys.
Table 1: Sample with maxillary E, maxillary 6 caries in both boys and girls

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Table 2: Sample with mandibular E, mandibular 6 caries in both boys and girls

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The occlusal surface was more involved with caries in maxillary permanent teeth in both boys (42%) and girls (47%). Buccal surface was more involved in mandibular permanent teeth in both boys (41.3%) and girls (40.6%).

Parental awareness that permanent first molar has erupted into the mouth was 77/310; that is 24.83% for both the sexes. Parental awareness that permanent first molar is not to be exfoliated and not replaced by another tooth is 22.9% for both the sexes.

Among 160 boys, there were no caries in both maxillary and mandibular permanent first molar in 19 boys only (11.87%). Average deft in those cases with no caries was 3.2. Among 150 girls, the absence of caries in both maxillary and mandibular permanent first molar was found only in 12 girls (8%). Average deft in those cases with no caries was 3.9. Thus, only 31 children of the entire sample (31/310 = 10%) did not have caries in permanent first molar, giving us a mean deft of 3.55 and plaque index of 0.43 [Table 3]. The mean deft and plaque score for the entire sample was 4.46 and 0.884, respectively [Table 4].
Table 3: Sample with no caries in maxillary 6 and mandibular 6

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Table 4: Sample with plaque index and deft

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   Discussion Top


The presence of caries was detected by visual and tactile examination. The cleaned teeth were dried and viewed under an illuminated light. [1] Examining a tooth visually has high specificity only but low sensitivity and reproducibility. [2] The water particles lodge in the pores of the carious teeth. As the refractive index of tooth and water are similar, detection of white spot lesions at the earliest becomes difficult. Thus, teeth were dried for detecting carious lesions. As a sharp explorer damages the enamel surface covering the early carious lesions, a ball ended explorer was used. [3] A proximal carious lesion, which were nonconfirmatory a bite-wing radiograph was used. [4],[5]

Paired association

According to Leroy et al., the formation of a cavity in the first permanent molar is influenced by the status of the adjacent primary second molar. [6] However, in the present study there was no significant paired association of caries between primary second molar and permanent first molar. The mean sample age of the present study of both the sexes is 7.7 years, which is an early mixed dentition period. The risk of developing carious lesions in the sound proximal surfaces of both primary teeth and first permanent molars is low during the early mixed dentition period. [7] Afterward, the risk of development of caries increase as the child is exposed to the more cariogenic environment, and development of caries is considered a cumulative process. [8]

Occurrence of caries in maxillary/mandibular teeth

There is an increase in the percentage of caries of mandibular teeth (mean E caries, associated primary second molar and permanent first molar) when compared to maxillary teeth of both the sexes. This could be because the mandibular permanent first molar generally erupts earlier of its maxillary counterpart. Moreover, mandibular teeth have more number of pits and supplementary grooves which can act as food retentive areas, hence promoting caries. [9]

Paired nonassociation

There was statistical significance between paired nonassociation of caries of mandibular primary molar and mandibular first permanent molar, in both sexes. Gray et al. have noted that caries experience at the age of 5 was the best predictor of caries experience in the permanent first molars at the age of 7. [10] In a child who has a good oral hygiene, the environmental factors for caries is reduced and hence the risk for caries decreases.

Surfaces involved in caries

The occlusal surface is more involved with caries in maxillary permanent first molar of both sexes. This might be because occlusal surface contains more pits and grooves which act as food retaining area. [11] In the mandibular teeth of both the sexes, the buccal tooth surface is more affected by caries as against the occlusal tooth surface. The buccal sulcus of mandibular teeth, stagnation of food and milk tends occurs and more so if the child does not gargle after a meal.

Incidence of caries in each sex

The incidence of caries was more in girls than boys. [12],[13] The reason could be that eruption of teeth occurs earlier in girls as compared to boys, [14] so the tooth is subjected to the longer cariogenic environment.

Parental awareness

The percentage for parental awareness that the permanent first molar has erupted was only 24.83% in both the sexes. The percentage of parents aware that permanent first molar is not to be exfoliated and not replaced by another tooth is only 22.9% for both the sexes. The lesser of awareness by parents might be possibly due to first permanent molar erupted uneventfully behind existing deciduous second molar. Another main reason is that tooth erupts posterior to the primary teeth, an area where parents might have difficulty in viewing, thus the tooth is more susceptible to caries because of neglect. Thus, the dentist has a responsibility in educating the parent about the child's dentition status.

Only 10% of cases in the sample (31 in 310) did not have caries in the maxillary and mandibular permanent first molar. Though these 31 children did not have caries in the permanent first molar, they did have caries in the primary teeth. This is reflected by deft (mean deft for 31 children is 3.55) and plaque score (mean plaque score for 31 children is 0.43). The mean plaque and deft index for the 31 children are less when compared to the entire sample.


   Conclusion Top


In both the sexes paired association of caries in primary second molar and permanent first molar, though found in large number of cases was not significant. This could be validated by a larger sample size. There was statistical significance in paired nonassociation of caries in mandibular second molar and mandibular permanent first molar in both the sexes. There was also statistical significance in paired nonassociation of caries in maxillary second molar and maxillary permanent first molar in girls. This could mean that a child who has a good oral hygiene status in the primary dentition, caries exposure gets minimized, and caries risks also decreases. Overall mandibular teeth have more caries when compared to maxillary. Only 10% of the sample did not have caries in a permanent first molar. Parental awareness is less regarding their child's dentition status. Thus, the community-based awareness program has to be conducted to emphasize pediatric oral health status and care.

Financial support and sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
   References Top

1.
Downer MC. Validation of methods used in dental caries diagnosis. Int Dent J 1989;39:241-6.  Back to cited text no. 1
    
2.
Bader JD, Shugars DA. The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries. J Evid Based Dent Pract 2006;6:91-100.  Back to cited text no. 2
    
3.
Ekstrand KR, Ricketts DN, Kidd EA. Reproducibility and accuracy of three methods for assessment of demineralization depth of the occlusal surface: An in vitro examination. Caries Res 1997;31:224-31.  Back to cited text no. 3
    
4.
Wenzel A. Bitewing and digital bitewing radiography for detection of caries lesions. J Dent Res 2004;83 Spec No C: C72-5.  Back to cited text no. 4
    
5.
Lussi A, Hack A, Hug I, Heckenberger H, Megert B, Stich H. Detection of approximal caries with a new laser fluorescence device. Caries Res 2006;40:97-103.  Back to cited text no. 5
    
6.
Leroy R, Bogaerts K, Lesaffre E, Declerck D. Effect of caries experience in primary molars on cavity formation in the adjacent permanent first molar. Caries Res 2005;39:342-9.  Back to cited text no. 6
    
7.
Vanderas AP, Manetas C, Koulatzidou M, Papagiannoulis L. Progression of proximal caries in the mixed dentition: A 4-year prospective study. Pediatr Dent 2003;25:229-34.  Back to cited text no. 7
    
8.
Al Khateeb TL, Darwih SK, Balsawi AE, O'Mullane DM. Caries prevalence and treatment need amongst children in Saudi Arabian community. Community Dent Oral Epidemiol 1999;19:227-80.  Back to cited text no. 8
    
9.
Togoo RA, Yaseen SM, Zakirulla M, Al-Garni F, Khoraj AL, Meer A. Prevalance of first permanent molar caries among 7-10 years old school going boys in Abha city, Saudi Arabia. J Int Oral Health 2011;3:30-4.  Back to cited text no. 9
    
10.
Gray MM, Marchment MD, Anderson RJ. The relationship between caries experience in the deciduous molars at 5 years and in first permanent molars of the same child at 7 years. Community Dent Health 1991;8:3-7.  Back to cited text no. 10
    
11.
Eklund SA, Ismail AI. Time of development of occlusal and proximal lesions: Implications for fissure sealants. J Public Health Dent 1986;46:114-21.  Back to cited text no. 11
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12.
Antunes JL, Junqueira SR, Frazão P, Bispo CM, Pegoretti T, Narvai PC. City-level gender differentials in the prevalence of dental caries and restorative dental treatment. Health Place 2003;9:231-9.  Back to cited text no. 12
    
13.
Demirci M, Tuncer S, Yuceokur AA. Prevalence of caries on individual tooth surfaces and its distribution by age and gender in university clinic patients. Eur J Dent 2010;4:270-9.  Back to cited text no. 13
    
14.
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. 14
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