Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
HOME | ABOUT US | EDITORIAL BOARD | AHEAD OF PRINT | CURRENT ISSUE | ARCHIVES | INSTRUCTIONS | SUBSCRIBE | ADVERTISE | CONTACT
Indian Journal of Dental Research   Login   |  Users online: 1731

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         

 


 
Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 5  |  Page : 697-698
Prevalence of developmental defects of enamel in children and adolescents with asthma: A cross-sectional study


Department of Pediatric Dentistry, Meenakshi Ammal Dental College, Maduravoyal, Chennai, Tamil Nadu, India

Click here for correspondence address and email

Date of Submission20-Jul-2011
Date of Decision28-Dec-2011
Date of Acceptance04-Feb-2012
Date of Web Publication19-Feb-2013
 

   Abstract 

Aim: The aim of this study was to evaluate the prevalence of developmental defects of enamel in children with asthma and its relation to specific characteristics of disease such as symptom onset, asthma severity and treatment initiation in pediatric asthma patients.
Materials and Methods: Children and adolescents (104 asthma patients and 104 control subjects), 7-14 years of age and residents of the city of Chennai were enrolled in the study. Medical and dental histories were obtained through the use of structured questionnaire. Each participant underwent a dental examination in which the examiner applied the modified developmental defect index.
Results: The prevalence of DDE in this study was as follows: of the 104 asthma group subjects, 80 (76.9%) presented with dental enamel defects, compared with only 28 (26.9%) of those in the control group. Using multivariate logistic regression analysis, the estimated risk of DDE in permanent dentition was 12 times higher in pediatric subjects with asthma than in those without asthma (OR - 12.526, P = 0.001). The occurrence of dental enamel defects correlated with greater asthma severity (P = 0.001) and earlier symptom onset (P = 0.001). However, dental enamel defects did not correlate with the timing of the initiation of treatment (P = 0.041).
Conclusion: Pediatric asthma patients with severe, early onset asthma are at increased risk of dental enamel defects and therefore require priority dental care.

Keywords: Adolescents, asthma, children, developmental defects of enamel

How to cite this article:
Visweswar VK, Amarlal D, Veerabahu R. Prevalence of developmental defects of enamel in children and adolescents with asthma: A cross-sectional study. Indian J Dent Res 2012;23:697-8

How to cite this URL:
Visweswar VK, Amarlal D, Veerabahu R. Prevalence of developmental defects of enamel in children and adolescents with asthma: A cross-sectional study. Indian J Dent Res [serial online] 2012 [cited 2020 Aug 6];23:697-8. Available from: http://www.ijdr.in/text.asp?2012/23/5/697/107432
Asthma is a serious global health problem affecting more than 100 million people worldwide. [1] Bronchial asthma is a common, chronic inflammatory disorder of the airways characterized by variable airflow obstruction and airway hyper responsiveness. [2],[3] Multiple causative factors including familial, infectious, allergic, socioeconomic, psychosocial and environmental have been reported. [4],[5] Although asthma affects people of all ages, most cases of asthma begin in the childhood and peak prevalence occurs between the ages of six and eleven years. [6] Childhood asthma is common and its prevalence is increasing in most countries of the world. [7] Considering that asthma is such a common disorder affecting children, limited studies have investigated the effects of asthma on oral environment. The literature also reports that for those children with asthma the prevalence of dental caries is higher than in those without asthma. [8] This increase in caries prevalence is in part associated with both altered salivary composition and salivary flow.There have also been reports suggesting that respiratory disorders are associated with dental enamel defects. [9]

Dental enamel defects have been associated with a broad spectrum of etiologies including systemic, genetic, local and environmental factors. [10] Studies have stated that systemic conditions such as perinatal, prenatal, postnatal illness, low birth weight, regular antibiotic consumption, coeliac disease and respiratory disorders are associated with dental enamel defects. [11],[12],[13],[14] Jalevik et al. (2001) [10] reported a positive relationship between asthma and developmental defects of enamel in permanent teeth. Van Amerongen et al. (1995) [14] and Narang et al. (2003) [15] reported that asthma is associated with the occurrence of developmental defects in permanent teeth. Epidemiological studies of enamel defects in children with systemic disease are quite important for public health, since they can identify possible etiological factors responsible for the occurrence of the enamel defects, as well as identifying populations that merit priority preventive interventions. [11] Hence the aims of the study were to evaluate the prevalence of developmental defects of enamel in children and adolescents with asthma and to find the correlation between the developmental defects of enamel and specific characteristics of disease such as symptom onset, asthma severity and treatment initiation.


   Materials and Methods Top


This cross-sectional study was planned in the Department of Pediatric and Preventive Dentistry Meenakshi Ammal Dental College Chennai, to evaluate the prevalence of developmental defects of enamel in children and adolescents with asthma. The study proposal was approved by the institutional review board of Meenakshi Academy of Higher Education and Research.Two hundred and eight children aged 7- 14 years from Chennai, India, were enrolled in the study. The participants were divided into two groups.

Group I - The study group included 104 children diagnosed with asthma attending the various pediatric chest clinics: outpatient department at Kanchi Kama Koti Child Trust hospital, Mehta Children hospital and a private pediatric pulmonologist clinic in Chennai. Prior consent was obtained from the respective hospital authorities to conduct the study.These children were either under continuous treatment with corticosteroids or using bronchodilators for acute attacks of asthma.

Group II consisted of 104 children selected from Arulmigu Meenakshi Ammal Higher Secondary School Chennai. Subjects selected in the control group were free from any systemic disease. Prior to the study, letters explaining the nature of the study and informed parental consent for the child's participation were obtained.

The inclusion criteria were as follows: Children in age group of 7 - 14 years and medical diagnosis of asthma confirmed by pediatrician. The exclusion criteria were as follows: presence of any other systemic disease, presence of fixed orthodontic appliance and extensive carious lesion that might mask dental enamel defects.

A general questionnaire related to personal, medical and dental history completed by all children and adolescents with the assistance of their parents or legal guardians was used. Children were examined at the hospital outpatient department, seated on an ordinary chair. The teeth were dried using cotton swabs and examined under natural light. The developmental defects of enamel were recorded in the modified developmental defects of enamel index form. All examinations were conducted by a single trained examiner using modified developmental defects of enamel index as recommended by World Health Organization. A trained recording clerk assisted the examiner in the survey.

Developmental defects of enamel Index (DDE) given by J Ainamus and T.W. Cutress (1977) [16] and modified by Clarkson J and O' MullaneD in (1989) [17] was used in the study. In this index all enamel defects regardless of location or size were recorded, being classified as: Absent- Normal condition, Demarcated opacities - white / yellow - single/multiple, Diffuse opacities - parallel lines or with a patchy distribution, Hypoplasia - pits, grooves or larger areas of missing enamel - single/ multiple.

Statistical analysis was performed using the program Statistical Package for the Social Sciences (SPSS Inc, Version 16, USA). For all statistical tests, a confidence interval of 95% and significance level of 5% (P £ 0.05) was adopted. Pearson Chi-Square test was used to compare the prevalence of developmental defects of enamel in the asthma group with the control group. Logistic regression was used in order to assess the risk of dental enamel defects in a multivariate analysis.


   Results Top


A total of 208 children aged 7-14 years were examined in this study, of which 62 (59.6%) were males and 42 (40.4%) were females in the study group and in control group 55 (52.9%) were males and 49 (47.1%) were females. There was no statistically significant difference between males and females (P > 0.05) as shown in [Table 1]. [Table 2] shows age wise distribution of samples in study and control groups. There was no statistically significant difference between the age group in both the groups (P > 0.05).
Table 1: Distribution of sample according to gender


Click here to view
Table 2: Distribution of sample according to age


Click here to view


Teeth free of dental enamel defects were seen in only 24 (23.1%) of the study group subjects and 76 (73.1%) of the control group subjects. Permanent tooth developmental defects of enamel were observed in 80 (76.9%) of the asthma group subjects and 28 (26.9%) of the control group subjects. [Table 3]. This was significant at a level of (P = 001). Demarcated opacities, which were observed in 46 asthma group subjects (44.2%) and 25 control group subjects (24%), constituted the most prevalent enamel defect observed in this population as shown in [Table 3].
Table 3: Individual prevalence of developmental defects of enamel in study and control group

Click here to view


The occurrence of developmental defect of enamel correlated with symptom onset (P = 0.001) and with asthma severity (P = 0.001), as shown in [Table 4] and [Table 5], respectively. Logistic regression revealed that the risk of dental enamel defects is approximately 12 times higher for children with asthma as shown in [Table 6]. The occurrence of dental enamel defects was not found to correlate with the timing of initiation of treatment (P = 0.041).
Table 4: Individual prevalence of dental enamel defects according to symptom onset in study group

Click here to view
Table 5: Prevalence of dental enamel defects according to asthma severity in study group

Click here to view
Table 6: Occurrence of dental enamel defects in the permanent teeth of children and adolescents presenting asthma

Click here to view



   Discussion Top


Ameloblasts are known to be very sensitive to a wide range of systemic and genetic disturbances during their secretory phase and are unable to recover once they are damaged. Thus tooth enamel can act like a fossil record or a repository of information, of the systemic insults which may have occurred during the tooth development. These disturbances of ameloblast function then present clinically as developmental defects of enamel. [18] It is known that respiratory illness during the first 3 years of life can lead to a lack of oxygen in active ameloblasts and it has been reported for example, that children with bronchial asthma demonstrated a higher prevalence of enamel hypolplasia than do non-affected children. [19]

The results of this study are similar to the previous studies done by Jalevik et al. (2001), [10] Gurgolette et al. (2009), [20] Arrow et al. (2009) [21] who did not find any statistical significance between the gender of the sample. Therefore, the prevalence of developmental defects of enamel was found to be higher in children with asthma (study group) 76.9%,than in the control group 26.9%.and the results were highly statistically significant (P = 0.001) This is in agreement with previous studies done by Suckling et al. (1987) [22] who reported a prevalence of 35% in New Zealand population, Jalevik et al. (2001) [10] who found a prevalence of 18.4% in Swedish population, Lukinmaa et al. (2001) [23] who reported a prevalence of 19.3% in Finland population, Jusulaiyte et al.(2007) [24] who reported a prevalence of 14.3% in Dutch population, Arrow et al. (2008) [25] who reported a prevalence of 22% in Australian population, Lygidakis et al. (2008) [26] who found a prevalence of 10.2% in Greece population, Gurgelotte et al. (2009) [20] who found a prevalence of 89.7% in Brazilian population and Jindhal et al. (2011) [18] who reported a prevalence of 40.9% among special needs children. In the present study logistic regression analysis revealed that the risk of dental enamel defects is approximately 12 times higher for children with asthma. The strong association between asthma and developmental defects of enamel was shown with increased odds ratio and highly statistically significant values (P = 0.001). This was in accordance with previous studies done by Jalevik et al. (2001) [10] who reported an odds ratio of 24 and Gurgelotte et al. (2009) [20] who reported an odds ratio of 11.

In the present study the most prevalent dental enamel defects observed were demarcated opacities. These were observed in 44.2% of study group i population. This was similar to Gurgelotte et al. (2009) [20] who reported an incidence of 54% of demarcated opacities in p Brazilian asthmatic children. Van Amerongen et al. (1995) [14] and Seow et al. (1996) [15] also observed a positive correlation between respiratory disorder such as asthma and the presence of demarcated opacities in permanent teeth. Mathu-Muju et al. (2006) [27] reported that the risk of dental enamel defects is higher in children with poor health during the first 3 years of life, a critical period for crown formation of first permanent molars, incisors and canines.

In this study the severity of asthma was correlated with the prevalence of developmental defects of enamel [Table 5]. The results were highly statistically significant (P = 0.001) with the risk being greater in moderate to severe asthma group who had a prevalence of developmental defects of enamel of 84.7% compared to the children of the mild asthma group, 66.6%. This was similar to that reported by Gurgelotte et al. (2009) [20] who recorded a prevalence of 100% in moderate asthma group (P = 0.001).


   Conclusions Top


Pediatric asthma patients with severe and early onset asthma are at increased risk of dental enamel defects and therefore require priority dental care. We would like to put forward recommendations for parents to better provide optimal oral health for their asthmatic children.

  • The first dental visit to be arranged by the age of one and thorough routine preventive measures to be commenced at this time. This should include when appropriate, periodic topical fluoride applications, meticulous oral hygiene instruction, dietary advice and sealant placements for posterior teeth.
  • Parents are advised that sweetened medications are preferably taken at mealtimes rather than between meals or before bed time. Also it is requested to use a spacer with inhalers.
  • The importance of thoroughly rinsing the mouth with water after all medications should be emphasized to the parents.
  • Parents are asked to request sugar-free medications where practicable or use tablets or capsules.
  • To avoid toothpaste containing peppermint which causes shortness of breath and bronchospasm in some patients. (Spurlock 1990). [28]


Pediatricians are usually the first to come in contact with the asthmatic children. Hence they should stress on a thorough dental checkup to start preventive and therapeutic management.

 
   References Top

1.Steinbacher DM, Glick M. The dental patient with asthma. An update and oral health considerations. J Am Dent Assoc 2001;132:1229-39.  Back to cited text no. 1
[PUBMED]    
2.David MM, Carol AP, Ashizawa A, Nixon LL. Surveillance for asthma - United States, 1960-1995. MMWR CDC Surveill Summ 1998;47:2-12.  Back to cited text no. 2
    
3.Sheffer AL, Taggart VS. The national asthma education program: Expert panel report guidelines for the diagnosis and management of asthma. Med Care 1993;31:20-8.  Back to cited text no. 3
[PUBMED]    
4.Weiss KB, Gregen PJ, Wagner DK. Breathing better or wheezing worse? The changing epidemiology of asthma morbidity and mortality. Annu Rev Public Health 1993;14:491-513.  Back to cited text no. 4
    
5.Barbee RA, Dodge R, Lebowitz ML. The epidemiology of asthma. Chest 1985;87:21-5.  Back to cited text no. 5
    
6.Taylor WR, Newacheck PW. Impact of childhood asthma on health. Pediatrics 1992;90:657-62.  Back to cited text no. 6
[PUBMED]    
7.Lenney W. The burden of pediatric asthma. Pediatr Pulmonol 1997;15:13-6.  Back to cited text no. 7
[PUBMED]    
8.Hyappa T, Paunio K. Oral health and salivary factors in children with asthma. Proc Finn Dent Soc 1979;75:7-10.  Back to cited text no. 8
    
9.Kellerhoff NM, Lussi A. Molar - incisor hypomineralization. Schweiz Monatsschr Zahnmed 2004;114:243-53.  Back to cited text no. 9
[PUBMED]    
10.Jalevik B, Noren JG, Klingberg G, Barregard L. Etiologic factors influencing the prevalence of demarcated opacities in permanent first molars in a group of Swedish children. Eur J Oral Sci 2001;109:230-4.  Back to cited text no. 10
    
11.Dini EL, Holt RD, Bedi R. Prevalence of caries and developmental defects of enamel in 9-10 year old children living in areas in Brazil with differing water fluoride histories. Br Dent J 2000;188:146-9.  Back to cited text no. 11
[PUBMED]    
12.Beentjes VE, Weerheijm KL, Groen HJ. Factors involved in the aetiology of molar-incisor hypomineralisation (MIH). Eur J Paediatr Dent 2002;3:9-13.  Back to cited text no. 12
[PUBMED]    
13.Weerheijm KL, Jalevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res 2001;35:390-1.  Back to cited text no. 13
    
14.Van Amerongen WE, Kreulen CM. Cheese molars: A pilot study of the etiology of hypocalcifications in first permanent molars. ASDC J Dent Child 1995;62:266-9.  Back to cited text no. 14
[PUBMED]    
15.Narang A, Maguire A, Nunn JH, Bush A. Oral health and related factors in cystic fibrosis and other chronic respiratory disorders. Arch Dis Child 2003;88:702-7.  Back to cited text no. 15
[PUBMED]    
16.Ainamus J, Cutress TW. A review of the developmental defects of enamel index (DDE index). Commission on oral health, research and epidemiology. Report of a FDI Working Group. Int Dent J 1982;42:411-26.  Back to cited text no. 16
    
17.Clarkson J, O'Mullane D. A modified DDE index for use in epidemiological studies of enamel defects. J Dent Res 1989;68:445-50.  Back to cited text no. 17
[PUBMED]    
18.Jindal C, Palaskar S, Kler S. Prevalence of the developmental defects of enamel in a group of 8-15 years old Indian children with developmental disturbances. J Clin Diagn Res 2011;5:669-73.  Back to cited text no. 18
    
19.Lai PY, Seow KW, Tudehope Y. Enamel hypoplasia and dental caries in very-low birthweight children: A case-control, longitudinal study. Pediatr Dent 1997;19:42-9.  Back to cited text no. 19
    
20.Guergolette RP, Dezan CC, Frossard WT, Ferreira FB, Neto AC, Fernandes KB. Prevalence of developmental defects of enamel in children and adolescents with asthma. J Bras Pneumol 2009;35:293-4.  Back to cited text no. 20
    
21.Arrow P. Risk factors in the occurrence of enamel defects of the first permanent molars among school children in western Australia. Community Dent Oral Epidemiol 2009;37:405-15.  Back to cited text no. 21
[PUBMED]    
22.Suckling GW, Herbison GP, Brown RH. Etiological factors influencing the prevalence of developmental defects of dental enamel in nine-year old New Zealand children participating in a health and development study. J Dent Res 1987;66:1466-9.  Back to cited text no. 22
[PUBMED]    
23.Lukinmaa PL, Leppaeniemi A, Alaluusua S. Nonfluoride hypomineralizations in the first molars and their impact on the treatment need. Caries Res 2001;35:36-40.  Back to cited text no. 23
    
24.Jasulaityte L, Veerkamp KL, Weerhejim KL. Molar incisor hypomineralisation: Review and prevalence data from a study of primary school children in Kaunas. Eur Arch Paediatr Dent 2007;8:87-94.  Back to cited text no. 24
    
25.Arrow P. Prevalence of developmental enamel defects of the first permanent molars among school children in Western Australia. Aust Dent J 2008;53:250-9.  Back to cited text no. 25
[PUBMED]    
26.Lygidakis NA, Dimou G, Briseniou E. Molar incisor hypomineralisation retrospective study in Greek children. Prevalence and defect characteristics. Eur Arch Paediatr Dent 2008;9:200-6.  Back to cited text no. 26
[PUBMED]    
27.Mathu-Muju K, Wright JT. Diagnosis and treatment of molar incisor hypomineralization. Compend Contin Educ Dent 2006;27:604-10.  Back to cited text no. 27
[PUBMED]    
28.Spurlock BW, Dailey TM. Shortness of breath: Toothpaste induced brochospasm. N Engl J Med 1990;323:1845-6.  Back to cited text no. 28
[PUBMED]    

Top
Correspondence Address:
Vaibhav Kenchamba Visweswar
Department of Pediatric Dentistry, Meenakshi Ammal Dental College, Maduravoyal, Chennai, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.107432

Rights and Permissions



 
 
    Tables

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

This article has been cited by
1 Enamel defects and tooth eruption disturbances in children with sickle cell anemia
Caroline Maria Igrejas LOPES,Marília Cabral CAVALCANTI,Ana Cláudia ALVES E LUNA,Kátia Maria Gonçalves MARQUES,Maria José RODRIGUES,Valdenice Aparecida DE MENEZES
Brazilian Oral Research. 2018; 32(0)
[Pubmed] | [DOI]
2 Enamel defects and tooth eruption disturbances in children with sickle cell anemia
Caroline Maria Igrejas LOPES,Marília Cabral CAVALCANTI,Ana Cláudia ALVES E LUNA,Kátia Maria Gonçalves MARQUES,Maria José RODRIGUES,Valdenice Aparecida DE MENEZES
Brazilian Oral Research. 2018; 32(0)
[Pubmed] | [DOI]
3 Developmental defects of enamel in first permanent molars associated with use of asthma drugs in preschool aged children: A retrospective case-control study
A. Mastora,G. Vadiakas,A. Agouropoulos,P. Gartagani-Panagiotopoulou,V. Gemou Engesaeth
European Archives of Paediatric Dentistry. 2017; 18(2): 105
[Pubmed] | [DOI]
4 Developmental defects of enamel in first permanent molars associated with use of asthma drugs in preschool aged children: A retrospective case-control study
A. Mastora,G. Vadiakas,A. Agouropoulos,P. Gartagani-Panagiotopoulou,V. Gemou Engesaeth
European Archives of Paediatric Dentistry. 2017; 18(2): 105
[Pubmed] | [DOI]
5 Drugs related to the etiology of molar incisor hypomineralization
Clara Serna,Ascensión Vicente,Christian Finke,Antonio J. Ortiz
The Journal of the American Dental Association. 2016; 147(2): 120
[Pubmed] | [DOI]



 

Top
 
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
    Materials and Me...
   Results
   Discussion
   Conclusions
    References
    Article Tables

 Article Access Statistics
    Viewed3077    
    Printed100    
    Emailed7    
    PDF Downloaded158    
    Comments [Add]    
    Cited by others 5    

Recommend this journal