Supervisors info:
Αγουρόπουλος Ανδρέας, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Γκιζάνη Σωτηρία, Αναπληρώτρια Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Καραβανάκη Κυριακή, Καθηγήτρια, Τμήμα Ιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Summary:
Osteogenesis imperfecta (OI) is a metabolic bone disease that affects the connective tissue and specifically the collagen; it is the most common form of primary osteoporosis. Patients with osteogenesis imperfecta present with skeletal abnormalities, increased risk of fractures, muscle weakness, hearing loss, and a variety of oral findings. The aim of the study is to record the oral health status of children with OI and compare the dental findings with those of healthy individuals of the same age and gender.
Methodology
The sample of this comparative cross-sectional study consisted of 40 children in the OI group and 38 in the healthy children’s group. The children of the OI group were patients of the Department of Bone and Mineral Metabolism, Institute of Child Health, Athens, Greece, whereas the healthy children were selected from the Postgraduate Paediatric Dental Clinic, Dental School NKUA, matched for age and gender. Exclusion criteria for both groups were uncooperative patients and lack of parental consent and for the control group wasthe absence of general health problems. Demographic data, children’s dental history, brushing frequency and dietary habits were collected from the parents, using self-administered questionnaires. Dental examination was carried out at the Postgraduate Paediatric Dental Clinic, NKUA and information was collected on periodontal health, dental caries, occlusion, dental anomalies and TMJ. Panoramic radiographs were also evaluated for possible tooth anomalies related to the disease and estimation of dental age. Descriptive statistics, Student’s t-test, x2, Spearman correlation coefficient rho and hierarchical multivariate regression analysis were used to analyze the data. Level of significance was set to P ≤ 0.05.
Results
The mean age of the children in the OI group was 9.5 (SD: 4.55) years and in the healthy children group was 9.04 (SD: 2.43) years. Most children in both groups, lived in urban areas and their parents had basic to higher education level (αυτό είναι πολύ γενικό, αφού περιγράφει όλο το φάσμα του μορφωτικού επιπέδου.....). There were no statistically significant differences between the groups for all the demographic variables.
About one fifth of the children in both groups had never been to the dentist before. Children in both groups brushed mostly once or twice per day with no difference between groups, while only one child in the OI group and two in the healthy group used dental floss. Participants in both groups consumed sugary snacks mainly between meals, while most did not have sugary drinks on daily basis. Nevertheless, healthy children consumed daily, significantly more sugary snacks (p=0.007) and believed that their oral hygiene routines were better compared to their counterparts in the OI group (p= 0.01).
Periodontal status was similar between the groups, but significantly more children in the OI group had caries on permanent teeth (p=0.05) and higher DMFT scores (p<0.001). In primary teeth, the distribution (p=0.9) and severity of dental caries (p=0.75) was similar in the two groups. Twenty five percent of the OI children had enamel dental defects and 10% had dentinogenesis imperfecta. In the healthy group, 18.4% had enamel defects. Radiographic defects were found in 45% of the OI children and they were mainly taurodontism and cervical constriction while in the healthy group 31.6% presented defects and they were mainly taurodontism and impaction.
At the time of the examination, 6 children in the OI and 4 in the healthy group were under orthodontic treatment or they had completed treatment in the past. Nevertheless, significantly more OI children had posterior crossbites (p=0.04), less overbite (p=0.03) and more need of orthodontic treatment (p=0.03). Finally, OI children had slightly higher TMD Pain scores (p=0.01), but none of the children in both groups had clicking. The mean estimated age from the orthopantomograms was 11.13 (SD: 3.55) in the OI and 9.86 (SD: 2.15) in the healthy group which was not statistically different. Bivariate correlations indicated that age (rho = 0.379, p=.002), having OI (rho=0.524, p<0.001), urban residency (rho = -0.265, p=0.03), between meals sugar consumption (rho = 0.269, p= 0.028), presence of bleeding/calculus (rho= 0.331, p=0.006) and need for orthodontic treatment (rho = 0.364, p=0.003), significantly correlated with DMFT. When entered in multiple regression models, having OI and between meals sugar consumption significantly predicted the DMFT, after controlling for age. There were no significant correlations between dmft and the examined parameters.
Conclusion
In this study, patients with OI had more caries on permanent teeth and higher DMFT scores than healthy children and diet is probably an important risk factor. Furthermore, OI children had more orthodontic problems and dental defects, findings that are in accordance with the international literature. Nevertheless, dentinogenesis imperfecta, which is reported as the most common dental finding in patients with OI, was observed in only 10% of our study group. Results of this study indicate that OI patients need careful dental examination starting at an early age and targeted oral health preventive programs to ensure good oral health for a better quality of life.
