*Angelika Kobylińska1, Joanna Borawska2, Agnieszka Chojnowska2, Joanna Janczewska2, Anna Turska-Szybka1, Dorota Olczak-Kowalczyk1
Częstość i przyczyny przedwczesnych ekstrakcji zębów trzonowych mlecznych – badanie retrospektywne
Frequency and causes of premature extractions of deciduous molar teeth – a retrospective study
1Department of Pediatric Dentistry, Medical University of Warsaw
Head of Department: prof. Dorota Olczak-Kowalczyk, MD, PhD
2Students' Scientific Club, Department of Pediatric Dentistry, Medical University of Warsaw
Trustee of the Students' Scientific Club: Anna Turska-Szybka, PhD
Summary
Introduction. Premature loss of deciduous molar teeth is a common cause of dysfunction of the masticatory system. Analysis of the causes of premature extractions of these teeth will allow the appropriate targeting of preventive and therapeutic interventions.
Aim. To determine the frequency and causes of premature extraction of deciduous molar teeth.
Material and methods. Analysis of randomly selected 1880 medical records of the patients of the Department of Pediatric Dentistry (Medical University of Warsaw) concerned the necessity and causes of premature extractions of deciduous molar teeth in children under the age of 6 and the course of previous dental treatment. Data was analyzed statistically using the Mann-Whitney U-test, Spearman’s rank correlation and a chi-square test; significance level – p ≤ 0.05.
Results. 228 deciduous molar teeth were extracted in 139 children, most commonly due to inflammation of the pulp and its complications (abscesses, fistulas) – 84.7%, and carious destruction – 7.9%. The incidence of acute purulent inflammation decreased with age, whereas the occurrence of chronic pulpitis increased. 87.3% of the extracted teeth had not been previously treated, 7.5% had fillings and 5.2% had been pulpotomized. 54.7% of the patients had a single tooth removed and the rest – more than one. Maxillary first molars were most frequently extracted. There was no statistically significant difference in terms of gender. No relationship between age and the number of the removed tooth was found. There was a positive correlation between chronic inflammation of the pulp and age; negative correlation was found between age and acute inflammatory process of the pulp or periapical tissue as causes of extraction (Spearman’s rank correlation, p < 0.05). A statistically significant difference in the average amount of premature extractions performed per one patient was found – more than one tooth was more often extracted in boys (Mann-Whitney U-test, P = 0.034).
Conclusions. Premature extractions of deciduous molar teeth are a significant clinical problem. The most common causes are complications of untreated caries – acute inflammation of the pulp in younger children and chronic pulpitis in older ones. Extractions are performed more often in boys. Most of the lost teeth were not previously treated.
Introduction
Premature loss of deciduous teeth occurs prior to the physiological period of teeth replacement. It is combined with incomplete resorption of the root and with insufficient mineralization of permanent teeth buds (1, 2). This phenomenon has very serious clinical implications as well as a negative effect on the development of the organ of mastication. Abundant data available in literature reports the serious consequences of premature loss of teeth in the form of stomatognathic system dysfunctions (1-4). The effects of premature teeth loss include rotations, positioning of teeth outside of the dental arch, supraposition of the antagonist, hindered eruption of permanent teeth and the formation of malocclusion caused by the loss of space in the dental arch as well as disorders in the development of the facial skull (5, 6). Mesialization of the first permanent molar tooth is one of the other observed consequences of premature loss of deciduous molar teeth (3, 7-9). Moreover, caries in deciduous teeth increases the risk of its development in permanent teeth (10).
Reasons for the premature loss of deciduous teeth include: caries, diseases of the pulp and periapical tissues; less frequently: traumas, paradontopathy, orthodontic indications, cancer (5, 11, 12).
Research shows that molar teeth are, of all deciduous teeth, most commonly affected by caries (13). It has been found that caries in posterior teeth affects 65% of Polish children in the preschool age (3). They are also the most often treated deciduous teeth. Tickle et al. have found that the first deciduous molars were subject to conservative treatment in 81.1% of the cases, second deciduous molars in 84.3%, while in the case of anterior teeth, fillings were made only in 40.5% of the cases (14). It has also been found that posterior teeth are more likely to be lost prematurely than anterior teeth (11).
Some of the authors point to the dubious justification of undertaking conservative treatment of deciduous teeth in the context of their keeping in the oral cavity until physiological exfoliation. No statistically significant differences have been found referring to the frequency of extraction of filled vs. untreated teeth (15-17). Moreover, fear may be another negative consequence following invasive treatment during the first visit (18, 19).
Aim
The aim of the study was to indicate the frequency and reasons for premature extractions of deciduous molars, taking into account the course of previous dental treatment.
Material and methods
Medical records of 1880 patients aged 1-19 years old, under the care of the Department of Pediatric Dentistry of the Medical University of Warsaw, were subject to retrospective analysis. 139 children, who had at least one deciduous molar tooth extracted before the age of 6 years old, were selected. The study accounted for the age at which the extraction took place, its reasons as well as the course of the previous dental treatment. The researched group was divided into four age categories: I – under 3 years old, II – 3-4 y/o, III – 4-5 y/o and IV – 5-<6 years old. The collected data was subject to statistical analysis (STATISTICA, Statsoft: Mann-Whitney U-test, Spearman’s rank correlation, chi-square test; significance p < 0.05).
Results
228 deciduous molar teeth were extracted from 139 children below 6 years of age. The researched group included 79 boys and 60 girls aged 1.06 to 5.9 years old (average age 4.61 ± 1.06). 139 extractions were made in boys (61% of all extracted teeth) and 89 extractions were made in girls (39%). Maxillary first deciduous molar teeth were the ones most frequently extracted (38.6% of all extractions) and least frequently – maxillary second molars (9.65%) (tab. 1). In the youngest group of patients, the most frequently extracted tooth was the maxillary first right molar (46.15%). In a smaller percentage of cases, extraction was performed of the homonymous tooth on the left side (26.92%). However, they constituted the majority of teeth extracted in this age group. For comparison, the percentage of extracted mandibular first molars amounted to a total of 15.38%. Second molars were extracted much less frequently (total for the maxilla and mandible – 11.54%).
Table 1. Frequency of extraction of individual teeth among deciduous molar teeth.
| | Maxilla | Mandible |
| First molar tooth | 54 | 19.3% | 38.6% | 74 | 14.47% | 28.94% |
| 64 | 19.3% | 84 | 14.47% |
| Second molar tooth | 55 | 4.39% | 9.65% | 75 | 12.28% | 22.81% |
| 65 | 5.26% | 85 | 10.53% |
In the age group of 3-4 year olds, only maxillary first deciduous molars were extracted (45.46%) and in the mandible – both first and second teeth; with more frequent extractions on the left side (40.91%), followed by those on the right side (13.64%). In children aged 4-5, the most frequently extracted tooth was the mandibular first molar on the right side (23.68%), and the least frequently extracted one was the maxillary second molar on the same side (2.63%). In the oldest group of children, the percentage share of extractions of individual teeth was more uniform than in other groups. The dominating group of extractions related to maxillary first molars on the left side (19.23%). Maxillary second molars on the right side were the least frequently extracted teeth in this age group (6.73%). No statistically significant differences in the frequency of extractions in girls and boys were identified (tab. 2).
Table 2. Frequency of extractions in individual age groups.
Age groups
(year of life) | Tooth number |
| 54 | 55 | 64 | 65 | 74 | 75 | 84 | 85 |
| < 3 | 46.15% | 3.85% | 26.92% | 0.00% | 7.69% | 7.69% | 7.69% | 0.00% |
| Girls | 50.00% | 0.00% | 12.50% | 0.00% | 12.50% | 12.50% | 12.50% | 0.00% |
| Boys | 44.44% | 5.56% | 33.33% | 0.00% | 5.56% | 5.56% | 5.56% | 0.00% |
| 3-4 | 22.73% | 0.00% | 22.73% | 0.00% | 22.73% | 18.18% | 9.09% | 4.55% |
| Girls | 8.33% | 0.00% | 25.00% | 0.00% | 25.00% | 25.00% | 8.33% | 8.33% |
| Boys | 40.00% | 0.00% | 20.00% | 0.00% | 20.00% | 10.00% | 10.00% | 0.00% |
| 4-5 | 11.84% | 2.63% | 15.79% | 5.26% | 15.79% | 11.84% | 23.68% | 13.16% |
| Girls | 20.69% | 3.45% | 17.24% | 6.90% | 20.69% | 10.34% | 13.79% | 6.90% |
| Boys | 6.38% | 2.13% | 14.89% | 4.26% | 12.77% | 12.77% | 29.79% | 17.02% |
| 5-6 | 17.31% | 6.73% | 19.23% | 7.69% | 13.46% | 12.50% | 10.58% | 12.50% |
| Girls | 17.50% | 2.50% | 20.00% | 7.50% | 10.00% | 15.00% | 12.50% | 15.00% |
| Boys | 17.19% | 9.38% | 18.75% | 7.81% | 15.63% | 10.94% | 9.38% | 10.94% |
| Total | 19.30% | 4.39% | 19.30% | 5.26% | 14.47% | 12.28% | 14.47% | 10.53% |
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