Dental prosthetic status and treatment needs of green marble mine laborers, udaipur, India.

BACKGROUND: Assessment of prosthetic needs in a special population would aid in planning the oral health service programs. The aim of this study was to assess the dental prosthetic status and prosthetic needs in a sample of green marble mine laborers of Udaipur, India.
METHODS: The study population comprised of 513 green marble mine laborers who were divided into four age groups (15-24, 25-34, 35-44 and 45-54). Prosthetic status and treatment needs along with dentition status were recorded using WHO oral health assessment form. The examination was done by two examiners who were calibrated for inter examiner variability with kappa statistic of 86%. Chi-square test was used to compare the proportions. The significance level was set at α= 0.05.
RESULTS: Mean number of missing teeth due to any reason for the whole sample was 0.82. Approximately, 96.5% of the subjects were free from any kind of prosthesis and only the rest of sample (3.5%) had single fixed prosthesis. The overall prosthetic treatment needs was 15.5%. Prosthetic needs increased as the age increased with the age group 45-54 showing the greatest. Prosthetic needs in the lower arch were found to be greater than that of the upper arch. Single unit prosthesis comprised a greater percentage of the whole prosthetic needs (41%).
CONCLUSION: Most of the prosthetic needs of the study population were unmet. The prosthetic needs being four and half-fold greater than the status.

Introduction

It has been suggested by several authors that the loss of teeth could be a disturbing emotional experience for many people1–3. Some people associate the loss of teeth with growing old, which may be emotionally depressing.

Much like the fact that decline in activities of daily living4 is a final common pathway for a broad range of decrements in general health, tooth loss constitutes a final common pathway for most dental diseases and conditions. This tooth loss can lead to substantial impacts on quality of life.5 Naturally, in an effort to prevent or ameliorate some of these decrements in oral health-related quality of life, dentists frequently recommend removable or fixed prosthetic treatment for tooth loss. However, it has been suggested by previous studies that the number of dentures should be decreased with higher priority for the preservation of natural dentition.6

There is abundant data on dental prosthetic needs of elderly institutionalized and non institutionalized population but most of these studies are from developed countries. It was observed among the elderly population living in long term care facilities in Singapore that 56.2% were edentulous and 94% of the population was in need of partial dentures.7 A study from India which was conducted on institutionalized elderly population observed that 88% of the population had no prosthesis and 79.7% required some kind of prosthesis.8 However, no study has been done till date on prosthetic status and treatment needs of marble mine laborers and no information is available about the role of mining on prosthetic need, although a significant amount of research has investigated the role that race plays in risk for both partial and total tooth loss,9 and consequently the risk for being “eligible” for prosthetic treatment. There are very few studies10–12 that have assessed prosthetic status and treatment needs from India. Assessment of prosthetic needs in a special population like marble mine laborers would aid in planning the oral health service programs .Thus, the present study aimed to assess the dental prosthetic status and prosthetic needs in a sample of green marble mine laborers of Udaipur, India.

Materials and Methods

In the present cross-sectional study, the target population was chosen by stratified cluster sampling technique from four green marble mining regions of Udaipur namely Masoronkiovri, Rushabhdev, Khandiovri and Kagdarbhatiya which accounted for 513 individuals who were in the age range of 15 to 54 years. The subjects were divided into four age groups (15-24, 25-34, 35-44 and 45-54 years). Inclusion criterion comprised of subjects who were present on the days of survey. Those who were absent on the corresponding days of survey and subjects who reported systemic diseases like hypertension and diabetes mellitus were excluded from the study. The methodology and the methods used in the present study have been presented explicitly in a previous paper.13 The examiners were two dentists who had been trained and calibrated for inter examiner variability and weighed kappa statistic was 86%.

The oral examination was conducted in natural day light and findings were recorded using WHO oral health assessment form.14 The prosthetic status and needs along with dentition status were recorded.

Within the ‘prosthetic status’ variable the categories of ‘no prosthetic restorations’, ‘fixed restorations’ and ‘removable dentures’ were differentiated. Subjects with both fixed restorations and removable dentures were considered separately. Dentition status comprised of recording decayed teeth, missing teeth due to caries or other reasons, traumatized teeth (fracture of tooth) and teeth with fixed restorations. Ethical clearance for the study was obtained from the Ethical Review committee of Darshan Dental College and Hospital (Udaipur, India). Data processing was done using SPSS software (version 15.0). Chi square was used to compare the proportions. The significance level was set at α= 0.05.

Results

Table 1 shows the dentition status and the number of subjects in each age group. The mean number of decayed teeth was greater in the younger age groups in comparison to the older groups. The mean number of missing teeth due to caries or any other reasons was highest in the 45-54 years age group. None of the subjects had filled teeth, fissure sealants, and not erupted teeth.

Table 1

Dentition status (mean and standard deviation per person) of the studied population

It was observed that, 96.5% of the study population was free from any kind of prosthesis. Of the whole sample, only 3.5% had single fixed prosthesis and none of the subjects had more than one fixed prosthesis, partial denture or full removable denture. None of the subjects in the age range 25-54 had prosthesis. Among the youngest age group, 5.2% of the population had fixed prosthesis in both the upper and lower arches.

Figures 1 and 2 depict the whole prosthetic needs of study population in the upper and lower archs respectively. The overall prosthetic treatment needs in the study population was 15.5%. Prosthetic needs increased as the age increased with the oldest age group presenting greatest prosthetic needs both in the upper and lower arches. Almost one fifth (20%) of the persons belonging to 45-54 years old age group needed full prosthesis for lower arch. Prosthetic need in the lower arch was found to be greater than that of the upper arch. Single unit prosthesis comprised a greater percentage of the whole prosthetic needs (41%). Chi square analysis revealed significant difference between the age groups for various prosthetic needs in both the upper and lower arches (p < 0.001).

Figure 1

Prosthetic needs in the upper arch of the study population in relation to age groups. (Chi square = 133.91, d.f. = 9, P <0.001)

Figure 2

Prosthetic needs in the lower arch of the study population in relation to age groups. (Chi square = 235.52, d.f. = 12, P <0.001).

Discussion

Many studies regarding dental prosthetic status and treatment needs were done on elderly individuals residing at elderly homes,15 hospitals,71617 institutions18–20 and elderly general population.21–23 Prosthetic needs of our study was 15.5% which was very low when compared to that of previous studies.15–23 In a study done on elderly home residents 82% of the subjects were in need of either fixed, removable or combined prosthodontic treatment.22 The reason for this great difference in prosthetic needs between the present and past studies may be due to the reason that our study population comprised of adults (15 – 54 years). It has been established from a past study24 that an increase in the educational level of a population affects the needs and demands of that population. The educational level and social standard of the study population was poor which led to unmet prosthetic needs. Past studies25–27 have collected information regarding prosthetic needs as subjective and normative prosthetic treatment and found out that a discrepancy always exists between the subjective and normative needs, but in our present study we have recorded only normative prosthetic needs as only clinical examination of the subjects was done without any questionnaires or interviews.

No subject was in need of complete denture; the reason was that no subject was older than 60 years, while 20% of the subjects belonging to the oldest age group exhibited need of lower full prosthesis. This need is very low when compared to the past studies;21–23 the reason might be the age factor. In the present study it was observed that the total prosthetic needs were 15.5% whereas in a study done on a representative German sample, 81% had normative prosthetic treatment needs.25 This vast difference in prosthetic needs might be due to the difference in criteria used in the assessment of prosthetic needs between the studies. While assessing the prosthetic needs, Walter et al.25 have included all those individuals with grade III mobile teeth, extreme malocclusion, intraosseous and non restorable hard tissue decay.

Treatment need of single unit prosthesis was the highest need reason being anterior teeth lost due to trauma in many subjects, trauma to anterior teeth was a common finding as marble mining requires working on slippery surfaces. However, it was also observed that many subjects (most of them belonging to the youngest age group) required single unit prosthesis in the lower arch which could be attributable to missing tooth due to caries. Greatest need was observed in oldest age group followed by youngest age group, need in 45-54 years old age group was due to teeth missing from periodontal disease whereas for the 15-24 years old age group it was due to teeth missing from dental caries.

Conclusion

Most of the prosthetic needs of the study population were unmet with prosthetic needs (15.5%) being approximately four and half folds greater than the prosthetic status (3.5%). Thus, the results obtained from the present study could be used in planning oral health programs for the study population.