Association between gender and deep pit and issure among index age group 35-45 years

Dental caries is a well-known factor leading to various dental complications, affecting both the health and quality of life. Type of pit and fissures such as "V" and "K" are more susceptible to dental caries where mechanical cleaning becomes a challenge. This study is conducted to evaluate the association of gender with deep pit and fissure among the Index age group 35-44 years old. A retrospective cross-sectional study was conducted using the patient records of the University hospital. A total of 103 consecutive case records of patients who underwent pit and fissure sealant were retrieved and analysed. Descriptive statistics were done to find the prevalence and association of gender and deep pit and fissures among the index age group. The number of teeth with bottomless pit and fissures was higher in males (52.43%) than in females (47.57%). Also, individuals of age group 35-40 years had a larger number of teeth with deep pit and fissures (74.75%) than the age group 41-45 years. No significant association was found between gender and the number of deep pits and fissures (p>0.05). The proportion of deep pit and fissures was high in males compared to females.


INTRODUCTION
World Health Organization (WHO) pertaining important attention to oral health and the prevalence and factors leading to oral diseases including dental caries and periodontal diseases as well as oral cancer since the last decade (Petersen, 2003) among children and adults. Dental caries and peri-odontal diseases likely to develop due to lifestyle habits (Mohapatra et al., 2019). Many healthy promoting lifestyles that can be practised daily to improve oral health and prevent oral diseases are infrequent sugar consumption, tooth brushing effectively and regularly at least twice a day, regular use of dental loss and six months visit to the dentist. Knowledge in oral health in adults and parents' attitudes regarding this matter aid in promoting children's oral health behaviour (Okullo et al., 2004;Qiu et al., 2013).
Evidence suggests that susceptibility to decay is related to the different types of occlusal morphologies (Nagano, 1960;König, 1963). Development of dental caries is likely to develop on pits and issures on occlusal surfaces of permanent teeth (Prabhakar et al., 2011). Dental caries are susceptible due to morphology of the tooth pits and issures, which can be a lourishing region for microorganisms and make the hygiene practices of these areas dif icult to contribute to greater plaque aggregation (Axelsson, 2002). Fissure sealant application is recommended in order to prevent dental caries, in case of samples observed in pits and issures that are very deep and narrow (Kannan et al., 2017). This is to create a physical barrier for the accumulation of plaque in these particular anatomical areas of the tooth (Mathew et al., 2020;Daniel et al., 2008). Dental caries formation can be avoided as this highly suggested primary prevention measure not only prevents caries but also to govern and halt the development of incipient dental caries (Narvai, 2006;Khatri et al., 2019;Rose, 2001). Fissure sealants are used frequently as a primary preventive measure in dental management (Tellez et al., 2011;Prabakar et al., 2018b;Mathew et al., 2020).
Natural cleaning mechanisms through the tongue, lips, and cheeks during chewing and swallowing during tooth eruption are absent (Carvalho, 2014) due to the deprived ability to clean occlusal surfaces of erupting teeth are particularly affected (Prabakar et al., 2016). Accumulation of bacteria and food residues occur in these areas, forming a bio ilm, and lead to demineralization and caries (Li et al., 2011;Pratha and Prabakar, 2019). Multiple risk factors, such as gender, oral hygiene and dietary habits (Kannan et al., 2017) contribute to the prevalence of caries in a population (Sevekar et al., 2012;Grif in et al., 2005). Moreover, the occurrence of caries tends to surge increasing age as it is a cumulative process (Kannan et al., 2017).
Oral health community programs (Pavithra and Jayashri, 2019) have included issure sealants as they are deliberated to be an effective and economical method for primary prevention of dental caries (Mullan et al., 1984;Prabakar et al., 2018a). Tooth decay in occlusal surface is mainly prevalent in developing countries due to the diet, oral habits (Harini and Leelavathi, 2019;Neralla et al., 2019), socioeconomic conditions and a lack of education (Kulkami and Deshpande, 2002). The sequence and pattern of carious lesions demonstrate a surface hierarchy in susceptibility to decay, with pit and issure surfaces exhibiting much greater risk than smooth surfaces (Batchelor and Sheiham, 2004). The issure becomes susceptible to caries since its base is very close to the dentin-enamel junction and often non-cleansable mechanically. This study aimed to assess the association of gender and deep pit and issures among the Index age group 35-44 years old.

Study setting and design
A retrospective study was conducted to ind out the association between gender and deep pit and issures. The study was employed by reviewing 86,000 records of patients visiting the author's University hospital from June 2019 to March 2020.

Selection criteria
A total of 4375 records with signed informed consent were sorted. Case records with the preventive procedures such as pit and issure sealants and preventive resin restorations done were iltered. Of which 103 case records of patients aged 35-45 years with only pit and issure sealants done were retrieved. We took an effort to con irm case records of patients with systemic diseases, physical and mental disabilities were excluded from the selection process with the help of an external reviewer.

Data collection
Data on patients' age, gender and number of deep pit and issures (indirectly a number of pit and issure sealants) were collected and entered into excel spreadsheet. Age of the patients was categorized into 35-40 years and 41-45 years for the convenience of statistical analysis.

Statistical analysis
Collected data was subjected to statistical analysis using SPSS version 20.0. Frequency distribution was performed to ind the proportion of the number of deep pit and issures based on age and gender. Chisquare association was done to ind the association between gender and deep pit and issures.

RESULTS AND DISCUSSION
This study involved 103 adults who reported in the outpatient department of the University hospital. Figure 1 showed most of the patients were in the age group 35-40 years (74.76%). Among the patients, 52.43% were males and 47.57% were females (Figure 2). Most of the patients (93.2%) had 1-5 teeth with deep and issure sealants (Figure 3). Figure 4 showed that most of the patients (69.9%) with age group 35-40 years had 1-5 teeth with deep pit and issures and most of them (23.3%) in 41-45 years had 6-10 teeth with deep pit and issures. However, the association between age and deep pit and issures was not statistically signi icant in Fisher's exact test (p=1.000). About 50.5% and 42.72% males and females had 1-5 teeth with deep pit and issures. The association between gender and deep pit and issures was not statistically signi icant in Fisher's exact test (p=0.283).
The present study observed that the number of teeth with deep pit and issure was declining as age increases due to mechanical tooth wear. In contrast with the current study, the prevalence of adults with deep pit and issures was increasing in older individuals, as stated by the (National Institute of Health, 2018). Another study, in contrast with the present study, showed a higher prevalence of deep pit and issures in females than males (Veiga et al., 2015). One other study presented a declining frequency in the prevalence of deep pits and issures in older patients (Abbass et al., 2019) which is inconsistency with the present study. The tooth morphology with deep pit and issures among males and females can be attributed to genetic phenotyping. Also, mechanical wear may contribute to the decreasing proportion of deep pit and issures among the 41-45 years age group.   able gender and Y-axis denotes the count of male and female patients. Green represents males and yellow represents females. Males predominated the study population.  Figure 4, X-axis denotes age group in years. Y-axis denotes the percent for the number of pit and issure sealants. Blue represents 1-5 teeth and red indicates 6-10 teeth with deep pit and issures. Most of the patients in both age groups had 1-5 teeth with deep pit and issures. However, the association between age and deep pit and issures was not statistically signi icant in Fisher's exact test (p=1.000)(p>0.05) Figure 5, X-axis denotes dichotomous nominal vari-able gender and Y-axis denotes the count for the number of deep pit and issures. Red indicates 1-5 teeth with deep pit and issures and blue color indicates 6-10 teeth with deep pit and issures. The association between gender and deep pit and issures was not statistically signi icant in Fisher's exact test (p=0.283);(p>0.05). Males had more deep pit and issures than females.

Figure 5: Cluster bar chart association of gender and deep pit and issures.
In our study, most of the patients underwent at least one deep pit and issure treated with sealant application and maximum nine sealants application reported in a few patients. One study presented one sealant treatment done for each patient as early preventive management (Veiga et al., 2015). A similar study reported placement of sealing materials on occlusal surfaces, reported deprivation in caries incidence compared to unsealed control groups (Cvikl et al., 2018). One other study reported a reduction in caries prevalence for an observation period of 15 years reported in all posterior teeth that were sealed (Jodkowska, 2008).
Pit and issures sealant application is considered as more effective the earlier the treatment is done. Thus, early preventive management of deep pits and issure caries should be implemented in childhood itself to prevent caries development in the adult population. Thus, pit and issure sealant application must be one of the goals in public health programs. The parents especially must be educated regarding early caries management so that the teeth can be protected from dental caries initiation, particularly in young permanent teeth (Prabakar et al., 2016). Dental services in village areas must be improved with the help of village health workers and publicprivate partnerships to improve the provided services may be considered as a long-term goal. The application of primary preventive methods, namely issure sealant application, (Prabakar et al., 2018b) in the dental appointment, complemented with oral health education, will undoubtedly reduce the inancial impact of oral treatments in the population and will ensure a reduction in the risk of oral disease progression during adulthood.
The present study had few limitations where type of deep pit and issures "V" or "K" would have been taken into account. Genetic and environmental (physical anthropology) variations play a signi icant role in the morphology of teeth.

CONCLUSIONS
Within the limitations of our study, it has shown that the prevalence of deep pit and issures was high in males compared to females. Therefore, health programs should include the mantle of creating awareness on preventive oral health services among all index age groups.

Con lict of Interest
The authors declare that they have no con lict of interest for this study.