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Table of Contents   
ORIGINAL RESEARCH  
Year : 2011  |  Volume : 22  |  Issue : 6  |  Page : 755-763
Eruption times and patterns of permanent teeth in school children of India


1 Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
2 Department of Oral Medicine and Radiology, JSS Dental College and Hospital, Mysore, Karnataka, India

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Date of Submission17-Feb-2010
Date of Decision03-Sep-2010
Date of Acceptance28-Apr-2011
Date of Web Publication5-Apr-2012
 

   Abstract 

Aim: To study the eruption pattern of permanent teeth excluding third molars in school children of Mysore, South India.
Objectives: To compare the eruption times determined with previous studies. To determine range of variation of the eruption time of each tooth and evaluate if any preponderance exists in the eruption timings of maxillary and mandibular teeth and between boys and girls.
Materials and Methods: This was a descriptive cross sectional study. A random sample of 5007 school children in the age group of 5-14 years was selected. The mean age of eruption of individual permanent teeth was recorded and results were analyzed using Probit analysis.
Results: The study population included 2371 boys constituting 47.26% and 2636 girls constituting 52.65% of the total sample. In the age group of 5 years, one of the permanent teeth was found to be erupted. In the age group of 14 years, all the permanent teeth except third molar had erupted. Girls showed early tooth eruption compared to boys. Mandibular teeth erupted earlier than maxillary teeth in both the sexes. Right and left sided teeth erupted at the same time in both the arches.
Conclusion: The mean ages of eruption obtained from the present study are strikingly comparable with those of other investigators in different populations across the world. Since the current study involves a large sample of children, the data reported in this study could be used as standards when assessing permanent tooth eruption in Indian children.

Keywords: Age, boys, eruption, girls, mandible, maxilla

How to cite this article:
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

How to cite this URL:
Lakshmappa A, Guledgud MV, Patil K. Eruption times and patterns of permanent teeth in school children of India. Indian J Dent Res [serial online] 2011 [cited 2014 Sep 30];22:755-63. Available from: http://www.ijdr.in/text.asp?2011/22/6/755/94568
Teeth are an important part of the dentomaxillofacial complex. They are biological markers of maturity and their eruption into oral cavity is an important milestone in an individual's life. [1] 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. [2] Studies have also reported differences in eruption of permanent teeth between ethnic groups, gender, socioeconomic and nutritional factors, carious condition, fluorides, congenital abnormalities such as supernumerary teeth, Down's syndrome, cleidocranial dysplasia, and environmental and secular trends. [3],[4],[5]

Rationalization of eruption timings is more desirable in the present era, since dentistry has widened its horizons towards many specific fields. Developmental norms of emergence of permanent teeth need to be established for diagnosis, orthodontic treatment planning, preventive dentistry procedures, archeological, anthropological, paleontological and may have legal as well as forensic application. [6] The growth and development patterns cannot be universally applied owing to ethnic variations. The standards for tooth eruption patterns derived for a western population cannot be extrapolated to an Indian scenario. Hence there is a need for a study that will generate local data.


   Materials and Methods Top


0The present study was carried out in Mysore city, Karnataka state, India. The sample collected was based on simple random technique. Children aged between 5-14 years in 8 primary and 8 high schools schools of Mysore city who fulfilled the inclusion criteria were involved in the study. Sample size was based on previous studies. Since there was a wide age range, a total sample of 5000 was thought to be appropriate as each age group would get approximately a sample of 500. Ethical clearance was obtained from the institutional Ethical Committee Review Board. Prior permission was obtained from the school authorities and the day of examination was scheduled. The children were informed briefly about the procedure involved and examinations were carried out after they were assured. Specially designed proformas were assigned to each child individually. The ages of the children were recorded as age at last birthday and were confirmed from school records.

The subjects who were apparently healthy both physically and mentally were included in the study. Children with a history of chronic infectious disease, nutritional, or endocrine disturbances, recognized syndromes and developmental disturbances such as cleft lip and palates were excluded from the study.

All the children were examined by a single trained examiner with the help of a trained assistant. A maximum of 50 children per day were examined over a period of one year. Examination was done using a mouth mirror and probe with adequate natural illumination (Type III examination). [7] The examination commenced from the maxillary right quadrant for the presence of permanent teeth followed by the maxillary left, mandibular left, and mandibular right quadrant. The number of permanent teeth erupted in the oral cavity of each child was recorded in his/her proforma. A tooth with any of its parts emerged through the gingiva was considered as erupted. When in doubt, the area was dried with cotton to confirm the eruption. [8] Similar procedure was carried out for all the 5007 children included in the study group.

The mean age of emergence of individual permanent teeth was calculated by using the Probit transformation. For each tooth, the percentages of subjects in whom the tooth was present at specific age levels were determined and transformed into probit values for each age group. Both male and female probit transformed graphs were plotted taking probit values on Y-axis and age on X-axis. Standard deviations (SD) were calculated separately for males and females for maxillary and mandibular teeth. Student's t-test was used for comparing two means. Ninety five percent upper and lower confidence intervals were taken as significant values.


   Results Top


The study population consisted of 5007 subjects in the age group of 5-14 years from 16 different primary and high schools. There were 2371 boys constituting 47.36% and 2636 girls constituting 52.66% of the total sample of 5007 children [Table 1].
Table 1: Distribution of the study population

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The mean age eruption and standard deviation were obtained by using Probit analysis. For each tooth the percentage of subjects in whom the tooth was present at specific levels was determined for both the sex [Graphs. 1-14] and [Table 2] and [Table 3].
Table 2: Number and percentage of maxillary permanent teeth erupted at different ages

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Table 3: Number and percentage of mandibular permanent teeth erupted at different ages

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The mean age of eruption obtained from the present study in boys were 7.7 ± 1.2 (CI), 8.67 ± 1.2 (LI), 11.68 ±1.2 (C), 10.78 ± 1.3 (IPM), 11.5 ± 1.31 (IIPM), 5.4 ± 1.18 (IM) and 12.64 ± 1.138 (IIM) years in maxilla and 6.8 ± 0.92 (CI), 7.9 ± 1.02 (LI), 11.4 ± 1.3 (C), 10.9 ± 1.41 (IPM), 11.3 ± 1.32 (IIPM), 5.14 ± 1.24 (IM), and 12.2 ± 1.17 (IIM) years in mandible. The mean age of eruption obtained in maxilla of girls were 7.46 ± 1.2 (CI), 8.54 ± 1.1 (LI), 11.2 ± 1.1 (C), 10.5 ± 1.3 (IPM), 11.21 ± 1.19 (IIPM), 5.4 ± 1.07 (IM), and 12.3 ± 1.02 (IIPM) years and 6.9 ± 0.92 (CI), 7.9 ± 1.07 (LI), 10.5 ± 1.3 (C), 11.21 ± 1.19 (IPM), 11.5 ± 1.32 (IIPM), 5.18 ± 1.24 (IM), and 11.9 ± 1.17 (IIM) years respectively in mandible [Table 4].
Table 4: Comparison of mean age of eruption of teeth in males and females

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In the 5-year age group none of the permanent tooth had erupted in both boys and girls. In the age group of 14 years all the permanent teeth except third molars had erupted. Teeth in the maxillary arch erupted earlier in girls than boys. Mandibular central incisor, second premolar, and first molar erupted earlier in boys than girls. Mandibular canine, first premolar, and second molar erupted earlier in girls than boys [Table 4].

Eruption of maxillary and mandibular teeth in boys was compared. The central incisor, lateral incisor, canine, second premolar, first molar, and second molar erupted earlier in mandible. The first premolar erupted earlier in the maxilla. In girls, the central incisor, lateral incisor, canine, first molar, and second molar erupted earlier in the mandible. The first premolar and second premolar erupted earlier in the maxilla [Table 5].
Table 5: Comparison of mean age of eruption of maxillary and mandibular teeth

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In boys, the mean age of eruption between right and left maxillary and right and left mandibular teeth were compared. In the maxilla, teeth erupted at the same time on both the sides but the left central incisor showed early eruption than right central incisor. In the mandible, right second premolar erupted earlier than the left. In girls, maxillary left central incisor erupted earlier than maxillary right central incisors. Maxillary right first premolar showed early eruption than the left. In the mandible, right central incisor and canine erupted earlier than the left and left second premolar and first molar erupted earlier than right [Table 6].
Table 6: Comparison of mean age of eruption between right and left maxillary and right and left mandibular teeth

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   Discussion Top


The timing of eruption of permanent teeth has been studied among different ethnic groups and within the same ethnic group by several researchers. A variation in the sequence of tooth emergence in both dentitions adds to the difficulties in establishing the dental age. Tooth eruption time must be based upon a mean with wide latitude of variation for individual cases as suggested by Steggerda and Hill. [9]

According to Dahlberg and Menagaz-Bock the cross-sectional method is preferable to the longitudinal method because it is amenable to include larger samples, thereby yielding results that are more representative of the population. Also the risk of bias is smaller than in the longitudinal studies. [9]

When biological responses are plotted against their causal stimuli, they often form a sigmoid curve. Sigmoid relationships can be linearized by transformations such as, probit. For most study systems the probit (normal sigmoid) gives the most closely fitting result. Probit transformation also helps in calculating the average eruption of permanent teeth and helps in determining the percentage of subjects in whom the tooth was present at specific levels. [10]

According to Heidmann, [11] probit analysis was the best method of analyzing tooth eruption than any other method. In the present study, probit analysis was applied for the estimation of mean age of eruption of permanent dentition.

The mean age of eruption of permanent teeth obtained from the study was comparable with various studies across the world when standard deviation is considered [Table 7].
Table 7: Comparision of eruption times of permanent teeth with previous studies

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In this study, early eruption of both maxillary and mandibular first molars was observed in both the sexes. It was opined that premature loss of deciduous molars due to high caries risk is generally expected to cause accelerated emergence of the permanent successors and other teeth in the posterior segment. [12]

When comparison of tooth emergence pattern in the maxillary arch among boys and girls was done, it was observed that maxillary teeth erupted earlier in girls. P values were statistically significant in all the teeth except in maxillary canine, second premolar, and second molar. In the mandible, the central incisor, second premolar, and first molar erupted earlier in boys than girls. It is also evident from the present study that premolars erupted earlier in boys than girls. This was in concurrence with the study conducted by Bogaerts. [13]

Mandibular canine, first premolar, and second molar erupted earlier in girls than boys. P values were statistically significant in all the mandibular teeth except mandibular canine, second premolar, and second molar. There was no difference between timing of calcification at early stages between males and females. However, in females there was an earlier completion of the root formation and apical closure, which may lead to accelerated eruption. Niswander and Sujaku linked the trend of earlier growth in girls with a general advancement in physical development. In girls, an increase in speed with which peak height is reached and a decrease in the age at which menarche occurs has been demonstrated in both western and Japanese girl children. [14]

The present study shows overall early eruption of permanent teeth in females than in males and this findings is in agreement with Hoffding et al., [14] Magnusson, [15] and Savara. [16] It is clear from the present study that mandibular teeth erupted earlier than their maxillary counterparts with minor discrepancies. This is in agreement with the studies of Lee et al. [17] and Hoffding et al. [14]

The sequence of eruption observed in boys was 6-1-2-4-5-3-7 in maxilla and 6-1-2-4-5-3-7 in mandible. Sequence of eruption observed in girls was 6-1-2-4-5-3-7 in maxilla and 6-1-2-4-3-5-7 in mandible. Sequence of eruption of maxillary teeth in males and females is in agreement with Logan and Kronfeld, [18] Helm, [19] Savara, [16] and Ommar et al. [20] According to Logan and Kronfeld, [18] eruption sequence of males in mandible is 6-1-2-3-4-5. According to the present study, it is 6-1-2-4-5-3-7. In males, canine erupted last in the sequence. This may be due to premature eruption of premolars, which is in turn due to early loss of deciduous molars due to caries experience. Sequence of eruption of mandibular teeth in females is in agreement with Lee et al. [17] According to Knott, [21] the fourth tooth to commonly erupt is the first premolar in the maxillary arch and the canine in the mandibular arch. However, the present study is in within this finding. The most common fourth tooth to erupt in the mandibular arch is the first premolar and not the canine in both males and females.

In the present study, the number of children surveyed falling in the age group of 5 were only 76, and it was observed that none of the permanent teeth were erupted in the children of this age group. Therefore, this result cannot be generalized for the entire population.

An Indian cross sectional study conducted by Sharma et al., including 483 children concluded that eruption of permanent teeth was earlier in females than males but there was no change in sequence of eruption. Mandibular teeth emerged earlier than their maxillary counterparts. [22]


   Conclusion Top


The mean ages of eruption obtained in the present study are strikingly comparable with those of other investigators in different populations across the world. Environmental, geographical, racial factors and secular trends may not have a major role to play in influencing the eruption of teeth. However, further studies considering may explore the possibilities of any such associations.

Since the current study involved a large sample of children, the data reported in this study could be used as standards when assessing permanent tooth eruption in Indian children.

 
   References Top

1.Ash MM, Nelson SJ. Development and Eruption of teeth. In: Dental Anatomy, Physiology and occlusion. 8 th Ed. St Louis: Elsevier; 2003. p. 49-51.  Back to cited text no. 1
    
2.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. 2
    
3.Leroy R, Bogaerts K, Lesaffre E, Declerck D. The effect of fluorides and caries in primary teeth on permanent teeth emergence. Community Dent Oral Epidemiol 2003;31:463-70.  Back to cited text no. 3
    
4.Baccetti T. Tooth anomalies associated with failure of eruption of first and second permanent molars. Am J Orthod Dentofacial Orthop 2000;118:608-10.  Back to cited text no. 4
    
5.Rousset MM, Boualam N, Delfosse C, Roberts WE. Emergence of permanent teeth: Secular trends and variance in a modern sample. J Dent Child (Chic) 2003;70:208-14.  Back to cited text no. 5
    
6.Arya VK. Oral Health Survey Basic Methods. 4 th Ed. World Health Organization. Geneva: A.I.T.B.S Publishers and Distributors; 1999.  Back to cited text no. 6
    
7.Peter S, editor. Essentials of preventive and community dentistry. New Delhi: Arya Publishing House; 2009. p. 292.  Back to cited text no. 7
    
8.Moslemi M. An epidemiological survey of the time and sequence of eruption of permanent teeth in 4-15-year-olds in Tehran, Iran. Int J Paediatr Dent 2004;14:432-8.  Back to cited text no. 8
    
9.Mahima VG, Balaji Rao B. Emergence time of permanent teeth - An epidemiological study. Dissertation submitted to the Kuvempu University, Davangere, Karnataka, 1997 [Unpublished data].  Back to cited text no. 9
    
10.Kim Vincent. Probit Analysis. Available from: http://userwww.sfsu.edu/~efc/classes/biol710/probit/ProbitAnalysis.pdf [Last cited 2010 on Jan 2].  Back to cited text no. 10
    
11.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. 11
    
12.Hägg U, Taranger J. Dental development, dental age and tooth counts. Angle Orthod 1985;55:93-107.  Back to cited text no. 12
    
13.Leroy R, Bogaerts K, Lesaffre E, Declerck D. Impact of caries experience in the deciduous molars on the emergence of successors. Eur J Oral Sci 2003;111:106-10.  Back to cited text no. 13
    
14.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. 14
    
15.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. 15
    
16.Savara BS, Steen JC. Timing and sequence of eruption of permanent teeth in a longitudinal sample of children from Oregon. J Am Dent Assoc 1978;97:209-14.  Back to cited text no. 16
    
17.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. 17
    
18.Ash MM. Wheeler's text book of dental anatomy, physiology and occlusion. 6 th Ed. Philadelphia: WB Saunders Company; 1988. p. 23-33.  Back to cited text no. 18
    
19.Helm S, Seidler B. Timing of permanent teeth emergence in Danish children. Community Dent Oral Epidemiol 1974;2:122-9.  Back to cited text no. 19
    
20.Ommar SM. Occlusal status and permanent teeth eruption in Libyan children. J Indian Soc Pedod Prev Dent 1994;12:1-6.  Back to cited text no. 20
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21.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. 21
    
22.Sharma K, Mittal S. Permanent tooth emergence in Gujjars of Punjab, India. Anthropol Anz 2001;59:165-78.  Back to cited text no. 22
    

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Correspondence Address:
Karthikeya Patil
Department of Oral Medicine and Radiology, JSS Dental College and Hospital, Mysore, Karnataka
India
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DOI: 10.4103/0970-9290.94568

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]

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