Eugen Bud

Haj Alexandra

Manuela Chibelean

Maria Cristina Figueiredo Pollmann

Mariana Pacurar

Open Repository of the University of Porto

 Acta Stomatologica Marisiensis 2018;1(1)48-54                                                                                ISSN 2601-6877(print)/ISSN-L 2601-6877(online) 
 
48 
ORIGINAL PAPER 
 
 
Clinical-statistical analysis of correlations between caries risk 
indicators and the prevalence of maxillary dental anomalies in a group 
of children from Tirgu Mures 
Mariana Păcurar1, Eugen Bud1,  Haj Alexandra2, Manuela Chibelean1 , Maria Cristina Figueiredo 
Pollmann 3  
1 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania 
2 Psihiatric Clinical, Emergency Mures Hospital, Tirgu Mures, Romania 
3 Faculdade de Medicina Dentária da Universidade do Porto, Portugal  
 
 
Abstract 
Aim: The authors proposed to analyse the pattern of carious lesions in children who underwent orthodontic treatment 
at the Orthodontic Department of the Faculty of Dental Medicine at the University of Medicine and Pharmacy, Tirgu 
Mures during 2015-2017 and to determine the correlation between the pathology of carries and the prevalence of 
maxillary dental anomalies in these children. 
Material and method. Study was a retrospective, in a group of 200 patients (91 young female and 109 young male 
patients), aged 6-9 years old, who underwent special treatment. We performed a caries risk assessment quantified 
by the DMFT/dmft scores of mixed dentition and determined a predictive factor of the occurrence of maxillary dental 
anomalies. We diagnosed maxillary anomalies based on study models and calculated the DAI score (Dental Aesthetic 
Index) characteristic to the degree of malocclusion 
Results. We registered the highest percentage of vertical anomalies for deep bite malocclusion, Class II division 2 
anomaly (according to Angle’s classification), in a percentage of 54%, found that the DMFT/dmft score was between 
0 - 11, the most frequent values being between 0 - 5. The DMFS/dmfs score was between 0 - 34, the most common 
score being 1, followed by values between 2 -7. A more suggestive characterization of these indices is obtained by 
addressing them as quantitative variables, by assessing mean and standard deviations. The DMFS/dmfs score was 
significantly higher in boys (10.86 ± 8.902) than in girls (7.93 ± 7.932), and respectively higher in rural areas (11.04 ± 
8.822) than in urban areas (8.02 ± 8.083). 
Conclusions. The presence of high DMFT/dmft index scores do not present a potential risk for the development of 
anomalies in the sagittal and vertical direction. 
Disharmony caused by maxillary dental crowding presents direct correlations between the caries index and the 
severity of the anomaly. 
Keywords: caries, anomalies DMFT/dmft, index DAI 
 
Introduction 
Although oral health has improved 
worldwide, oral diseases still continue to pose 
a major public health problem, especially 
within communities belonging to socially 
disadvantaged groups who still face increased 
levels of carious lesions and periodontal 
diseases. Currently, the distribution and 
severity of oral diseases vary greatly from one 
country to another as well as among the 
different areas of the same country. 
There are several studies published that 
have attempted to establish the correlation 
between the indicator of dental caries in mixed 
dentition and the risk of maxillary dental 
anomalies, as well as the way in which intra-
arch and inter-arch modifications occur. 
Premature loss of temporary teeth, as a 
consequence of untreated dental caries, can 
cause severe three-dimensional disorders of the 
dental arches and implicitly of dental occlusion, 
interfering with the harmonious development 
of the physiological dentition. 
 
Aim of research 
The authors proposed to analyse the pattern 
of carious lesions in children who underwent 
orthodontic treatment at the Orthodontic 
Department of the Faculty of Dental Medicine 
at the University of Medicine and Pharmacy, 
Tirgu Mures during 2015-2017 and to 
determine the correlation between the 
 ISSN 2601-6877(print)/ISSN-L 2601-6877(online)                                                                                Acta Stomatologica Marisiensis 2018;1(1)48-54 
 
49 
pathology of carries in the mixed dentition 
stage and the prevalence of maxillary dental 
anomalies in these children. We compared the 
DAI (Dental Aesthetic Index) scores, which 
characterizes the degree of malocclusion, with 
the DMFT/dmft and DMFS/dmfs  
 
Material and method 
We conducted a retrospective study in a 
group of 200 patients (91 young female and 
109 young male patients), aged 6-9 years old, 
who underwent special treatment. The 
inclusion criteria were: carious pathology of the 
temporary and permanent teeth; diagnosed 
maxillary dental anomalies, compliant patients, 
whose parents signed the informed consent. 
The exclusion criteria were: non-
cooperative patients; patients older than nine 
years of dental age; patients with dental 
dystrophies; labial, maxillary and palatine clefts 
or genetic/ endocrine disorders.  The 
processing of the collected data was performed 
by using SPS 22.0 for Windows, a medical 
statistical analysis program. 
We performed a caries risk assessment 
quantified by the DMFT/dmft scores of mixed 
dentition and determined a possible predictive 
factor of the occurrence of some maxillary 
dental anomalies. We diagnosed maxillary 
dental anomalies based on study models and 
calculated the DAI score (Dental Aesthetic 
Index) characteristic to the degree of 
malocclusion. We also established the 
correlations between DAI and DMFT/dmft 
scores respectively DAI and DMFS/dmfs 
scores. The modified DAI score for mixed 
dentition was calculated for each patient 
without taking into account the number of 
missing teeth: canine, premolars of the 
maxillary and mandibular arches. 
 
Results 
Out of the 200 subjects comprised in the 
survey 91 (48.5%) were females with a median 
age of 7.31±0.6 and 109 (51.5%) were males 
with a median age of 7.45±0.8; 114 (53%) 
patients came from urban area and 86 (47%) 
from rural area. 
The distribution by gender and background 
(urban or rural) is shown in figures 1 and 2.   
 
48,5%51,5%
Female
Male
 
47,0%53,0% Rural
Urban
 
Figure 1. Gender distribution Figure 2. Rural-urban distribution of patients 
 
Analysing the frequency of maxillary dental 
anomalies we found an uneven distribution 
among classes of anomalies, gender and 
background. Thus, the most frequent sagittal 
anomalies were class II, division1 anomalies 
(40% of the cases), figure 3, and the most 
frequent transverse anomalies were dental-
maxillary disharmonies with crowding 
(secondary) (55% of the cases), figure 4. 
We registered the highest percentage of 
vertical anomalies for deep bite malocclusion, 
Class II division 2 anomaly (according to 
Angle’s classification), in a percentage of 54% 
(figure 5). The Chi- square test revealed 
statistically significant differences in the 
prevalence of these abnormalities. Thus, the 
percentage of male patients without sagittal 
anomalies (24.3%) was significantly higher in 
comparison to female patients (16.5%), and 
class II/2 malocclusion was more frequent in 
young female patients than in young male 
patients (32.0% versus 23.3%). 
 
 Acta Stomatologica Marisiensis 2018;1(1)48-54                                                                                ISSN 2601-6877(print)/ISSN-L 2601-6877(online) 
 
50 
22,5%
16%
16,5%
24,3%
20,5%
35,1%
44,3%
40,2%
39,8%
40%
26,6%
28,3%
32%
23,3%
27,5%
12,8%
11,3%
11,3%
12,6%
12%
0% 20% 40% 60% 80% 100%
rural
urban
female
male
Total group
normal overjet
d.II/1
d.II/2
d.III
 
Figure 3. The frequency of sagittal malocclusions 
 
Regarding background, the percentage of 
patients without anomalies (25.5%) was higher 
in the rural area than in the urban area (16.0%), 
while class II/1 malocclusions were more 
frequent in patients coming from urban areas 
(44.3%). 
 
 
 
Figure 4. The frequency of vertical malocclusions 
 
 
Figure 5. The frequency of transverse malocclusions 
We found that transverse crowding and 
spacing anomalies were more frequent in males 
than in females (10.7% vs. 6.2%), while in 
females crowding anomalies were more 
39,40%
31,10%
36,10%
34,00%
35,00%
13,80%
8,50%
14,40%
7,80%
11,00%
46,80%
60,40%
49,50%
58,30%
54,00%
0% 20% 40% 60% 80% 100%
rural
urban
fem…
male
Tota…
Normal
anterior open bite occlusion
3,20%
1,00%
1,90%
1,50%
51,10%
58,50%
61,90%
48,50%
55,00%
1,10%
0,90%
6,20%
1,90%
1%
10,60%
8,50%
18,60%
12,60%
9,50%
21,30%
13,20%
6,20%
15,50%
17,00%
6,40%
10,40%
2%
10,70%
8,50%
3,20%
3,80%
3%
3,90%
3,50%
3,20%
4,70%
3,10%
4,90%
4,00%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
rural
urban
female
male
Total group
normal crowding
lateral balanced reverse occlusion spacing
crowding+ lateral balanced reverse occlusion spacing + spacing
lateral balanced reverse occlusion + spacing crowding+ lateral balanced reverse occlusion +spacing
 ISSN 2601-6877(print)/ISSN-L 2601-6877(online)                                                                                Acta Stomatologica Marisiensis 2018;1(1)48-54 
 
51 
frequent (61.9%), and lateral balanced reverse 
occlusion was completely absent. Crowding 
anomalies were more common in patients 
coming from urban areas compared to rural 
areas (58.5% vs. 51.1%), as well as crowding 
and spacing (10.4% versus 6.4%), and 
crowding and lateral balanced reverse 
occlusion appeared more frequently in rural 
areas (21.3% vs. 13.2%). 
We analyzed the frequency distribution 
chart of caries risk assessment and found that 
the DMFT/dmft score was between 0 - 11, the 
most frequent values being between 0 - 5. The 
DMFS/dmfs score was between 0 - 34, the 
most common score being 1, followed by 
values between 2 -7. A more suggestive 
characterization of these indices is obtained by 
addressing them as quantitative variables, by 
assessing mean and standard deviations. From 
this perspective, the global DMFT/dmft score 
was 3.64 ± 2.686 and the DMFS/dmfs score 
was 9.44 ± 8.56.  
 
          Graph 1. The frequency distribution of DMFT/dmft scores 
 
 
 
The comparative study of gender indices 
showed a significant increase of the 
DMFT/dmft score in young male patients 
(3.90 ± 2.679) compared to young female 
patients (3.36 ± 2.669), as well as in rural areas 
(4.40 ± 2.865) compared to urban areas (2.96 
± 2.318), graph 1.  
Similarly, the DMFS/dmfs score was 
significantly higher in boys (10.86 ± 8.902) 
than in girls (7.93 ± 7.932), and respectively 
higher in rural areas (11.04 ± 8.822) than in 
urban areas (8.02 ± 8.083), graph 2. 
 
       Graph 2. The frequency distribution of DMFS/dmfs scores 
 
93
42
36
18
45
24
12
42
21
15
21 21 18
12 12
24
9
15 12
24
3
12 12 12
6 3 6
9 6 3 3 6 3
0
10
20
30
40
50
60
70
80
90
100
1
/1
/1
90
0
1
/2
/1
90
0
1
/3
/1
90
0
1
/4
/1
90
0
1
/5
/1
90
0
1
/6
/1
90
0
1
/7
/1
90
0
1
/8
/1
90
0
1
/9
/1
90
0
1
/1
0/
19
0
0
1
/1
1/
19
0
0
1
/1
2/
19
0
0
1
/1
3/
19
0
0
1
/1
4/
19
0
0
1
/1
5/
19
0
0
1
/1
6/
19
0
0
1
/1
7/
19
0
0
1
/1
8/
19
0
0
1
/1
9/
19
0
0
1
/2
0/
19
0
0
1
/2
1/
19
0
0
1
/2
2/
19
0
0
1
/2
3/
19
0
0
1
/2
4/
19
0
0
1
/2
5/
19
0
0
1
/2
6/
19
0
0
1
/2
7/
19
0
0
1
/2
8/
19
0
0
1
/2
9/
19
0
0
1
/3
0/
19
0
0
1
/3
1/
19
0
0
2
/1
/1
90
0
2
/2
/1
90
0
 
 Acta Stomatologica Marisiensis 2018;1(1)48-54                                                                                ISSN 2601-6877(print)/ISSN-L 2601-6877(online) 
 
52 
The presence of class II division 1 anomaly 
was not influenced by the DMFT/dmft score, 
on the contrary, in patients with such 
DMFT/dmft score we observed a lower 
percentage of class II/1 anomalies (38.3%) 
compared to other patients of class II/1 
anomalies scoring 40.5%. Similarly, neither the 
presence of class II division 2 anomaly was 
influenced by the DMFT/dmft score 5; on the 
contrary, in patients with this DMFT/dmft 
score, a lower percentage of Class II/2 
anomalies (23.4%) were observed compared to 
other Class II/2 patients, with a percentage of 
28.8% anomalies. 
 
       Graph 3. DMFT/dmft: Descriptive statistical parameters of transversal anomalies 
 
 
No correlation could be established 
between the caries risk scores and the presence 
of Angle Class III anomalies. The patients with 
DMFT/dmft score greater than 5, presented 
statistically significantly lower percent of class 
III anomalies (6.4%) compared to other lower 
score DMFT/dmft class III malocclusion 
patients (13.7%). 
We observed a more complex situation 
regarding the variation of DMFT/dmft and 
DMFS/dmfs scores in case of transversal 
anomalies. Thus, for the DMFT/dmft indices, 
we found that in case of crowding of teeth, 
lateral balanced reverse occlusion and spacing 
the calculated scores were slightly lower than in 
patients with normal occlusion. Combined 
diagnoses of crowding + lateral balanced 
reverse occlusion showed increased 
DMFT/dmft score, while crowding +  reverse 
occlusion,  demonstrated a slight decrease in 
the DMFT/dmft score (graphs 3,4). 
 
            Graph 4. DMFS/dmfs: Descriptive statistical parameters of transversal anomalies 
 
 ISSN 2601-6877(print)/ISSN-L 2601-6877(online)                                                                                Acta Stomatologica Marisiensis 2018;1(1)48-54 
 
53 
 
The frequency distribution graph (graph 5) 
for the study group shows that the DAI index 
values were between 13-60, the most frequent 
values being 24, 26 and 32 respectively. 42% of 
the patients had the DAI index values 
corresponding to an absent or slight 
malocclusion, while 58% of patients had 
varying degrees of malocclusion: 24.5% 
presented stable malocclusion (DAI between 
26-30), 16.5% sever malocclusion (DAI 
between 31-35), and 17.0% extremely severe 
malocclusion (DAI score over 36). 
 
                 Graph 5. The frequency distribution of the DAI score 
 
 
 
Discussions 
A situation of the caries risk index on the 
national level was reported in a study 
conducted by the representative of WHO 
(World Health Organization), Prof. Dr. P.E. 
Petersen in 1992, in the framework of a 
Tempus project comprising five of our major 
cities: Bucharest, Iasi, Timisoara, Cluj and 
Tirgu Mures. Thus, during 1986 - 1992 there 
was an increase in the DMFT score of 12-year-
old patients from 3.1 to 4.1. (6)  Subsequently 
a slight downward trend of the DMFT score 
(3.4) was recorded in 1995. In 1996, the 
National Oral Health Pathfinder Survey, 
conducted in Romania by WHO, showed that 
the average level of DMFT score in 12-year-old 
patients was 3.1, much higher than 
recommended for Europe (2 for children of 
the same age). 
Attempts to demonstrate a direct link 
between the presence of dental caries and 
maxillary dental anomalies reported 
inconclusive results [4, 9].  Parker have found 
parallelism between tooth decay prevalence 
and mandibular overjet for mixed dentition, 
which proved to be statistically significant after 
the assessment of the risk of developing a 
particular malocclusion [10]. The likelihood of 
developing an open occlusion is twice as high 
in children with dental caries then in children 
without caries [6]. Peres reported similar results 
in children with a DAI index > 35 and a 
significantly higher caries experience compared 
to other children. Moreover, DAI scores have 
shown a significant correlation with the mean 
scores of the DMFT index (r = 0.368, p <0.05). 
Another survey conducted in Argentina in 
2016 also showed a positive correlation 
between the severity of malocclusions and 
dental caries based on the DAI index. But 
Axelsson [7] concluded that there was no 
statistically significant correlation between the 
DAI and DMFT index scores (although the 
prevalence of malocclusion and dental caries 
had proven to be high). 
 
Conclusions 
1. The presence of high DMFT/dmft index 
scores do not present a potential risk for the 
 Acta Stomatologica Marisiensis 2018;1(1)48-54                                                                                ISSN 2601-6877(print)/ISSN-L 2601-6877(online) 
 
54 
development of anomalies in the sagittal 
and vertical direction. 
2. Disharmony caused by maxillary dental 
crowding presents direct correlations 
between the caries index and the severity of 
the anomaly, so that the premature loss of 
temporary teeth associated with untreated 
dental caries determines the drifting of 
antagonistic adjacent permanent teeth. 
3. The most accurate predictor of caries 
activity in mixed dentition, the 
DMFT/dmft index, showed lower mean 
values in patients with dental spacing and 
higher in patients with dental crowding. 
4. The combination of anomalies: disharmony 
caused by dental crowding and reverse 
occlusion, respectively by lateral reverse 
occlusion can be associated with higher 
values of the DMFT/dmft indices. 
5. High DMFT/dmft index values influence 
DAI index values only in a low percentage, 
which cannot be considered a positive 
influence. Low DMFT/dmft index values 
have greater influence on low DAI index 
values. 
 
Conflict of interest: None to declare. 
 
 
 
 
 
References  
1. Cushing AM, Sheiham A, Meizels J. Developing 
socio-dental indicators -the social impact of dental 
disease. Community Dent Health 1996; 3: 3-17; 
2. Gift HG, Atchison KA, Dayton CM. Conceptualizing 
oral health and oral health-related quality oflife. 
Soc Sci Med 1997; 44: 601-609; 
3. Marthaller TM. Caries status in Europe and 
poredictions of future trends , Caries research, 
1990, 24(6) , 381-396 
4. Broder HL, Slade G, Caine R, et al. Perceived impact 
of oral health conditions and quality oflife among  
American adolescents. J Dent Res 207: 26 (8) 201-
205;  
5. Maxim A, Bălan A, Păsăreanu M. Demographic 
trends of caries activity in children and teenagers, 
Medicina Stomatologică, 2004, 8 (1) 80-83 
6. Petersen PE, Hoerup N, Poomviset N, Prommajan 
J, Watanapa A. Oral health status and oral health 
behaviour of urban and rural schoolchildren in  
Europe . Int Dent J 2001, 51:95-102. 
7. Axelsson S, Soder B, Nordenram G et al. Effect of 
combined caries-preventive methods: a 
systematic review of controlled clinical trials. Acta 
Odontol Scand 2004; 62: 163-9. 
8. Dănilă I, Hanganu C, Timis T. Trends in oral health 
status in schoolchildren from Iasi, Romania. Oral 
Health and Preventive Dentistry' 2004: 2 (1): 71 
9. Widstrom E, Eaton KA, Borutta A. Oral health care 
in transition in Eastern Europe. British. Dental  
Journal 2009; 190: 580-4 
10. Parker MW. The significance of occlusion in 
restorative dentistry. Dental Clinic North. 
American Journal, 2013, 37 (3), 341-347 
 
Corresponding author:  
Manuela Chibelean 
University of Medicine and Pharmacy of Tirgu Mures, 38 Gheorghe Marinescu street, Tirgu Mures, 540139, Romania 
Email: drmchibelean@yahoo.com 
 
Received: April 30, 2018 / Accepted: May 29, 2018 


English

Clinical-statistical analysis of correlations between caries risk indicators and the prevalence of maxillary dental anomalies in a group of children from Tirgu Mures

Repositório Aberto da Universidade do Porto

 Acta Stomatologica Marisiensis 2018;1(1)48-54                                                                                ISSN 2601-6877(print)/ISSN-L 2601-6877(online)  48 ORIGINAL PAPER   Clinical-statistical analysis of correlations between caries risk indicators and the prevalence of maxillary dental anomalies in a group of children from Tirgu Mures Mariana Păcurar1, Eugen Bud1,  Haj Alexandra2, Manuela Chibelean1 , Maria Cristina Figueiredo Pollmann 3  1 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania 2 Psihiatric Clinical, Emergency Mures Hospital, Tirgu Mures, Romania 3 Faculdade de Medicina Dentária da Universidade do Porto, Portugal    Abstract Aim: The authors proposed to analyse the pattern of carious lesions in children who underwent orthodontic treatment at the Orthodontic Department of the Faculty of Dental Medicine at the University of Medicine and Pharmacy, Tirgu Mures during 2015-2017 and to determine the correlation between the pathology of carries and the prevalence of maxillary dental anomalies in these children. Material and method. Study was a retrospective, in a group of 200 patients (91 young female and 109 young male patients), aged 6-9 years old, who underwent special treatment. We performed a caries risk assessment quantified by the DMFT/dmft scores of mixed dentition and determined a predictive factor of the occurrence of maxillary dental anomalies. We diagnosed maxillary anomalies based on study models and calculated the DAI score (Dental Aesthetic Index) characteristic to the degree of malocclusion Results. We registered the highest percentage of vertical anomalies for deep bite malocclusion, Class II division 2 anomaly (according to Angle’s classification), in a percentage of 54%, found that the DMFT/dmft score was between 0 - 11, the most frequent values being between 0 - 5. The DMFS/dmfs score was between 0 - 34, the most common score being 1, followed by values between 2 -7. A more suggestive characterization of these indices is obtained by addressing them as quantitative variables, by assessing mean and standard deviations. The DMFS/dmfs score was significantly higher in boys (10.86 ± 8.902) than in girls (7.93 ± 7.932), and respectively higher in rural areas (11.04 ± 8.822) than in urban areas (8.02 ± 8.083). Conclusions. The presence of high DMFT/dmft index scores do not present a potential risk for the development of anomalies in the sagittal and vertical direction. Disharmony caused by maxillary dental crowding presents direct correlations between the caries index and the severity of the anomaly. Keywords: caries, anomalies DMFT/dmft, index DAI  Introduction Although oral health has improved worldwide, oral diseases still continue to pose a major public health problem, especially within communities belonging to socially disadvantaged groups who still face increased levels of carious lesions and periodontal diseases. Currently, the distribution and severity of oral diseases vary greatly from one country to another as well as among the different areas of the same country. There are several studies published that have attempted to establish the correlation between the indicator of dental caries in mixed dentition and the risk of maxillary dental anomalies, as well as the way in which intra-arch and inter-arch modifications occur. Premature loss of temporary teeth, as a consequence of untreated dental caries, can cause severe three-dimensional disorders of the dental arches and implicitly of dental occlusion, interfering with the harmonious development of the physiological dentition.  Aim of research The authors proposed to analyse the pattern of carious lesions in children who underwent orthodontic treatment at the Orthodontic Department of the Faculty of Dental Medicine at the University of Medicine and Pharmacy, Tirgu Mures during 2015-2017 and to determine the correlation between the  ISSN 2601-6877(print)/ISSN-L 2601-6877(online)                                                                                Acta Stomatologica Marisiensis 2018;1(1)48-54  49 pathology of carries in the mixed dentition stage and the prevalence of maxillary dental anomalies in these children. We compared the DAI (Dental Aesthetic Index) scores, which characterizes the degree of malocclusion, with the DMFT/dmft and DMFS/dmfs   Material and method We conducted a retrospective study in a group of 200 patients (91 young female and 109 young male patients), aged 6-9 years old, who underwent special treatment. The inclusion criteria were: carious pathology of the temporary and permanent teeth; diagnosed maxillary dental anomalies, compliant patients, whose parents signed the informed consent. The exclusion criteria were: non-cooperative patients; patients older than nine years of dental age; patients with dental dystrophies; labial, maxillary and palatine clefts or genetic/ endocrine disorders.  The processing of the collected data was performed by using SPS 22.0 for Windows, a medical statistical analysis program. We performed a caries risk assessment quantified by the DMFT/dmft scores of mixed dentition and determined a possible predictive factor of the occurrence of some maxillary dental anomalies. We diagnosed maxillary dental anomalies based on study models and calculated the DAI score (Dental Aesthetic Index) characteristic to the degree of malocclusion. We also established the correlations between DAI and DMFT/dmft scores respectively DAI and DMFS/dmfs scores. The modified DAI score for mixed dentition was calculated for each patient without taking into account the number of missing teeth: canine, premolars of the maxillary and mandibular arches.  Results Out of the 200 subjects comprised in the survey 91 (48.5%) were females with a median age of 7.31±0.6 and 109 (51.5%) were males with a median age of 7.45±0.8; 114 (53%) patients came from urban area and 86 (47%) from rural area. The distribution by gender and background (urban or rural) is shown in figures 1 and 2.    48,5%51,5%FemaleMale 47,0%53,0% RuralUrban Figure 1. Gender distribution Figure 2. Rural-urban distribution of patients  Analysing the frequency of maxillary dental anomalies we found an uneven distribution among classes of anomalies, gender and background. Thus, the most frequent sagittal anomalies were class II, division1 anomalies (40% of the cases), figure 3, and the most frequent transverse anomalies were dental-maxillary disharmonies with crowding (secondary) (55% of the cases), figure 4. We registered the highest percentage of vertical anomalies for deep bite malocclusion, Class II division 2 anomaly (according to Angle’s classification), in a percentage of 54% (figure 5). The Chi- square test revealed statistically significant differences in the prevalence of these abnormalities. Thus, the percentage of male patients without sagittal anomalies (24.3%) was significantly higher in comparison to female patients (16.5%), and class II/2 malocclusion was more frequent in young female patients than in young male patients (32.0% versus 23.3%).   Acta Stomatologica Marisiensis 2018;1(1)48-54                                                                                ISSN 2601-6877(print)/ISSN-L 2601-6877(online)  50 22,5%16%16,5%24,3%20,5%35,1%44,3%40,2%39,8%40%26,6%28,3%32%23,3%27,5%12,8%11,3%11,3%12,6%12%0% 20% 40% 60% 80% 100%ruralurbanfemalemaleTotal groupnormal overjetd.II/1d.II/2d.III Figure 3. The frequency of sagittal malocclusions  Regarding background, the percentage of patients without anomalies (25.5%) was higher in the rural area than in the urban area (16.0%), while class II/1 malocclusions were more frequent in patients coming from urban areas (44.3%).    Figure 4. The frequency of vertical malocclusions   Figure 5. The frequency of transverse malocclusions We found that transverse crowding and spacing anomalies were more frequent in males than in females (10.7% vs. 6.2%), while in females crowding anomalies were more 39,40%31,10%36,10%34,00%35,00%13,80%8,50%14,40%7,80%11,00%46,80%60,40%49,50%58,30%54,00%0% 20% 40% 60% 80% 100%ruralurbanfem…maleTota…Normalanterior open bite occlusion3,20%1,00%1,90%1,50%51,10%58,50%61,90%48,50%55,00%1,10%0,90%6,20%1,90%1%10,60%8,50%18,60%12,60%9,50%21,30%13,20%6,20%15,50%17,00%6,40%10,40%2%10,70%8,50%3,20%3,80%3%3,90%3,50%3,20%4,70%3,10%4,90%4,00%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%ruralurbanfemalemaleTotal groupnormal crowdinglateral balanced reverse occlusion spacingcrowding+ lateral balanced reverse occlusion spacing + spacinglateral balanced reverse occlusion + spacing crowding+ lateral balanced reverse occlusion +spacing ISSN 2601-6877(print)/ISSN-L 2601-6877(online)                                                                                Acta Stomatologica Marisiensis 2018;1(1)48-54  51 frequent (61.9%), and lateral balanced reverse occlusion was completely absent. Crowding anomalies were more common in patients coming from urban areas compared to rural areas (58.5% vs. 51.1%), as well as crowding and spacing (10.4% versus 6.4%), and crowding and lateral balanced reverse occlusion appeared more frequently in rural areas (21.3% vs. 13.2%). We analyzed the frequency distribution chart of caries risk assessment and found that the DMFT/dmft score was between 0 - 11, the most frequent values being between 0 - 5. The DMFS/dmfs score was between 0 - 34, the most common score being 1, followed by values between 2 -7. A more suggestive characterization of these indices is obtained by addressing them as quantitative variables, by assessing mean and standard deviations. From this perspective, the global DMFT/dmft score was 3.64 ± 2.686 and the DMFS/dmfs score was 9.44 ± 8.56.             Graph 1. The frequency distribution of DMFT/dmft scores    The comparative study of gender indices showed a significant increase of the DMFT/dmft score in young male patients (3.90 ± 2.679) compared to young female patients (3.36 ± 2.669), as well as in rural areas (4.40 ± 2.865) compared to urban areas (2.96 ± 2.318), graph 1.  Similarly, the DMFS/dmfs score was significantly higher in boys (10.86 ± 8.902) than in girls (7.93 ± 7.932), and respectively higher in rural areas (11.04 ± 8.822) than in urban areas (8.02 ± 8.083), graph 2.         Graph 2. The frequency distribution of DMFS/dmfs scores  9342361845241242211521 21 1812 1224915 1224312 12 126 3 69 6 3 3 6 301020304050607080901001/1/19001/2/19001/3/19001/4/19001/5/19001/6/19001/7/19001/8/19001/9/19001/10/19001/11/19001/12/19001/13/19001/14/19001/15/19001/16/19001/17/19001/18/19001/19/19001/20/19001/21/19001/22/19001/23/19001/24/19001/25/19001/26/19001/27/19001/28/19001/29/19001/30/19001/31/19002/1/19002/2/1900  Acta Stomatologica Marisiensis 2018;1(1)48-54                                                                                ISSN 2601-6877(print)/ISSN-L 2601-6877(online)  52 The presence of class II division 1 anomaly was not influenced by the DMFT/dmft score, on the contrary, in patients with such DMFT/dmft score we observed a lower percentage of class II/1 anomalies (38.3%) compared to other patients of class II/1 anomalies scoring 40.5%. Similarly, neither the presence of class II division 2 anomaly was influenced by the DMFT/dmft score 5; on the contrary, in patients with this DMFT/dmft score, a lower percentage of Class II/2 anomalies (23.4%) were observed compared to other Class II/2 patients, with a percentage of 28.8% anomalies.         Graph 3. DMFT/dmft: Descriptive statistical parameters of transversal anomalies   No correlation could be established between the caries risk scores and the presence of Angle Class III anomalies. The patients with DMFT/dmft score greater than 5, presented statistically significantly lower percent of class III anomalies (6.4%) compared to other lower score DMFT/dmft class III malocclusion patients (13.7%). We observed a more complex situation regarding the variation of DMFT/dmft and DMFS/dmfs scores in case of transversal anomalies. Thus, for the DMFT/dmft indices, we found that in case of crowding of teeth, lateral balanced reverse occlusion and spacing the calculated scores were slightly lower than in patients with normal occlusion. Combined diagnoses of crowding + lateral balanced reverse occlusion showed increased DMFT/dmft score, while crowding +  reverse occlusion,  demonstrated a slight decrease in the DMFT/dmft score (graphs 3,4).              Graph 4. DMFS/dmfs: Descriptive statistical parameters of transversal anomalies   ISSN 2601-6877(print)/ISSN-L 2601-6877(online)                                                                                Acta Stomatologica Marisiensis 2018;1(1)48-54  53  The frequency distribution graph (graph 5) for the study group shows that the DAI index values were between 13-60, the most frequent values being 24, 26 and 32 respectively. 42% of the patients had the DAI index values corresponding to an absent or slight malocclusion, while 58% of patients had varying degrees of malocclusion: 24.5% presented stable malocclusion (DAI between 26-30), 16.5% sever malocclusion (DAI between 31-35), and 17.0% extremely severe malocclusion (DAI score over 36).                   Graph 5. The frequency distribution of the DAI score    Discussions A situation of the caries risk index on the national level was reported in a study conducted by the representative of WHO (World Health Organization), Prof. Dr. P.E. Petersen in 1992, in the framework of a Tempus project comprising five of our major cities: Bucharest, Iasi, Timisoara, Cluj and Tirgu Mures. Thus, during 1986 - 1992 there was an increase in the DMFT score of 12-year-old patients from 3.1 to 4.1. (6)  Subsequently a slight downward trend of the DMFT score (3.4) was recorded in 1995. In 1996, the National Oral Health Pathfinder Survey, conducted in Romania by WHO, showed that the average level of DMFT score in 12-year-old patients was 3.1, much higher than recommended for Europe (2 for children of the same age). Attempts to demonstrate a direct link between the presence of dental caries and maxillary dental anomalies reported inconclusive results [4, 9].  Parker have found parallelism between tooth decay prevalence and mandibular overjet for mixed dentition, which proved to be statistically significant after the assessment of the risk of developing a particular malocclusion [10]. The likelihood of developing an open occlusion is twice as high in children with dental caries then in children without caries [6]. Peres reported similar results in children with a DAI index > 35 and a significantly higher caries experience compared to other children. Moreover, DAI scores have shown a significant correlation with the mean scores of the DMFT index (r = 0.368, p <0.05). Another survey conducted in Argentina in 2016 also showed a positive correlation between the severity of malocclusions and dental caries based on the DAI index. But Axelsson [7] concluded that there was no statistically significant correlation between the DAI and DMFT index scores (although the prevalence of malocclusion and dental caries had proven to be high).  Conclusions 1. The presence of high DMFT/dmft index scores do not present a potential risk for the  Acta Stomatologica Marisiensis 2018;1(1)48-54                                                                                ISSN 2601-6877(print)/ISSN-L 2601-6877(online)  54 development of anomalies in the sagittal and vertical direction. 2. Disharmony caused by maxillary dental crowding presents direct correlations between the caries index and the severity of the anomaly, so that the premature loss of temporary teeth associated with untreated dental caries determines the drifting of antagonistic adjacent permanent teeth. 3. The most accurate predictor of caries activity in mixed dentition, the DMFT/dmft index, showed lower mean values in patients with dental spacing and higher in patients with dental crowding. 4. The combination of anomalies: disharmony caused by dental crowding and reverse occlusion, respectively by lateral reverse occlusion can be associated with higher values of the DMFT/dmft indices. 5. High DMFT/dmft index values influence DAI index values only in a low percentage, which cannot be considered a positive influence. Low DMFT/dmft index values have greater influence on low DAI index values.  Conflict of interest: None to declare.      References  1. Cushing AM, Sheiham A, Meizels J. Developing socio-dental indicators -the social impact of dental disease. Community Dent Health 1996; 3: 3-17; 2. Gift HG, Atchison KA, Dayton CM. Conceptualizing oral health and oral health-related quality oflife. Soc Sci Med 1997; 44: 601-609; 3. Marthaller TM. Caries status in Europe and poredictions of future trends , Caries research, 1990, 24(6) , 381-396 4. Broder HL, Slade G, Caine R, et al. Perceived impact of oral health conditions and quality oflife among  American adolescents. J Dent Res 207: 26 (8) 201-205;  5. Maxim A, Bălan A, Păsăreanu M. Demographic trends of caries activity in children and teenagers, Medicina Stomatologică, 2004, 8 (1) 80-83 6. Petersen PE, Hoerup N, Poomviset N, Prommajan J, Watanapa A. Oral health status and oral health behaviour of urban and rural schoolchildren in  Europe . Int Dent J 2001, 51:95-102. 7. Axelsson S, Soder B, Nordenram G et al. Effect of combined caries-preventive methods: a systematic review of controlled clinical trials. Acta Odontol Scand 2004; 62: 163-9. 8. Dănilă I, Hanganu C, Timis T. Trends in oral health status in schoolchildren from Iasi, Romania. Oral Health and Preventive Dentistry' 2004: 2 (1): 71 9. Widstrom E, Eaton KA, Borutta A. Oral health care in transition in Eastern Europe. British. Dental  Journal 2009; 190: 580-4 10. Parker MW. The significance of occlusion in restorative dentistry. Dental Clinic North. American Journal, 2013, 37 (3), 341-347  Corresponding author:  Manuela Chibelean University of Medicine and Pharmacy of Tirgu Mures, 38 Gheorghe Marinescu street, Tirgu Mures, 540139, Romania Email: drmchibelean@yahoo.com  Received: April 30, 2018 / Accepted: May 29, 2018 

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Clinical-statistical analysis of correlations between caries risk indicators and the prevalence of maxillary dental anomalies in a group of children from Tirgu Mures

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