Jodat Askari1 , Feroze Ali2, Afreen Shameem3 , Salman Zafar4 , Nadya Sultan5
J Pak DentAssoc.2009; 18(1): 015 – 018
The aim of the study is to record the frequency and pattern of missing maxillary teeth in a sample population of Karachi, Pakistan.
A total of 4000 patients were screened at Dr Ishrat- ul-Ibad Institute of Oral Health Diseases, Karachi. Out of the total, 3621 patients were selected for the study. Student’s t test was used to analyze the data using SPSS 10.
Total missing maxillary teeth were 2197 (60.6 %) out of the total molars were 1119(30.9%), premolars were 537 (14.8%), canine 156 (4.3%) and incisors 385 (10.6%). No significant difference was seen between male ad female.
The present cross sectional study formulates a base line data to depict the pattern of tooth loss and its frequency in our Pakistani population.
Cross sectional study, maxillary, missing teeth
Tooth loss has long been associated with human ageing. However, edentulism or lack of teeth is basically a key indicator of oral health status of
populations and is associated with reduced quality of life: Various oral health diseases are widespread which can also result in loss of teeth. Data from a large study of Swedish twins suggests the hypothesis that the cause of tooth loss in adult life may be related to the childhood.2 A number of risk factors for tooth loss have been identified. These include both sexes (both male3 and female have been reported as having increased risk), education,’ social class,6 alcohol consumption,’ and cigarette smoking.8 The pattern of tooth loss has also been regarded as one of the most important measures for assessing the standard, availability and utilization of curative and preventive dental care in a given population. Sanya et a18 showed in their analyses on Kenyans the causes and pattern of missing permanent teeth. They found lower molars to be most frequently missing followed by upper molars and periodontal disease to be the most likely causative factor.
Three most important factors have been recognized responsible for tooth loss, which are, dental caries (which accounts for most teeth lost in early and later life), periodontal problems (which accounts for most teeth loss in later age), and trauma:6 It has been confirmed by various studies and surveys that after 40 years of age, periodontitis has been shown to be the major cause of tooth loss.11 Some authors” have commented that diseases in later life like Metabolic Syndrome can also lead to tooth loss. Other diseases like Diabetes” type I & II
Cardiovascular diseases,” lower respiratory diseases,” and low birth weight” are also implicated as possible risk factors for periodontitis which may lead to tooth loss.
Basically, it has become evident with all these studies that the major pathogenic factor in tooth loss with all these
diseases is low-grade inflammation created by increase in inflammatory markers. However, there is no epidemiological evidence to suggest that tooth loss or specific oral diseases are a necessary concomitant of the aging process.”
Among the oral cavity related health complications, loss of teeth constitutes an important health issue in old age. Tooth loss can considerably impact the quality of life particularly by affecting the ability to eat and even the esthetics of face can be diminished negatively affecting the confidence level too.18In the industrialized nations the efforts have been directed towards the treatment and prevention of loss of teeth. This has resulted in dramatic decline in edentulousness with age has now been documented.19
In developing countries, oral diseases data are primarily collected to aid planning of health care system and better understanding of the nature of oral diseases and changing patterns. Thus, there is a similar need to compile data for our country to aid in planning management and eradicating oral health diseases.
The objectives of the study were; to report the patterns of maxillary tooth loss in a selected sample of Karachi, to compare the frequency of right and left side of maxillary missing teeth and to establish a baseline data, in order to develop a better plan for prevention and treatment of oral health diseases in our country
This cross sectional study was carried out at the Prosthodontic Out Patient Department (OPD) of Dr. Ishratul-Ibad Institute of Oral Health Sciences (D I I 0 H S), Karachi. The sampling frame comprised of 4000 patients who were screened from January 2007 to August 2007. The patient examination and data collection was performed by means of a performa. The performa reported the name, gender, age and the number of missing teeth. The reason for the missing teeth was not noted. Periodontal condition assessment was also not a part of the examination.
Out of the total patients screened, 379 records had incomplete entries thus, were excluded leaving 3621 records for final analysis.
All the data was analyzed by SPSS version 10 software, for windows on professional computer for descriptive statistics. The significance of difference between missing right and left side of maxillary teeth was obtained by Paired t test.
Total 3621 patients records were analyzed, 1911 were male and 1710 were female, age ranging from 10 to 90 years. Total missing maxillary teeth were 2197 (60.6 %) out of the total molars were 1119(30.9%), premolars were 537 (14.8%), canine 156 (4.3%) and incisors 385 (10.6%) (Table I)
Frequency of missing teeth was obtained between different age and sex groups a higher number of teeth found missing in older groups of age (40-70 years). Whereas, no significant difference were found between molars, premolars and anterior teeth of right and left maxilla with p-value 0.567, 0.125 and 0.964 respectively (Table II).
Facial appearance is important in all societies of the world. Even minor changes in the patient’s facial appearance can cause major impact on the psychological status and the quality of life style. Any changes like tooth loss, facial injury etc especially in the anterior region of dental arch or front of face can create many concerns for the patient. He/she may think of it as disfigurement and a cause of ridicule. Therefore, regarding this concern the objectives of the present study focused on analyzing the local population for the incidence of missing teeth.
The present study showed that the tendency of missing teeth is found more or less equal in both sex groups but contradicts the results of other studies by Meskin et al”, Renson et al21 and Idowu et al.” The higher-level tooth mortality in females has been attributed in these studies due to more frequent visits to dentists. Whereas, in the present study there was no such significant difference found between the numbers of patients of both sexes. In another local study, Naeem commented that females in Pakistan had higher incidence of tooth loss as compared to males.”
Tooth loss has been encountered as a major risk factor in reducing the quality of life in old age people. Sometimes, this tooth loss is even an indication of an underlying disease leading to more severe consequences. But, for people belonging to our part of the world tooth loss or missing teeth is also because of low socioeconomic status. Since such people cannot afford dental treatment, they prefer to get the problematic tooth extracted rather than treat it. Present study provides a pattern of tooth loss
n a selected local population. A direct relationship was found between the increase in age and loss of teeth as is evident by other researches both local” and abroad.”
Loss of teeth increases with aging could be attributed to frequent periodontal problems in elderly group.25 The molars were found to be the most commonly missing whereas, canines are the longest retained teeth on both sides. The higher incidence of missing molars is known to be caused by high vulnerability of these teeth to both periodontal disease and dental caries. Although, marking the reason for the missing teeth is beyond the scope of this present study but other researchers have given a long list of risk factors as well as definitive markers contributing towards this problem. The present study showed that the most frequently missing teeth were molars (30%) and the least missing teeth were canines (4.3%).
Sanya et a126 showed that Kenyans have the lower molars to be the commonest missing teeth followed by upper molars. The major cause for their missing teeth was found to be dental caries followed by periodontal disease. In Afghanistan, Da’ameh et a127 found that the most commonly missing teeth were posterior teeth which were mainly extracted because of dental caries. These results were reconfirmed by Sarita et a128 in Tanzania, Sayagh et a129 in Jordon and Madukwe3° in Nigeria. But geriatic tooth loss is still considered to be mainly of periodontal origin.31
Pattern of mortality of different tooth groups (molars, premolars, canine and incisors) of both left and right side is usually not compared nevertheless, the pattern of loss was found to be same on both sides of the maxilla in this study.
This study has mainly focused on gathering a preliminary data on local Pakistani population.
This study presents the frequency of tooth morbidity in our local population compared with the developing as well as developed countries. The variation of results seen are because of improved dental services in conjunction with an increased public awareness of dental health among the population of industrialized countries. Finally this study provides the superficial view of oral health status in our population. The results emphasize the improvement of oral health, provision of better oral health facilities / services and awareness about the importance of oral health in our country
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