Evaluation of the Effect of Medications Used in Children with Rheumatic Diseases on Dental Maturation.

Abstract

The study's main objective is to compare dental maturation in healthy children and those with rheumatic diseases. It also aims to determine the age of children with Pediatric Rheumatic Diseases (PRD), specifically focusing on comparing those receiving medical treatment to those who are not, and to differentiate between biological and non-biological medication recipients, to identify potential differences.

This observational cross-sectional study was conducted to assess the dental maturation stages in a cohort of 278 children (126 boys, 152 girls) aged between 6 and 14 years between September 2021 and December 2023. The study population included individuals with PRD requiring dental treatment and systemically healthy children. Digital panoramic radiographs were utilized for the evaluation of dental maturation in both groups.

A statistically perfect agreement was found among the dental age (DA) calculated by the researchers (ICC=1.000; p<0.01). A statistically perfect level of agreement was found between the chronological age (CA) of the cases and the DA measured by the Willems method (ICC=0.921; p<0.01). It was found that the difference between the estimated  DA and CA was higher in girls and boys in the PRD group who were taking medication.

No significant differences were found in DA estimated based on gender and treatment status among individuals with PRD. The Willems method tended to underestimate the age of girls receiving biological treatment while overestimating the age in all other groups.

Keywords:

dental age estimation, Willems method, pediatric rheumatic diseases

References

Maber M, Liversidge H, Hector M. Accuracy of age estimation of radiographic methods using developing teeth. Forensic science international. 2006;159:S68-S73.

Tunc ES, Koyuturk AE. Dental age assessment using Demirjian's method on northern Turkish children. Forensic science international. 2008;175(1):23-6.

Cameron N. Can maturity indicators be used to estimate chronological age in children? Annals of human biology. 2015;42(4):302-7.

Cameriere R, Ferrante L. Age estimation in children by measurement of carpals and epiphyses of radius and ulna and open apices in teeth: a pilot study. Forensic science international. 2008;174(1):60-3.

Cameriere R, Ferrante L, Cingolani M. Age estimation in children by measurement of open apices in teeth. International journal of legal medicine. 2006;120:49-52.

Willems G, Van Olmen A, Spiessens B, Carels C. Dental age estimation in Belgian children: Demirjian's technique revisited. Journal of forensic sciences. 2001;46(4):893-5.

Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Human biology. 1973:211-27.

Harris E, Hullings J. Delayed dental development in children with isolated cleft lip and palate. Archives of oral biology. 1990;35(6):469-73.

Jaffe EC, Roberts G, Chantler C, Carter J. Dental maturity in children with chronic renal failure assessed from dental panoramic tomographs. J Int Assoc Dent Child. 1990;20(2):54-8.

Mahaney M. Delayed dental development and pulmonary disease severity in children with cystic fibrosis. Archives of Oral Biology. 1986;31(6):363-7.

MYLLÄRNIEMI S, LENKO HL, PERHEENTUPA J. Dental maturity in hypopituitarism, and dental response to substitution treatment. European Journal of Oral Sciences. 1978;86(5):307-12.

Sterba Y, Ilowite N. Biologics in Pediatric Rheumatology: Quo Vadis? Curr Rheumatol Rep. 2016;18(7):45.

Pilania RK, Singh S. Rheumatology Panel in Pediatric Practice. Indian Pediatrics. 2019;56:407-14.

Spradley MK. Metric methods for the biological profile in forensic anthropology: sex, ancestry, and stature. Academic forensic pathology. 2016;6(3):391-9.

Laaksonen A-L. A prognostic study of juvenile rheumatoid arthritis. Analysis of 544 cases. Acta Paediatrica Scandinavica. 1966:1-163.

Bhattad S, Mohite RS, Singh N. Growth and development in children with rheumatic diseases: Maintaining a balance between drugs and disease activity. Indian Journal of Rheumatology. 2023;18(Suppl 1):S38-S43.

Lehtinen A, Oksa T, Helenius H, Rönning O. Advanced dental maturity in children with juvenile rheumatoid arthritis. European Journal of Oral Sciences. 2000;108(3):184-8.

Pinchi V, Bianchi I, Pradella F, Vitale G, Focardi M, Tonni I, et al. Dental age estimation in children affected by juvenile rheumatoid arthritis. International Journal of Legal Medicine. 2021;135:619-29.

Liversidge HM. The assessment and interpretation of Demirjian, Goldstein and Tanner's dental maturity. Annals of human biology. 2012;39(5):412-31.

Marinelli A, Giuntini V, Franchi L, Tollaro I, Baccetti T, Defraia E. Dental anomalies in the primary dentition and their repetition in the permanent dentition: a diagnostic performance study. Odontology. 2012;100:22-7.

Marinkovic N, Zelic K, Milovanovic P, Milutinovic J, Djuric M, Nikodijevic Latinovic A, et al. Dental age and skeletal maturity assessment in patients with cerebral palsy. European Journal of Oral Sciences. 2021;129(3):e12780.

Altan HO, Altan A, Bilgiç F, Sözer ÖA, Damlar I. The applicability of Willems' method for age estimation in southern Turkish children: A preliminary study. Journal of forensic and legal medicine. 2016;38:24-7.

Koç A, Özlek E, Öner Talmaç AG. Accuracy of the London atlas, Willems, and Nolla methods for dental age estimation: a cross-sectional study on Eastern Turkish children. Clinical Oral Investigations. 2021:1-8.

Apaydin B, Yasar F. Accuracy of the demirjian, willems and cameriere methods of estimating dental age on turkish children. Nigerian journal of clinical practice. 2018;21(3):257-63.

Ozveren N, Serindere G, Meric P, Cameriere R. A comparison of the accuracy of Willems’ and Cameriere’s methods based on panoramic radiography. Forensic science international. 2019;302:109912.

Gabardo G, Maciel JVB, Franco A, de Lima AAS, da Costa TRF, Fernandes Â. Radiographic analysis of dental maturation in children with amelogenesis imperfecta: A case‐control study. Special Care in Dentistry. 2020;40(3):267-72.

Wang J, Ji F, Zhai Y, Park H, Tao J. Is Willems method universal for age estimation: A systematic review and meta-analysis. Journal of Forensic and Legal Medicine. 2017;52:130-6.

Paz Cortés MM, Rojo R, Alía García E, Mourelle Martínez MR. Accuracy assessment of dental age estimation with the Willems, Demirjian and Nolla methods in Spanish children: Comparative cross-sectional study. BMC pediatrics. 2020;20:1-9.

Guzman J, Kerr T, Ward LM, Ma J, Oen K, Rosenberg AM, et al. Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Pediatric Rheumatology. 2017;15:1-11.

MacRae V, Wong S, Farquharson C, Ahmed S. Cytokine actions in growth disorders associated with pediatric chronic inflammatory diseases. International Journal of Molecular Medicine. 2006;18(6):1011-8.

McErlane F, Carrasco R, Kearsley-Fleet L, Baildam EM, Wedderburn LR, Foster HE, et al., editors. Growth patterns in early juvenile idiopathic arthritis: Results from the Childhood Arthritis Prospective Study (CAPS). Seminars in Arthritis and rheumatism; 2018: Elsevier.

Wang S-J, Yang Y-H, Lin Y-T, Yang C-M, Chiang B-L. Attained adult height in juvenile rheumatoid arthritis with or without corticosteroid treatment. Clinical rheumatology. 2002;21:363-8.

d’Angelo DM, Di Donato G, Breda L, Chiarelli F. Growth and puberty in children with juvenile idiopathic arthritis. Pediatric Rheumatology. 2021;19:1-13.

Marks Jr SC, Schroeder HE. Tooth eruption: theories and facts. The Anatomical Record: An Official Publication of the American Association of Anatomists. 1996;245(2):374-93.

Soldin OP, Mattison DR. Sex differences in pharmacokinetics and pharmacodynamics. Clinical pharmacokinetics. 2009;48(3):143-57.