Assessment of the current dental condition and treatment needs of permanent first molars in university students

Assessment of the current dental condition and treatment needs of permanent first molars in university students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of the current dental condition and treatment needs of permanent first molars in university students Eda GURSU SAHIN, Basak KARASU This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6465517/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The aim of this study was to investigate the current endodontic and periodontal conditions, treatment history, treatment needs and oral hygiene habits of university students in Türkiye in a comparative study of students in the dentistry faculty and other faculties. Methods The study included university students of the Faculty of Dentistry who had undergone panoramic radiography for any reason and had not received treatment related to the first molar over the past six months. A total of 202 university students were analyzed, with 101 from the Faculty of Dentistry and 101 from other faculties. The presence, treatment status, periodontal health parameters (plaque index, bleeding on probing, probing depth and clinical attachment level), treatment needs, medical history of PFMs and responses to questionnaires about oral hygiene habits were recorded in Excel. Results Hypomineralization was detected in 31% of the PFMs, with treatment needs being higher in mandibular PFMs exhibiting hypomineralization. A significant bilateral relationship was found in terms of hypomineralization (p < 0.001). Conclusion Individuals with oral health education had fewer caries and less gingivitis. Hypomineralization was found to occur bilaterally and associated with a higher risk of dental caries. These findings highlight the symmetrical distribution of Hypomineralization and its link to an increased susceptibility to caries. Permanent First Molar Hypomineralization Dental Assessment University Students Background Permanent First Molars (PFMs) play a crucial role in the development and physiology of the stomatognathic system. These teeth function as key elements of occlusion and are considered significant factors in jaw development [ 1 ]. PFMs are essential in maintaining a balanced and normal occlusion, forming the foundation of masticatory function and contributing to approximately 50% of this function. PFMs serve as guides for the subsequent permanent teeth and contribute to the establishment of Angle’s Class I occlusion. Additionally, they play a pivotal role in maintaining occlusal function, balancing masticatory movements, preserving vertical facial height, preventing craniofacial trauma and ensuring the success of orthodontic treatments [ 1 ]. The early extraction of PFMs may negatively affect overall occlusion and the development of both jaws. This may lead to the development of asymmetry and contribute to the onset of temporomandibular joint dysfunctions [ 2 ]. Additionally, adverse outcomes such as the mesial tipping of adjacent teeth into the extraction space, extrusion of opposing teeth in the occlusion, development of asymmetric masticatory habits and periodontal complications arising from alveolar bone atrophy in the extraction site may occur [ 3 , 4 ]. In orthodontic extraction planning, PFMs are often preferred over other teeth due to the higher prevalence of deep caries, extensive endodontic and restorative treatments and hypoplasia. Additionally, they may be utilized in treatment planning aimed at regulating vertical facial height. First molars are the most frequently extracted teeth due to caries and endodontic complications, with mandibular first molars being at a particularly higher risk. In some populations, the prevalence of early extraction of these teeth reaches significantly high levels [ 5 ]. Andrews et al. reported that maxillary and mandibular PFMs have the highest susceptibility to caries and are the most prone to hypoplasia among permanent teeth [ 6 ]. Hypomineralization occurs as a result of the interaction of various factors affecting the function of ameloblasts, leading to abnormal enamel formation. Systemic or environmental factors that may arise during the maturation stage of enamel development, combined with the genetic susceptibility of ameloblasts to environmental stressors, contribute to the onset of hypomineralization [ 7 , 8 ]. Molar Incisor Hypomineralization (MIH) is defined as a developmental disorder that affects the degree of enamel mineralization. Clinically, it occurs in distinct opacities ranging from white to yellow and brown, affecting one or more PFMs and less frequently incisors. Due to the low mineral concentration in the enamel associated with MIH, structural breakdown of the teeth may occur after eruption under masticatory forces [ 8 , 9 ]. Teeth affected by MIH exhibit increased sensitivity to temperature changes and mechanical stimuli. This condition may cause discomfort even during brushing. Additionally, the hypomineralized enamel surface facilitates biofilm accumulation, making affected teeth more susceptible to carious lesions. Hypomineralized enamel may enhance bacterial adhesion and due to its porous structure, may allow easier bacterial penetration into dentinal tubules. Studies have reported that hypomineralization is observed in 10–19% of PFMs [ 10 , 11 ]. MIH is considered a risk factor for the development of carious lesions, regardless of patients’ habits [ 12 ]. Caries indices classify restorations applied to the tooth as treatment for carious lesions. This is an important consideration in analyzing the relationship between caries and MIH [ 13 ]. Oral and dental health is an integral part of overall health and has a direct impact on an individual's quality of life. Tooth loss is considered a significant public health issue and is recognized as one of the effectiveness indicators of community health programs, which are intended to prevent dental caries, periodontal diseases and tooth loss and raise awareness within the community [ 14 ]. Dental caries remains a prevalent health issue in developing countries [ 1 ]. Despite various approaches developed to maintain oral health, early tooth loss continues to be a significant problem. Tooth loss negatively affects an individual's quality of life by leading to impairments in aesthetics, speech and masticatory function. The primary purpose of community health programs is to reduce and prevent plaque accumulation, dental caries, periodontal diseases and tooth loss while raising public awareness of oral health. Tooth loss resulting from inadequate oral hygiene contributes to aesthetic deterioration and impairments in speech and mastication, thereby adversely affecting an individual's quality of life. While most of the existing research focuses on the condition of first molars in children, studies specifically targeting university students in early adulthood remain limited [ 15 , 16 ]. This study aims to comparatively evaluate the current endodontic and periodontal status, treatment history, and treatment needs of PFMs and oral hygiene habits of university students aged 18–30 with a focus on the differences between the students of dentistry and other faculties. Methods Study design Inclusion and Exclusion Criteria The study was conducted on a group of university students aged between 18 and 30 years, who had previously undergone panoramic radiography and had not received treatment related to the first molar within the past six months. Individuals without any first molars due to congenital anomalies or those who did not consent to participate in the study were excluded from the study. Clinical Examination A total of 202 students were approved for participation in the present study. 101 of those students were from the faculty of dentistry (Group 1) and 101 was from other faculties (Group 2). Prior to the clinical examination, the demographic data, smoking status, and oral hygiene practices (the frequency of brushing, duration of brushing, and use of interdental brush and mouthwash) of the subjects were documented in a case report form which was specifically developed for this study and is provided in English as Supplementary File 1. Panoramic radiographs of the participants were evaluated, and intraoral examinations were performed by an endodontic specialist (E.G.Ş). All participants underwent dental examinations while seated under artificial light, a dental explorer and a dental mirror. A methodical technique was used to examine each PFM, starting with the upper right PFM and moving to the lower right one [ 17 ]. The presence of the first molars, root canal treatment, restoration or other therapy and treatment needs of the first molars in all four quadrants were recorded. Teeth classified as "decayed" exhibited pit and fissure lesions, obvious surface cavities, weakened enamel or what appeared to be softening walls or floors. Additionally, PFMs with temporary fillings or secondary caries were also classified as "caries" [ 18 ]. The teeth meeting the said criteria were recorded as in need of treatment. For PFMs that were removed due to caries, the missing tooth code was used. For PFMs without cavities or with permanent restorations, filled tooth codes were utilized. A Williams probe (Hu-Friedy, Chicago, IL, USA) calibrated in millimeters was used to perform periodontal examinations for the entire mouth and to record the periodontal state of the first molars in each of the four quadrants by a periodontist (B.K). Plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment levels (CAL) were recorded. Individuals with fewer than 10% of all sites exhibiting BOP and those who demonstrated no attachment or bone loss from prior periodontitis were classified as healthy according to the periodontal disease classification proposed at the 2017 World Workshop. Patients with gingivitis were identified as having BOP in at least 10% of all sites and no loss of attachment from prior periodontitis; patients were diagnosed with periodontitis if they had interproximal clinical loss of attachment or bone loss as identified by radiography and a periodontal probe. The number and proportion of the teeth with a probing pocket depth above a certain threshold (usually Probing Pocket Depth > 4 mm and bleeding on probing and Probing Pocket Depth ≥ 6 mm) were also considered in the classification of the number of teeth lost due to periodontitis and the number of teeth with intraosseous lesions and/or furcation lesions as periodontitis [ 19 ]. To evaluate intra-examiner consistency and reproducibility, 20 students were assessed by each examiner. A Kappa coefficient greater than 0.85 was considered statistically significant. Additionally, 5% of the participants were randomly re-examined throughout the study to ensure accuracy and consistency of the data [ 20 ]. Statistical Analysis The statistical analysis of the collected data was conducted using the R programming language in the RStudio environment [ 21 , 22 ]. First, a chi-square test was performed to evaluate the relationship between the categorical variables. To determine the strength and direction of the relationship, the Odds Ratio (OR) was calculated. The McNemar test was used to assess whether there was a significant difference in the number of extracted teeth between the maxilla and mandible. A significance level of p < 0.05 was set for all analyses. Results In the present study, data from a total of 202 university students were analyzed. The sample included 101 students from the faculty of dentistry (Group 1), and 101 students from other faculties (Group 2). 38 teeth were extracted and a total of 766 PFMs were evaluated. Hypomineralization was detected in 31% of the teeth examined. A bilateral evaluation of hypomineralization showed a significant relationship between the right and left sides (p < 0.001). A statistically significant need for treatment was observed in mandibular PFM teeth with hypomineralization (p < 0.01). Although the treatment history of the mandibular PFM teeth was higher than the maxillary PFM teeth, this difference was not found to be statistically significant. A statistically significant relationship was found between the presence of hypomineralized PFM teeth and dental caries (p = 0.01916) (See Table 1 ). Table 1 The relationship between hypomineralization and caries status in the maxillary and mandibular teeth Presence of hypomineralization Absence of hypomineralization Tooth# Presence of caries Absence of caries Presence of caries Absence of caries Total OR p-value Maxilla 16 10 48 18 126 202 1.13 0.8403 26 7 56 18 121 202 Total (n) 17 104 36 247 404 % 4.2 25.7 8.9 61.1 100 Mandible 36 12 47 12 131 202 2.84 0.0020 46 9 47 9 137 202 Total (n) 21 94 21 268 404 % 5.2 23.3 5.2 66.3 100 All Teeth n 38 198 57 515 808 1.73 0.0192 % 4.7 24.5 7.1 63.7 100 OR: Odds Ratio, n: number of teeth, %: percentage The presence of existing caries was found to be statistically higher in Group 2. Additionally, a statistically significant difference was observed between mandibular and maxillary PFMs (p < 0.01) When the treatment status (treatment history and treatment need) was evaluated, a statistically significant relationship was found between the right and left sides (p < 0.001). In the faculty-based evaluation, the treatment history of PFMs was found to be statistically higher in Group 1 than in Group 2 (p = 0.03204). This rate was determined to be statistically higher in mandibular PFMs than in maxillary PFMs (p < 0.001). A significantly higher need for treatment was observed in Group 2 compared to Group 1 (p = 0.03311). It was also found that mandibular PFMs had a higher treatment need than maxillary PFMs (p = 0.01345). The extraction rate of mandibular PFM teeth was found to be significantly higher compared to maxillary PFM teeth (p = 0.00365). Statistically significant differences were observed between the groups in terms of oral hygiene habits including frequency and duration of tooth brushing and interdental cleaning. Group 1 demonstrated a significantly higher performance in maintaining these habits compared to Group 2 (p = < 0.001) (See Table 2 ). Table 2 Comparison of oral hygiene habits Frequency of toothbrushing Duration of brushing Interdental cleaning Adequate inadequate adequate inadequate adequate inadequate Faculty of Dentistry n 77 24 62 39 43 58 % 76 24 61 39 43 57 Other Faculties n 55 46 39 62 18 83 % 54 46 39 61 18 82 p-value < .001 < .001 < .001 n: number of participants Students who brushed their teeth twice a day and performed interdental cleaning exhibited a statistically lower presence of caries (p < 0.001). However, no significant association was found between the duration of brushing and the presence of caries. Students with better oral hygiene habits including proper brushing frequency, brushing duration, and sufficient interdental cleaning had lower rates of gingivitis (p < 0.001). No significant association was found between smoking and the presence of dental caries. Similarly, no significant relationship was observed between mouthwash use and the presence of dental caries. A total of 9 PFM teeth (4.45%) exhibited the presence of a fistula. Additionally, periapical lesions were detected in 14 PFM teeth. Among these, 4 teeth (1.98%) exhibited both a fistula and a periapical lesion. Discussion PFMs play a crucial role in the development of normal occlusion, and their preservation is essential for maintaining optimal oral health. PFMs exhibit distinct anatomical features such as deep pits, fissures, and concavities, which can provide an environment suitable for plaque accumulation. Moreover, the misidentification of primary teeth as PFMs in childhood, and failure to adopt adequate oral hygiene practices during their eruption may expedite the progression of caries in those teeth [ 23 ]. PFMs are considered the most at-risk teeth, as they may be affected by damage caused by systemic and environmental factors during the early years of life [ 24 – 27 ]. Early loss of these teeth may lead to midline deviation, the formation of diastema, supereruption of antagonistic teeth and unilateral chewing, resulting in malocclusion [ 28 ]. Numerous studies have investigated the oral health status of preschoolers and students with mixed dentition [ 29 – 31 ]. To the best of our knowledge, the present study is the first to comparatively assess PFMs in a sample of students aged 18 to 30 years from the faculty of dentistry and other faculties, which represents a broader age range than previously examined in the literature. Therefore, the findings of the present study may provide significant insights for developing oral health promotion strategies tailored to individuals within this age group. A comparison of the PFMs in the maxilla and mandible showed higher caries prevalence and restoration rates in mandibular PFMs. Mandibular PFMs were found to be more prone to caries due to their complex pit and fissure morphology, which facilitates the accumulation of food as well as earlier eruption into the oral cavity compared to maxillary PFMs, resulting in prolonged exposure to etiological factors that contribute to the development of caries [ 32 , 33 ] Several similar studies have demonstrated that the incidence of caries is higher in mandibular PFMs than in maxillary molars. In the present study, in coherence with the body of literature, the frequency of caries, history of caries-related treatments, and treatment needs in mandibular PFMs were found to be statistically significantly higher than in maxillary PFMs [ 32 – 34 ]. The mandibular PFMs were found to be missing more frequently than their maxillary counterparts [ 35 – 37 ]. However, studies conducted in various age groups have also demonstrated that greater loss occurs in maxillary first molars compared to mandibular molars. The present study revealed a higher prevalence of mandibular first molar extraction compared to maxillary first molars. While there was no statistically significant difference, the mandible had a higher prevalence of extracted permanent first molars. The variations observed in these studies may be caused by differences in the age ranges examined and the sample sizes used. Studies conducted around the world have reported an increased prevalence of MIH in children aged 10 years and younger, while its prevalence decreases in children older than 10 years. This reduction in prevalence in older children is thought to be associated with the application of preventive treatments or extractions for these teeth [ 38 ]. Another study reported that MIH was observed in half of the 260 children aged 8 to 12 years [ 39 ]. Participants with hypomineralization in the current study were evaluated as a single group without distinguishing between dental and other faculties. The findings revealed a high prevalence of MIH with 48% of participants affected. A study conducted by Fagrell et al. demonstrated the presence of bacteria in the dentin tubules of hypomineralized teeth. Since hypomineralization is an enamel anomaly observed during tooth eruption, it has been suggested that the dentin tubules are sufficiently wide to facilitate bacterial infiltration [ 40 ]. The surface characteristics of hypomineralized enamel contribute to bacterial adhesion with even seemingly intact surfaces exhibiting a porous structure that permits the invasion of cariogenic bacteria and subsequent tissue destruction [ 41 ]. Most studies have reported a higher presence of caries in individuals with MIH compared to those without [ 42 – 44 ]. In the present study, in line with the literature, the presence of caries in hypomineralized PFMs was found to be statistically significantly higher. In a study evaluating PFMs across different age groups, a bilateral relationship was found between the treatment needs, treatment status and extractions of teeth numbered 16–26 and 36–46 [ 36 ]. The right and left sides of the jaws were assessed separately with healthy teeth found in 45.6% and 45.9% of the cases, respectively. Additionally, the need for interventional treatment was similar on both sides [ 45 ]. In our study, the treatment needs, current status of PFMs and the rate of extracted PFMs were found to be similar to those reported in the literature; furthermore, a significant bilateral relationship was observed in the prevalence of hypomineralization. Hypomineralized teeth which have areas of demarcated opacities and structural breakdown are known to present difficulties in maintaining the retention for restorations [ 46 ]. This leads to the need for re-treatment in previously treated hypomineralized teeth. In older age groups, the extended duration of exposure to caries risk factors and MIH-related complications increases the risk of dental caries and the need for treatment. In this context, it was expected in our study that the treatment needs of hypomineralized mandibular PFMs would be statistically higher. Removing biofilm through brushing and interproximal tools is an effective method for preventing the formation of caries [ 47 ]. Preventive strategies include teaching people how to brush properly and making it a habit to brush twice a day with a fluoride toothpaste [ 48 ]. It was reported in a study conducted by Marchesan et al. which examined the relationship between oral hygiene habits and the frequency of caries, periodontal disease and extracted teeth that individuals with daily oral hygiene habits were found to have lower levels of periodontal disease, caries, and extracted teeth [ 49 ]. Studies have shown that students who habitually brush their teeth twice a day had a lower incidence of caries compared to those who did not brush their teeth at all [ 50 ]. In the present study, the incidence of caries in PFMs was found to be significantly higher in students from other faculties than in students of dentistry. In addition, the need for restorative treatments, root canal therapy, retreatments, and extractions in PFMs was significantly higher in students from other faculties. We believe that this difference is related to the significantly higher oral hygiene habits such as brushing frequency, brushing duration, and interdental cleaning observed in the students of dentistry who receive oral health education. In a study where inflammation was detected in the gingiva of at least one anterior region in all students, it was reported that the high prevalence of this condition could be attributed to the lack of regular dental visits and oral health promotion programs. Additionally, similar studies have identified brushing teeth only once a day as a significant risk factor for dental caries and gingivitis [ 31 ]. In our study, the prevalence of gingivitis was found to be significantly higher in students from other faculties. This is known to be directly related to individuals' oral hygiene habits. Also, we believe that the oral and dental health education received by dental students plays a significant role in achieving better oral hygiene. The impact of smoking on the progression of periodontal diseases is well established, and the mechanisms behind this effect have been thoroughly investigated [ 51 ].A study of individuals aged 20–29 years found that 75.8% of the participants had gingivitis. 84.2% of the smokers had gingivitis, highlighting the strong and rapid impact of smoking on gingival health [ 52 ]. Smokers had considerably higher scores for PI, GI, and BOP. Smoking is considered a major risk factor for periodontal disease, influencing its prevalence, severity, progression, and response to treatment [ 53 ]. The mean percentage of sites that bled upon gentle probing was greater in smokers (41.4%) than in non-smokers (29.5%) [ 54 ]. In our study, no significant association was found between smoking and gingivitis. The fact that a relatively small number of the participants were smokers may have contributed to the lack of a statistically significant relationship. Chlorhexidine mouthwash effectively reduces gingival inflammation and bleeding in comparison with untreated controls [ 55 ]. Mouthwash with essential oils has been shown to reduce dental plaque and gingivitis. Dentists may recommend mouthwash with essential oils as an adjunct to daily oral hygiene [ 56 ]. Reviews on CHX and essential oils have demonstrated their efficacy in plaque reduction. The evidence supports that CHX mouthwash is the preferred option for plaque control, with essential oils serving as a viable alternative. No significant difference has been found between CHX and essential oils concerning their impact on gingivitis [ 57 ]. However, contrary to the literature, we did not find a significant association between mouthwash use and gingivitis. This may be due to the small number of participants using mouthwash. Since statistical significance is often difficult to achieve with small sample sizes, studies with larger sample groups may provide a stronger indication of the effect of smoking on gingivitis. Our study had several limitations. First, sociodemographic characteristics and the gender variable were not considered in the analysis process. Second, participants' self-reported oral hygiene habits may introduce a risk of bias regarding the accuracy of the responses. Additionally, the limited sample size may restrict the generalizability of the findings. Conclusion In the age group we evaluated, individuals with education on oral health exhibited a lower incidence of caries and a reduced frequency of gingivitis. Our study revealed that MIH is bilateral. Additionally, we found a higher prevalence and risk of caries in teeth affected by MIH. These findings provide a novel perspective on the symmetrical distribution of MIH and its association with increased caries susceptibility. Clinical relevance Dental caries remains one of the most prevalent health issues in developing countries. Despite the development of various alternative approaches to maintaining oral health, early tooth loss remains a significant problem today. In our study, in addition to the oral and dental health screening programs maintained by the Ministry of Health of Türkiye and the initiatives supporting oral hygiene education for teachers and students in schools, we believe that evaluating the dental health of university students who are teachers, healthcare professionals, and parents of the future may help identify treatment needs and contribute to the development of appropriate guidance. Declarations Conflict of Interests The authors have no financial and non-financial conflict of interests to declare. Ethical Approval and Consent to Participate This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (2024 revision). Ethical approval for the study was granted by the Health Sciences Ethics Committee of Çankırı Karatekin University (Decision No: 11, Date: 05-02-2024). The participants were informed about the study before their written informed consent was obtained. 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Int J Paediatr Dent. 2012;22:85–91. Sacide Duman GD. The evaluation of the clinical and radiographic records of the first molar teeth in pediatric patients. Ann Med Res. Fayle SA. Molar incisor hypomineralisation: restorative management. Eur J Paediatr Dent. 2003. Hujoel PP, Hujoel MLA, Kotsakis GA. Personal oral hygiene and dental caries: A systematic review of randomised controlled trials. Gerodontology. 2018;35:282–9. Recommendations for Preventive Pediatric Health Care. Pediatrics. 2000;105:645–6. Marchesan JT, Morelli T, Moss K, Preisser JS, Zandona AF, Offenbacher S, et al. Interdental Cleaning Is Associated with Decreased Oral Disease Prevalence. J Dent Res. 2018;97:773–8. Ozmen Bilal. Evaluation of permanent first molar tooth loss in young population from North Turkey. Balkan J Dent Med. 2019. Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89. Ababneh KT, Abu Hwaij ZMF, Khader YS. Prevalence and risk indicators of gingivitis and periodontitis in a Multi-Centre study in North Jordan: a cross sectional study. BMC Oral Health. 2012;12:1. Matthews CR, Joshi V, de Jager M, Aspiras M, Kumar PS. Host–Bacterial Interactions During Induction and Resolution of Experimental Gingivitis in Current Smokers. J Periodontol. 2013;84:32–40. Linden GJ, Mullally BH. Cigarette Smoking and Periodontal Destruction in Young Adults. J Periodontol. 1994;65:718–23. Ioanna Karamani EKKSSGDK. Chlorhexidine Mouthwash for Gingivitis Control in Orthodontic Patients: A Systematic Review and Meta-Analysis. Oral Health Prev Dent; 2022. Hollaar VRY, van Swaaij BWM. Effects of mouthwash with essential oils on dental plaque and gingivitis. Ned Tijdschr Tandheelkd. 2022;129:381–4. n der Weijden FA, Ciancio SG, Slot DE. Can Chemical Mouthwash Agents Achieve Plaque/Gingivitis Control? Dent Clin North Am. 2015;59:799–829. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1CaseReportForm.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6465517","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":454776576,"identity":"f9f6f01a-ef19-4d24-8708-dcb51da6a99f","order_by":0,"name":"Eda GURSU SAHIN","email":"data:image/png;base64,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","orcid":"","institution":"Çankırı Karatekin University","correspondingAuthor":true,"prefix":"","firstName":"Eda","middleName":"GURSU","lastName":"SAHIN","suffix":""},{"id":454776578,"identity":"27b365c5-4fb9-4873-aa43-b3d547ebab60","order_by":1,"name":"Basak KARASU","email":"","orcid":"","institution":"Çankırı Karatekin University","correspondingAuthor":false,"prefix":"","firstName":"Basak","middleName":"","lastName":"KARASU","suffix":""}],"badges":[],"createdAt":"2025-04-16 17:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6465517/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6465517/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86909137,"identity":"b7506839-3a40-473c-b929-1164be443dd2","added_by":"auto","created_at":"2025-07-17 04:46:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":657755,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6465517/v1/c2abe2e5-9ed0-4c2b-b7e4-e80cbab295b7.pdf"},{"id":82522176,"identity":"2764000b-7fcd-41ad-9234-054f453b5c87","added_by":"auto","created_at":"2025-05-12 13:03:10","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":33588,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1CaseReportForm.docx","url":"https://assets-eu.researchsquare.com/files/rs-6465517/v1/7002f1161070ddfeee9df019.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of the current dental condition and treatment needs of permanent first molars in university students","fulltext":[{"header":"Background","content":"\u003cp\u003ePermanent First Molars (PFMs) play a crucial role in the development and physiology of the stomatognathic system. These teeth function as key elements of occlusion and are considered significant factors in jaw development [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. PFMs are essential in maintaining a balanced and normal occlusion, forming the foundation of masticatory function and contributing to approximately 50% of this function. PFMs serve as guides for the subsequent permanent teeth and contribute to the establishment of Angle\u0026rsquo;s Class I occlusion. Additionally, they play a pivotal role in maintaining occlusal function, balancing masticatory movements, preserving vertical facial height, preventing craniofacial trauma and ensuring the success of orthodontic treatments [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe early extraction of PFMs may negatively affect overall occlusion and the development of both jaws. This may lead to the development of asymmetry and contribute to the onset of temporomandibular joint dysfunctions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Additionally, adverse outcomes such as the mesial tipping of adjacent teeth into the extraction space, extrusion of opposing teeth in the occlusion, development of asymmetric masticatory habits and periodontal complications arising from alveolar bone atrophy in the extraction site may occur [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In orthodontic extraction planning, PFMs are often preferred over other teeth due to the higher prevalence of deep caries, extensive endodontic and restorative treatments and hypoplasia. Additionally, they may be utilized in treatment planning aimed at regulating vertical facial height. First molars are the most frequently extracted teeth due to caries and endodontic complications, with mandibular first molars being at a particularly higher risk. In some populations, the prevalence of early extraction of these teeth reaches significantly high levels [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Andrews et al. reported that maxillary and mandibular PFMs have the highest susceptibility to caries and are the most prone to hypoplasia among permanent teeth [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHypomineralization occurs as a result of the interaction of various factors affecting the function of ameloblasts, leading to abnormal enamel formation. Systemic or environmental factors that may arise during the maturation stage of enamel development, combined with the genetic susceptibility of ameloblasts to environmental stressors, contribute to the onset of hypomineralization [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Molar Incisor Hypomineralization (MIH) is defined as a developmental disorder that affects the degree of enamel mineralization. Clinically, it occurs in distinct opacities ranging from white to yellow and brown, affecting one or more PFMs and less frequently incisors. Due to the low mineral concentration in the enamel associated with MIH, structural breakdown of the teeth may occur after eruption under masticatory forces [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Teeth affected by MIH exhibit increased sensitivity to temperature changes and mechanical stimuli. This condition may cause discomfort even during brushing. Additionally, the hypomineralized enamel surface facilitates biofilm accumulation, making affected teeth more susceptible to carious lesions. Hypomineralized enamel may enhance bacterial adhesion and due to its porous structure, may allow easier bacterial penetration into dentinal tubules. Studies have reported that hypomineralization is observed in 10\u0026ndash;19% of PFMs [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. MIH is considered a risk factor for the development of carious lesions, regardless of patients\u0026rsquo; habits [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Caries indices classify restorations applied to the tooth as treatment for carious lesions. This is an important consideration in analyzing the relationship between caries and MIH [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOral and dental health is an integral part of overall health and has a direct impact on an individual's quality of life. Tooth loss is considered a significant public health issue and is recognized as one of the effectiveness indicators of community health programs, which are intended to prevent dental caries, periodontal diseases and tooth loss and raise awareness within the community [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Dental caries remains a prevalent health issue in developing countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite various approaches developed to maintain oral health, early tooth loss continues to be a significant problem. Tooth loss negatively affects an individual's quality of life by leading to impairments in aesthetics, speech and masticatory function.\u003c/p\u003e \u003cp\u003eThe primary purpose of community health programs is to reduce and prevent plaque accumulation, dental caries, periodontal diseases and tooth loss while raising public awareness of oral health. Tooth loss resulting from inadequate oral hygiene contributes to aesthetic deterioration and impairments in speech and mastication, thereby adversely affecting an individual's quality of life. While most of the existing research focuses on the condition of first molars in children, studies specifically targeting university students in early adulthood remain limited [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aims to comparatively evaluate the current endodontic and periodontal status, treatment history, and treatment needs of PFMs and oral hygiene habits of university students aged 18\u0026ndash;30 with a focus on the differences between the students of dentistry and other faculties.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eThe study was conducted on a group of university students aged between 18 and 30 years, who had previously undergone panoramic radiography and had not received treatment related to the first molar within the past six months.\u003c/p\u003e \u003cp\u003eIndividuals without any first molars due to congenital anomalies or those who did not consent to participate in the study were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Examination\u003c/h3\u003e\n\u003cp\u003e A total of 202 students were approved for participation in the present study. 101 of those students were from the faculty of dentistry (Group 1) and 101 was from other faculties (Group 2).\u003c/p\u003e \u003cp\u003e Prior to the clinical examination, the demographic data, smoking status, and oral hygiene practices (the frequency of brushing, duration of brushing, and use of interdental brush and mouthwash) of the subjects were documented in a case report form which was specifically developed for this study and is provided in English as Supplementary File 1.\u003c/p\u003e \u003cp\u003ePanoramic radiographs of the participants were evaluated, and intraoral examinations were performed by an endodontic specialist (E.G.Ş). All participants underwent dental examinations while seated under artificial light, a dental explorer and a dental mirror. A methodical technique was used to examine each PFM, starting with the upper right PFM and moving to the lower right one [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe presence of the first molars, root canal treatment, restoration or other therapy and treatment needs of the first molars in all four quadrants were recorded. Teeth classified as \"decayed\" exhibited pit and fissure lesions, obvious surface cavities, weakened enamel or what appeared to be softening walls or floors. Additionally, PFMs with temporary fillings or secondary caries were also classified as \"caries\" [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The teeth meeting the said criteria were recorded as in need of treatment.\u003c/p\u003e \u003cp\u003eFor PFMs that were removed due to caries, the missing tooth code was used. For PFMs without cavities or with permanent restorations, filled tooth codes were utilized. A Williams probe (Hu-Friedy, Chicago, IL, USA) calibrated in millimeters was used to perform periodontal examinations for the entire mouth and to record the periodontal state of the first molars in each of the four quadrants by a periodontist (B.K). Plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment levels (CAL) were recorded.\u003c/p\u003e \u003cp\u003eIndividuals with fewer than 10% of all sites exhibiting BOP and those who demonstrated no attachment or bone loss from prior periodontitis were classified as healthy according to the periodontal disease classification proposed at the 2017 World Workshop. Patients with gingivitis were identified as having BOP in at least 10% of all sites and no loss of attachment from prior periodontitis; patients were diagnosed with periodontitis if they had interproximal clinical loss of attachment or bone loss as identified by radiography and a periodontal probe. The number and proportion of the teeth with a probing pocket depth above a certain threshold (usually Probing Pocket Depth\u0026thinsp;\u0026gt;\u0026thinsp;4 mm and bleeding on probing and Probing Pocket Depth\u0026thinsp;\u0026ge;\u0026thinsp;6 mm) were also considered in the classification of the number of teeth lost due to periodontitis and the number of teeth with intraosseous lesions and/or furcation lesions as periodontitis [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo evaluate intra-examiner consistency and reproducibility, 20 students were assessed by each examiner. A Kappa coefficient greater than 0.85 was considered statistically significant. Additionally, 5% of the participants were randomly re-examined throughout the study to ensure accuracy and consistency of the data [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe statistical analysis of the collected data was conducted using the R programming language in the RStudio environment [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. First, a chi-square test was performed to evaluate the relationship between the categorical variables. To determine the strength and direction of the relationship, the Odds Ratio (OR) was calculated. The McNemar test was used to assess whether there was a significant difference in the number of extracted teeth between the maxilla and mandible. A significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was set for all analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn the present study, data from a total of 202 university students were analyzed. The sample included 101 students from the faculty of dentistry (Group 1), and 101 students from other faculties (Group 2). 38 teeth were extracted and a total of 766 PFMs were evaluated. Hypomineralization was detected in 31% of the teeth examined.\u003c/p\u003e \u003cp\u003eA bilateral evaluation of hypomineralization showed a significant relationship between the right and left sides (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eA statistically significant need for treatment was observed in mandibular PFM teeth with hypomineralization (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Although the treatment history of the mandibular PFM teeth was higher than the maxillary PFM teeth, this difference was not found to be statistically significant.\u003c/p\u003e \u003cp\u003eA statistically significant relationship was found between the presence of hypomineralized PFM teeth and dental caries (p\u0026thinsp;=\u0026thinsp;0.01916) (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe relationship between hypomineralization and caries status in the maxillary and mandibular teeth\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePresence of hypomineralization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAbsence of hypomineralization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTooth#\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePresence of caries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAbsence of caries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePresence of caries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAbsence of caries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMaxilla\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.8403\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal (n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMandible\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e36\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e46\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal (n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAll Teeth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.0192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eOR: Odds Ratio, n: number of teeth, %: percentage\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe presence of existing caries was found to be statistically higher in Group 2. Additionally, a statistically significant difference was observed between mandibular and maxillary PFMs (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003c/p\u003e \u003cp\u003eWhen the treatment status (treatment history and treatment need) was evaluated, a statistically significant relationship was found between the right and left sides (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIn the faculty-based evaluation, the treatment history of PFMs was found to be statistically higher in Group 1 than in Group 2 (p\u0026thinsp;=\u0026thinsp;0.03204). This rate was determined to be statistically higher in mandibular PFMs than in maxillary PFMs (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eA significantly higher need for treatment was observed in Group 2 compared to Group 1 (p\u0026thinsp;=\u0026thinsp;0.03311). It was also found that mandibular PFMs had a higher treatment need than maxillary PFMs (p\u0026thinsp;=\u0026thinsp;0.01345).\u003c/p\u003e \u003cp\u003eThe extraction rate of mandibular PFM teeth was found to be significantly higher compared to maxillary PFM teeth (p\u0026thinsp;=\u0026thinsp;0.00365).\u003c/p\u003e \u003cp\u003e Statistically significant differences were observed between the groups in terms of oral hygiene habits including frequency and duration of tooth brushing and interdental cleaning. Group 1 demonstrated a significantly higher performance in maintaining these habits compared to Group 2 (p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (See Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of oral hygiene habits\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eFrequency of toothbrushing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eDuration of brushing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eInterdental cleaning\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003einadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003einadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003einadequate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFaculty of Dentistry\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eOther Faculties\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003en: number of participants\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStudents who brushed their teeth twice a day and performed interdental cleaning exhibited a statistically lower presence of caries (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, no significant association was found between the duration of brushing and the presence of caries.\u003c/p\u003e \u003cp\u003eStudents with better oral hygiene habits including proper brushing frequency, brushing duration, and sufficient interdental cleaning had lower rates of gingivitis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eNo significant association was found between smoking and the presence of dental caries. Similarly, no significant relationship was observed between mouthwash use and the presence of dental caries.\u003c/p\u003e \u003cp\u003eA total of 9 PFM teeth (4.45%) exhibited the presence of a fistula. Additionally, periapical lesions were detected in 14 PFM teeth. Among these, 4 teeth (1.98%) exhibited both a fistula and a periapical lesion.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePFMs play a crucial role in the development of normal occlusion, and their preservation is essential for maintaining optimal oral health. PFMs exhibit distinct anatomical features such as deep pits, fissures, and concavities, which can provide an environment suitable for plaque accumulation. Moreover, the misidentification of primary teeth as PFMs in childhood, and failure to adopt adequate oral hygiene practices during their eruption may expedite the progression of caries in those teeth [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePFMs are considered the most at-risk teeth, as they may be affected by damage caused by systemic and environmental factors during the early years of life [\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly loss of these teeth may lead to midline deviation, the formation of diastema, supereruption of antagonistic teeth and unilateral chewing, resulting in malocclusion [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous studies have investigated the oral health status of preschoolers and students with mixed dentition [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. To the best of our knowledge, the present study is the first to comparatively assess PFMs in a sample of students aged 18 to 30 years from the faculty of dentistry and other faculties, which represents a broader age range than previously examined in the literature. Therefore, the findings of the present study may provide significant insights for developing oral health promotion strategies tailored to individuals within this age group.\u003c/p\u003e \u003cp\u003eA comparison of the PFMs in the maxilla and mandible showed higher caries prevalence and restoration rates in mandibular PFMs. Mandibular PFMs were found to be more prone to caries due to their complex pit and fissure morphology, which facilitates the accumulation of food as well as earlier eruption into the oral cavity compared to maxillary PFMs, resulting in prolonged exposure to etiological factors that contribute to the development of caries [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSeveral similar studies have demonstrated that the incidence of caries is higher in mandibular PFMs than in maxillary molars. In the present study, in coherence with the body of literature, the frequency of caries, history of caries-related treatments, and treatment needs in mandibular PFMs were found to be statistically significantly higher than in maxillary PFMs [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mandibular PFMs were found to be missing more frequently than their maxillary counterparts [\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. However, studies conducted in various age groups have also demonstrated that greater loss occurs in maxillary first molars compared to mandibular molars. The present study revealed a higher prevalence of mandibular first molar extraction compared to maxillary first molars. While there was no statistically significant difference, the mandible had a higher prevalence of extracted permanent first molars. The variations observed in these studies may be caused by differences in the age ranges examined and the sample sizes used.\u003c/p\u003e \u003cp\u003eStudies conducted around the world have reported an increased prevalence of MIH in children aged 10 years and younger, while its prevalence decreases in children older than 10 years. This reduction in prevalence in older children is thought to be associated with the application of preventive treatments or extractions for these teeth [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Another study reported that MIH was observed in half of the 260 children aged 8 to 12 years [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Participants with hypomineralization in the current study were evaluated as a single group without distinguishing between dental and other faculties. The findings revealed a high prevalence of MIH with 48% of participants affected.\u003c/p\u003e \u003cp\u003eA study conducted by Fagrell et al. demonstrated the presence of bacteria in the dentin tubules of hypomineralized teeth. Since hypomineralization is an enamel anomaly observed during tooth eruption, it has been suggested that the dentin tubules are sufficiently wide to facilitate bacterial infiltration [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The surface characteristics of hypomineralized enamel contribute to bacterial adhesion with even seemingly intact surfaces exhibiting a porous structure that permits the invasion of cariogenic bacteria and subsequent tissue destruction [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Most studies have reported a higher presence of caries in individuals with MIH compared to those without [\u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, in line with the literature, the presence of caries in hypomineralized PFMs was found to be statistically significantly higher.\u003c/p\u003e \u003cp\u003eIn a study evaluating PFMs across different age groups, a bilateral relationship was found between the treatment needs, treatment status and extractions of teeth numbered 16\u0026ndash;26 and 36\u0026ndash;46 [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The right and left sides of the jaws were assessed separately with healthy teeth found in 45.6% and 45.9% of the cases, respectively. Additionally, the need for interventional treatment was similar on both sides [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In our study, the treatment needs, current status of PFMs and the rate of extracted PFMs were found to be similar to those reported in the literature; furthermore, a significant bilateral relationship was observed in the prevalence of hypomineralization.\u003c/p\u003e \u003cp\u003eHypomineralized teeth which have areas of demarcated opacities and structural breakdown are known to present difficulties in maintaining the retention for restorations [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This leads to the need for re-treatment in previously treated hypomineralized teeth. In older age groups, the extended duration of exposure to caries risk factors and MIH-related complications increases the risk of dental caries and the need for treatment. In this context, it was expected in our study that the treatment needs of hypomineralized mandibular PFMs would be statistically higher.\u003c/p\u003e \u003cp\u003eRemoving biofilm through brushing and interproximal tools is an effective method for preventing the formation of caries [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Preventive strategies include teaching people how to brush properly and making it a habit to brush twice a day with a fluoride toothpaste [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. It was reported in a study conducted by Marchesan et al. which examined the relationship between oral hygiene habits and the frequency of caries, periodontal disease and extracted teeth that individuals with daily oral hygiene habits were found to have lower levels of periodontal disease, caries, and extracted teeth [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Studies have shown that students who habitually brush their teeth twice a day had a lower incidence of caries compared to those who did not brush their teeth at all [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. In the present study, the incidence of caries in PFMs was found to be significantly higher in students from other faculties than in students of dentistry. In addition, the need for restorative treatments, root canal therapy, retreatments, and extractions in PFMs was significantly higher in students from other faculties. We believe that this difference is related to the significantly higher oral hygiene habits such as brushing frequency, brushing duration, and interdental cleaning observed in the students of dentistry who receive oral health education.\u003c/p\u003e \u003cp\u003eIn a study where inflammation was detected in the gingiva of at least one anterior region in all students, it was reported that the high prevalence of this condition could be attributed to the lack of regular dental visits and oral health promotion programs. Additionally, similar studies have identified brushing teeth only once a day as a significant risk factor for dental caries and gingivitis [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In our study, the prevalence of gingivitis was found to be significantly higher in students from other faculties. This is known to be directly related to individuals' oral hygiene habits. Also, we believe that the oral and dental health education received by dental students plays a significant role in achieving better oral hygiene.\u003c/p\u003e \u003cp\u003eThe impact of smoking on the progression of periodontal diseases is well established, and the mechanisms behind this effect have been thoroughly investigated [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].A study of individuals aged 20\u0026ndash;29 years found that 75.8% of the participants had gingivitis. 84.2% of the smokers had gingivitis, highlighting the strong and rapid impact of smoking on gingival health [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Smokers had considerably higher scores for PI, GI, and BOP. Smoking is considered a major risk factor for periodontal disease, influencing its prevalence, severity, progression, and response to treatment [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. The mean percentage of sites that bled upon gentle probing was greater in smokers (41.4%) than in non-smokers (29.5%) [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. In our study, no significant association was found between smoking and gingivitis. The fact that a relatively small number of the participants were smokers may have contributed to the lack of a statistically significant relationship.\u003c/p\u003e \u003cp\u003eChlorhexidine mouthwash effectively reduces gingival inflammation and bleeding in comparison with untreated controls [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Mouthwash with essential oils has been shown to reduce dental plaque and gingivitis. Dentists may recommend mouthwash with essential oils as an adjunct to daily oral hygiene [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Reviews on CHX and essential oils have demonstrated their efficacy in plaque reduction. The evidence supports that CHX mouthwash is the preferred option for plaque control, with essential oils serving as a viable alternative. No significant difference has been found between CHX and essential oils concerning their impact on gingivitis [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. However, contrary to the literature, we did not find a significant association between mouthwash use and gingivitis. This may be due to the small number of participants using mouthwash. Since statistical significance is often difficult to achieve with small sample sizes, studies with larger sample groups may provide a stronger indication of the effect of smoking on gingivitis.\u003c/p\u003e \u003cp\u003eOur study had several limitations. First, sociodemographic characteristics and the gender variable were not considered in the analysis process. Second, participants' self-reported oral hygiene habits may introduce a risk of bias regarding the accuracy of the responses. Additionally, the limited sample size may restrict the generalizability of the findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the age group we evaluated, individuals with education on oral health exhibited a lower incidence of caries and a reduced frequency of gingivitis. Our study revealed that MIH is bilateral. Additionally, we found a higher prevalence and risk of caries in teeth affected by MIH. These findings provide a novel perspective on the symmetrical distribution of MIH and its association with increased caries susceptibility.\u003c/p\u003e\n\u003ch3\u003eClinical relevance\u003c/h3\u003e\n\u003cp\u003eDental caries remains one of the most prevalent health issues in developing countries. Despite the development of various alternative approaches to maintaining oral health, early tooth loss remains a significant problem today. In our study, in addition to the oral and dental health screening programs maintained by the Ministry of Health of T\u0026uuml;rkiye and the initiatives supporting oral hygiene education for teachers and students in schools, we believe that evaluating the dental health of university students who are teachers, healthcare professionals, and parents of the future may help identify treatment needs and contribute to the development of appropriate guidance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no financial and non-financial conflict of interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (2024 revision). Ethical approval for the study was granted by the Health Sciences Ethics Committee of \u0026Ccedil;ankırı Karatekin University (Decision No: 11, Date: 05-02-2024).\u003c/p\u003e\n\u003cp\u003eThe participants were informed about the study before their written informed consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used and analyzed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEbrahimi M, Ajami B-A-M, Sarraf Shirazi AR, Afzal Aghaee M, Rashidi S. Dental treatment needs of permanent first molars in mashhad schoolchildren. 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Dent Clin North Am. 2015;59:799\u0026ndash;829.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Permanent First Molar, Hypomineralization, Dental Assessment, University Students","lastPublishedDoi":"10.21203/rs.3.rs-6465517/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6465517/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe aim of this study was to investigate the current endodontic and periodontal conditions, treatment history, treatment needs and oral hygiene habits of university students in T\u0026uuml;rkiye in a comparative study of students in the dentistry faculty and other faculties.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study included university students of the Faculty of Dentistry who had undergone panoramic radiography for any reason and had not received treatment related to the first molar over the past six months. A total of 202 university students were analyzed, with 101 from the Faculty of Dentistry and 101 from other faculties. The presence, treatment status, periodontal health parameters (plaque index, bleeding on probing, probing depth and clinical attachment level), treatment needs, medical history of PFMs and responses to questionnaires about oral hygiene habits were recorded in Excel.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eHypomineralization was detected in 31% of the PFMs, with treatment needs being higher in mandibular PFMs exhibiting hypomineralization. A significant bilateral relationship was found in terms of hypomineralization (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e Individuals with oral health education had fewer caries and less gingivitis. Hypomineralization was found to occur bilaterally and associated with a higher risk of dental caries. These findings highlight the symmetrical distribution of Hypomineralization and its link to an increased susceptibility to caries.\u003c/p\u003e","manuscriptTitle":"Assessment of the current dental condition and treatment needs of permanent first molars in university students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-12 13:03:06","doi":"10.21203/rs.3.rs-6465517/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ba1c5a8d-bb47-497f-acb8-c31db04aef58","owner":[],"postedDate":"May 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-17T04:38:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-12 13:03:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6465517","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6465517","identity":"rs-6465517","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}