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ORIGINAL ARTICLE
Year : 2015  |  Volume : 6  |  Issue : 1  |  Page : 5-10

Dental Esthetic Index of in vitro fertilization children Of West Bengal: An epidemiological study


Department of Pedodontics and Preventive Dentistry, Guru Nanak Institute of Dental Science and Research, Kolkata, West Bengal, India

Date of Web Publication19-Jan-2015

Correspondence Address:
Sudipta Kar
21F, Charakdanga Road, Uttarpara, Hooghly - 712 258, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-433X.149554

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  Abstract 

Context: Malocclusion is the second most common of the dental diseases in children and young adults. It should be identified at its earliest to prevent the further derangement. The prevalence and severity of malocclusion among in vitro fertilization (IVF) children of West Bengal was not documented till date. Aims: The aim of this study is to evaluate the orthodontic status and treatment need of IVF children of West Bengal using dental esthetic index (DAI). Settings and Design: In a cross-sectional case control study, 251 IVF children and 251 spontaneously conceived children in the age group of 12-14 years who fulfilled the inclusion and exclusion criteria were considered. Materials and Methods: The information of the samples was collected using a predesigned questionnaire by a single examiner using criteria of DAI (World Health Organization oral health assessment form 1997) The case group consisted of term, singleton babies who were the outcome of IVF in the studied area in 2009-2011. The control group consisted of spontaneously conceived children of the same area. Statistical analysis used: Statistical analysis was carried out using Z-test. Results: No statistically significant difference found in studied (IVF children) and control group (spontaneously conceived children) except when comparing anterior maxillary irregularity in 0 mm category 1-2 mm category and molar relationship in one full cusp category the results are statistically significant at P < 0.05. Conclusions: IVF children are considered nearly same as spontaneously conceived children when studied according to DAI except in three categories. So they may be treated in the same manner as like spontaneously conceived children with a little bit of more precaution because they are more precious to their parent.

Keywords: Dental esthetic index, in vitro fertilization children, malocclusion, orthodontic treatment


How to cite this article:
Kar S, Sarkar S, Mukherjee A. Dental Esthetic Index of in vitro fertilization children Of West Bengal: An epidemiological study. SRM J Res Dent Sci 2015;6:5-10

How to cite this URL:
Kar S, Sarkar S, Mukherjee A. Dental Esthetic Index of in vitro fertilization children Of West Bengal: An epidemiological study. SRM J Res Dent Sci [serial online] 2015 [cited 2023 Feb 8];6:5-10. Available from: https://www.srmjrds.in/text.asp?2015/6/1/5/149554


  Introduction Top


Infertility and its treatment have a considerable impact on a person's quality of life. Most couples who plan to have in vitro fertilization (IVF) treatment have already experienced extensive and emotionally challenging methods of diagnosis and treatment. Louise Brown, the first test tube baby in the world, [1] was born on 25 th July 1978 after IVF and embryo transfer (IVF-ET) technique by Steptoe and Edwards in Oldham, (1978). [1] On 3 rd October 1978, an Indian team from Kolkata, West Bengal, led by (Late) Dr. Subhas Mukherjee [2] an excellent cryobiologist and (Late) Dr. Saroj Bhattacharya, [2] a well-known gynecologist; announced the birth of "Durga" [2] following a test tube baby procedure. The face is the most readily apparent feature, and thus is said to be the most important physical characteristic in the development of self-image and self-esteem. In modern countries, utmost attention is given to the development of orofacial disorders and treatment of malocclusions. [3] In developing countries like India, this inclination is still lacking. Identification of orofacial abnormality at its earliest is very much essential. Improved dental esthetic status of an individual not only essential for esthetics but also is essential for proper development and function of orofacial structures. Dental esthetic index (DAI) is one of the most effective methods recommended by World Health Organization (WHO), to determine the prevalence and severity of malocclusion. [4] It is essential to know the prevalence of malocclusion in any society or community as it reveals the true extent of the upcoming problem and necessary preventive, interceptive and corrective measures can be accomplished. The objective of the study was to evaluate the prevalence of maloccusion and orthodontic treatment needs in 12-14 year old IVF children of West Bengal.


  Materials and methods Top


This was a descriptive, analytic, cross-sectional study approved by the ethical committee of the institution. The study was conducted on 251 IVF and 251 spontaneously children, in the age group of 12-14 years, who fulfilled the inclusion and exclusion criteria were considered for study DAI of those children were evaluated. The children in both case and control groups based on the route of pregnancy were enrolled for the entire course of study. The case group consisted of term (gestational age = 37-42 weeks), singleton babies whom were outcomes of IVF of the studied area and were chosen by a computer generated random number list. The control group consisted of term, first child, singleton and spontaneously conceived 12-14 years old children who were referred to the Department of Pedodontics and preventive dentistry for the primary dental health check-up. Case and control matched for the year of birth, area of residence, parity, gestational age, maternal weight, maternal age and socioeconomic status. Neonatal medical records of the case and control groups were reviewed and variables such sex, gestational age, birth weight and length, route of delivery, maternal age and parity were recorded. Multiple pregnancies, severe asphyxia, gross facial asymmetry, children with major congenital malformations, history of orthodontic treatment previously, chromosomal abnormalities, genetic syndromes, variable path of closure of mandible during mandibular movements, abnormalities in tooth shape, size and number and children with heavily caries teeth were excluded from the sample. To obviate error due to inter observer variations all examinations were made by a trained single examiner who was not informed about the birth status of the children. The study was conducted after informed consent was obtained from the concerned authorities and guardians of children. A total of 832 parents of studied samples was approached to participate in the present study. Out of the above total sample, the parents of 251 IVF and 251 spontaneously agreed to participate in the present study. After informed consents had been collected from the parents, all children were examined by DAI. Examination of the children was done under normal illumination with the help of a mouth mirror, and William's probe that was used to determine the overjet and overbite. The data on orthodontic status were obtained using the criteria of DAI(WHO oral health assessment form 1997).

The calculation of scores of DAI parameters [Table 1] was performed in the following manner: (Missing teeth Χ 6) + crowding + spacing + (midline diastema Χ 3) + anterior irregularity on the maxilla + anterior irregularity on the mandible + (anterior maxillary overjet Χ 4) + (anterior mandibular overjet Χ 4) + (vertical anterior open bite Χ 4) + (anterior posterior molar relation Χ 3) + 13. The points obtained from the regression equation were then tabulated. The obtained scores were included into a four-point scale. Obtained data was statically analyzed. For comparison of proportions, Z-test was used. There is no baseline data for orthodontic treatment need of IVF children. This study aimed to assess the orthodontic treatment need of IVF children according to the DAI and relate it to the same of spontaneously conceived children providing baseline data that can be used in orthodontic treatment planning.


  Results Top


The unique study consisted of 251 IVF and 251 spontaneously conceived children and among them 127 (50.59%) and 129 (51.40%) were male and 124 (49.40%) and 122 (48.60%) were female respectively [Table 2] and [Table 3]. DAI according to each category was then evaluated. When comparing missing teeth category in both group the Z-score is 0.6404. The P 0.52218. The result is not significant at P < 0.05. When comparing crowding in the incisal segments category in IVF and Spontaneously conceived children, the Z-score is −1.3311. The P 0.18352. The result is not significant at P < 0.05. When comparing crowding incisal segments in 1 mm category, the Z-score is 1.9262. The P = 0.0536. The result is not significant at P < 0.05. When comparing crowding incisal segments in 2 mm category, the Z-score is −0.3224. The P0.74896. The result is not significant at P < 0.05. when comparing spacing (incisal segments) in 0 mm category the Z-score is 0.5461. The P 0.58232. The result is not significant at P < 0.05. When comparing spacing (incisal segments) in 1 mm category, the Z-score is −0.3606. The P 0.71884. The result is not significant at P < 0.05. When comparing spacing (incisal segments) in 2 mm category, the Z-score is −0.2391. The P 0.81034. The result is not significant at P < 0.05. When comparing midline diastema in mm category, the Z-score is −0.7034. The P 0.48392. The result is not significant at P < 0.05. When comparing anterior maxillary irregularity in 0 mm category, the Z-score is −2.0748. The P 0.03846. The result is significant at P < 0.05. When comparing anterior maxillary irregularity in 1-2 mm category the Z-score is 2.8107. The P 0.00496. The result is significant at P < 0.05. When comparing anterior maxillary irregularity in ≥3 mm category, the Z-score is 1.5373. The P0.12356. The result is not significant at P < 0.05. When comparing anterior mandibular irregularity in 0mm category, the Z-score is 1.4654. The P 0.14156. The result is not significant at P < 0.05. When comparing anterior mandibular irregularity in 1-2 mm category the Z-score is 1.509. The P 0.13104. The result is not significant at P < 0.05. When comparing anterior mandibular irregularity in ≥3 mm category the Z-score is 0.2229. The P 0.82588. The result is not significant at P < 0.05. When comparing maxillary overjet in 0-3 mm category the Z-score is −0.9659. The P 0.33204. The result is not significant at P < 0.05. When comparing maxillary overjet in ≥4 mm category, the Z-score is 0.9659. The P is 0.33204. The result is not significant at P < 0.05. When comparing mandibular overjet >0 mm category the Z-score is −0.5844. The P 0.56192. The result is not significant at P < 0.05. When comparing open bite in>0 mm category the Z-score is 0.4495. The P 0.65272. The result is not significant at p <0.05. when comparing molar relationship in normal category, the Z-score is −1.8988. The P 0.05744. The result is not significant at P < 0.05. when comparing molar relationship in one half cusp deviation category, the Z-score is 0.4797. The P 0.63122. The result is not significant at P < 0.05. when comparing molar relationship in one full cusp deviation category, the Z-score is 2.3435. The P 0.01928. The result is significant at P < 0.05 [Table 4] and [Table 5]. when comparing no or slight need of treatment in IVF and spontaneously conceived children group the Z-score is 1.1618. The P 0.24604. The result is not significant at P < 0.05. When comparing elective treatment needed in both group, the Z-score is −0.195. The P-value is 0.84148. The result is not significant at P < 0.05. when comparing treatment highly desirable needed in both group, the Z-score is −0.7731. The P 0.4413. The result is not significant at P < 0.05. When comparing Mandatory treatment needed in both group, the Z-score is −0.7974. The P 0.42372. The result is not significant at P < 0.05 [Table 6] and [Table 7].

No statistically significant difference was observed in IVF children and spontaneously conceived children except when comparing anterior maxillary irregularity in 0 mm category 12 mm category and molar relationship in one full cusp category.


  Discussion Top


The face lends a unique, distinctive character and identity to an individual. A balanced face is the outcome of intricate proportion and balance between the hard tissues and soft tissues. A dental and/or skeletal malocclusion may upset this balance and may lead to dissatisfaction in an individual. The DAI scores evaluate prevalence rates of different types of malocclusion by examining the occlusal characteristics of a permanent dentition. In our study the age group of 12-14 years was selected because most malocclusions are manifested to their full extent during this lifespan.

Spanish [5] and Nigerian [6] populations are having 3.7% and 3.5% one missing tooth respectively. In the current study, 5.17% of the IVF children and 3.98% spontaneously conceived children had one or more missing anterior teeth either in maxilla/or mandible and showed no statistically significant result among two groups. The results of the present study were not in accordance with the studies done in America, [7] New Zealand, [8] Malaysia [9] and India. [10] But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

Researchers [11] expressed that crowding was the relatively most frequent of all the traits of malocclusion. In the current study, 77.29% of the IVF population and 82.07% spontaneously conceived children had incisal crowding and showed no statistically significant result among two groups. The results of other studies done in New Zealand, [8] Spain [5] showed nearly same prevalence. Studies done in Nigeria [6] Showed lower prevalence. But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

In the present study, in IVF population 41.43% showed spacing 0, 42.23% showed 1 mm spacing, 16.33% showed 2 mm spacing and in spontaneously conceived children group 39.04% showed spacing 0, 43.82% showed 1 mm spacing, 17.13% showed 2 mm spacing and showed no statistically significant result among two groups. Such types of higher prevalence were observed in studies done in Nigeria. [6] But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

In South India (Madras), [12] 1.6% of subjects showed maxillary diastema. In the present study, in IVF population 10.35% and in spontaneously conceived children, 12.35% cases had a median diastema, and the results are statistically nonsignificant. Studies done in Malaysia, [9] New Zealand [8] and Nigeria [6] showeda higher prevalence for midline diastema. But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

In the present study, IVF and spontaneously conceived children group 29.48%, 38.24% showed 0 mm anterior maxillary irregularity (statistically significant), 64.94%, 52.58% showed 1-2 mm anterior maxillary irregularity (statistically significant) and 5.57%, 9.16% showed ≥3 mm anterior maxillary irregularity respectively of the study subjects had ≥1 mm of maxillary anterior irregularity (statistically insignificant) higher prevalence were also observed in Nigeria, [6] and Malaysia [9] But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

In the present study, IVF and spontaneously conceived children group 26.69%, 32.66% showed 0mm anterior mandibular irregularity (statistically nonsignificant), 69.32%, 62.94% showed 1-2 mm anterior mandibular irregularity (statistically nonsignificant) and 3.98%, 4.38% showed ≥3 mm anterior mandibular irregularity respectively of the study subjects had ≥1 mm of mandibular anterior irregularity (statistically nonsignificant). Previous study in India [10] observed such higher prevalence. But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

In the present study, IVF and spontaneously conceived children group 82.07%, 85.25% showed 0-3 mm maxillary overjet (statistically nonsignificant), 17.92%, 14.74% showed ≥4 mm maxillary overjet (statistically nonsignificant). These results were in correlation with the studies done in Saudi Arabia [20] and Canada [13] But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

In the present study, IVF and spontaneously conceived children group 1.99%, and 2.78% respectively showed >0 mm mandibular overjet (statistically nonsignificant). Glasgow school children [6] showed a higher prevalence for mandibular overjet. But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

In the present study, IVF and spontaneously conceived children group 1.99%, and 0.79% respectively showed >0 mm anterior open bite (statistically nonsignificant). Glasgow school children [6] and studies done in Nairobi, Kenya [14] showed higher prevalence for mandibular overjet. But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

In the present study, IVF and spontaneously conceived children group 53.78%, 62.15% showed normal molar relationship (statistically nonsignificant), 32.66%, 30.67% showed half cusp deviation (statistically nonsignificant) and 13.54%, 7.17% showed one full cusp deviation (statistically significant) respectively. Dissimilar results were observed by the studies done in Nigeria [6] and Sureshbabu et al. [15] India. But no previous study was found involving IVF children in this field. So no comparison was possible with the previous study.

In the present study, among IVF and spontaneously conceived children group 51.19% and 45.02% had ≤25 DAI scores with no abnormality or minor malocclusion requiring no or slight orthodontic treatment need, 29.48% and 30.28% had 26-30 DAI scores with definite malocclusion requiring elective orthodontic treatment, 12.74% and 15.14% had 31-35 DAI scores with severe malocclusion requiring highly desirable orthodontic treatment and 7.57% and 9.56% had ≥36 DAI scores with very severe/handicapping malocclusion requiring definite/mandatory orthodontic treatment respectively and the result is statistically nonsignificant. Researchers [16] 1994 observed 63.4% subjects required no treatment but 6% of the subjects needed mandatory treatment. In country wise observation researchers found DAI scores <25, in Nigeria [6] 77.4%, in South Africa, [17] 58.6% in Spain, [5] 47.7% and 3% in India. [19] DAI scores between 26 30, found in Spain [5] 21.2%, 20.3% in South Africa [17] and 15% in India [19] DAI scores of 31-35, observed in 14.1% in South Africa, [17] 9.6% in Turkey, [18] 11.2% in Spain, [5] and 5.5% in Nigeria, [6] and 27% in India. [19] DAI scores >36 observed 9.9% in Spain, [5] 3.7% in Nigeria, [6] 11.9% in Turkey, [18] 16.8% in South Africa, [17] and 55% in India. [19] No previous study was found involving IVF children in this field. So no comparison was possible with the previous study.


  Conclusion Top


Evaluating the severity and prevalence of malocclusion is very important for the community in establishing the treatment objective and priority in relation to dental esthetics. It can also be used as an epidemiological tool for preventive and interceptive orthodontic procedures. Hopefully, this kind of study will bring positive assurance to numerous parents of IVF children. This study is also significant from social perspective as it motivates the parents of IVF children in a significant manner. It is necessary to point out some limitations of this study. The study was conducted with a small group of IVF sample, moreover the study assess the degree of treatment need but does not diagnose or aid in orthodontic planning. Further research in this arena is important so that the more findings can be obtained for planning and evaluation of these precious babies.

 
  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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