Bone disease and oromaxillofacial disorders: a cross- sectional study in a Tanzanian pediatric population

Certain bone diseases of congenital origin are associated with dental alterations and with oromaxillofacial (OMF) disorders. The objective of this study was to evaluate and compare the OMF alterations presented by patients affected by bone pathology with respect to a healthy population from the same geographical environment.

A cross-sectional study was carried out at Mount Meru Regional Referral Hospital and Kaloleni secondary school in Arusha, Tanzania. The patients with bone pathologies (n = 60) were consecutively recruited from the hospital, while the controls (n = 581) comprised a population of healthy students from the school, which was located in the same neighbourhood as the hospital. In the case group, the different bone pathologies were divided into two subgroups: (i) disorders in cellular metabolism (DCM); and (ii) disorders of bone growth/deformity (DGD). Musculoskeletal and oral clinical examinations were performed in both groups.

The case group presented significantly higher values of moderate and severe inflammation on the Löe & Silness Gingival Index (GI 2: 65%, GI 3: 25%) than the control group (p < 0.001), where mild inflammation predominated (GI 1: 88%). The case group also had higher scores for decayed, missing and filled teeth. Dental fluorosis was reported in 75.2% of controls and in only 26.6% of cases, the differences being clearly significant (p < 0.001). Significant differences for fluorosis were also reported between the two subgroups (p < 0.001), with a higher incidence for the DCM subgroup (43.8%). Twenty-two patients (36.7%) in the case group displayed clinical absence of teeth: the rate was significantly higher in the DGD subgroup (n = 15, 50%) than in the DCM subgroup (n = 8, 25%) (p = 0.045). In relation to the type of dental occlusion, the group with bone pathology presented a significant predominance of Angle class II - III malocclusions (p < 0.001). Craniofacial abnormalities were more frequent in the DGD subgroup, although the difference was not significant. The spine was normal in 41 patients (68.3%) and the differences between subgroups were not significant. Pathological fractures were significantly more frequent in the DGD subgroup (50% vs. 6.3%; p < 0.001). Assessing whether there was a relationship between malocclusion and skeletal deformities (spine and upper limb) in the case group, subjects with upper limb deformity (n = 16) presented significant differences for inverted overjet (p = 0.031).

Patients with bone disease had worse oral health and more severe dental malocclusion than controls. The results presented here may help to raise awareness among orthopedic and pediatric professionals of abnormalities related to OMF conditions in childhood.