Epidemiology of enamel hypoplasia in deciduous teeth: explaining variation in prevalence in western India

This study is based on seven samples of school children (n = 516) from rural (five groups) and urban (two groups) settings in western Maharashtra, India. Height and weight were recorded for each subject. Intra-oral observation of the labial surface of maxillary and mandibular anterior teeth was conducted with a low power (3x) illuminated hand lens. Presence of enamel hypoplasia was recorded on a dental chart by drawing the size and location of the defect on the affected tooth. Data analysis was conducted in two stages: 1) Enamel hypoplasia (EH) prevalence was analyzed by percentage of teeth and by percentage of individuals affected for the composite sample and independently for each study group and 2) an assessment of the relationship between anthropometric variables (height and weight), socio-economic status (SES), and localized hypoplasia of primary canines (LHPC; Skinner, 1986) was evaluated using multiple linear regression analysis. EH was observed less often in deciduous incisors (0.2% in di(2) to 2.5% in di(2)) than in deciduous canines (dc). Mandibular dc were affected with the greatest frequency (23.1%, tooth count). The overall individual count prevalence of dc hypoplasia (LHPC) is 26.2% (134/511) for all village samples and sexes combined. Difference in LHPC frequency by sex is non-significant, with males (24.7%, 70/284) and females (28.2%, 64/227) exhibiting nearly equal values. Significant inter-group variation in LHPC prevalence was documented among the seven groups, and the range of LHPC prevalence the among living groups exceeds variability in LHPC among four prehistoric Chalcolithic skeletal series of the Deccan Plateau. Multiple regression analysis revealed no significant relationship between height-for-age or weight-for-age in four school samples (two urban/two rural), but a significant association between stature and LHPC was found for three rural endogamous groups. Children with LHPC were significantly shorter by 1.5 cm than children who lacked the defect after controlling for differences in age. While the association between low birth weight and EH is strong and well documented clinically, the association between childhood stature and LHPC is more variable across groups and may reflect inter-group variation in the duration and intensity of environmental stress.