Timing of permanent tooth emergence and its association with physical growth among children aged from four to seven years in nine cities of China / 中华儿科杂志

ABSTRACT

Objective@#To investigate the timing of permanent tooth emergence and its association with physical growth among children aged 4-7 years in 9 cities of China, and to analyze the trend of permanent teeth development.@*Methods@#According to a stratified cluster sampling design, a cross-sectional survey on the timing of permanent tooth emergence children aged 4-7 years was carried out in 9 cities (Beijing, Harbin and Xi′an in northern China; Shanghai, Nanjing and Wuhan in central China; Guangzhou, Fuzhou and Kunming in southern China) from June to October in 2015. A total of 37 973 children (19 035 boys and 18 938 girls) were recruited and were divided into different age groups (4.0-<4.5, 4.5-5.0, 5.0-5.5 and 6.0-<7.0 years of age). The situation of the exfoliation of primary teeth and the eruption of permanent teeth were investigated. Height and weight were measured using the standardized methods. Z-scores of physical growth indicators were calculated using the growth standards for Chinese children in 2009. Probit regression analysis was used to determine the median and percentile age of transition from deciduous to permanent teeth. Chi-square test was used for comparison of categorical data and t test was used for comparison of measurement data between boys and girls, urban and suburban as well as among different ages and regions. Meanwhile, the data from the national survey on physical growth and development of children under 7 years of age in 9 cities of China in 1995 were used to analyze the trends of the permanent teeth development.@*Results@#The rate of transition from deciduous to permanent teeth in 37 973 children aged 4-7 years was higher with age, which was 0.6% (42/7 568) in 4.0-<4.5 years of age group, 30.3% (2 295/7 583) in 5.5-<6.0 years of age group, and 74.5% (5 680/7 627) in 6.0-<7.0 years of age group. The rates of transition from deciduous to permanent teeth in boys were all lower than those of girls except for children aged 4.0-<4.5 years (all P<0.01). The rate of transition from deciduous to permanent teeth in urban children was higher than that in suburban children for older than 5.5-6.0 years of age group in boys and older than 4.5-5.0 years of age group in girls, which was 74.2% (1 427/1 924) in urban boys aged 6.0-<7.0 years and 69.2% (1 305/1 885) in suburban boys aged 6.0-<7.0 years (χ2=11.446, P<0.01). The age of transition from deciduous to permanent teeth was 6.00 (95%CI 5.98-6.01) years and the range of the 3-97 percentile was 4.88-7.11 years of age. The median permanent tooth emergence age of girls was lower than that of boys (5.94 vs. 6.06 years) and the median age of urban children was lower than that of suburban children (5.94 vs. 6.05 years). The median permanent tooth emergence age of southern Chinese children (6.05 years) was higher than that of northern (5.97 years) and central Chinese children (5.97 years). The weight for age Z-scores (WAZ), height for age Z-scores (HAZ) and body mass index for age Z-scores (BMIZ) of children with transition from deciduous to permanent teeth (0.35±1.17, 0.32±1.00, 0.23±1.16) were significantly higher than those of children without transition from deciduous to permanent teeth (0.03±1.13, 0.03±1.02, 0.04±1.13, t=20.81,21.67,12.09, all P<0.05). In comparison with the data in 1995, data in 2015 showed that the rate of transition from deciduous to permanent teeth was higher, for example, the rate of urban boys aged 6.0-<7.0 years group was 63.8% (1 146/1 796) in 1995, and increased to 74.2% (1 427/1 924) in 2015 (χ2=46.748, P<0.01). The median permanent tooth emergence age decreased by 0.24 years in 2015 as compared with that in 1995.@*Conclusions@#The development of permanent teeth is earlier in girls than in boys, earlier in urban children than in suburban children and slightly delay in southern children than in central and northern Chinese children. In addition, the development of permanent teeth, which is related to the physical growth, slightly accelerate in China during the past 20 years.