ORIGNAL RESEARCH

Status of Third Molars In North Indian Population - A Radiographic Survey

Bhawandeep Kaur1, Soheyl Sheikh2

_______________________________________________________________ Abstract
Background: With the change in number of life style factors, lack of proper dental care and genetic factors, the incidence of agenesis and impactions of third molars is increasing. Material & Method: Panoramic radiographs of 960 males and 880 females of age group ranging from 18-25 years were selected irrespective of sex, caste, nutritional and socioeconomic status. Results: Impaction rate was found to be 42.98% having no sexual predilection. Vertical impaction was of 36.6%, more than mesio-angular 29.2%. Agenesis rate was found to be 15.7%. Bilateral agenesis of third molars in maxilla was more 12.6% as compared to mandible 0.86%. Conclusion: Evolutionary changes and genetic factors are predisposing humans for having agenesis and impaction of the third molars. Key-words: Agenesis, Impaction, Third Molar. ___________________________________________________________________________

Introduction
Evolution is a complex subject and many different theories regarding this concept are emerging. The old ones are being reexamined in the light of emerging genetic discoveries. One common and widely accepted explanation contends that molars evolved when human ancestors roamed the Earth on four legs, more than hundred million years ago. Due to biological, cultural and

evolutionary changes with time, humans have experienced a decreased dependency on all tooth types. This is especially the case where third molars are concerned. Anthropologists state that constantly

increasing cerebration of man is enlarging his brain size at the expense of his jaws1,2. It is a well known fact that nature tries to eliminate what is not in use. Likewise, the advent of civilization and use of soft and refined diet has eliminated the human need for large and powerful

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ORIGNAL RESEARCH

jaws. In this decrease in size, the number of certain teeth no longer necessary for function of mastication and feeding, are either getting increasingly impacted or are not developing at all. So, the incidence of the third molars getting impacted or genetically missing is the highest. Hence, third molars may be considered as Vestigial2 Agenesis is the congenitally

insufficient room for it with in the dental arch4. It is generally accepted that

patterns of facial growth, jaws and tooth size are inherited and likely to differ

among populations and races. Previous studies have shown the incidence of impaction of third molars as 47.44% (1970), 68.6% (2003), respectively5,6. Studies have been conducted to determine the agenesis of the third molars in different parts of the world like Jordan, Australia, Jerusalem, Singapore, South Korea etc. but no similar study has been documented till now in North India7-11. The present study was undertaken to review the prevalence of agenesis as well as impaction of third molars in population of age group 18-25 years.

absence of at least one permanent tooth. It is the most frequently encountered dental anomaly. Since the first reported study by Albert W. Goblirsch in 19303, there have been several studies done in various countries all over the world proving that the percentage of agenesis of third molar agenesis is increasing. An impacted tooth is one which, because of some impediment, is prevented from assuming its normal position in the arch at its physiological time of eruption. The time of eruption of the third molars is also variable, starting at the age of 16 years. Averages of eruption times of 17.8, 19.0, 20.5 & 24 years have been reported . The third molar is the last tooth to erupt. Hence it may readily become either impacted or displaced if there is
4

Aim & Objectives:

The aim and objectives of the study were as follows: 1. To assess the prevalence of agenesis of the third molars in age group ranging between 18-25 years. 2. To assess the prevalence of impacted third molars in age group ranging between 18-25 years.

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Materials & Methodology:

In this study, a total number of 1840 students which were totally

(Rotagraph

plus,

panoramic

and

cephalometric machine VILLA SISTEMI MEDICALLI, 2002, Made in Italy) at 80 KVp, 10 mA for 17 seconds with total filtration of 2.5mm aluminium. 5X12 inches curved rigid aluminium cassette with green light sensitive intensifying screens (Konika KR-II) and 5X12 inches Kodak T-Mat green sensitive panoramic dental films made in U.S.A. by Eastman Kodak, Rochester, New York were used in the study. The radiographs were observed were selected by two observers and were examined for the following: a) Number of third molars present per person b) Number of impacted of third molars c) Number of third molars revealing agenesis Impacted third molars were also grouped according to their position as vertical, horizontal, mesioangular,

asymptomatic, of age group ranging from 18-25 years irrespective of sex, status, caste were selected randomly from

different institutions of M. M. University, Mullana, Ambala, Haryana. An ethical clearance was obtained from the ethical committee of M.M.University,Mullana, Ambala, Haryana. The subjects

irrespective of their sex, caste, nutritional and socio-economic status. Their

demographic data and previous history of extraction of third molar was recorded in the designed proforma. The purpose of the study was explained to them verbally and written consent was obtained. Exclusion Criteria: 1. Subjects having history of third molar extraction were not included in the study. 2. Subjects having any history of pain in third molar region, trismus was not included. Radiographic accomplished by procedure Panoramic was

distoangular impacted molars

Results
Total number of students examined was 1840 including 960 males and 880

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females having age group ranging from 18-25 years. Agenesis of all third molars was found to be in 104 students (5.65%) as shown in figure 1. Agenesis of the third molars was found to be more in males as compared to females. In maxilla bilateral agenesis of third molars was found in 232 cases (12.6%) as shown in figure 2. In mandible bilateral agenesis was found to be in 16 cases (0.86%). The prevalence of agenesis of third molars is shown in table 1. Impaction rate was found to be 42.98% in total subjects as shown in figure 3.
Fig 3: Showing impacted all third molars as well as 37.

The various types of impaction status of third molars is being summarized in table 2. Impaction status of third molars in male and female was found to be in the ratio of 1:1. Impaction status in maxillary and mandibular dentition was found to be in the ratio of 1:1.74.

Discussion
The third molars are the last teeth to erupt in the oral cavity. Since they erupt
Fig 1 Showing agenesis of all the third molars

at about the time when the youth goes off in to the world to become wise, they referred to as wisdom teeth. The word wisdom tooth is derived from latin word dens sapientiae. In many Spanish speaking countries it is called as the molar of judgement. This is because

Fig 2: Showing bilateral agenesis of third molars in maxilla.

when they appear, the person is considered to have better judgement ability than that

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of a child. Turkish refers the third molar directly to the age at which wisdom teeth appear and calls it 20 yas disi which means 20 year tooth. Racial variation, nature of diet, degree of use of masticatory apparatus and genetic inheritance can affect the jaw size and tooth size
12, 13 th

of both sexes was found to be 42.98%. Previous studies have shown prevalence of impaction of the third molars as of 20.5% (1959, Nanda & Chawla), 37%

(1993,Vohra FS), 33% (1995, faiez N. Hatteb),40% ( 1998, Dr. Vandana KV), 68.6% (SL Quick, 2003) respectively57,14,15

. Unlike Hellman, observed Hugson no &

The third molars are the teeth that are most common congenitally missing. If present, the third molars may follow an abnormal eruption path and become impacted as a result of the skeletal insufficiency in the areas where they normally erupt. Impacted third molars are developmental pathologic medical

Kugelberg,

we

sexual

predilection in incidence of third molars impactions16, 17. In our results, 7360 third molars1160 third molars showed agenesis & out of remaining 6200 third molars, 4600 were found to be impacted. Most of the teeth were in vertical impaction state (36.6%) in contrary to the findings of previous studies, which concluded that

deformities characteristics of a modern civilization. To our knowledge, this is the first study in Haryana, a state in Northern part of India, to evaluate the status of third molars in population of age group ranging from 18-25 years. As such, this study has the potential to make a substantial contribution to ongoing debate on the outcome of third molars i.e. whether they should be prophylactically removed or preserved. The prevalence of third molar impaction after examining 1840 subjects

mesioangular impaction was the common state of impacted third molars.(8)

However, prevalence of mesioangular impaction was 29.2%, distoangular 16% and horizontal 18% respectively. In our study, agenesis of the third molars is found to be 15.7% as compared to previous studies done by Sandhu 1982 (7.78%), Faeiz N. Hattab 1995 (9.1%), Daniela Gamba Garib 1995 (20.7%). Our study has documented prevalence of

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agenesis in the maxilla in 12.6% of examined subjects which is more as compared to the subjects exhibiting

wherein the view of entire maxillamandibular region on a single film could be obtained. The procedure is convenient to patient and requires little expertise of the radiologist. The main advantages of this

agenesis of third molars bilaterally in mandible (0.86%)5, 7, 18. In our study, total number of 80 subjects right maxillary third molars, 88 subjects left maxillary third molars, 48 subjects left mandibular third molars, 32 subjects right mandibular third molars, 232 subjects bilateral maxillary third molars, 16 subjects bilateral mandibular third molars & 104 subjects all third molars showed agenesis on the panoramic

procedure is that the status of developing third molars can be viewed, their relation to inferior alveolar dental canal, type of impaction and site of third molar can be easily revealed.

The

main

advantages

of

this

procedure is that the status of developing third molars can be viewed, their relation

radiographs. Previous studies have shown

to inferior alveolar dental canal, type of impaction and site of third molar can be easily revealed.

incidence of agenesis is more in males (Sandhu S.S, 1982) and females (Vohra F.S, 1993), but our study has revealed no sexual predilection5, 14. Previous studies have shown the incidence of agenesis of the maxillary third molar on the right side (Vohra F.S) while contrary to these finding our study has shown no predilection to any side of maxilla14. Panoramic radiographic procedure was selected over the IOPA, due to its advantage of being a fast process and

The

growth

of

maxilla

and

mandible ceases by 16-17 years of age. The mean age of subjects included in this study was 20.94 years which is very close to average age of eruption of third molars reported to be of 20.3 years. Schersten et al19 suggested that 20-25 years is the most suitable age for studying the third molars. DA Vies PL20 showed agenesis of third molars to be more in females as compared to males. But contrary to his findings studies conducted by Hattab FN, Journal of Dental Peers, Vol.1, Issue 1, April 2013 15

ORIGNAL RESEARCH

Lynham A, Mok YY, Thompson GW et al showed no sexual predilection for agenesis of the third molars. But in our study results

revealed the agenesis of the third molars more in males7, 8, 10, 21.

Table 1: Prevalence of Agenesis of the Third molars

TOOTH NUMBER 18 28 38 48 18,28 38,48 18,28,38,48

INCIDENCE 4.34% (80subjects) 4.78% (88 subjects) 2.60% (48 subjects) 1.73% (32 subjects) 12.6% (232 subjects) 0.86% (16 subjects) 5.65% (104 subjects)

Table 2: Prevalence of Impacted Third molars

Mesioangular Distoangular Vertical Horizontal

29.2% 16% 36.6% 18%

Conclusion & Summary

Among 1840 subjects of age group ranging from 18-25 years who were screened for impacted third molars,

impacted without any sexual predilection. Agenesis of third molars was found to be 15.7%. Depending upon the impaction status, treatment options can be planned for impacted third molars. But probably because of changing food habits, there

42.98% showed one or more third molars

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may be complete agenesis of third molars in future, if the same trend continues. Further in the evolutionary ladder of living kingdom the presence of third molars in developed body system of human being seems irrelevant and loathsome instead of being helpful and work-worthy as happens to other living being lower down.

6. Quek SL, Tay CK, Toh SL, Lim KC. Pattern of third molar

impaction in a Singapore Chinese population : A retrospective

radiographic survey. Int J Oral & Maxillofac. Surg. 2003; 32:548552. 7. Hattab FN, Rawashdeh MA,

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Correspondence: 1Dr Bhawandeep kaur, Senior Lecturer, Department of Oral Medicine & radiology, Genesis Institute of Dental Sciences & Research, Ferozepur, Punjab, India Contact Info: E mail: drbhawana@yahoo.co.in Phone No: +91 8146375602 2 Dr Soheyl Sheikh2, Professor & HOD, Department of Oral Medicine & Radiology, M.M. College of Dental Sciences & Research, Mullana, Ambala

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