Primary culprit for tooth loss!!

AIM: In order to facilitate planning for dental health services and to progress strategies to continue the reduction in tooth loss, it is important to identify the factors that result in such loss. therefore the aim of the study is to investigate the major cause for tooth extraction.
OBJECTIVE: to examine whether the major reason for tooth extraction is dental caries or periodontal disease.
MATERIALS AND METHODS: The study is carried out among the dental practitioners in our district. A questionnaire containing 10 items was distributed to the dental practitioners, which included age, gender, no of teeth indicated for extraction, the reason for extraction, and the periodontal parameters that are involved with the extracted tooth and were requested to complete the form on every extraction they were to undertake. the study form was collected at the end of the study period and data was subjected to statistical analysis.
RESULTS: A total of 502 patients were enrolled during the study period, and a total of 1055 teeth were extracted for several reasons. we found that 51.14%extractions are due to dental caries in case of 20-30years age groups, which is more when compared to tooth loss due to periodontal diseases in this age group. whereas in case of >40years of age group periodontal diseases account for 54.11%, and dental caries accounts for only 29.11%. Showing more teeth were lost due to periodontal disease.
CONCLUSION: therefore we concluded that, caries is the dominant reason for extraction in patients with 20-30 years of age while periodontal disease accounts for the majority of tooth extraction in patients older than 40 years.

INTRODUCTION

Although edentulism has been described to be on the decline in many developed countries, tooth loss continues to be a major public health problem globally, and causes of tooth extractions had large geographical and cultural differences among various regions in a country, and from one country to another.[1]

In order to facilitate planning for dental health services and to progress strategies to continue the reduction in tooth loss, it is important to identify the factors that result in such loss.[2]

Extraction of permanent teeth is carried out for several reasons, including caries, periodontal disease, orthodontic treatment, traumatic injuries, prosthetic indications, and tooth impaction. However, caries and periodontal disease have been shown as the 2 main reasons for tooth loss.[2]

Cahen et al. reported caries to be the main reason for tooth loss,[3] whereas another study reported that periodontal disease was the main reason,[4] while others found that caries and periodontal disease were equally responsible,[5] and it was generally believed that dental caries was the main cause of tooth loss in the young, whereas periodontal diseases turned out to be more prominent after 40 years of age,[1] whereas socioeconomic and cultural aspects may also be related with wish and possibility of patients to seek dental care.[6]

Hence, the aim of the study was to investigate the major cause for tooth extraction, and the objective was to examine whether the major reason for tooth extraction was dental caries or periodontal disease.

MATERIALS AND METHODS

This was a cross-sectional study, examining the reason for tooth extraction, and the study was carried out in the Department of Periodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh. The samples were taken from the individuals attending Oral Surgery Department in our College, and General Dental Practitioners in Nellore District, Andhra Pradesh.

The dentists were requested to complete a specially designed study form; on every extraction, they were to undertake within 1 month period (February 2014). The study form included age, gender, and number of teeth that were planned for extraction, and reason for tooth extraction that included the periodontal problems, dental caries, failed root canal therapy, orthodontic purpose, preprosthetic or esthetic purpose, root fractures, and patient's refusal of alternative treatments, and space was also provided for listing other reasons which were not mentioned in the study form. In addition, the periodontal conditions that are associated with the tooth planned for extraction, i.e., mobility, recession, malpositioning, food impaction, and sensitivity are included in the study form. Study forms were collected by the principal investigator at the end of the study period from each center.

Statistical analysis

The data were calculated using statistical analysis system, and the descriptive data were expressed by means of numbers and percentages.

RESULTS

A total of 502 patients were enrolled during the study period, and a total of 1055 teeth were extracted for several reasons.

The distribution of patients and the extracted teeth according to age range and gender are presented in [Tables 1 and 2], where males had fewer teeth extracted than females, and the number of extractions increased with increasing age. Factors, which influenced extraction, are depicted in Graph 1.

Table 1

Distribution of study population based on age

Table 2

Distribution of study population based on gender

Graph 1

Factors affecting extraction

The majority of extractions are due to periodontal problems followed by dental caries [Table 3]. Other reasons frequently involved were root fractures, abscess, impaction, and apical periodontitis. When periodontal parameters that are associated with the tooth that is going to be extracted are taken into consideration, mobility was the primary reason followed by mobility associated with recession [Table 4].

Table 3

Reason for extraction

Table 4

Periodontal parameters that are involved with the extracted tooth

While comparing the age and reason for tooth extraction, we found that chronic periodontitis and dental caries were the 2 main reasons for tooth extraction in all the age groups followed by root fracture. In patients aged above 40 years, periodontal problems were the main reason for extraction, whereas, in 20–30 years age group dental caries was the primary reason [Graph 2].

Graph 2

Comparison between age and reason for tooth extraction. AP: Apical periodontitis, PD: Periodontal disease, RCT: Root canal treatment, RF: Root facture

Graph 3 describes the comparison between gender and reason for tooth extraction. Though the main cause of extraction in males was due to periodontal problems, it was dental caries in females.

Graph 3

Comparison between the gender and reason for tooth extraction. AP: Apical periodontitis, PD: Periodontal disease, DC: Dental caries, failed RCT: Root canal treatment, RF: Root fracture

DISCUSSION

The results of this study indicate that caries and periodontal disease are the main reasons for tooth extractions in our district, which was similar to a previous study[1] that caries was the dominant reason for extraction in patients with 20–30 years of age, while periodontal disease accounts for the majority of tooth extraction in patients older than 40 years whereas other study[2] reported that caries and its sequel remains the most important cause of tooth loss throughout adult life in Scotland.

We also found that males accounts for 46.02% of the sample size and had fewer teeth extracted than females, which was in agreement with the study conducted by Barbato et al.,[7] Kalyanpur and Prasad, who assessed the tooth mortality among the urban and rural adult population of Dharwad district (India) and found that females compared to males had higher tooth loss.[8] In contrast to these studies Cahen et al., 1985[3] stated that more extractions are in male patients than in females.

Significant gender differences were also noted in this study such that extractions due to caries were more common in females, extractions due to periodontal disease were more common in males, which is in agreement with the previous investigation.[1] This could be because of deleterious habits such as smoking, (where smoking is considered as a potential risk indicators for periodontal disease),[9] alcoholism, and also poor oral hygiene maintenance.

We also noted that 40.24% of total extractions were due to periodontal diseases, i.e., more teeth per patient were lost due to periodontal disease than for any other reason. This confirms the findings of 2 previous studies that periodontal disease is responsible for the loss of more teeth than any other cause,[14] among which mobility is responsible for extraction, and it accounts for 47.5% of all the periodontal conditions, followed by mobility associated with gingival recession, i.e. 44.5%, which was similar to the findings of Moreira et al.,[10] who stated that mobility and attachment loss are indicated as the criteria for extraction in case of periodontally involved tooth. This could be due to the lack of awareness and negligent oral hygiene maintenance, hence periodontal problems.

29.68% of the total extractions are due to patients own interest. This is because of the poor socioeconomic status, which leads to lack of awareness of the conditions due to lower levels of education, and also less affordability of these individuals for treatment, which is in agreement of the previous study by Manski and Magder,[11] who stated that demographic data such as race, socioeconomic conditions are the predictors of dental care utilization, whereas in the present study, sample was taken from the same region without much cultural differences.

CONCLUSION

Therefore, we conclude that caries is the dominant reason for extraction in patients with 20–30 years of age while periodontal disease accounts for the majority of tooth extraction in patients older than 40 years.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest