Rationale Despite improvements in oral health care during the last decade, caries and other tooth structure defects still represent major global public health concerns. To date, no index has satisfied records of different tooth structure defects that could be present in the same mouth and in the same tooth. Available indices provide data on some defects separately. Exposing decision makers to deficient information leaves them unaware of the high levels of untreated defects. Objective Our long term objective is to develop a method for valid and reliable evaluation of tooth structure defects. Such a method would have a broader utility in the implementation of cost effective preventive, non-operative and therapeutic measures to sustain oral health. Specific aims of the current study was to describe: 1) Different tooth structure defects in a random sample for the target population ( Qataris and Egyptians); 2) determine the most prevalent defect(s) in this population and 3)identify the most frequently affected teeth subject to these defects Materials and methods We carried out a cross sectional study to address the stated objectives. A random sample was recruited from 2 subpopulations ( Qatar and Egypt). Each study unit received thorough clinical assessment and each tooth was scored accordingly (table 1 shows clinical evaluation criteria). Data was entered in the data base and statistical methods were used. The association between condition and nationality was performed using the Chi square test/ Fischer's exact test. Results All individuals(93) showed evidence of tooth structure defect(s). Table 2 shows the frequency and percent distribution according to teeth structure defects (fig a, b). Apparently, decay is the most common defect in this target population (87%) followed by filled teeth (57%). The least common defects are abrasion and abfraction. A remarkable finding was that hypoplasia and hypo calcification are common in this population. These 2 conditions render teeth susceptible to caries. Among Qataris, the most common defect was decay followed by missed teeth(wisdom probably due to age) which is a similar pattern observed in Egyptians . Qataris are less likely to experience fractured teeth in comparison to Egyptians (odds ratio = 0.06 , p<0.001). Qataris are four times more likely to experience hypoplasia in comparison to Egyptians ( odds ratio 3.7 and the p value is 0.07). However, Qataris are 1.4 times more likely to experience hypo calcification compared to Egyptians but the odds ratio is not significant (p value 0.5). In this population it was common to see that teeth have more than one tooth structure defect which was not captured in the previous indices. Molars and premolars were most susceptible to decay whereas anterior teeth showed hypo calcification in Qataris whereas for Egyptians, molars and premolars were mostly decayed (tables 3 and 4) Conclusions To our knowledge, this is the first attempt to demonstrate the need to develop a thorough evaluation method that captures all possible tooth structure defects likely to occur in the same mouth and within the same tooth. The results urges the development of a valid and reliable index.


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