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CLINICAL DENTISTRY AND RESEARCH 2016; 40(3): 123-129 Original Research Article
EVALUATION OF TREATMENT NEEDS OF PERMANENT FIRST
MOLAR TEETH IN A GROUP OF SCHOOLCHILDREN ATTENDING TO
UNIVERSITY DENTAL CLINICS IN ANKARA AND ISTANBUL
Banu Öter, DDS, PhD
Dr, Baskent University,
İstanbul Research and Training Hospital,
Istanbul, Turkey
Resmiye Ebru Tirali DDS, PhD
Associate Professor, Baskent University,
Faculty of Dentistry, Department of Pedodontics,
Ankara, Turkey
Sevi Burçak Çehreli DDS, PhD
Professor, Baskent University,
Faculty of Dentistry, Department of Pedodontics,
Ankara, Turkey
ABSTRACT
Background and Aim: The permanent first molar teeth (PFM)
have a great importance because of playing a key role in occlusion.
The aim of this study is to evaluate caries prevalance and
treatment needs of first molar teeth in a group of schoolchildren
attending to the university’s dental clinics in Ankara and Istanbul.
Material and Methods: In this multi-centered retrospective
study, records of 507 children aged between 6-12 (mean age
9.39±1.47) who attended to Başkent University Dental Faculty
Department of Pedodontics (Ankara) and Başkent University
Istanbul Hospital (Istanbul) were evaluated and dft, DMFT and
treatment need index (TNI) were detected. One way ANOVA
with Tukey’s multiple comparison tests, independent t tests and
extension of Fisher’s exact test to r x c contingency table were
performed.
Results: Mean dft, DMFT scores were found 3.44±2.93,
1.35±1.72 in boys, and 3.24±2.94, 1.57±1.74 in girls respectively.
Totally 2028 PFM teeth radiograph were examined, 20% needed
fissure sealant, 21% needed one surface, 5% needed two surface
restoration, 3% needed endodontic treatment, 0.2% extraction,
0.8% needed prosthetic treatment. When the study group was
evaluated in three different age groups, DMF scores of first molars
in 6-8 ages were found statistically lower than 9-10 and 11-12
age groups (p<0.001).
Conclusion: According to the results obtained from schoolage
children attending to the university dental clinics in two different
cities, caries threatens first molar health severely. The treatment
need increases with age, thus, as soon as molars erupt, preventive
procedures are of great importance.
Correspondence
Banu Öter
Clin Dent Res 2016: 40(3): 123-129
İstanbul Research and Training Hospital
Baskent University, Istanbul, Turkey
Mahir Iz St. 43 34662 Altunizade/Istanbul-Turkey
Phone: +90 216 651 51 53
Fax: +90 651 38 82
Cellular phone: +90 532 681 96 17
E-mail: [email protected]
Keywords: Children, Permanent First Molar, Treatment
Needs
Submitted for Publication: 03.15.2016
Accepted for Publication : 11.22.2016
123
CLINICAL DENTISTRY AND RESEARCH 2016; 40(3): 123-129
Orijinal Araştırma
ANKARA VE İSTANBUL’DA ÜNİVERSİTE DİŞ KLİNİKLERİNE
BAŞVURAN BİR GRUP OKUL ÇAĞI ÇOCUKLARINDA SÜREKLİ
BİRİNCİ BÜYÜK AZI DİŞLERİNİN TEDAVİ GEREKSİNİMİNİN
DEĞERLENDİRİLMESİ
Banu Öter
Dr., Başkent Üniversitesi, İstanbul Sağlık Uygulama ve
Araştırma Merkezi Hastanesi, Ağız ve Diş Sağlığı Polikliniği
İstanbul, Türkiye
Resmiye Ebru Tirali
Doç. Dr., Başkent Üniversitesi,
Diş Hekimliği Fakültesi, Pedodonti Anabilim Dalı,
Ankara, Türkiye.
Sevi Burçak Çehreli
Prof. Dr., Başkent Üniversitesi,
Diş Hekimliği Fakültesi, Pedodonti Anabilim Dalı,
Ankara, Türkiye.
ÖZ
Amaç: Birinci büyük azı dişleri okluzyonda kilit bir rol oynadığından
büyük öneme sahiplerdir. Bu çalışmanın amacı, İstanbul ve Ankara
illerinde üniversitenin diş kliniklerine başvuran bir grup okulçağı
çocuklarında birinci büyük azı dişlerinin çürük prevalansını ve tedavi
indekslerini değerlendirmektir.
Gereç ve Yöntem: Bu çok merkezli retrospektif çalışmada, Başkent
Üniversitesi Diş Hekimliği Fakültesi Pedodonti Anabilim Dalı’na
(Ankara) ve Başkent Üniversitesi İstanbul Hastanesi’ne (İstanbul)
başvuran ve yaşları 6-12 (ort 9.39±1.47) arasında değişen 507
çocuğun ilk muayene kayıtları incelenmiştir ve dft, DMFT ve tedavi
gereksinimi indeksi (TGİ) belirlenmiştir. Tek yönlü varyans (ANOVA)
analizi ve çoklu karşılaştırma için Tukey testi, bağımsız t testi ve rxc
kontenjans tablolarına göre Fisher’s exact testleri yapılmıştır.
Bulgular: Ortalama dft, DMFT değerleri erkeklerde sırasıyla
3.44±2.93, 1.35±1.72 ve kızlarda 3.24±2.94, 1.57±1.74 belirlendi.
Toplam 2028 adet birinci büyük azı dişinin radyografları incelendi,
bu dişlerin %20’sinde fissür örtücü gereksinimi, %21’inde bir yüzlü
restorasyon, % 5’inde iki yüzlü restorasyon, %3’ünde endodontik
tedavi, %0.2’sinde çekim ve %0.8’inde protetik tedavi gereksinimi
bulunduğu kaydedildi. Üç farklı yaş grubu değerlendirildiğinde, 6-8
yaşları arasındaki çocuklarda DMF değerleri 9-10 ve 11-12 yaş
gruplarına göre anlamlı derecede (p<0.001) düşük görüldü.
Sorumlu Yazar
Banu Öter
Başkent Üniversitesi,
İstanbul Sağlık Uygulama ve Araştırma Merkezi Hastanesi,
Ağız ve Diş Sağlığı Polikliniği Mahir İz Cad.
No:43 34662
Altunizade/İstanbul-Türkiye
Telefon: +90 216 651 51 53
Fax: +90 651 38 82
Gsm: +90 532 681 96 17
E-mail: [email protected]
124
Sonuç: İki büyük ve farklı şehirde bulunan üniversite kliniklerine
başvuran okulçağı çocuklarından elde edilen bilgilere göre, diş
çürüklerinin birinci büyük azı dişlerinin sağlığını önemli derecede
tehdit ettiği görülmüştür. Tedavi ihtiyacı yaşla birlikte artmaktadır,
bu nedenden azı dişleri sürer sürmez koruyucu uygulamalar büyük
önem taşımaktadır.
Clin Dent Res 2016: 40(3): 123-129
Anahtar Kelimeler: Çocuklar, Birinci Büyük Azı Dişleri,
Tedavi İhtiyacı
Yayın Başvuru Tarihi : 15.03.2016
Yayına Kabul Tarihi : 22.11.2016
A multi-centered retrospective study
INTRODUCTION
Dental caries and periodontal diseases are important
microbiologic diseases that threaten oral health in many
countries, especially the developing ones. Since 1980s,
a decline has been reported in the prevalence of dental
caries by developed countries.
1,2
The situation was linked
to a variety of factors such as (i) the increase in the use
included in the study population. The PFM was considered as
erupted once it is fully exposed to oral cavity or be suitable
to examine with an explorer without displacing soft tissues.
The records of children with systemic disease or the ones
undergoing orthodontic treatment were excluded.
Exclusion criteria
and treatment needs of PFM in a group of schoolchildren
Children with unerupted PFM and enamel hypoplasia and
history of dental trauma were excluded from the study
population.
All intraoral examinations were performed by 3 pediatric
dentists. All examiners were trained and calibrated in a
postgraduate doctorate programme in pediatric dentistry
in the diagnostic criteria guidelines based on those of the
World Health Organisation and independently carried out the
child’s oral examination for dental caries.9 The examinations
were performed according to WHO criteria with a mouth
mirror, an explorer and reflector light. In both departments,
panoramic radigraphs were taken when needed during
first appointment. Thus the researchers evaluated the
orthopantomographs (OPGs) as well. In present study OPGs
were used to aid clinical diagnosis of dental caries. According
to the WHO guidelines on epidemiological studies the use
of radiographs do not indicate diagnose dental caries 9
because of financial, ethical and practical reasons. However,
all children attending in our university dental clinics should
have radiographs taken routinely because health insurance
system requests OPGs both prior to and following treatment
of patients.
attending to university dental clinics in Istanbul and Ankara,
Ethics
of toothpastes containing fluoride, (ii) decrease in sugar
consumption (iii) the increase in socio-economic status,
preventive dental services, and personal oral hygiene
practices.
2,3
However, in developing countries which
preventive dental practice is not yet widespread, dental
health problems are still seriously effecting the population
both socially and economically. 3.4.5
The permanent first molar teeth (PFM) are commonly the
first permanent teeth to erupt in the posterior region and
they play a key role in the developing occlusion. These
teeth mostly emerge in the oral cavity at 5-7th years of life,
which is the initiation of the transition stage for permanent
dention and development of normal occlusion.3,6 PFMs are
claimed to be the most susceptible tooth to carious attack
due to several factors such as (i) deeper pit and fissures
when compared with other posterior teeth (ii) lack of
toothbrushing habits at the time they emerge (iii) patients’
lack of knowledge about these teeth are permanent teeth
which do not have a predecessor .7,8
The aim of this study was to evaluate caries prevalence
two biggest cities in Turkey. Although the data belongs to
measures.
This study was approved by Baskent University Institutional
Review Board (Project No D-KA12/05). Informed consent
forms were delivered as a routine procedure before dental
examination or interventions in both clinics.
Study population and methods
Study design
Study material
The clinical data for present study were collected by
following the general principles for Basic Oral Health
surveys of the WHO.9 Traditional dft, DMFT (WHO) and
treatment need index (TNI) were used. 10
Basic levels of treatment need were classified in seven
groups in TNI index: (1) no treatment needed; (1) preventive
treatment; fissure sealants; (3) initial conservative
restorations; one surface restorations (4) moderate
conservative restorations; two or more surface restorations
(5) invasive treatment, including pulp therapy, (6) prosthetic
restorations and (7) extractions. Children were divided into
a small group among whole population, the findings will
give light to construction and development of preventive
This is a multi-centered retrospective study, which evaluated
the records of a total of 507 children aged between 6-12
(med age 9.39±1.47) who attended to Baskent University
Dental Faculty Department of Pedodontics (Ankara) and
Baskent University İstanbul Hospital (İstanbul) between the
years 2010-2012.
Inclusion criteria
Retrospective examination records of otherwise healthy
children whose 4 permanent first molars had erupted were
125
CLINICAL DENTISTRY AND RESEARCH
different groups according to sex (boys and girls) and age
groups (6-8 and 9-10, 11-12 years). For each child, the
overall caries experience and treatment needs of both
primary and permanent teeth were calculated.
Statistical analysis
The data obtained was statistically analyzed by using
statistical package of NCSS (Number Cruncher Statistical
System) 2007 Statistical Software (Utah, USA). One
way ANOVA with Tukey’s multiple comparison tests,
independent t tests and extension of Fisher’s exact test
to r x c contingency table tests were performed. The
results were considered significant at p<0.05. Sample
size was determined with power analysis prior to study.
Accordingly,335 patients were needed for 1.9 incidence
rate, 80 power and 0,05 significance rate.
RESULTS
A total of 507 children aged between 6-12 (med age
9.39±1.47) consisting of 267 boys (52.7%) and 240
girls (47.3%) were surveyed. All the children were in the
mixed dentition. The mean dft, DMFT scores were found
3.44±2.93, 1.35±1.72 in boys, and 3.24±2.94, 1.57±1.74
in girls respectively. There was no significant difference
between genders regarding dft and DMFT (p>0.05). The
mean dft, DMFT scores according to age groups(6-8,
9-10, 11-12 ages) were shown in Table 1. The mean
caries and fillings in primary teeth was found statistically
lower (p=0.002) in 11-12 years old group compared with
mean caries and fillings in 6-8 and 9-10 years old group.
There was also significant difference in mean DMFT values
(p=0.0001) between three age groups. In 6-8 years group
mean DMFT values was significantly lower than 9-10 years
and 11-12 year (Table 1).
Table 2 shows the dental treatment needs of PFM on each
quadrant (tooth number 16, 26, 36 and 46). Treatment
need was seen in 47.9% and 48.3% of PFM 16 and 26
respectively. Although this ratio was lower in 36 and 46,
almost half of the group needed (43.4% and 41.4%) at least
one type of dental treatment.
Totally 2028 PFM teeth were examined. On assessment of
treatment need types nearly 20% of PFM needed fissure
sealant. This is followed with one surface restoration which
is the second highest treatment need (21%). The need for
pulp therapy (3%), prosthetic (0.8%) and extraction (0.2%)
treatment was minimal as compared with the need for
fıssure sealant and other conservative restorations. Lower
126
PFM needed more two surface restorations, pulp therapy
and prosthetic and extraction treatment as compared with
upper PFM (Figure 1).
There were significant differences in health, caries and clinic
status of 16, 26, 36, 46 in different ages (p<0.001). From
139 upper right molar examined, 77.7% were sound and
21.60 % had caries, 0.70 % had filling. No missing tooth was
present in 6-8 age. However healthy teeth were decreased
to 63.60%, caries teeth were increased (22.70%), 12.90
% had filling and one tooth was extracted at 11-12 age.
Overall, children at 11-12 years age showed a significantly
higher percentage of filled and missing teeth in almost
every PFM (p<0.001) (Table3).
DISCUSSION
In 1981 World Health Organisation (WHO) and the FDI World
Dental Association (FDI) released the global targets to be
achieved in terms of oral and dental health. Accordingly, by
the year 2015 it targets DMFT was to be 1.5 for children
under the age of 12.1,11 There is a limited number of studies
on assessment of caries prevalence and treatment needs
of permanent first molars in Turkey. Most of these were
conducted in cities, in dental schools at universities, and
covered a small group of children.4,5,12 According to the major
pathfinder study on oral and dental health profile conducted
in 2004, the DMFT at 12 years of age in Turkey was reported
to be 1.9, that is close to WHO European Region’s target for
the year 2000. Although there is an improvement compared
to previous years, the goals of the 21st century are still far
Figure1 Treatment need types and rates (percentage) of PFM 16, 26,
36, 46
A multi-centered retrospective study
Table 1. Mean dmft, DMFT values in different age groups 6-8, 9-10, 11-12 ages
6-8 Year
9-10 Year
11-12 Year
F
p
dft
3.65±3.02
3.6±2.95
2.55±2.68
6.50
0.002
DMFT
0.86±1.34
1.54±1.69
1.93±2
14.03
0.0001
Tukey Multiple Comparison Test
dmft
DMFT
6-8 Year / 9-10 Year
0.987
0.001
6-8 Year / 11-12 Year
0.006
0.0001
9-10 Year / 11-12 Year
0.003
0.087
t: t value obtained from t test
p: the probability value
dft: mean number of decayed (d), and filled (f) primary teeth
DMFT: mean number of decayed (D), missing (M) and filled (F) permanent teeth
Table 2. Dental treatment needs of each PFMs on each quadrant tooth number (13,26,36,46).
Treatment need
n
%
No need
264
52.1
Needed
243
47.9
No need
262
51.7
Needed
245
48.3
No need
287
56.6
Needed
220
43.4
No need
297
58.6
Needed
210
41.4
Tooth number 16
Tooth number 26
Tooth number 36
Tooth number 46
behind the group. 5 Kuvvetli SS et al.12 reported dmft score as
1.93 in a group of five year old Turkish children. Gökalp et al.5
surveyed the severity of dental caries and the periodontal
status of 7,833 Turkish children aged 5.12-15 and reported
mean dmft as 3.7, mean DMFT as 1.9 in 12-year-olds. The
present study revealed similar results with previous studies
about dental caries and in 12 years old children mean dmft
was found 0.86 and mean DMFT was found 1.93.
Most researchers showed that there was an increase in
mean dmft and DMFT in PFM with age. 6.8.13 This information
is important because knowledge about dental caries and
treatment needs provides planning appropriate preventive
and restorative oral health programmes in school children.13
In a study conducted in Spain, Alvarez-Arenal et al.13 aimed
to observe caries prevalance, dmft and DMFT indices and
treatment needs of schoolchildren, they showed a mean
caries incidence as 2.7 dft and 0.25 DMFT in 6 years old,
2.38 dft and 1.50 DMFT in 9 years of age and 3.30 DMFT
in 12 year olds. Dhar et al.8 divided their study population in
two age groups 6-7 years and 8-10 years and showed that,
dmft was significantly higher in 8-10 years and especially
“decayed teeth” was the highest component of dmft.
In this study, the children were also divided in three age
groups 6-8, 9-10, 11-12 years. The importance of the
6-8 group is that, this period is thetime for emergence of
PFM in oral cavity. After eruption, in 11-12 years PFMs are
supposed to be more susceptible to develop dental caries.
We have seen significant increase in caries, missing and
fillings in both primary and permanent teeth in older ages.
These findings were similar with previous studies conducted
127
CLINICAL DENTISTRY AND RESEARCH
Table 3. The distribution of clinical status of 16,26,36,46 in different age groups 6-8, 9-10, 11-12 ages
6-8 Year
9-10 Year
11-12 Year
healthy
108
77.70%
167
70.80%
84
63.60%
caries
30
21.60%
65
27.50%
30
22.70%
filling
1
0.70%
4
1.70%
17
12.90%
χ²:30.17
missing
0
0.0%
0
0.00%
1
0.80%
p<0.001
healthy
117
84.20%
166
70.30%
82
62.10%
caries
21
15.10%
66
28.00%
32
24.20%
filling
1
0.70%
4
1.70%
17
12.90%
χ²:37.99
missing
0
0.00%
0
0.00%
1
0.80%
p<0.001
healthy
108
77.70%
149
63.10%
70
53.00%
caries
31
22.30%
82
34.70%
36
27.30%
filling
0
0.00%
5
2.10%
24
18.20%
χ²:56.82
missing
0
0.00%
0
0.00%
2
1.50%
p<0.001
healthy
104
74.80%
142
60.20%
70
53.00%
caries
34
24.50%
85
36.00%
40
30.30%
filling
1
0.70%
9
3.80%
20
15.20%
χ²:36.91
missing
0
0.00%
0
0.00%
2
1.50%
p<0.001
Tooth 16
Tooth 26
Tooth 36
Tooth 46
in different age groups of children.6.8.13
In epidemiological studies, choosing an appropriate
representation of a target population is a difficult problem
for researchers.5 The relative homogenity of the study
population (living in a developed city, being able to reach
health providers easily) which the data was pooled in the
present study is a drawback. From another point of view,
it can be interpreted as the target population would have
a greater treatment need for FPMs considering that the
studied population herein represents relatively moderatehigh sociocultural level when compared to urban areas and
towns. Another reason of highcaries risk might be attributed
to our study group since they attend the dental clinic
because of caries, trauma, orthodontic problems. Therefore
they may have more problems with the dentition from the
normal population.
Estimating the caries risk and treatment need is important
of individuals in increasing oral health.8,10 Mann J et al.10
suggested using the treatment needs index to traditional
128
DMFT index because it provides a more accurate description
of caries severity and extent than does the traditional
DMFT index, and can be used to estimate the time required
to treat a community. In this study we used DMFT index for
caries severity and treatment need index to estimate the
treatment according to caries. The present data can be used
to assess both the required time and money for treating
FPMs in 6-12 years studied herein.
To date, treatment need is studied in various populations
and these researches concluded with different data. Thus,
population based strategies are based on population based
pathfinder studies.3,6,8,13,14
Devaki et al.3 evaluated permanent first molar caries status
and treatment needs among school going children aged
6-14 years in Tenali, Guntur (India) district. They showed
that the treatment needs out of 700 subjects were as
follows: 57.35% had caries and 46.65% were caries free,
30.39% required treatment. In those, number of subjects
requiring one surface restorations were 18.86%, number
A multi-centered retrospective study
of subjects requiring 2 or more surface restorations were
12.71%, number of subjects requiring pulp care were 2.86%,
number of subjects requiring extraction were 3.43%, and
number of subjects requiring crown/bridge were 1.57% .3
In Jain M et al’s14 study, among 127 institutionalized subjects
aged 5-22 87.4% needed some sort of treatment and
12.6% did not. One surface filling was needed for 79.5%
of 127 subjects, while 22% needed two surface fillings.
At Alvarez-Arenal A et al’s study13, one and two surface
fillings were required in all age groups; 58.39% of subjects
one surface filling and 27.02% required two. Ebrahimi et
al.6 showed that 95.3% of children needed some type of
treatment. They found significant differences in needs for
fissure sealant, fillings and orthodontic treatment between
different age groups. 8-year-old children had the greatest
need for fissure sealant, and 9-year-old children had the
greatest need for fillings and orthodontic treatment.
To our knowledge present study is the first study that
evaluated treatment needs of each permanent first molars
in schoolaged children attending the university’s dental
clinic in Turkey. Treatment need was seen almost 50%
of PFMsexamined on each dental quadrant. We found
significant differences in health, caries and clinic status of
16, 26, 36, 46 in different age groups. From 139 upper right
molar examined, 77.7% were sound and 21.60 % had caries,
0.70 % had filling in 6-8 years old. No missing tooth was
present at this age. However healthy teeth were decreased
63.60% and teeth with caries were increased (22.70%),
Among all PFMs, 12.90 % had filling and one tooth was
extracted at 11-12 age. Overall, children at 11-12 age
showed a significantly higher percentage of filled and
missing teeth in almost every PFM. Similarly, in Dhar et
al’s study8 among two age groups (6-7 and 8-10), the
age group 8-10 years age group required more treatment
when compared to 6-7 years age group. These findings are
important in terms of early use of preventive procedures.
One or two surface fillings were more wide spread followed
by other treatment needs in accordance with previous
studies.13,14
It can be concluded from the present study that the
treatment need of first permanent molars increased in late
mixed dentition stage (11-12 years). Caries prevalence
did not differ among genders and lower PFM needed more
two surface restorations, pulp therapy and prosthetic and
extraction treatment when compared with upper PFM.
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