|Year : 2013 | Volume
| Issue : 2 | Page : 110-114
Reasons and pattern of tooth mortality in a Nigerian Urban teaching hospital
BD Saheeb1, MA Sede2
1 Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
2 Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
|Date of Web Publication||22-May-2013|
B D Saheeb
P.O. Box 2799, Benin City, Edo State, 300 - 001
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Studies from Nigeria have documented different reasons for tooth mortality and regular follow-up studies to determine any changes in reasons and pattern among Nigerians appears not to be common. The purpose of this study was to determine the reasons and pattern of tooth mortality among Nigerians and the changes that might have occurred after 38 years of the first report.
Materials and Methods: The case records of patients seen at the Oral Surgery clinic of the University of Benin Teaching Hospital between March 2007 and February 2008 were retrieved from the Medical Records Department and analyzed for age, gender, reasons for extraction, tooth extracted, frequency of extraction, and mode of extraction.
Results: A total of 990 patients were referred for exodontia and 1050 teeth were extracted from 397 (40.1%) males and 593 (59.9%) females of age 14--89 years. The reasons for extraction include caries and its sequelae (n = 905, 86.2%), periodontal disease (n = 69, 6.6%), trauma (n = 41, 3.9%), orthodontics (n = 24, 2.3%), failed endodontics (n = 5, 0.5%), prosthetics (n = 4, 0.4%), pericoronitis (n = 2, 0.2%). The most frequently extracted teeth were the lower right first molars (n = 109, 10.4%) and the lower left first molars (n = 95, 9.0%), respectively. Molar teeth (n = 830, 79.0%) were more frequently extracted while canines (n = 13, 1.2%) were the least. The lower molars were more commonly extracted (n = 479, 45.6%) followed by upper molars (n = 351, 33.4%). The age range of 21-30 years was more commonly referred for extraction with the most frequently extracted teeth being the lower left first molars (n = 32, 3.0%) in females and (n = 27, 2.7%) in males, respectively.
Conclusion: Tooth mortality in Nigerians is significantly associated with dental caries and its sequelae especially in younger patients.
| Abstract in French|| |
Fond: Études du Nigeria ont documenté des raisons différentes pour la mortalité de la dent et des études de suivi réguliers pour déterminer toutes les modifications dans les motifs et le modèle parmi les Nigérians ne semble ne pas être commun. Le but de cette étude était de déterminer les raisons et le patron de mortalité de dents chez les Nigérians et les modifications qui seraient intervenues après le premier rapport de 38 ans.
Méthodes et matériaux: Les dossiers des patients vus à la clinique de chirurgie buccale de l'hôpital universitaire de l'Université du Bénin entre mars 2007 et février 2008 ont été extraites le service médicale d'enregistrements et analysés pour l'âge, le sexe, les raisons pour l'extraction, la dent extraite, fréquence d'extraction et le mode d'extraction.
Résultats: 990 Patients au total ont été renvoyées pour exodontie et 1050 dents ont été extraites de 397 (40,1 %) étaient des hommes et 593 (59,9 %) les femmes d'âge 14 -89 ans. Pour extraction notamment caries et ses séquelles (n = 905, 86,2 %), la maladie parodontale (n = 69, 6,6 %), un traumatisme (n = 41, 3,9 %), orthodontie (n = 24, 2,3 %), n'a pas d'endodontie (n = 5, 0,5 %), prothèses (n = 4, 0,4 %), péricoronarite (n = 2, 0,2 %). Les dents plus souvent extraites ont été les droite premières molaires inférieures (n = 109, 10,4 %) et la partie inférieure gauche premières molaires (n = 95, 9,0 %), respectivement. Dents molaires (n = 830, 79,0 %) étaient plus fréquemment extrait tout en canines (n = 13, 1,2 %) ont été le moins. Les molaires inférieures ont été plus souvent extraites (n = 479, 45,6 %) suivie des molaires supérieures (n = 351, 33,4 %). La tranche d'âge des 21-30 ans a été plus communément pour extraction avec le plus souvent extraites dents étant les gauche premières molaires inférieures (n = 32, 3,0 %) chez les femelles et (n = 27, 2,7 %) chez les mâles, respectivement.
Conclusion: Dent la mortalité dans les Nigérians est significativement associée à la carie dentaire et ses séquelles, surtout chez les jeunes patients.
Mots clés: Caries, Nigérians, motif, motifs, mortalité de dent
Keywords: Caries, Nigerians, pattern, reasons, tooth mortality
|How to cite this article:|
Saheeb B D, Sede M A. Reasons and pattern of tooth mortality in a Nigerian Urban teaching hospital. Ann Afr Med 2013;12:110-4
| Introduction|| |
Exodontia forms the bulk of the workload of the oral surgeon in our environment. Tooth loss among Nigerians is a worrying phenomenon and the causes and pattern of mortality among the population have been previously reported. , Regular follow-up studies to determine changes in pattern and reasons for tooth mortality among Nigerians appears not to be common.
Several authors ,,, in different countries have documented the various reasons underlying the extraction of teeth by dentists. Analysis of these reasons shows some variations albeit, the principal reasons that have been consistently given are caries and periodontal disease. In some reports, , extraction due to caries dominated the findings. In others , periodontal disease was the main reason for tooth mortality while there was no predominant reason in some studies. ,
Although caries is reported to be declining in industrialized countries, , it appears to be increasing in Nigeria.  Regular preventive measures for caries and periodontal disease have not been vigorously pursued in our community. Tooth mortality among the populace will become an increasing problem for the profession for a long time to come.
The purpose of this study was to determine the reasons and pattern of tooth loss in Nigerians and examine whether these reasons have changed 38 years after the first report  from Nigeria.
| Materials and Methods|| |
The case notes of patients that were referred for tooth extraction in the Oral and Maxillofacial Surgery Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria between March 2007 and February 2008 were retrieved from the Medical Records Department and analyzed for age, gender, reasons for extraction, tooth extracted, frequency of extraction, and mode of extraction.
The data obtained were analyzed using the statistical package SPSS software version 17.0. Cross-tabulation of some variables were done to determine any pattern or association. The confidence level was set at 95% and probability value (P-value) less than 0.05 was regarded as significant. Only the permanent teeth were analyzed.
| Results|| |
Between March 2007 and February 2008, 990 patients were referred to the Oral and Maxillofacial Surgery Clinic for teeth extraction. They comprised 397 (40.1%) males and 593 (59.9%) females of age range 14 to 89 years (average 33.4 years) and a male to female ratio of 1:1.5. The total number of teeth extracted was 1050. [Table 1] shows the age, gender distribution of patients, number of patients, and the reasons for tooth extraction. The patients of age range 21-30 years were more frequently referred to the clinic for extraction and they accounted for 479 (48.4%) of all extractions. The most common reason for extraction was caries and its sequelae and this accounted for 905 (86.2%) of extractions followed by periodontal disease (n = 69, 6.6%), trauma (n = 41, 3.9%), orthodontics (n = 24, 2.3%), faile dendodontics (n = 5, 0.5%), prosthetics (n = 4, 0.4%), pericoronitis (n = 2, 0.2%).
|Table 1: Age, gender, number of patients, and reasons for tooth extraction|
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The dental forcep was used to extract 1040 (99.0%) teeth while 10 (1.0%) teeth were extracted through the transalveolar route. The teeth most frequently extracted were the lower right first molar (n = 109, 10.4%) and the lower left first molar (n = 95, 9.0%) respectively. [Table 2] shows the teeth extracted and their frequency.
The teeth extracted were molars (n = 830, 79.0%), premolars (n = 124, 11.8%), canine (n = 13, 1.2%), and incisors (n = 83, 7.9%). These were broken down as follows: lower molars (n = 479, 45.6%), upper molars (n = 351, 33.4%), upper premolars (n = 87, 8.3%), lower premolars (n = 37, 3.5%), upper canines (n = 8, 0.8%) lower canines (n = 5, 0.5%), upper incisors (n = 64, 6.1%), and lower incisors (n = 19, 1.8%). The individual teeth extracted are shown in [Table 3].
However, when age, gender, and reasons for extractions were cross-tabulated, caries accounted for the most common reason for extraction in females and males of age range 21-30 years (n = 260, 24.8%) (n = 183, 17.4%), respectively. Extraction due to periodontal disease did not show any remarkable difference between the genders of age above 50 years [Table 1]. The reasons for extraction and the teeth extracted were cross-tabulated and showed significant association P < 0.05.
The teeth most commonly extracted in females of age range 21-30 years were lower left first molar (n = 32, 3.0%) and lower left third molar (n = 29, 2.8%). Similarly lower left first molar (n = 27, 2.7%) and lower left second molar (n = 21, 2.0%) were the teeth most commonly extracted in males of the same age range.
When the ages of the patients were cross-tabulated with the teeth extracted, there was a significant association P < 0.05. However, there was no significant association between the gender and the teeth extracted P > 0.05 and gender and reasons for extraction P > 0.05.
[Table 4] shows the reasons for extraction of individual teeth. The incisor teeth were mainly extracted as a result of trauma.
| Discussion|| |
Extraction of teeth is a routine surgical procedure commonly carried out in many oral surgery clinics. In this study, most extractions in our clinic were carried out with the dental forceps and only 1.0% of extractions were done through the trans-alveolar route in contrast to the 4.1% reported by Oginni.  Caries was the predominant reason for the extraction of teeth in many studies from different countries. , However, in this study, caries and its sequelae were the predominant reasons for tooth extraction. In all age groups, more teeth were extracted as a result of caries than as a result of periodontal disease, which is in contrast to earlier reports by Macgregor  in 1972 and Odusanya  in 1987, respectively but agrees with another study  carried out in Ile-Ife, Nigeria in 2005.
However, the observation that the age group of > 51 years had more teeth extracted as a result of periodontal disease than the age group of < 50 years tend to agree with some UK studies , that have observed a similar pattern of tooth extraction in these age groups. In this study, trauma mainly accounted for extraction of the anterior teeth, which disagrees with a previous study from Nigeria  and a Jordanian study  that reported periodontal disease as the most common cause of extraction of these teeth. Although a study by Stabholz et al.  found that the predominant reason for tooth loss in their patients was periodontal disease (65%), this is understandable because their patients were mainly elderly of age 65-95 years.
Caries accounted for more teeth extracted in all age groups in females and of note was the age group of 21-30 years where 29.5% of extractions were due to caries. This finding was not significantly different from the males of the same age group. While some studies  found the age group of 41-50 years, 21 and 30 years in males and females respectively, most commonly presenting for extractions, our study found that the age group of 21-30 years of both gender presented more commonly for extraction. Extraction due to periodontal disease did not show any remarkable difference between the gender of age >50 years, although there was a significant association (P < 0.05) between the teeth extracted and the ages of the patients.
The molar teeth were most frequently extracted due to caries in this study and accounted for 79.0% of all extractions, which agrees with many investigators , but differs in their quadrant location. Although the first molars extracted in all quadrants were 29.0%, this was not significantly different from the second molars (27.2%) extracted P > 0.05. However, previous studies from Nigeria recorded 41.6% 2 and 50%,  respectively. While a UAE study  reported extraction of upper molars more frequently than the lower molars in the study, our study shows that lower molars were extracted more than the upper molars. The reason for loss of molar teeth could be attributed to their early eruption, presence of deep fissures, inaccessibility of fissures to proper brushing, and the fact that they are more commonly used for mastication. Consequently, they are more likely to be exposed to early caries and loss than the other teeth in the mouth. There was a significant association (P < 0.05) between the reasons for extraction and the teeth extracted. However, Hawkins et al.  generally attributed the risk of losing teeth to low socio-economic status, which was corroborated by Cahen et al.,  in their separate studies.
This study shows that trauma was the third most common reason for tooth extraction accounting for 3.9% while orthodontics was the fourth reason patients were commonly referred for tooth extraction. The age group of 21-30 years was more frequently referred for orthodontics extraction than the younger age group which is in contrast to McCaul et al.' finding in Scotland where orthodontics has replaced caries as the most common reason for tooth extraction in the 0-20 years of age. Some authors did not find trauma a significant reason for tooth extraction and together with pericoronitis and other reasons, it accounted for 5.5% of extractions.  In this study, failed endodontics, prosthetics, and pericoronitis accounted for 1.1% of reasons patients were referred for extraction.
This study is different from many UK studies ,, that relied on responses to questionnaires or telephone surveys of practitioners as a means of studying pattern of tooth mortality. Our data were analyzed from recorded reasons of extraction of each tooth in each patient's case file. Our results are therefore more reliable than the results obtained from questionnaires administered on practitioners.
In conclusion, caries and periodontal disease have continued to account for a large proportion of tooth mortality in Nigerians. Although earlier reports from Nigeria in 1972  and 1987,  respectively, had attributed tooth loss to be due mainly to periodontal disease, this study and others  from Ile-Ife have shown contrary trends as more teeth are now being lost as a result of caries. This study has shown that the younger age groups were more commonly referred for tooth extraction as a result of caries unlike an earlier study from Nigeria  that documented less tooth mortality in Nigeria than in England. Awareness programs to educate the citizenry about oral health should be vigorously pursued so as to prevent the emerging trend from producing a predominantly edentulous population in the future. Regular dental check up will also obviate the dreadful consequence of tooth loss.
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[Table 1], [Table 2], [Table 3], [Table 4]
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