To Evaluate the Prevalence of Edentulousness, the Present Prosthetic Status, and the Need for Prosthetic Treatment in the Population of Garhwa, Jharkhand.

AIM: This study aimed to evaluate the prevalence of edentulousness, the present prosthetic status, and the need for prosthetic treatment in the population of Garhwa, Jharkhand.
MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among the population of Garhwa, Jharkhand. The sample size included 460 subjects belonging to an age group of 25 years and above. Detailed case history and thorough dental examination was done and all the findings were recorded and compiled. Each subject was interrogated with the help of a predesigned closed ended questionnaire.
RESULTS: A total of six patients were completely edentulous, while 55.04% of males and 42.80% of females were partially edentulous. All patients who were completely edentulous were denture wearer, while among partially edentulous patients, 6.31% of males and 3.15% of females had RPD and 13.68% and 6.31% of males and females, respectively, had FPD as prosthesis. Prosthetic status of females was better than males In a comparison of prosthetic status between male and female, out of 460 subjects, 195 subjects opted for prosthesis, in which 117 were male and 78 were female.
CONCLUSION: Community-based oral health education programs should be conducted to improve patients' oral health knowledge. Educating patients regarding the limitations of prosthesis as mechanical substitutes for natural teeth must be a continuing process from the initial patient contact until adjustments are completed. Copyright:

INTRODUCTION

According to the WHO definition, a person who is edentulous is deemed to be handicapped.[1] Edentulism is regarded widely as a poor health outcome since it may compromise an individual's quality of life.[2] Loss of teeth could be a disturbing emotional experience for many people. Some people associate the loss of teeth with old age, which may be emotionally disturbing. Poor oral health and loss of teeth adversely affect the dietary intake and nutritional status, thereby compromising the general health, other than that it also deny people the pleasure of taking food of their choice. The loss of teeth is an end product of oral disease and reflects the attitudes of the patients, the dentists in a society, the availability and accessibility of dental care as well as the prevailing philosophies of care.[3]

Epidemiologic studies on edentulism and tooth loss vary considerably, with great differences evident in prevalence between countries, between geographic regions within countries, and between patient groups with various backgrounds. Some studies have reported that the incidence of edentulism correlates with education level and income status, with those in the lower levels of both sociodemographic factors exhibiting higher risks of becoming completely edentulous.[4]

Data on oral health, especially on geriatric oral health, in India are scant.[5] India, second most populous country in world with 72% socioeconomically disadvantaged rural peoples, has good ground for the increased prevalence of tooth/teeth loss. Faster growing older population across the world as well as in India, with the expectation that India shall have the highest elderly population by 2025, appears to further pose the amplified prevalence of tooth loss (edentulousness) among Indian peoples in years to come.[6]

Epidemiological data on health and its related issues are very important to plan for future health-care provision. Data on oral health, especially on geriatric oral health, in India are scant. To promote the oral health and formulating a plan for an oral health care program, we need to know and acquire the baseline information regarding the prevalence of edentulousness, dental prosthetic status, and prosthetic needs. As of today, there are no data available for Garhwa district. Hence, an effort has been made to collect the baseline information.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted among the population of Garhwa, Jharkhand. The sample size included 460 subjects belonging to an age group of 25 years and above. Before conducting the study, prior permission of the ethical committee was obtained for the study. All the subjects were randomly selected from the outdoor patient department of Vananchal Dental College and Hospital, Garhwa, Jharkhand. The subjects were explained in detail about the purpose and nature of the study. Only those subjects willing to sign written consent were included in the study. Subjects suffering from long-standing debilitating diseases that preclude the use and maintenance of prostheses such as paralysis, advanced Parkinsonism, and psychotic disorders were excluded from the study. Detailed case history and thorough dental examination was done and all the findings were recorded and compiled. Each subject was interrogated with the help of a predesigned closed ended questionnaire.

RESULTS AND DISCUSSION

It was observed a total of 6 patients (4 males and 2 females) were completely edentulous, while 55.04% of males and 42.80% of females were partially edentulous [Table 1]. Table 2 shows the number of preexisting prosthetic wearer. All patients who were completely edentulous were denture wearer (2 females and 4 males), while among partially edentulous patients, 6.31% of males and 3.15% of females had Removable Partial Denture and 13.68% and 6.31% of males and females, respectively, had Fixed partial denture as prosthesis. Prosthetic status of females was better than males [Table 3]. In a comparison of prosthetic status between male and female, out of 460 subjects, 195 subjects opted for prosthesis, in which 117 were male and 78 were female [Table 3]. When the results for the mandibular segment were seen, there was an increase in the number of both males and females. Complete edentulous males were found to be three as compared to be two females. Seventy-nine males had single-unit edentulousness and 39 females had single-unit edentulousness. Multiunit edentulousness was seen in 39 males and 30 female participants [Table 4].

Table 1

Prevalence of edentulousness patient in the town of Garhwa

Type of edentulousness	Male (%)	Female (%)	Total (%)
Completely	4 (1.40)	2 (0.70)	6
Partial	157 (55.04)	122 (42.80)	279
Total	161 (56.50)	124 (43.50)	285 (100)

Table 2

Number of preexisting prosthesis wearer

Prosthetic wearer	Male (%)	Female (%)	Total
CD	4 (1.40)	2 (0.70)	6
RPD	18 (6.31)	9 (3.15)	27
FPD	39 (13.68)	18 (6.31)	57

CD: Complete denture, RPD: Removable partial denture, FPD: Fixed partial denture

Table 3

Comparison of prosthetic need between male and female

Sex	Prosthetic status	Total	P
Male	117	250	0.18266
Female	78	210

Table 4

Comparison of edentulousness in maxilla and mandible between male and female

Dental arch	Type of prosthesis	Male	Female	P
Maxilla	Complete	1	0	0.02
	Partial (single)	17	37
	Partial (multiunit)	22	16
Mandible	Complete	3	2	0.35
	Partial (single)	79	39
	Partial (multiunit)	39	30

DISCUSSION

The loss of teeth is an end product of oral disease and reflects the attitudes of the patients, the prosthodontic treatment in a society, the availability and accessibility of dental care as well as the prevailing philosophies of care. One of the major handicaps in the elderly of our population is loss of teeth, affecting their mastication, dietary intake, and nutritional status. Hence, our focus should be to increase the awareness regarding oral health needs of various age groups' individuals. This should be aimed at providing best-quality care at the lowest possible cost maximizing treatment effectiveness and reaching those in greater need of our service.

In the present study after the examination of 460 patients, it was seen that a total of 285 were edentulous, which included partially edentulous to be 279 (60.00%) and completely edentulous to be 6 (4.75%) [Table 1]. The rate of male edentulism was more as compared to female. Which was similar to the studies conducted in the year (2007)[7] and (2004)[5] in Gujarat which showed that the prevalence of edentulism was more in male as compared to female. Vigild[8] revealed the prevalence of more edentulism in females as compared to the males, which might be because of various social stigmas of the region. In this study, the prevalence of males was more because of their various habits such as smoking, gutkha chewing, betel nuts chewing, and not brushing habits, whereas the females were less into these habits as compared to males and were found to be taking more care of oral health as compared to the male counterpart.

A total of 19.5% of total people enrolled in our study had some sort of denture. Similar results were obtained by Bansal et al.[9] who showed that 19.1% of participants of their study had some kind of prosthesis. Only 3.5% of the subjects surveyed in marble mine labors in Udaipur, India, had some sort of dental prosthesis.[10] The reason for the lack of dental treatment in the present study and study by other authors was the financial constraints under the qualified and knowledgeable people.

The present study showed fixed partial denture, to be the most preferred treatment of choice by the local practitioners which could be due to monetary benefits. The examination also revealed that fixed partial dentures were not of good quality as well as faulty in nature. The second most prevalent were removable partial dentures which were also faulty prosthesis and were given to the patient on the pretext of fixed treatment given to them by the quacks rather than the dentist, the prevalence was more because of lack of awareness and socioeconomic factors [Table 2] All patients who were completely edentulous were denture wearer, but the prostheses seen and examined were either too old or if new were all faulty as well as below the standard reason being same as mentioned above.

A large number of males were indicated for some sort of dental treatments as compared to the female counterparts other than the need for the prosthesis directly. Even the edentulousness in maxilla and mandible was also studied among the male and female participants. The results in maxilla and mandible edentulousness when compared it was found that the edentulousness was found more in the maxillary segment as compared to the mandibular segment.

While considering the distribution of the prosthetic needs among the male and female out of 460 subjects, 117 were male and 78 were female. Quite similar results were found in a study conducted at the Gujarat in the year 2012[7] and similar study conducted at Gulbarga in the year 2013.[11] They found that there is a low percentage of prosthetic replacement. A similar study was conducted in Taiwanese in the year 2009.[12] Nadgere et al.[3] found that 88% of the total population surveyed did not have any prosthesis. The low proportion of those who had prosthesis may be due to underuse dental facilities due to lack of awareness and financial constraints. Thus, it is concluded that there are lack of dental facilities and lack of dental hygiene in the present study.

In a comparison of edentulousness in maxilla between male and female, out of 285 subjects, male 1 and female 0 is complete edentulouness, partial single 17 were male and 37 were female, and partial multiunit 22 were male and 16 were female whereas in mandible 3 were in male and 2 were in female were completely edentulous, partial (single) 79 were male and 30 were female subject. Similar results were found by Shah et al.[13]

CONCLUSION

Community-based oral health education programs should be conducted to improve patients' oral health knowledge and these programs can be organized by the government and dental professionals. They could be implemented through mass media as these are powerful and influential forces in modern society. Thus, television, radio, and printed media such as newspapers and magazines could be appropriate ways to disseminate oral health messages to the population. Programs to modify the knowledge, skills, and habits of patients who wear dentures may also assist them to adapt more successfully. Educating patients regarding the limitations of prosthesis as mechanical substitutes for natural teeth must be a continuing process from the initial patient contact until adjustments are completed.

In India, being an agrarian society, 72% of its total population and 80% of its geriatric population reside in rural areas.[12] In contrast, 80% of the trained dental workforce are concentrated in urbanareas.[13] The government should take steps to bring the dental professional residing in urban areas to such rural areas where they are required more for the betterment of the people of such remote locations as the one used in the present study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.