Dental Maturity in Children With Celiac Disease

A Case-control Study

Najlaa M. Alamoudi; Farah A. Alsadat; Azza A. El-Housseiny; Osama M. Felemban; Amani A. Al Tuwirqi; Rana H. Mosli; Omar I. Saadah

Disclosures

BMC Oral Health. 2020;20(311) 

In This Article

Results

Sample Charactristics

Two-hundred and eight participants (104 children with CD, and 104 healthy controls) were included in the analysis. A total of 149 CD patients were contacted, and 520 letters of invitation were distributed to the classmates of CD children. The response rate of the CD group was 69.80%, while the response rate of the control group was 20%. In both the CD and control groups, 50% of the participants were girls. No statistically significant differences were found between the socioeconomic distribution of the two groups with respect to family income (P = 0.874), mother education (P = 0.052), and father education (P = 0.781). Children in the CD group were less likely to report daily intake of protein (76.0%), compared to the control group (80.8%) and the difference was statistically signifcant (P = 0.027). Thirteen of the children with CD were taking growth hormones (GHs) (Table 1).

The mean CA was 10.67 ± 2.40 (95% CI 10.21–11.14) years in the children with CD, and 10.69 ± 2.37 (95% CI 10.23–11.15) years in the healthy controls (P = 0.958). Children with CD had significantly lower mean DA compared to controls (10.01 years ± 2.05; 95% CI 9.62–10.41 vs. 11.27 years ± 2.42; 95% CI 10.81–11.75, P < 0.001) (Figure 1). Therefore, children with CD had a delayed DM of 0.66 ± 0.91 years, corresponding to 7.94 ± 10.94 months, while the healthy controls had an advanced DM of 0.58 ± 0.73 years, corresponding to 6.99 ± 8.77 months (P < 0.001). The DM categories among all participants showed that 95.60% were CD children in the category of delayed DM, (P < 0.001). In the category of advanced DM, 82.50% were healthy controls (P < 0.001) (Figure 2).

Figure 1.

Comparison between chronological age (CA), and dental age (DA) in the study and control groups

Figure 2.

Comparison in the degree of dental maturity (DM) between the study and control groups

In the CD group, 65 patients (62.5%) had delayed DM, 22 patients (21.2%) had normal DM, and 17 patients (16.3%) had advanced maturity. In the control group, only 3 participants (2.9%) had delayed DM, 21 participants (20.2%) had normal DM, and 80 participants (76.9%) had advanced DM.

DM Categories in Children With CD and Healthy Controls

Grading the DM for the CD group, 22 patients (21.2%) had normal maturity, 35 patients (33.7%) had mild delay, 26 patients (25%) had moderate delay, 4 patients (3.8%) had severe delay, 12 patients (11.5%) had mild advanced, only 5 patients (4.8%) had moderate advanced, and none had severe advanced. Grading the DM for the healthy controls showed that 21 participants (20.2%) had normal maturity, 45 participants (43.3%) had mildly advanced, 31 participants (29.8%) had moderately advanced, 4 participants (3.8%) had severly advanced, 3 participants had mild delay, and none had moderate or severe delay (Figure 3).

Figure 3.

Percentage distribution of dental maturity (DM) categories among the whole sample

Bivariate Analysis of the Mean Difference Between DA and CA in Children With CD vs. Healthy Controls

A bivariate analysis of the DM in months (difference between DA and CA) by demographic, SES, and dietary variables was carried out speparately for CD and control groups. Boys in the control group had signifcantly higher mean DM of 8.77 ± 9.27 months (95% CI 6.19–11.35), compared to girls (5.22 ± 7.94 months; 95% CI 3.01–7.43) (P = 0.034). Moreover, the youngest age category (6–7 years) in general had higher DM of 5.65 ± 7.66 months (95% CI 1.71–9.59), corresponding to an advanced DM, which was significantly different from the other two age groups (P < 0.001); the middle age group (8–10 years) had a mean DM of − 8.52 ± 07.50 months (95% CI − 11.18 to − 5.86), corresponding to a delayed DM; and the oldest age group (11–14 years) had a mean DM of -11.85 ± 10.28 months (95% CI − 14.66 to − 9.05), corresponding to a delayed DM.

Family income was found to be associated with the DM in the CD group (P = 0.016). The middle-income group (between 5000 and 10,000 SAR) had a mean DM of − 11.32 ± 9.70 months (95% CI − 14.66 to − 7.99), corresponding to a delayed DM, which was significantly different from the highest-income group (> 10,000 SAR), which had a mean DM of − 4.07 ± 10.90 months (95% CI − 7.70 to − 0.43), corresponding to a delayed DM. Mother education was also associated with DM in the CD group (P = 0.042). Children whose mothers had less than 12 years of education had a mean DM of − 9.24 ± 10.16 months (95% CI − 11.91 to − 6.57), corresponding to delayed DM, which was significantly different from those whose mothers had more than 12 years of education, with a mean DM of − 6.29 ± 11.75 months (95% CI − 9.78 to − 2.80), corresponding to a delayed DM.

In the control group, daily intake of vegetables was significantly associated with DM (P = 0.048). The mean CA and DA and the mean DM did not show a significant difference between children with CD that were taking growth hormones (GHs) and those that were not taking them (P = 0.783). The mean DM of children taking GH was 5.64 ± 9.36 months (95% CI 0.036–11.4), while the mean DM of those that were not taking GHs was 6.48 ± 10.44 months (95% CI 4.32–8.76) (Table 2).

Predictors of DM in the CD and Control Groups

A multiple linear regression model was applied to confirm the relationship between CD and DM, while controlling for confounding variables. Children with CD had a signifcanlty delayed DM by about 15 months on average (β ± SE, − 14.84 ± 1.31; 95% CI − 17.41 to − 12.26, P < 0.001) compared to control subjects, after controlling for other variables. Children aged 6–7 years had advanced DM by 9.32 ± 1.88 months (95% CI 5.61–13.03, P < 0.001) in comparison with the 11–14 year-old children after controlling for other variables (Table 3).

Predictors of DM in CD Group

A multiple linear regression model was used to explore possible predictors of DM in the CD group (n = 104). Young age was found to be the only significant predictor for DM. Children in the youngest age group (6–7 years) had significantly advanced DM by 16.21 ± 2.58 months (95% CI 11.09–21.32, P < 0.001) compared to 11–14 year-old children (Table 4).

Inter and Intra-rater Reliability Assessment

Intra-class correlation coefficient (ICC) for inter-rater agreement was carried out for each tooth separately on the lower left quadrant; the score ranged from 0.96 to 1, which indicated excellent reliability.[19] Also, intra-rater reliability was performed for each tooth separately; the score ranged from 0.95 to 1, which likewise indicated excellent reliability.[19]

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