Wednesday, July 4, 2018

A Research On The Prevalence Of Dental Hyperdontia Among High School Students Of A Rural Community IN NIgeria


DESCRIPTION OF TEETH
        The teeth are the hardest structures in the human body. A tooth is divided into two basic parts, the crown, which is the visible, white part of the tooth, and the root, which cannot be seen the root extends below the gum line and anchors the tooth into the bone.
Teeth tend erupt in parallel, meaning that the top molar on your left side should grow in, at about the same time as the top molar on the right.
        Tooth development begins long before the first tooth becomes visible. For example, a baby’s first tooth appears at around six months of age, but development of those teeth actually begins during the early second trimester of pregnancy. The crown of a tooth forms first, while the roots continue to develop even after the tooth has erupted.
        The 20 primary teeth are in place by age 3 and remain until around 6 years of age when they begin to fall out to make way for the permanent set of teeth.
Adult teeth start to grow between 6 and 12 years of age, most adults have 32 permanent teeth. Permanent teeth are larger and take longer to grow in their primary teeth? Adim (2010).
Types of Teeth
        According to David, (1999), teeth helps to cut, tear or chew your food, making it easier to digest? Thos teeth are discussed below:
Incisors: Incisors are the eight teeth in the front and center of the mouth (four on top and four on bottom). These are the teeth used to take bites of food. Incisors are usually the first teeth to erupt, at around 6 months of age for the first set of teeth, and between 6 and 8 years of age for the adult set.
Canines: The four canines are the next types to develop. These are the sharpest teeth and are used for ripping and tearing food apart. Primary canines generally appear between 16 and 20 months of age with the upper canines coming in just ahead of the lower canines. In permanent teeth, the order is reversed. Lower canines erupt around age 9 with the uppers arriving between 11 and 12 years of age.
Premolars or biscuspids: Right behind the canine teeth are the premolars on each side of the jaw, making them 8 premolars in number. They are also known as bicuspids. Premolars have cusps on top of the broader, surfaces that allow for grinding and chewing.
Molars: Primary molars are also used for chewing and grinding food. These appear between 12 and 15 months of age. These molars, also known as deciduous molars, are replaced by the first and second permanent premolars (four upper and four lower). The permanent molars do not replace? but come in behind the primary teeth, the first molars erupt around 6 years of age (before the primary molars fall out) while the second molars come in between 11 and 13 years of age.
Third Molars: Third molars are commonly known as wisdom teeth. These are the last teeth to develop.


Structures of Teeth
The structures or tissue of the teeth are described below:
-      Enamel: The hardest, white outer part of the tooth (crown). Enamel is mostly made of calcium phosphate, a rock hard mineral.
-      Dentin: A layer underlying the enamel. Dentin is made of living cells, which secrete a hard mineral substance.
-      Pulp: The softer, living, inner structure of teeth. Blood vessels and nerves run through the pulp of the teeth.
-      Cementum: A layer of connective tissue that binds the roots of the teeth firmly to the gum and jaw bone.
-      Periodontal Ligament: Tissue that helps hold the teeth tightly against the jaw. (Renner, 1995).
Over view of hyperdontia
        Hyperdontia are the teeth in excess of the normal number varied in form and location and occur in both primary and permanent dentition. The prevalence of hyperdontia is between 0.15 and 3.9 percent. These can be single or multiple, unilateral or bilateral, malformedmorphologically or normal in size and shape, erupted or may be impacted or may remain in position for years without any clinical manifestation (Samjay saraf, 2006).
        The supernumerary teeth may be present in deciduous as well as in permanent dentition but are less frequently seen in deciduous dentition. Approximately 80-90 percent of extra teeth are seen in maxilla preferably in anterior regions.
        The extra causes of supernumerary teeth is not known but there are various theories to explain the etiology of supernumerary teeth. The widely accepted theory that explain the cause is thepersistence of a part of dental lamina even after the formation of normalnumber of tooth buds.
According to (Scheiner and Sampson, (1997), the residual dental lamina (cells rests of serreis) if initiated by induction factors develop into a supernumerary tooth or odotoma
Aetiology of Hyperdontia
According to (Samjay Saraf, 2006), there is evidence of hereditary factors along with some evidence of environmental factors leading to this condition. Hyperdontia is rare in people with no other associated disease or syndromes. Many supernumerary teeth never erupt, but they may delay eruption of nearby teeth or cause other dental or orthodontic problems. Molar type extra teeth are the rarest form, dental x-rays are often used to diagnose hyperdontia. It is suggested that supernumerary teeth develop from a second tooth but arising from the dental lamina near the regular tooth but or possibly from splitting the regular tooth bud itself.
Supernumerary teeth in deciduous (baby) teeth are less common than in permanent teeth. These conditions are seen in a number of disorders including Guradner’s syndrome and cleidocranial dysostosis.where multiple supernumerary teeth are seen that are uesually impacted (Rajab and Hamdan, 2002).
Classification of hyperdontia
        Supernumerary teeth can be classified according to shape and location
According to shape.
1.  Conical: These often occur singly and are smallpeg-shaped, conical and may be of inverted type. These displace erupting permanent maxillary central incisor and have a normal root.
2.  Tuberculate: These are multicuspid, short, barrel shaped teeth with abnormal root. Tuberculate rarely erupts themselves, as compared to conical but rather these delay the eruption of permanent maxillary central incisors teeth and develop.
3.  Supplemental: These resemble adjacent teeth, eg. Maxillary and mandibular lateral incisors of deciduous dentition.
4.  Odontomas: These have no regular shape
5.  Molariform: These have the shape of premolar crown with a complete root.
Supernumerary according to location
1.    Mesiodens:         Located between maxillary central incisors
 (pre-maxillary region)

2.    Paramolar:         Buccally, lingually or palatally in between
second and third maxillary molars, rarely in    between first and second maxillary molars
3.    Distomolar:       Located distal or distolingual to third molars
(maxillary or mandibular, in mandibular often impacted).
4.  Parapremolar:    Additional tooth in premolar region
5.  Paramolar root:  Additional cusp present on buccal surface of a
permanent molar parastyle, if additional cusp  is present on buccal surface of a permanent molar protostylid, if addition cusp is present on mandibular molar. (Garvey, Blake, 1999).


Complications of hyperdontia
1.   Crowding occurs when the dental arch is too small to accommodate the teeth. Severe crowding can result in the bone and gum becoming thin and receding, and people with severely crowded teeth are more susceptible to gum disease as it is difficult for them to brush and floss well.
2.   Root Resorption: root resportion is the break down or destruction, and subsequent loss of the root structure of a tooth. This is caused by living body cells attacking part of the tooth. When the damage extends to the whole tooth, it is called tooth resportion.
3.   Dilacerations: Dilacerations is a dental anomaly characterized by an angulations or bend inroot or less frequency in the crown of tooth. This condition is thought to be caused by trauma during the period in which the tooth is forming.
4.   Gingival Inflammation: Gingival inflammation it commonly occurs because of film of bacteria that accumulate on the teeth.
5.   Subacute Pericoronitis: Pericoronitis is inflammation of soft tissue covering the crown of the partially erupted or impacted tooth and is caused by normal oral flora or the inflammation of gingival in relation to the crown of partially erupted tooth. Pericoronitis is said to be subacute when itis gradually progressing for the acute stage to more serious chronic stage andcharacterized by slow development and pain.
6.   Periodontal abscess is a localized collection of pus within the tissues of the periodontium. Periodontal abscess occurs alongside of a tooth. Periodontal abscesses are usually associated with vital (living) tooth.
7.   Alveolar bone crafting: Supernumerary teeth may compromise secondary alveolar bone grafting in patient with cleft lip and palate. Erupted supernumerary are usually removed and the socket are allowed to heal prior to bone grafting.
Supernumerary should not be extracted without consultation with the cleft team.
8.       Failure of Eruption: The presence of a supernumerary tooth is the most common causes for the failure of eruption of a maxillary central incisor. It may also cause retention of the primary incisor.
9.       Increase risk of Dental caries due to the presence of supernumerary teeth that makes the area inaccessible to maintain oral hygiene. (Intelligent Dental, 2011).



Dentigerous cyst formation
Dentigerous cyst also called follicular cysts, are benign, non-inflammatory odontogeniccysts that thought to be developmental in origin.
Dentigerous cysts are the second most common odontogenic cysts after those related to the roots of the (Periapica cysts). They usually present in the 2nd to 4th decades of life and are rarely seen in childhood because they almost exclusively occur in secondary dentition 1-3.
Ameloblastoma:
Ameloblastoma is a rare, non-cancerous (benign) tumor that develops most often in the jaw near the molars. Ameloblastoma occurs in men more often than it occurs in woman. Though it can be diagnosed at any age, ameloblastoma is most often diagnosed in adults in their 40s or 50s. despite being benign, ameloblastoma can be  very aggressive, growing into the jaw bone and causing swelling and pain. Very rarely, ameloblastoma cell can spread to other areas of the body, such as the lymh nodes in the neck and the lungs.
Ameloblastoma is the most common type of odontogenic lesion.
Odontomas:
Diagnosis of Hyperdontia
        Occasionally, supernumerary teeth are asymptomatic and may be detected as a chance finding during radiographic examination. Detailed history, clinical examination, thorough investigation,early diagnosis and appropriate treatment of supernumerary teeth are mandatory. Unerupted supernumerary may be found by chance during radiographic examination. Sometimes clinician may suspect the presence of supernumerary teeth, if there is  failure of eruption or ectopic eruption of permanent tooth, persistence of deciduous tooth, wide diastema and obvious presence of additional teeth. An anterior occlusal or perapical radiograph using paralleling technique and panaromic view are the most useful radiographic investigation to visalize supernumerary teeth. Recently, computed tomography has also been used to detect the presence of supernumerary teeth.
         Complete radiographic survey of the entire oral cavity is essential to identify the presence of all impacted supernumerary teeth ranges from 3 to 1. However, radiographs alone are not adequate for the definitive diagnosis. Their interpretation should always be conducted in conjunction with clinical finding.
Management of Hyperdontia
        According to Parolia(2011),management depends on the type and location of the supernumerary teeth and on its potential effect on adjacent hard and soft tissue structures.
        It can be managed either by removal or endodontic therapy or by maintaining them in the arch and frequent observation.
        Extraction should be performed carefully to prevent damage to adjacent permanent teeth, which may cause ankylosis and maleruption of these teeth. The clinican should be careful to avoid complications such as damaging nerve and blood vessels during manipulation of the tooth perforation of maxillary sinus, pterygomaxillary space, orbit and fracture of maxillary tuberosity. Clinican must be alert as sometimes supernumerary teeth are fused with adjacent tooth structure at crown or root levels which may make the extraction difficult.
        Supernumerary teeth can also be kept under observation without extraction when satisfactory eruption of related teeth has occurred with no association pathology and not causing any functional and esthetic interference.









CHAPTER FOUR
TABLE 1: THE SEX OF THE STUDENTS
Sex
Frequency
%
Male
110
44.72
Female
136
55.28
Total
246
100

Table 1 above illustrate the sex of the students. 110(44.72%) of males and 136(55.28%) of female make-up the 246(100%) of the tote students.
 TABLE 2: THE AGE RANGE OF THE STUDENTS
Age range
Frequency
%
No of
 Male
%
No of
Female
%
11 – 13
36
14.63
16
6.50
20
8.13
14 – 16
92
37.40
37
15.04
55
22.36
17 – 19
104
42.28
49
19.9
55
22.36
20-22
14
5.69
8
3.25
6
2.44
Total
246
100
110
44.69
136
55.29

Table 2 above illustrate that 36(14.63%) of student falls in age range 11-13; 16(14.55%) of male and 20(8.13%) of females. 92(37.40%) of students falls in age range 14-16, 37(15.04%) of males and 55(22.36%) of females. 104(42.28%) students falls in 17-19, 49(44.55%) of male and 55(22.36%) of females. 14(5.69%) student falls in 20-22, 8(3.25%) of males and 6(2.44%) of females.
TABLE 3: The class of the students
Class
Frequency
%
No of
 Male
%
No of
Female
%
JSS 1
41
16.67
22
8.94
19
7.72
JSS 2
41
16.67
18
7.32
28
9.35
JSS 3
41
16.67
17
6.91
24
9.76
SS 1
41
16.67
15
6.10
26
10.57
SS 2
41
16.67
17
6.91
24
9.76
SS 3
41
16.67
21
8.54
20
8.13
Total
246
100
110
44.72
136
55.29

Table 3 above show the classes of the students used. Out of the 246 student 41(16.67%) student were from each class ie JSS 1 – SSS 3. 22(20%) males and 19(13.97%) female were in JSS 1, 18(16.36%) males and 28(20.59%) females were in JSS 2, 17(15.45%) males and 24 (17.65%) females were in JSS 3, 15(13.64%) males and 26(19.12%) females were in SSS 1, 17(15.45%) males and 24(17.65%) females were in SSS 2, while 21(19.09%) males and 20(14.71%) females were in SSS 3.
TABLE 4: THE ORAL CONDITIONS OF THE STUDENTS
 SELECTED
Oral Condition
Frequency
%
No of
 Male
%
No of
Female
%
Fair
149
60.57
58
52.73
91
66.91
Poor
76
30.89
40
36.36
36
26.47
Very Poor
21
8.54
12
10.91
9
6.62

Table 4 above shows the oral conditions of the students selected. 149(60.57%) had fair mouth, 76(30.89%) had poor mouth while 21(8.54%) had very poor oral health condition. Higher number of females had fair mouth than males while higher number of males had poor and very poor mouth than the females.



TABLE 5: THE PRESENCE OF SUPERNUMERARY
 (HYPERDONTIA)
Supernumerary
Frequency
%
No of
 Male
%
No of
Female
%
Yes
5
2.03
1
0.91
4
2.94
No
241
97.97
109
99.09
132
97.06
Total
246
100
110
100
136
100

Table 5 above shows the presence of supernumerary (hyperdontia) as observed. Out of 246 students examined, 5(2.03%) were having supernumerial teeth which comprises of 1(0.91%) males and 4(2.94%) females. While 241(97.97%) were having normal dentition (not supernumerary).



TABLE 6: THE LOCATION OF THE SUPERNUMERARY AS OBSERVED
Location of supernumerary
Frequency
%
No of
 Male
%
No of
Female
%
Mandibulary
2
40
1
100
1
25
Maxillary
3
60
0
0
3
75
Both mandible and maxilla

0

0

0

0

0

0
Total
5
100
1
100
4
100

Table 6 above shows the location of the supernumerary on the observed students. Out of the 5 students observed, 2(40%) were having mandible supernumerial teeth, 3(60%) student were having maxillary supernumerial teeth while no student had supernumerary on both mandible and maxilla. 1(100%) males had mandibular supernumerary while 1(25%) females had mandibular supernumerary. And maxillary supernumerary were found on 3(75%) of females only.
TABLE 7: THE SHAPE OF THE SUPERNUMERIAL TEETH AS OBSERVED
Shape
Frequency
%
No of
 Male
%
No of
Female
%
Conical
4
80
1
100
3
75
Tuberculate
0
0
0
0
0
0
Supplemental
1
20
0
0
1
25
Odotomas
0
0
0
0
0
0
Molariform
0
0
0
0
0
0
Total
5
100
1
100
4
100

Table 7 above shows the various shape of the supernumerary teeth as observed. Out of the 5 students observed 4(80%) had conical shape comprise of 1(100%) male and 3(75%) females while 1(20%) had supplemental type ie 1(25%) female only.



TABLE 8: THE TOOTH AFFECTED
Tooth Affect
Frequency
%
No of
 Male
%
No of
Female
%
Central Incisor
0
0
0
0
0
0
Lateral Incisor
3
60
0
0
3
75
Canine
0
0
0
0
0
0
1st Premolar
2
40
1
100
1
25
2nd Premolar
0
0
0
0
0
0
3rd Molar
0
0
0
0
0
0
Total
5
100
1
100
4
100

Table 8: above shows the type of the tooth affect in their mouth as observed. Out of the 5 students 3(60%) students had their on lateral incisor while 2(40%) had theirs on the 1st premolar.
TABLE 9: THE LEVEL OF DENTAL AWARENESS THEY HAVE
Dental awareness
Frequency
%
No of Male
%
No of Female
%
Yes
40
16.26
18
16.36
22
16.18
No
206
83.74
92
83.64
114
83.82
Total
246
100
110
100
136
100
Table 9 above show the level of dental awareness the students have. Out of the 246 student questioned, 40(16.26%) had been aware while 206(83.74%) had no knowledge at all.
TABLE 10: THE TOTAL NUMBER OF TOOTH AFFECTED BY SUPERNUMERARY
No of Tooth
Frequency
%
No of Male
%
No of Female
%
1 tooth
2
40
0
0
2
50
2 teeth
3
60
1
100
2
50
3 teeth
0
0
0
0
0
0
4 teeth
0
0
0
0
0
0
Total
5
100
1
100
4
100

Table 10 above shows the total number of teeth affected. And it was observed that out of the 5 student 2(40%) were having only 1 tooth extra for the females only while 3(60%) were having 2 teeth extra, 1(100%) male and 2(50%) females.



TABLE 11: THE CAUSES OF THE HYPERDONTIA
Causes
Frequency
%
No of Female
%
No of Male
%
Syndrome
0
0
0
0
0
0
Hereditary
5
100
1
0
4
100
Disease
0
0
0
0
0
0
Environmental factors

0

0

0

0

0

0
Total
5
100
1
100
4
100

Table 11 shows the causes of the hyperdontia found on the observed students. Out of the 5 students found all were as a result of hereditary 5 (100%)
TABLE 12: VARIOUS COMPLICATIONS FOUND ON THE AFFECTED STUDENTS
Complication
Frequency
%
No of Male
%
No of Female
%
Crowding
5
100
1
100
1
100
Dental caries
2
40
1
100
1
25
Root resportion
1
20
0
0
1
25
Delaceration
0
0
0
0
0
0
Loss of vitality of adjacent teeth

0

0

0

0

0

0
Subacute pericoronitis

0

0

0

0

0

0
Gingival inflammation

3

60

1

100

2

Periodontal abscesses

0

0

0

0

0

0
Total







Table 12 above shows some complications found on the affected students. It was observed that all the victims had crowded teeth. 2(40%) had dental caries, 1(20%) had root resorption while 3(60%) had gingival inflammation.
TABLE 13: THE POSSIBLE TREATMENT NEED FOR EACH OF THEM
Treatment
Frequency
%
No of Males
%
No of Female
%
Removal/Extraction
4
80
1
100
3
75
Orthodontic therapy
1
20
0
0
1
25
Total
5
100
1
100
4
100

Table 13 above shows the possible treatment needed for the affected students. Due to the position and nature of the problems, it was observed that out of the 5 students, 4(80%) need removal or extraction while 1(20%) need orthodontic therapy.
TEST OF HYPOTHESIS



Sex (x)
110
136
Presence of hyperdontia (y)
5
241


X
Y
(x-x)
(y-y)2
(x-x)2
(y-y)2
(x-x) (y-y)
110
5
13
118
961
13924
1534
136
241
13
118
961
13924
1534




1922
27848
3068


CHAPTER FIVE
DISCUSSION, CONCLUSION, RECOMMENDATION AND
  SUGGESTION

DISCUSSION
        In view of the findings from the research question asked previously in chapter one, answer have been provided by the study participants. Then, following the analysis in table 1, it shows 246 people was used for the study which was selected from Junior High School to Seniors. (41) forty-one were selected from each class to assemble to 246 participants.
        From table 2, the research revealed that out of 246 students, 36(14.63%) were from 11-13 age range group, 92(37.40%) were from 14-16 age range group, 104(42.28%) were from 17-19 age range group while 14(5.69%) were from 20-22 age range group.
Table 3 shows that out of 246 students selected, 22(20%) male participated more than female in JSS1, 28(20.59%) females participated more than male in JSS II, 24(17.65%) female participated more than male in JSS III, 26(19.12%) female participated more than male in SS I, 24(17.65%) female participated more than male in SS II, while 21(19.09%) male participated more than female in SS III, the participation of female students were more than male due to the higher number of female in the school. It was also observed in table 4, that out of 246 participants, 149(60.57%) had fair oral health status comprising of 58(52.73%) male and 91(66.91%) female, 76(30.89%) had poor oral health status comprising of 40(36.36%) male, 36(26.47%) female while 21(8.54%) had very poor oral health status comprising of 12(10.11%) male 9(6.62%) female. This can be attributed to the fact that female take care of their teeth than male who gave their oral health less concerned as stated that does not for beauty like women (cultural believe).
Table 5 revealed that 5(2.03%) of the population had supernumerary while 241(97.97%) showed absence of supernumerary observed. Out of five(5) students observed, 2(40%) were having mandibular supernumerial teeth, 3(60%) students were having maxillar supernumerial teeth.
Table 7 revealed the shape of the supernumerary teeth observed. Out of 5 students observed 4(80%) had conical shape, comprised of 1(100%) male and 3(75%) females while 1(20%) had supplemental type. Ie1(25%) female only. Table 8 shows the tooth affected. Out of 5 students 3(60%) students had their on lateral incisors while 2(40%) had theirs on the 1st premolar. It was found from table 9, that out of 246 student questioned, 40(16.26%) had been aware while 206(83.74%) had no knowledge at all.
Table 10 revealed the total number of tooth affected by supernumerary. Out of 5 students 2(40%) were having only 1 tooth, extra for the females only while 3(60%) were having 2 teeth extra, 1(100%) male and 2(50%) female.
        From table 11, it was found the cause of hyperdontia. Out of 5 students found, all were as a result of hereditary.
Table 12 revealed various complications found on the affected students. It was observed that all the victim had crowded teeth. 2(40%) had dental caries, 1(20%) had root resportion while 3(60%) had gingival inflammation. Table 13 shows possible treatment needed for each of them. Due to the position and nature of the problems, it was observed that out of the 5 students 4(80%) need removal or extraction while 1(20%) need orthodontic therapy.
CONCLUSION
From the research carried out in community secondary school Obeagu, in Awgu Local Government area of Enugu state of Nigeria. It was 2.03% of the students had hyperdontia. Therefore, there is no prevalence of hyperdontia among students attending the school.
RECOMMENDATION
Following the results of the study the following are the
 recommendation:
1.  Oral health education should be included in their school curriculum.
2.  Adequate awareness to dental treatment should be created.
3.  Since the condition can be inherited, pregnant women should be educated on oral health during ante-natal
SUGGESTION FOR FURTHER STUDIES
1.  The knowledge, attitude and practice of students towards oral health
2.  Oral hygiene measures among members of Obeagu
 community.




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