10.59987/ads/2011.1-2.13-18
Aim. Describe the occurrence of dental caries in a sample of pre-school children and school children, aged 3 and 12, and study the possible association between caries and malocclusion.
Methods. We selected and analyzed the medical records of a sample of 588 patients who had their first dental examination at the Pediatric Dentistry Unit, Department of Oral and Maxillofacial Sciences of Policlinico Umberto I, “Sapienza” University of Rome.
Results. In the sample, 55.4% of the children had no decayed deciduous elements, while 44.6% had at least one decayed deciduous element. The prevalence of decayed permanent teeth was 10.2%, while 89.8% had no decayed permanent teeth. In the sample, 9.4% of the children showed advanced carious lesions, that needed tooth extraction and 6.6% needed a space maintainer for post-extractive interceptive treatment. In the sample, 26.7% of the examined patients had increased overjet, while 3.7% had decreased overjet and 25.4% of the sample had an increased overbite, 11, 2% had reduced overbite values. A percentage over 10% of the sample had an anterior openbite in centric occlusion. The prevalence of posterior crossbite among entire samples was 19.8%.
Conclusions. Although the incidence of caries disease was high in the selected samples, the study did not show a statistically significant association between caries and clinical orthodontic abnormalities, except for the association between the midline deviation and the severe carious diseases, necessitating extraction.
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Annali di stomatologia
early childhood caries
Experience of dental caries and its effects on early dental occlusion: a descriptive study
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A. Polimeni 
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early childhood caries
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Experience of dental caries and its effects on early dental occlusion: a descriptive study
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                                                                                                           Original article



    Experience of dental caries and its effects on early
    dental occlusion: a descriptive study




                                                                                                        li
                                                                                                     na
    Valeria Luzzi, DDS, PhD                                      the association between the midline deviation and the
    Miriam Fabbrizi, DDS                                         severe carious diseases, necessitating extraction.
    Camilla Coloni, DDS




                                                                                                  io
    Cristina Mastrantoni, DDS                                    Key words: malocclusion, caries, early childhood caries.
    Carla Mirra, DDS
    Maurizio Bossù, DDS, PhD




                                                                            az
    Annarita Vestri, MD, PhD*                                    Introduction
    Antonella Polimeni, MD
                                                                 The specific aims of the present study were to describe
                                                                 the occurrence of dental caries in a sample of preschool
    "Sapienza" University of Rome, Rome, Italy                   children and school children, aged 3 and 12, and to study




                                                                          rn
    Department of Oral and Maxillo Facial Sciences               the possible association between caries and malocclusion.
    Pediatric Dentistry Unit                                     Many industrialised countries have experienced a decline
    * Department of Science of Public Health                     in dental caries prevalence among children over the past
    and Infectious Disease                                       decades. This trend of caries reduction may be ascribed




                                                                 te
                                                                 to several factors of which the most important are improved
                                                                 oral hygiene, a more sensible approach to sugar con-
                                                                 sumption, effective use of fluorides, and school-based pre-
    Corresponding author:
                                                        In       ventive programmes. However, dental caries remains a ma-
    Valeria Luzzi                                                jor public health problem in most industrialized countries,
    Mobile: +393495138825                                        especially for those countries where preventive pro-
    E-mail: v.luzzi@tiscali.it                                   grammes have not been established (1).
                                                                 Dental caries is an infective transmittable bacterial disease
                                                   ni
                                                                 characterised by a multi factorial pathology (2). The main
                                                                 players in the aetiology of this disease are: cariogenic bac-
                                                                 teria, fermentable carbohydrates, a susceptible tooth and
    Summary
                                       io

                                                                 host and time. The Early Childhood Caries (ECC) is a se-
    Experience of dental caries and its effects on early den-
                                                                 vere form of caries, defined in 2004 by the American Acad-
    tal occlusion: a descriptive study.
                                                                 emy of Pediatric Dentistry, which affects children of 2-5
    Aim. Describe the occurrence of dental caries in a sam-
                                                                 years of age and which is characterized by precise topo-
                             iz



    ple of pre-school children and school children, aged 3
    and 12, and study the possible association between           graphical and clinical parameters. The decay pattern of
    caries and malocclusion.                                     ECC is characteristic and pathognomonic of the condition.
                                                                 The four maxillary incisors are most often affected. The low-
             Ed




    Methods. We selected and analyzed the medical records
    of a sample of 588 patients who had their first dental ex-   er primary incisors are intact and the primary cuspids can
    amination at the Pediatric Dentistry Unit, Department of     be occasionally affected. In very severe cases the
    Oral and Maxillofacial Sciences of Policlinico Umberto I,    mandibular incisors are also affected. The primary canines
    “Sapienza” University of Rome.                               most of the times remain unaffected as the disease pro-
    Results. In the sample, 55.4% of the children had no de-     gression halts prior to the eruption of these teeth. ECC has
    cayed deciduous elements, while 44.6% had at least one       been given a number of different names including nursing
 IC




    decayed deciduous element. The prevalence of decayed         bottle syndrome, milk bottle syndrome, baby bottle caries,
    permanent teeth was 10.2%, while 89.8% had no de-            and baby bottle tooth decay. The term “baby bottle tooth
    cayed permanent teeth. In the sample, 9.4% of the chil-      decay” is easily understood by parents and therefore is use-
    dren showed advanced carious lesions, that needed            ful in a programme that educates them about this condi-
C




    tooth extraction and 6.6% needed a space maintainer          tion. However, children who never use a bottle may still de-
    for post-extractive interceptive treatment. In the sample,   velop the disease. Early childhood caries is a relatively new
    26.7% of the examined patients had increased overjet,
                                                                 term that describes rampant caries in infants and toddlers
    while 3.7% had decreased overjet and 25.4% of the sam-
                                                                 (3,4). Johnston and Messer classifies ECC into 3 patterns:
    ple had an increased overbite, 11, 2% had reduced over-
©




    bite values. A percentage over 10% of the sample had         1) developmental defects; 2) smooth surface lesions; 3)
    an anterior openbite in centric occlusion. The preva-        rampant caries. Verkamp and Weerheijm use 4 stages to
    lence of posterior crossbite among entire samples was        classify the ECC: initial, damaged, deep and traumatic le-
    19.8%.                                                       sions.
    Conclusions. Although the incidence of caries disease        Dental elements conservation is an important condition to
    was high in the selected samples, the study did not          harmonic development of dental arches. Several studies
    show a statistically significant association between         refer that caries is one of the most important cause of space
    caries and clinical orthodontic abnormalities, except for    loss and arch change with an alteration of the normal oc-

    Annali di Stomatologia 2011; II (1-2): 13-18                                                                           13
    V. Luzzi et al.


    clusion. There is a general agreement that premature loss            side and the unaffected side (P = 0,33). Therefore, the pre-
    of primary teeth usually results in loss of arch space (6,8).        mature loss of a first deciduous mandibular molar, in the
    Northway and Wainright reported that even without the pre-           case of Class I molar relationship, has a limited influence
    mature loss of primary teeth, arch length was shown to be            on the space for the eruption of permanent teeth.
    reduced due to the breakdown of dental structures from               It is therefore essential to devise a treatment plan to ear-
    caries. However, only caries which become severe have                ly care of decidous teeth, which represent the best space




                                                                                                                  li
    a significant effect on dental arch circumference (9).               maintainers or, if the assessment is too late, it is essen-
    As caries prevention programmes are effective in reduc-              tial to use an orthodontic appliance for “maintenance of




                                                                                                               na
    ing caries risk and as caries and loss of tooth structure in         space” (12). This term refers to the set of preventive treat-
    the primary teeth is associated with loss of tooth structure         ments studied to avoid unwanted mesial movements of all
    in the primary teeth is associated with loss of space in the         teeth, including permanent molars, due to the early loss
    dental arch, children who had received an effective caries           of a deciduous tooth in order to maintain the space need-




                                                                                                            io
    prevention programme at the primary dentition should have            ed for the proper eruption of unchanged permanent
    less crowding than children who had not experienced such             teeth.
    a programme. Nevertheless, there is no study to test the             The early extraction of deciduous elements is, however,
    effect of caries prevention programme started in the pri-            the most common cause of malocclusion because it leads




                                                                                     az
    mary dentition on crowding in the permanent dentition.               to the loss of the incisal guide (if front teeth are involved),
    Early loss of deciduous teeth may compromise the “har-               to myofunctional alterations, to underdevelopment of pre-
    monic state” of the dental arches which comes from the               maxilla and to changes in the vertical dimension, and it is
    balanced evolution of maxillary growth and dentitional               also a factor causing the loss of space for permanent el-




                                                                                   rn
    change.                                                              ements, resulting in crowding of teeth. Crowding can be
    In fact the treatment of dental caries (5) is often reduced          separated on the basis of aetiology into three categories:
    to the extraction of infected deciduous elements; this rad-          primary, secondary and tertiary. Primary crowding refers
    ical treatment plan is partly due to the severity of the prob-       to the discrepancy between jaw size and teeth dimension




                                                                        te
    lem, in part to the poor compliance of the young patients.           that is mainly determined genetically. Secondary crowd-
    Northway (10) has carried out studies on the early ex-               ing refers to the crowding that is caused mainly by envi-
    traction of deciduous molars. The rear arch dimensions vary          ronmental factors. The premature loss of decidous teeth
    if the loss affects only one or both deciduous molars. The           is the most common contributing factor. Other factors in-
                                                            In
    loss, in the lower arch, ranges from 3 mm in the exfolia-            clude interproximal caries and fillings with improper con-
    tion of the deciduous first molar to 4 mm in the absence             tact points (6). Tertiary crowding refers to crowding that oc-
    of the second deciduous molar, or both. Clinch and                   curs during the adolescent and post-adolescent period (7).
    Healy correlate the age of the dental exfoliation with the           A correct maintainance (13) of the space can be obtained
                                               ni
    amount of space lost.                                                with the use of orthodontic devices.
    Early extractions of deciduous molars performed before
    the age of 6, that’s to say before the eruption of the first
    permanent molar, leads to the loss of up to 7 mm in 25%              Materials and Methods
                                     io


    of cases, and with smaller losses in the remaining 75%.
    The loss is more marked in the upper arch. If the tooth ex-          We selected and analyzed the medical records of a sam-
    traction is performed after the eruption of the first molar,         ple of 588 patients who had their first dental examination
                            iz



    the loss of the space is less, being found in 1/3 of cases           at the Department of Oral and Maxillofacial Sciences, Pe-
    in the maxillary arch and in ¼ in the mandibular arch.               diatric Dentistry Unit, “Sapienza” University of Rome.
    Park (11) conducted a study to assess the effects of the             The following parameters were considered: molar class,
            Ed




    extraction of the mandibular first deciduous molar after the         overjet, overbite, as well as the presence of factors such
    eruption of the first permanent molar and did not detect             as dental crowding, crossbite, deflected midline and the
    any statistically significant difference between the extracted       presence of decayed, deciduous or permanent teeth. The


    Table 1 - Frequency distribution of decayed deciduous teeth.
 IC




          Valid                    Frequency                         Percent              Valid percent          Cumulative percent

            0                          325                            55,4                    55,4                       55,4
C




            1                           65                            11,1                    11,1                       66,4
            2                           51                             8,7                     8,7                        75,1
            3                           37                             6,3                     6,3                        81,4
            4                           24                             4,1                     4,1                        85,5
©




            5                           25                             4,3                     4,3                        89,8
            6                           30                             5,1                     5,1                        94,9
            7                           24                             4,1                     4,1                        99,0
            8                            2                             ,3                      ,3                        99,3
            9                            2                             ,3                      ,3                        99,7
            10                           2                             ,3                      ,3                        100,0
            Total                      587                            100,0                   100,0


    14                                                                                        Annali di Stomatologia 2011; II (1-2): 13-18
    Experience of dental caries and its effects on early dental occlusion: a descriptive study


    average age of the sample and the prevalence of sex and
    nationality were also evaluated.
     The data were collected in a Microsoft Excel program table
    and prepared for statistical analysis. The latter was divid-
    ed into several phases. In a first descriptive phase, the
    prevalence of sex, the average age, the nationality, and the




                                                                                                              li
    percentage of decayed permanent and deciduous elements
    of the sample were assessed.




                                                                                                           na
    The prevalence of orthodontic-specific parameters, such
    as the molar class, the upper and lower crowding, in-
    creased or decreased overjets and overbites, crossbites
    and the midline deviation were then examined.




                                                                                                        io
    The following associations were then studied:
    - caries and occlusal changes;
    - caries and deviation of the midline;
    - ECC (Early Childhood Caries) and occlusal changes.




                                                                                 az
    To assess the statistical significance of these associations
    we used Pearson chi-square test, also known as the good-
    ness of fit, a nonparametric test which is used in the pres-     Figure 1 - Prevalence of advanced carious lesions that needed
    ence of nominal variables. The test was considered sig-          tooth extraction.




                                                                               rn
    nificant when p <0.05.


    Results




                                                                     te
    Overall, clinical records of 588 patients, aged 3 to 12 , have
    been selected and assessed.
    Analysis of the data showed that the percentage of
    males (50.9%) was higher than the percentage of females
                                                            In
    (49.1%), 93.4% coming from the European Union. The av-
    erage age of the samples was 8 years. In the sample,
    55.4% had no decayed deciduous elements, while 44.6%
                                                   ni
    had at least one decayed deciduous element (Table 1).
     In the sample the prevalence of decayed permanent teeth
    was 10.2%, while 89.8% had no decayed permanent teeth.
    In a sub-sample made of children who had at least one per-
                                        io


    manent tooth, the percentage of children with at least one
    decayed permanent teeth was 12.7% (Table 2).                     Figure 2 - Prevalence of need for a post-extraction space main-
    In the sample, 9.4% of the children showed advanced car-         tainer.
                             iz



    ious lesions, that needed tooth extraction (Fig. 1) and 6.6%
    needed a space maintainer for post-extractive interceptive
    treatment (Fig. 2). The prevalence of ECC was 27.4% of           Specific malocclusions were analyzed: 48.9% of patients
              Ed




    the sample (Table 3).                                            had a right first molar class, 22.8% a right second molar
                                                                     class, 8.7% had a third right molar class. While in 19.3%
                                                                     of the samples, the right molar class was not detectable
                                                                     because of the non-eruption of the first permanent molars
    Table 2 - Frequency distribution of decayed permanent teeth.     (Table 4). As to the left molar class the data collected were
                                                                     as follows: 47.9% first class, 24.9% second class, 7.7%
     Valid     Frequency       Percent       Valid Cumulative        third class and 19.3% was not detectable (Table 5).
 IC




                                            percent percent          The upper and lower dental crowding was present in 12.4%
                                                                     (Table 6) of the sample and, specifically, 7.0% had an up-
       0           414           87,3         87,3      87,3         per crowding (Fig. 3) and 9.9% a lower crowding (Fig. 4).
      ≥1            60           12,7         12,7     100,0         In the examined patients, 26.7% had increased overjet,
C




     Total         474          100,0        100,0                   while 3.7% had decreased overjet (Table 7).
                                                                     In the sample, 25.4% had an increased overbite, 11, 2%
                                                                     had reduced overbite values (Fig. 5). A percentage over
                                                                     10% of the samples had an anterior openbite in centric oc-
    Table 3 - Distribution of Early Childhood Caries (ECC).
©




                                                                     clusion (Table 8).
      Valid    Frequency       Percent       Valid Cumulative        The prevalence of posterior crossbites among entire
                                            percent percent          samples was 19.8% (Table 9). In addition, the 8.3% had
                                                                     a deviation of the median line (Table 10).
    Absent          82           72,6         72,6      72,6         The association between caries disease, in both decidu-
                                                                     ous and permanent teeth, and the onset of occlusal al-
    Present        31           27,4         27,4      100,0
                                                                     terations, was not statistically significant in the selected
     Total         113          100,0        100,0
                                                                     samples (p> 0.05). However, the association between the

    Annali di Stomatologia 2011; II (1-2): 13-18                                                                                 15
    V. Luzzi et al.


    Table 4 - Right molar class.
                                                                    Right molar class
                                              Frequency             Percent           Valid percent      Cumulative percent

    Valid              First                     287                 48,9                  49,1                    49,1




                                                                                                                li
                       Second                    134                 22,8                   22,9                   72,0




                                                                                                             na
                       Third                      51                  8,7                    8,7                   80,7
                       Undetectable              113                 19,3                  19,3                   100,0
                       Subtotal                  585                 99,7                  100,0
    Missing            System                      2                  ,3




                                                                                                          io
    Total              587                      100,0




                                                                                   az
    Table 5 - Left molar class.
                                                                     Left molar class
                                              Frequency             Percent           Valid percent      Cumulative percent




                                                                                 rn
    Valid              First                     281                 47,9                  48,0                    48,0
                       Second                    146                 24,9                   25,0                   73,0
                       Third                      45                  7,7                    7,7                   80,7




                                                                      te
                       Undetectable              113                 19,3                  19,3                   100,0
                       Subtotal                  585                 99,7                  100,0
    Missing            System                      2                  ,3

    Total              587                      100,0
                                                            In
    Table 6 - Distribution of crowding.                                Discussion
                                                 ni
                                  Crowding
                                                                       Studies on the prevalence of malocclusion were carried
      Valid    Frequency         Percent      Valid Cumulative         out in various parts of the world.
                                             percent percent
                                          io

                                                                       In this study, thanks to a descriptive statistical analysis, it
                                                                       was possible to assess the prevalence of various forms of
       No             514         87,6       87,6       87,6           altered occlusion, in a group of children aged between 3
       Yes             73          12,4       12,4      100,0
                               iz



                                                                       and 12.
      Total           587         100,0      100,0                     Most of the subjects had a first molar class, while the third
                                                                       molar class was less frequent (less than 10%). These data
              Ed




                                                                       are similar to those reported by Savannah (14) (Tables 4
    deviation of the midline and the carious disease is statis-        and 5).
    tically significant when the latter is so severe to require        Table 6 shows that just over 10% of the subjects had up-
    the extraction of the affected tooth (P = 0.007).                  per or lower dental crowding; while in literature other stud-
    The ECC was statistically significantly associated with a          ies (20) show that in the patients that had not received a
    normal overjet and overbite (p = 0.001) (Table 11).                caries prevention programme, the arch perimeter is small-
                                                                       er and subsequently more crowding than in the patients
 IC




    Furthermore, only 2.6% of patients with ECC had ante-
    rior crossbites while 92.3% had neither front nor rear cross-      underwent to a preventive programme. This could be ex-
    bites.                                                             plained by loss of arch perimeter as a result of interprox-
C




    Table 7 - Overjet distribution.

    Valid              Overjet                Frequency             Percent           Valid percent      Cumulative percent
©




                       No                        408                 69,5                   69,5                   69,5

                       Increased                 157                 26,7                   26,7                   96,3

                       Decreased                  22                  3,7                    3,7                  100,0

                       Total                     587                 100,0                 100,0


    16                                                                                      Annali di Stomatologia 2011; II (1-2): 13-18
    Experience of dental caries and its effects on early dental occlusion: a descriptive study




                                                                                                               li
                                                                                                            na
                                                                                                         io
                                                                                 az
    Figure 3 - Prevalence of crowding in the upper dental arch.      Figure 5 - Prevalence of overbite alterations.




                                                                               rn
                                                                     Table 9 - Crossbite distribution.

                                                                                                      Crossbite
                                                                                     Frequency    Percent      Valid Cumulative




                                                                    te
                                                                                                              percent percent


                                                                     Valid Absent       471          80,2       80,2      80,2
                                                              In           Present      116          19,8       19,8      100,0
                                                                           Total        587         100,0      100,0
                                                   ni
                                                                     overjet and approximately 25.4% had an increased over-
                                                                     bite, in agreement with the results reported by Martins and
                                                                     Lima (16). Besides, Table 12 shows that less than 10% of
                                       io


                                                                     the sample had deviations of the median line.
    Figure 4 - Prevalence of crowding in the lower dental arch.      Prevalence of carious disease
                                                                     Although many authors agreed to record a decreasing of
                             iz



                                                                     caries in industrialized countries, data reported in this study
    Table 8 - Openbite distribution.                                 show a high prevalence of caries disease.
                                                                     Campus et al (17) report a caries prevalence in Italian chil-
                                       Openbite
                                                                     dren of approximately 22% at the age of 4 and about 44%
             Ed




                    Frequency    Percent      Valid Cumulative       at the age of 12. In our study the percentage of subjects
                                             percent percent         with at least one decayed deciduous tooth is 44.6%.
                                                                     The prevalence of children with decayed permanent ele-
    Valid Absent       524          89,3       89,3        89,3      ments in the entire sample is 10.2%, however, in a sub-
          Present      63          10,7       10,7        100,0      sample of children who had at least a permanent element
          Total        587         100,0      100,0                  in the arch is equal to 12.7%.
 IC




                                                                     The prevalence of children with so severely decayed teeth
                                                                     to require the extraction of the element was also quite high.
                                                                     The carious disease did not appear to be associated with
    imal caries and premature extraction of the deciduous teeth      alterations of occlusal characteristics and with deviations
C




    which was greater in the patients without caries preven-         of the median line except where the pathology was so se-
    tive programme.                                                  rious to require the dental extraction.
    The crowding in the lower arch was slightly more frequent         The prevalence of ECC is equal to 27.4% of the sample.
    than in the upper one (Figs. 3 and 4), while in Legovic’s        This prevalence is higher than what reported in the liter-
©




    study (21) the space loss after premature extraction of de-      ature; this data is attributable to our UOC pre-selected
    ciduous teeth or after breakdown of dental structures from       population. The prevalence of ECC occurs between 1% and
    caries was greater in the upper arch compared to that in         12% in industrialized countries and about 70% in devel-
    the lower arch.                                                  oping countries populations (16). The study also does not
     The prevalence of posterior crossbites among entire sam-        show a statistically significant association between caries
    ples was 19.8%, much higher than what was reported by            and clinical orthodontic abnormalities, except for the as-
    Brunelle et al.(15). The prevalence of front openbites was       sociation between the midline deviation and the extrac-
    also found higher. 26.7% of the sample had an increased          tion of a deciduous element (p =. 07).

    Annali di Stomatologia 2011; II (1-2): 13-18                                                                                  17
    V. Luzzi et al.


    Table 10 - Distribution of deviation of midline.
                                                                                                Midline
                                                   Frequency                     Percent              Valid percent        Cumulative percent

    Valid              Non phatological                 538                       91,7                      91,7                      91,7




                                                                                                                                   li
                       Phatological                      49                        8,3                       8,3                      100,0




                                                                                                                                na
                       Total                            587                       100,0                     100,0

    Table 11 - Association between overjet/overbite and ECC (Early Childhood Caries).

                                                                                        overjet




                                                                                                                             io
                                              no                                        increased                                   decresed
                                          Count Column N, %                            Count Column N, %                         Count Column N, %
    ECC           absent                    371           90,9%                           156          99,4%                       21           95,5%




                                                                                                  az
                  present                    37            9,1%                            1            ,6%                         1           4,5%

                                                                                       overbite
                                              no                                        increased                                   decresed




                                                                                                rn
                                          Count Column N, %                            Count Column N, %                         Count Column N, %
    ECC           absent                    335           90,1%                           148          99,3%                       65           98,5%
                  present                    37            9,9%                            1            ,7%                         1           1,5%




                                                                                   te
    Conclusion                                                                       8. Seward FS. Natural closure of the deciduous molar extraction
                                                                                        spaces. Angle Orthodontist 1965; 35: 85-94.
    Considering the high incidence of caries disease in the se-
                                                                       In            9. Northway W, Wainright R. D-E Space - A realistic measure of
    lected samples, 44.6% for deciduous teeth and 12.7% for                             changes in arch morphology: space loss due to unattended caries.
    permanent teeth, we think we should boost the oral health                           J Dental Research 1980; 59: 1577-80.
                                                                                    10. Northway WM: Antero-posterior Arch Dimension Changes in
    campaign among children, in order to achieve the new
                                                                                        French-Canadian Children: A Study of the Effects of Dental
    world trends that are recording a significant reduction in
                                                       ni
                                                                                        Caries and Premature Extractions, thesis. School of Dentistry, Uni-
    the incidence of caries in children.                                                versity of Montreal, Quebec, Canada, 1977.
    Although this study has not achieved significant results from                   11. Park K, Jung DW, Kim JY. Three-dimensional space changes af-
    a statistical point of view regarding the association between                       ter premature loss of a maxillary primary first molar. Int J Paedia-
                                           io


    caries disease and the onset of malocclusions, we agree                             tr Dent 2009; 19(6): 383-389.
    with the international literature (18)(19) on the importance                    12. Laing E, Ashley P, Naini FB, Gill DS. Space Maintenance. Int J Pae-
    of interceptive orthodontic treatment in order to maintain                          diatr Dent 2009; 19(3): 155-162.
                                iz



    the space for permanent teeth unchanged, both in the case                       13. Ierardo G, Luzzi V, Vassallo D, Bassani AL, Polimeni A. Nuovi con-
    of early extractions and of significant interproximal caries.                       cetti di management in ortodonzia preventiva. Efficacia ed Efficienza.
    (17)                                                                                Dental Cadmos 2000; 15: 98-103.
                                                                                    14. Savara BS. Incidence of dental caries, gingivitis and malocclusion
             Ed




                                                                                        in Chicago children (14 to 17 years of age), J Dent Res 1955; 34(4):
                                                                                        546-552.
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