Relationship between class 1 dental caries and sextant involving caries among patients visiting the outpatient department of Saveetha Dental College, Chennai, India

Ankita Komal Labh1, Anjaneyulu K*2, Geo Mani3 1Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai – 600 077, Tamil Nadu, India 2Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai – 600 077, Tamil Nadu, India 3Department of Pedodontics and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai – 600 077, Tamil Nadu, India


INTRODUCTION
Dental caries is one of the most prevalent chronic diseases of people worldwide. Individuals are susceptible to this throughout their lifetime. (Selwitz et al., 2007) It is a cause of great pain and discomfort if left untreated for a long period of time. (Ramamoorthi et al., 2015) Dissolution of tooth structure weakens the crown often resulting in fracture of the tooth. (Jose et al., 2020) The susceptibility of individual tooth surfaces to dental caries varies vastly. (Hannigan et al., 2000) Also, the spread of dental caries varies greatly from tooth to tooth and surface-to-surface. There is evidence that occlusal caries precedes other types of caries in the spread. It has the highest prevalence in molars. (Eklund and Ismail, 1986) Caries prevalence also varies based on gender. There is a higher prevalence seen in females due to various factors such as the early eruption of teeth in girls, frequent snacking during food preparation, pregnancy etc. Due to hormonal luctuations during several events such as puberty, menstruation, pregnancy etc., the oral environment is highly cariogenic in women. (Lukacs and Largaespada, 2006) There are various other factors that may lead to caries. (Rajakeerthi and Nivedhitha, 2019) These include inadequate salivary low and composition, high numbers of cariogenic bacteria, insuf icient luoride exposure, gingival recession, immunological components, genetic factors, among others. (Selwitz et al., 2007) Host matrix metalloproteinases get activated, leading to dentin matrix breakdown in the course of dental caries. (Ramesh et al., 2018) Diagnostic tests such as thermal test, electric pulp test, pulse oximeter etc. are employed to check the vitality of the tooth. (Janani et al., 2020) Ef icient removal of carious lesions is necessary to prevent recurrence of caries. (Manohar and Sharma, 2018;Teja and Ramesh, 2019) The treatment of dental caries depends on various factors such as remaining dentin thickness, pulpal involvement, vitality tests etc. (Ramanathan and Solete, 2015) Commonly used dental materials used for cavity illing are resin composite, lowable composite, GIC, amalgam, gold etc. Kumar and Antony, 2018) Veneers and laminates can be used for the aesthetic management of caries in anterior teeth. (Ravinthar and Jayalakshmi, 2018) Traditional medicines such as neem, tulsi, grape seed extract etc. have been advised for the prevention of dental caries. (Nasim and Nandakumar, 2018) In the case of the incipient lesion, remineralisation pastes can be used to reverse the cariogenic activity. (Rajendran et al., 2019) Proper brushing technique, frequent usage of loss, chlorhexidine mouthwash should be advised to prevent dental caries. (Noor and Pradeep, 2016)

Study design and setting
This is a retrospective cross-sectional study in which patient records from a Dental College, Chennai were obtained. Data was collected for patients reporting to the Department of Conservative Dentistry and Endodontics after reviewing patient records and analysing the data of 86000 patients from June 2019-April 2020 who had class 1 dental caries.

Data Collection
A total of 19014 cases of class 1 dental caries were identi ied. Other relevant data such as age, gender, patient ID, patient name etc., were also recorded. Repeated patient data and incomplete records were excluded. Clinical photos and radiographs were used to verify the site of dental caries. Data was also veri ied by an external reviewer.

RESULTS AND DISCUSSION
The inal data consisted of 19014 cases of patients with class 1 dental caries (DC). Gender distribution among the patients was found to be -55.56% males and 44.44% females. (Table 2, Figure 2) Incidence of class 1 DC in the different age groups was 72.6% in 18-35-year-olds, 25.2% in 36-55 years olds and 2.2% in > 56-year-olds. (Table 1, Figure 1) The distribution of site of occurrence of class 1 DC in decreasing order of incidence was 31.51% in sextant 6, 30.95% in sextant 4, 18.31% in sextant 1, 18.08% in sextant 3, 1.09% in sextant 2 and 0.06% in sextant 5. (Table 3, Figure 3) Chi-square test done between gender and site class 1 DC (Table 4, Figure 4), and age and site of class 1 DC (Table 5, Figure 5) had p<0.05 making the data statistically signi icant.
From Figure 4, X-axis denotes gender and Y-axis denotes the site of Class 1 Dental Caries. This graph represents the correlation of gender and site of class 1 dental caries where blue colour denotes sextant 1, and green denotes sextant 2, white denotes sextant 3, purple denotes sextant 4, yellow denotes sextant 5 and red denotes sextant 6. It shows that most Class 1 DC have occurred in sextant 6 in both males and females followed by sextant 4. Least number of       Class 1 DC was seen in sextant 5 among both genders. (Chi-square test; p-value=0.000; statistically signi icant) Data has a statistically signi icant association.
From Figure 5, X-axis denotes age and Y-axis denotes the site of Class 1 Dental Caries. This graph represents the chi-square analysis of age and site of class 1 dental caries where blue colour denotes sextant 1, and green denotes sextant 2, white denotes sextant 3, purple denotes sextant 4, yellow denotes sextant 5 and red denotes sextant 6. The most common site of class 1 DC among all 3 age groups was sex- In the present study, it is revealed that the incidence of class 1 DC is higher in the mandibular posterior region than other areas. When comparing incidence between upper and lower jaws, caries is seen more frequently in the mandible (62.52%) than the maxilla (37.48%). Also, caries incidence shows a male predilection. (Table 2 dence is higher in the maxillary jaw (62.4%) than the mandibular jaw (37.6%) (Demirci et al., 2010). This contradiction could be due to the high sample size in the present study. However, an interarch analysis of caries revealed that the mandibular arch was more affected by dental caries than the maxillary arch. In the mandibular arch, the molars were most commonly involved. (Goyal et al., 2007) In the same study by Demirci et al. (2010), it was reported that caries had a slightly higher female predilection (59.1%) among genders. The reason for such opposing indings could be the high prevalence of certain oral habits such as tobacco chewing, smoking etc. among males in the Indian subcontinent, which is known to increase the susceptibility of dental caries. (Vellappally et al., 2007) A study by Chestnutt et al. suggested that molar occlusal surfaces have the highest susceptibility to attack by cariogenic bacteria. Also, the highest incidence of caries in this study was in pit and issures, which are most commonly found in molars and premolars (Chestnutt et al., 1996). The irst molar was reported to be the most commonly affected tooth, followed by the second molar. (Manji et al., 1986) These studies are in line with the present study as the incidence of class DC in posterior teeth is 98.95%. (Table 3, Figure 3) Hopcraft et al. reported that irst molar teeth had the highest caries experience and caries was present more frequently on the occlusal surfaces than on the proximal surfaces. (Hopcraft and Morgan, 2006) CONCLUSION Within the limits of the study, it can be concluded that class 1 dental caries is most prevalent in mandibular molars and premolars. There is a male predominance in its occurrence and is seen mostly in the age group of 18-35 years.