Impact of conflict-induced stress on dental and skeletal development in children and adolescents

Objectives: To investigate the impact of living in a war zone on acceleration of skeletal maturation and development of permanent teeth. Materials and Methods: A total of 272 Israeli children and adolescents aged 9-15 years participated in this study. The Gaza group included 106 participants from the Gaza envelope area (within 7 km of the Gaza Strip border), while the central group consisted of 166 participants from central Israel. Skeletal maturation and dental development were assessed using lateral cephalometric and panoramic radiographs, respectively. Results: Significant differences were observed in all maturation variables, including skeletal maturation as well as maturation of the upper and lower second molars (right and left) and upper canines. The Gaza envelope group exhibited more advanced and accelerated maturation than the central group (P < .0005). Positive correlations were identified among tooth maturation, chronological age, and skeletal development (0.519 < r < 0.599). Linear regression analysis revealed that the maturation of the lower left second molar accounted for 47.8% of variance in skeletal maturation. Conclusions: In this study, we confirm that children living under the stress of a conflict zone exhibited earlier skeletal maturation and accelerated eruption of permanent second molars and upper canines than their peers. The early eruption of second molars and canines, particularly the lower left second molar, may serve as a predictive marker for pubertal progression.