Enamel Hypoplasia in Relation to Caries in Guatemalan Children PETER F. INFANTE* and GEORGE M. GILLESPIE
Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan 48109, USA, and Dental Section, Pan American Health Organization, Washington, DC, USA Guatemalan children with anterior linear enamel hypoplasia (LEH) had a significantly greater caries experience in posterior dentition than their peers who did not have anterior LEH. The findings suggest that the synergistic mechanism of undernutrition and infection, w;hich may underlie the occurrence of anterior LEH, may also predispose clinically normal appearing deciduous molars to an excessive caries attack equal to that observed in the grossly hypoplastic anterior teeth. The nutritional implications merit further investigation.
et al'2 had observed entire crowns of deciduous molars destroyed proximate to cariesfree first permanent molars in children of other malnourished populations, the data presented here were analyzed to determine the relation of anterior LEH to caries experience in the deciduous molars of Guatemalan children two through seven years of age.
Materials and Methods Using field methodology for caries detection as described previously,13 oral examinations were conducted in four rural Guatemalan Linear enarrmel hypoplasia (LEH) of the de- Ladino villages located in the Department of ciduous maxillary incisors is commonly ob- El Progreso. Anterior teeth were scrubbed with served in undernourished children throughout a gauze sponge to facilitate detection of the the wvorld.1' The lesion is very rarely observed lesions. All dental examinations were conin the posterior dentition. Clinically, the lesion ducted by one examiner. Calibration prois characterized by a horizontal groove most cedures for caries and enamel hypoplasia clasfrequently found on the labial surface of the sification were conducted before the field middle third of the maxillary central incisors portion of the study. For enamel hypoplasia and on the incisal third of the maxillary lat- status, children were categorized as reported eral incisors. Although the etiology of this previously.7 For the first analysis, children enamel defect is undetermined, factors associ- categorized as questionable as to whether they ated with the synergistic mechanisms of under- had LEH were combined with children idennutrition and infection5,6 common to popula- tified as not having LEH, and children in whom tions where the lesion is prevalent may be con- LEH was not possible to determine were comtributing factors.7-9 In children living in com- bined. Thus, three groups remained for analymunities where caries prevalence is relatively sis: 113 children with 246 without LEH, high, the eruption of these defective teeth into and 29 in whom LEHLEH, was not possible to dethe oral cavity is usually followed by a highly because caries was either too extensive invasive caries attack. The teeth often become termine or because the maxillary incisors had been exreduced to blackened stumps and chronic peri- foliated. Since LEH obviously cointributed to apical abscess follows.3,4'8 Since a high caries the caries attack rate in the anterior teeth high attack in the posterior dentition of Apache In- of children, it was decided to determine dian children with anterior LEH had been ob- thethese to which caries experience in the extent -viously previouslylO and Russell1' and Russell posterior teeth (teeth that rarely manifest LEH) might be related to the presence or Received for publication April 21, 1975. absence of LEH in the anterior teeth. Thus, Accepted for publication June 11, 1976. * Present address: Biometry Section, Division of mean numbers of decayed deciduous molar -Surveillance, Hazard Evaluations and Field Studies, teeth and tooth surfaces as well as percentages National Institute for Occupational Safety and Health, of children in whom all eight deciduous molars Cincinnati, Ohio 45202. 493 Downloaded from jdr.sagepub.com at SIMON FRASER LIBRARY on May 29, 2015 For personal use only. No other uses without permission.
INFANTE
494
&
J
GILLESPIE
Dent Res
May 1977
TABLE 1 MEAN TOTAL NUMBERS OF CARIOUS DECIDUOUS MOLAR TEETH AND SURFACES IN CHILDREN BY LINEAR HYPOPLASIA STATUS AND AGE, BOYS AND GIRLS COMBINED, GUATEMALA, 1973 Children With Anterior Hypoplasia Mean Decayed Molars N (Teeth) (Surf aces)
Age Group (Yr)
33 16 24 19 21
2 3 4 5 6
1.03 2.88 3.88 5.74 5.05
1.33 3.88 5.75 12.32 10.67
Children Without Anterior Hypoplasia Mean Decayed Molars N (Teeth) (Surfaces)
N.P.D.* Because of Caries or Exfoliation Mean Decayed Molars N (Teeth) (Surfaces)
53
0 7 8 4 10
0.28 1.06 1.69 2.15 3.16
65
42 48 38
0.36 1.29 2.12 3.08 5.53
5.29 5.00 4.25 6.50
8.14 9.25 6.75 12.50
* N.P.D., Not possible to determine linear hypoplasia status. were
with
cariesfree were computed for children those without anterior LEH.
versus
Results As given in Table 1, children with anterior LEH had mean numbers of decayed deciduous molar teeth and tooth surfaces that were about two to four times greater than the means in children without anterior LEH. The percentages of children with one or more decayed deciduous molars were then computed for children positively identified as having anterior LEH and for children of all other categories combined. These data are given in Table 2. For each one-year age group comparison, the percentages of children in whom all of the deciduous molars were cariesfree were consistently lower in the group with anterior LEH versus all other children. With all age groups
combined, 31 % of the children with anterior LEH had one or more decayed deciduous molars as compared with 48% in the group of all other children. These differences were highly significant (P
Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan 48109, USA, and Dental Section, Pan American Health Organization, Washington, DC, USA Guatemalan children with anterior linear enamel hypoplasia (LEH) had a significantly greater caries experience in posterior dentition than their peers who did not have anterior LEH. The findings suggest that the synergistic mechanism of undernutrition and infection, w;hich may underlie the occurrence of anterior LEH, may also predispose clinically normal appearing deciduous molars to an excessive caries attack equal to that observed in the grossly hypoplastic anterior teeth. The nutritional implications merit further investigation.
et al'2 had observed entire crowns of deciduous molars destroyed proximate to cariesfree first permanent molars in children of other malnourished populations, the data presented here were analyzed to determine the relation of anterior LEH to caries experience in the deciduous molars of Guatemalan children two through seven years of age.
Materials and Methods Using field methodology for caries detection as described previously,13 oral examinations were conducted in four rural Guatemalan Linear enarrmel hypoplasia (LEH) of the de- Ladino villages located in the Department of ciduous maxillary incisors is commonly ob- El Progreso. Anterior teeth were scrubbed with served in undernourished children throughout a gauze sponge to facilitate detection of the the wvorld.1' The lesion is very rarely observed lesions. All dental examinations were conin the posterior dentition. Clinically, the lesion ducted by one examiner. Calibration prois characterized by a horizontal groove most cedures for caries and enamel hypoplasia clasfrequently found on the labial surface of the sification were conducted before the field middle third of the maxillary central incisors portion of the study. For enamel hypoplasia and on the incisal third of the maxillary lat- status, children were categorized as reported eral incisors. Although the etiology of this previously.7 For the first analysis, children enamel defect is undetermined, factors associ- categorized as questionable as to whether they ated with the synergistic mechanisms of under- had LEH were combined with children idennutrition and infection5,6 common to popula- tified as not having LEH, and children in whom tions where the lesion is prevalent may be con- LEH was not possible to determine were comtributing factors.7-9 In children living in com- bined. Thus, three groups remained for analymunities where caries prevalence is relatively sis: 113 children with 246 without LEH, high, the eruption of these defective teeth into and 29 in whom LEHLEH, was not possible to dethe oral cavity is usually followed by a highly because caries was either too extensive invasive caries attack. The teeth often become termine or because the maxillary incisors had been exreduced to blackened stumps and chronic peri- foliated. Since LEH obviously cointributed to apical abscess follows.3,4'8 Since a high caries the caries attack rate in the anterior teeth high attack in the posterior dentition of Apache In- of children, it was decided to determine dian children with anterior LEH had been ob- thethese to which caries experience in the extent -viously previouslylO and Russell1' and Russell posterior teeth (teeth that rarely manifest LEH) might be related to the presence or Received for publication April 21, 1975. absence of LEH in the anterior teeth. Thus, Accepted for publication June 11, 1976. * Present address: Biometry Section, Division of mean numbers of decayed deciduous molar -Surveillance, Hazard Evaluations and Field Studies, teeth and tooth surfaces as well as percentages National Institute for Occupational Safety and Health, of children in whom all eight deciduous molars Cincinnati, Ohio 45202. 493 Downloaded from jdr.sagepub.com at SIMON FRASER LIBRARY on May 29, 2015 For personal use only. No other uses without permission.
INFANTE
494
&
J
GILLESPIE
Dent Res
May 1977
TABLE 1 MEAN TOTAL NUMBERS OF CARIOUS DECIDUOUS MOLAR TEETH AND SURFACES IN CHILDREN BY LINEAR HYPOPLASIA STATUS AND AGE, BOYS AND GIRLS COMBINED, GUATEMALA, 1973 Children With Anterior Hypoplasia Mean Decayed Molars N (Teeth) (Surf aces)
Age Group (Yr)
33 16 24 19 21
2 3 4 5 6
1.03 2.88 3.88 5.74 5.05
1.33 3.88 5.75 12.32 10.67
Children Without Anterior Hypoplasia Mean Decayed Molars N (Teeth) (Surfaces)
N.P.D.* Because of Caries or Exfoliation Mean Decayed Molars N (Teeth) (Surfaces)
53
0 7 8 4 10
0.28 1.06 1.69 2.15 3.16
65
42 48 38
0.36 1.29 2.12 3.08 5.53
5.29 5.00 4.25 6.50
8.14 9.25 6.75 12.50
* N.P.D., Not possible to determine linear hypoplasia status. were
with
cariesfree were computed for children those without anterior LEH.
versus
Results As given in Table 1, children with anterior LEH had mean numbers of decayed deciduous molar teeth and tooth surfaces that were about two to four times greater than the means in children without anterior LEH. The percentages of children with one or more decayed deciduous molars were then computed for children positively identified as having anterior LEH and for children of all other categories combined. These data are given in Table 2. For each one-year age group comparison, the percentages of children in whom all of the deciduous molars were cariesfree were consistently lower in the group with anterior LEH versus all other children. With all age groups
combined, 31 % of the children with anterior LEH had one or more decayed deciduous molars as compared with 48% in the group of all other children. These differences were highly significant (P
