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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 143-147

Pattern of tooth mortality in patients attending a tertiary dental care center: A descriptive study


1 Department of Oral and Maxillofacial Surgery, Government Dental College, Thrissur, Kerala, India
2 Department of Oral Medicine and Radiology, Government Dental College, Thrissur, Kerala, India
3 Department of Transfusion Medicine, Malabar Cancer Centre, Thalassery, Kerala, India
4 Department of Oral and Maxillofacial Surgery, Sree Anjaneya Institute of Dental Sciences, Kozhikode, Kerala, India

Date of Submission18-Mar-2022
Date of Decision18-Mar-2022
Date of Acceptance23-May-2022
Date of Web Publication22-Aug-2022

Correspondence Address:
Divya Kallanchira Devaraj
Department of Oral Medicine and Radiology, Government Dental College, Thrissur, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_44_22

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  Abstract 


Background: Tooth loss is a cumulative index of oral health impairment and an integral part of the decayed, missing, and filled teeth index used to assess oral health status. In spite of the increased awareness of oral hygiene and preventive dental treatments, tooth extraction remains to be the most common procedure in the Indian population following a toothache. The study aims to assess certain demographic characteristics and patterns of tooth loss among patients who underwent extraction from the department of oral and maxillofacial surgery in a dental tertiary care center in Kerala, India. Materials and Methods: A retrospective cross-sectional survey was conducted during 2017–2021 time period in all the patients who underwent permanent teeth extraction from the oral and maxillofacial surgery department. Results: A total of 9673 patients underwent tooth extraction during the study period. Among them, 68.4% were adults (18–59 years) and 27.7% were senior adults (above 60 years). More than half of the patients underwent single-tooth extraction (55%), two (24%), and three in 10%. The most frequent tooth extraction was the first molar (30%), followed by the third molar (27%) and second molar (26%). Among children, the most common pattern of tooth extraction was first molars both in the maxilla and mandible (25%). In adolescent age groups, premolars were extracted frequently along with first molars. In adults and senior adults, the premolar and molar extractions were performed commonly. Conclusion: The mean tooth loss for the cohort was 1.7 ± 1.1 (range 1–12) indicative of good dental hygiene practice. The trends noticed in teeth extraction pattern provide baseline data about the access and availability of dental care in that region.

Keywords: Dental health, oral health, tooth loss, tooth mortality


How to cite this article:
Khaja Hussain A S, Devaraj DK, Michael MJ, Murugesan M, Vishnudas P. Pattern of tooth mortality in patients attending a tertiary dental care center: A descriptive study. J Dent Res Rev 2022;9:143-7

How to cite this URL:
Khaja Hussain A S, Devaraj DK, Michael MJ, Murugesan M, Vishnudas P. Pattern of tooth mortality in patients attending a tertiary dental care center: A descriptive study. J Dent Res Rev [serial online] 2022 [cited 2022 Sep 28];9:143-7. Available from: https://www.jdrr.org/text.asp?2022/9/2/143/354205




  Introduction Top


Oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex. It is a fundamental component of health and physical and mental well-being. It exists along a continuum influenced by the values and attitudes of people and communities. It reflects the physiological, social, and psychological attributes that are essential to the quality of life. It is influenced by the person's changing experiences, perceptions, expectations, and ability to adapt to circumstances.[1] Tooth loss is a cumulative index of oral health impairment and an integral part of the decayed, missing, and filled teeth (DMFT) index used to assess oral health status. In spite of the increased awareness of oral hygiene and preventive dental treatments, tooth extraction remains to be the most common procedure in the Indian population following a toothache. Various reasons for tooth loss include dental caries and its sequel, advanced periodontal disease, orthodontic reasons, impacted teeth, failed dental treatment, prosthetic indications, and other reasons.[2]

Studies conducted to examine the pattern of tooth loss in various parts of our country have put forth some specific trends. In a study conducted in Davengere, the mean number of missing teeth per person was 4.2 ± 7.4 and gave conclusive evidence of increase in tooth loss in the rural population.[3] The overall mean tooth loss was 2.7 in a study in a suburban area of Chennai and another conducted in Nellore of Tamil Nadu gave a lower mean of missing teeth (2.5) compared to the previous ones.[4],[5] Many studies have reported an increase in tooth loss with an increase in the age of an individual, although an actual correlation was not established in any. This increase in tooth loss in the elderly is attributed to the change in social attitude, inadequate oral hygiene maintenance, socioeconomic factors, decreased awareness, irregular visits to dentists, and socioeconomic factors.[3],[4],[6] A South Indian study done on adults aged over 60 years showed a mean missing component of 10.98 teeth in the total DMFT.[7] An increase in tooth loss in females and loss of maxillary teeth compared to the mandibular teeth has also been a common observation in some studies.[6],[8]

The study aims to assess certain demographic characteristics and patterns of tooth loss among patients who underwent extraction from the department of oral and maxillofacial surgery in a dental tertiary care center in Kerala, India.


  Materials and Methods Top


A retrospective cross-sectional survey was conducted during 2017–2021 time period in patients who underwent permanent teeth extraction from the oral and maxillofacial surgery department in Kerala. All the patients who underwent teeth extraction procedures from the department of oral and maxillofacial surgery were included in the study. The data regarding patients such as age, gender, and type of teeth extracted were extracted from the clinical record using data extraction form manually and incomplete data forms were discarded.

Statistical analysis

Descriptive statistics were expressed as frequency and proportion for the categorical variables and mean ± standard deviation for continuous variables. The independent t-test was used to study the association between gender and the mean number of tooth extracted from the maxilla and mandible. The analysis was performed using the IBM, Statistical Package for the Social Sciences (SPSS), Chicago, IL, USA version 20.0 and a P < 0.05 was considered statistically significant in this study.


  Results Top


A total of 9673 patients underwent tooth extraction during the study period. Among them, 68.4% were adults (18–59 years) and 27.7% were senior adults (above 60 years). Only 0.2% was child (till 12 years) and 3.7% were adolescent (13–18 years). [Figure 1] displays the age group with respect to gender. Among the adult group, males were predominant in number, whereas in senior adults, females were higher.
Figure 1: Age distribution of patients who underwent tooth extraction at tertiary dental center in South India

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More than half of the patients underwent single-tooth extraction (55%), two (24%), and three in 10%. [Figure 2] displays the average tooth extraction in patients with respect to age group. Senior adults had a mean tooth extraction of 2.1 ± 1.4 (range 1–12), whereas adults had 1.5 ± 1.0 (range 1–9) tooth extracted. Interestingly, patients in the child age group had a mean tooth extracted of 1.9 ± 1.3 (range 1–6), whereas adolescents had the least extraction of 1.4 ± 0.6.[1],[2],[3],[4],[5] The overall tooth extraction for the cohort was 1.7 ± 1.1 (range 1-–12).
Figure 2: Box‒Whisker plot displaying the number of tooth extractions with different age groups at tertiary dental center in South India

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The mean number of tooth extracted from the maxilla was similar between males (0.9 ± 1.1) and females (0.9 ± 1.0) (P = 0.769). While males (0.8 ± 1.1) had a significantly higher tooth extraction from the mandible than females (0.7 ± 0.9) (P = 0.001) [Figure 3].
Figure 3: Box‒whisker plot showing the number of tooth extraction in the maxilla and mandible in males and females at tertiary dental center in South India

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[Table 1] shows the most frequent tooth extracted was the first molar (30%), followed by the third molar (27%) and second molar (26%). Single-tooth extraction was the most common in all types of teeth. Only central and lateral incisors had a higher percentage of two or more tooth extractions per patient.
Table 1: Pattern of tooth extraction at tertiary dental center in South India

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In the maxilla, the predominant tooth extracted was the third molar (15.8%), whereas in the mandible, the first molars were extracted more commonly (16.3%). The maximum number of third molar extractions in the maxilla and first molar extractions in the mandible was found to be done in females [Table 2].
Table 2: Pattern of tooth extraction maxilla versus mandible at tertiary dental center in South India

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Among children, the most common pattern of tooth extraction was first molars both in the maxilla and mandible (25%). In adolescent age groups, premolars were extracted frequently along with first molars. In adults and senior adults, the premolar and molar extractions were performed commonly [Table 3].
Table 3: Pattern of tooth extraction among age groups at tertiary care dental center in South India

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  Discussion Top


Tooth loss is the ultimate barometer to assess failure or success in dentistry and dental health programs.[9] Females have experienced more tooth loss compared to males in other countries such as Saudi Arabia, Brazil, and China.[10],[11],[12] A similar trend is noticed in India also.[4],[6] In our study, we noticed that females (56%) underwent more extraction than males (44%); however, adult females who underwent extraction were significantly lower compared to adult males. This could be attributed to the increased awareness or increased esthetic sense in the female population. This observation was in agreement with studies conducted in other parts of Kerala.[8],[13]

There is an increase in tooth loss experienced with increasing age in all populations of developing and developed countries.[9],[14],[15] Greater tooth loss among the older age groups may be due to the cumulative effect of dental diseases and lack of oral health-care measures.[5] The tooth extractions in adults are more common than in senior adults which could be due to the increased dependence on primary health center by senior adults rather than the remote tertiary center. The neglect of personal health and well-being or the effect of comorbid conditions and their treatment on dental health causes an increased tooth loss as age advances.

The most commonly extracted teeth are found to be the first molars (30%), third molar (27%), followed by second molars (26%) in our center, and most of the first molar removal took place in the adolescent age group. The reasons for increased extractions of molars in both dentitions can be explained by their morphology, the timing of eruption, and position in the oral cavity. The presence of deep pits and fissures increases the susceptibility of molars to the accumulation of food debris and retention of plaque which increases the risk of caries. First, permanent molars erupt earlier in the oral cavity which predisposes them to acid attack more than other teeth.[16] A study conducted in private dental clinics in the southern region of Kerala and studies from dental teaching institutions' in Kerala also show an increasing trend of molar extraction.[8],[13] The increased extraction of premolar teeth in the adolescent age group in our center is also observed in the other studies too which could be attributed to extraction correction in orthodontic treatment.[8],[13],[17] Interestingly, adolescent females have extracted more first premolars than their counterparts due to increased awareness of esthetic sense among them.

The mean number of tooth extracted from the maxilla was similar between males (0.9 ± 1.1) and females (0.9 ± 1.0) (P = 0.769). In males, mandibular teeth extraction is done more than in females which is similar to the findings observed in studies conducted in other dental care centers in Kerala.[8],[13] The mean tooth loss in our sample is 1.7 ± 1.1 (range 1–12) which is lesser than the studies conducted in the other states of the southern province of India.[4],[5],[6],[7],[18] Most of the patients underwent single-teeth extraction (55%) and more than one teeth extraction in adult male mandibular anterior. The reason for such an extraction pattern of adult male mandibular anterior teeth was described in Saudi, Brazilian, and Iranian populations as well and is mainly attributed to periodontal diseases.[2],[11],[19]

This study did not aim to assess the reasons for tooth loss and henceforth forms the limitation of this study. The possible causes of extraction trends were analyzed and compared with the studies done in the regional as well as the global population. The global causes of tooth loss are found to be dental caries, periodontal diseases, orthodontic purposes, eruption problems, comorbid conditions, and dental trauma.[20] The present data from the tertiary dental care center is not representative of the general population although it could provide some useful insights while assessing the population from other regions. The neglect of dental health and poor socioeconomic factors contribute to the oral health burden in any population.


  Conclusion Top


Tooth extraction is widely practiced in developing nations like India even though tooth loss has wide implications for the social and psychological well-being of a person. The mean tooth loss noticed in the study is 1.7 ± 1.1 (range 1–12). The pattern of teeth extraction in a patient population reveals the level of dental awareness and oral hygiene maintenance. The trends noticed in teeth extraction pattern provide baseline data about the access and availability of dental care in that region. The intensification of oral health care programs and increased dental awareness campaigns can bring down the mean tooth loss index in our population and add more quality to the life of individuals.

Ethical clearance

The study protocol was approved by Institutional Ethics Committee with reference no: 007/IEC/GDCTSR/2022 dated 21-02-2022.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Sesha Reddy P, Swaroop Kumar Reddy A, Jain AR, Pradeep R. Tooth loss prevalence and risk indicators in an isolated population of Kadapa-South India. Am J Public Health Res 2014;2:221-5.  Back to cited text no. 6
    
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Thomas S, Raja RV, Kutty R, Strayer MS. Pattern of caries experience among an elderly population in south India. Int Dent J 1994;44:617-22.  Back to cited text no. 7
    
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Parayaruthottam P, Antony V. Background characteristics, pattern and reasons for tooth extraction among patients seeking dental treatment at a tertiary dental center in Kottayam, India. IJDSIR 2020;3:478-88.  Back to cited text no. 8
    
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Al Shammery A, el Backly M, Guile EE. Permanent tooth loss among adults and children in Saudi Arabia. Community Dent Health 1998;15:277-80.  Back to cited text no. 9
    
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Susin C, Haas AN, Opermann RV, Albandar JM. Tooth loss in a young population from south Brazil. J Public Health Dent 2006;66:110-5.  Back to cited text no. 10
    
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Al-Safadi R, Al-Safadi R, Al-Lahim A, Al-Bander W, Al-Masloukh M, Shami M, et al. Patterns of and reasons for permanent tooth extractions in a Saudi population authors. IJETST 2019;6:6811-21.  Back to cited text no. 11
    
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Lin HC, Corbet EF, Lo EC, Zhang HG. Tooth loss, occluding pairs, and prosthetic status of Chinese adults. J Dent Res 2001;80:1491-5.  Back to cited text no. 12
    
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Anand PS, Kuriakose S. Causes and patterns of loss of permanent teeth among patients attending a dental teaching institution in south India. J Contemp Dent Pract 2009;10:E057-64.  Back to cited text no. 13
    
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Caplan DJ, Weintraub JA. The oral health burden in the United States: A summary of recent epidemiologic studies. J Dent Educ 1993;57:853-62.  Back to cited text no. 14
    
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Hugo FN, Hilgert JB, de Sousa Mda L, da Silva DD, Pucca GA Jr. Correlates of partial tooth loss and edentulism in the Brazilian elderly. Community Dent Oral Epidemiol 2007;35:224-32.  Back to cited text no. 15
    
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Aljafar A, Alibrahim H, Alahmed A, AbuAli A, Nazir M, Alakel A, et al. Reasons for permanent teeth extractions and related factors among adult patients in the eastern province of Saudi Arabia. ScientificWorldJournal 2021;2021:5534455.  Back to cited text no. 16
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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