0

CAUSES AND EFFECTS OF TOOTH LOSS AMONG PATIENTS

VISITING THE UNIVERSITY OF NAIROBI DENTAL HOSPITAL.

INVESTIGATOR;

MINNEH GATHONI KAMAU

V28\35580\2010

BDS LEVEL III

A COMMUNITY DENTISTRY RESEARCH PROPOSAL SUBMITTED IN PARTIAL

FULFILLMENT OF THE REQUIREMENT FOR THE BACHELOR OF DENTAL

SURGERY (BDS) DEGREE OF THE UNIVERSITY OF NAIROBI.

SUPERVISORS

INTERNAL

PROF. LOICE GATHECE

BDS.,MPH., PhD. (Nbi)

DEPARTMENT OF PERIODONTOLOGY/COMMUNITY AND PREVENTIVE DENTISTRY

SCHOOL OF DENTAL SCIENCES .

1

UNIVERSITY OF NAIROBI .

EXTERNAL.

DR.JAMES MURIITHI NYAGA

BD., MDS., (Nbi)

LECTURER DEPARTMENT OF CONSERVATIVE AND PROSTHETICS DENTISTRY.

SCHOOL OF DENTAL SCIENCES .

UNIVERSITY OF NAIROBI.

DECLARATION AND SUBMISSION FOR APPROVAL.

I MinnehGathoniKamau hereby solemnly declare that this is my original proposal for a research

project and that it has not been submitted to any other university. I wish to submit the proposal to

the Kenyatta National Hospital/University of Nairobi Research ethics and standards committee

for approval.

Signed………………………… Date……………………………..

SUPERVISORS APPROVAL.

This proposal has been submitted with our approval as University of Nairobi supervisors.

PROF.GATHECE LOICE

BDS.,MPH.,PhD.(Nbi)

DEPARTMENT OF PERIODONTOLOGY/COMMUNITY AND PREVENTIVE DENTISTRY

SCHOOL OF DENTAL SCIENCES .

2

UNIVERSITY OF NAIROBI .

Signed…………………….. Date…………………………..

DR.JAMES MURIITHI NYAGA

BDS.,MDS., (Nbi)

LECTURER DEPARTMENT OF CONSERVATIVE AND PROSTHETICS DENTISTRY.

SCHOOL OF DENTAL SCIENCES .

UNIVERSITY OF NAIROBI.

Signed……………………… Date……………………………

3

TABLE OF CONTENTS

SUPERVISORS............................................................................................................................. 0

DECLARATION AND SUBMISSION FOR APPROVAL. ..................................................... 1

LIST OF ABBREVIATIONS ...................................................................................................... 4

SUMMARY ...................................................................................... Error! Bookmark not defined.

1.0 INTRODUCTION................................................................................................................... 5

1.1JUSTIFICATION OF RESEARCH . ..................................................................................... 6

1.2 GENERAL OBJECTIVE . .................................................................................................... 7

1.3SPECIFIC OBJECTIVES . .................................................................................................... 7

2.0 LITERATURE REVIEW. ..................................................................................................... 7

2.1 STATEMENT OFRESEARCH PROBLEM . .................................................................... 10

2.2 HYPOTHESIS . .................................................................................................................. 10

3.0 METHODOLOGY . ............................................................................................................. 10

3.1STUDY DESIGN . ............................................................................................................... 10

3.2 STUDY AREA . .................................................................................................................. 10

3.3 STUDY POPULATION . ................................................................................................... 11

3.4 SAMPLE SIZE . .................................................................................................................. 11

3.5 INCLUSION CRITERIA . .................................................................................................. 11

3.6 EXCLUSION CRITERIA . ................................................................................................. 11

3.7 TOOLS AND TECHNIQUE OF COLLECTION OF DATA . .......................................... 12

3.8 ETHICAL CONSIDERATIONS . ...................................................................................... 12

4.0 BUDGET AND TIME FRAME. .......................................................................................... 14

4

4.1 BUDGET . ........................................................................................................................... 14

4.2TIME FRAME . ................................................................................................................... 14

5.O REFERENCES . ................................................................................................................. 15

6.0APPENDIX I .......................................................................................................................... 17

7.0 APPENDIX II . ...................................................................................................................... 19

8.0 APPENDIX III ...................................................................................................................... 20

LIST OF ABBREVIATIONS

UONDH…………….University of Nairobi Dental Hospital

WHO………………..World Health Organization .

5

ABSTRACT

BACKGROUND;There are some factors that lead to tooth loss and some effects that occur due

to the loss of tooth loss.There is little known about the causes and effects of tooth loss in the

country.Tooth loss affects the oral health related quality of life .

OBJECTIVE;To determine the causes and effects of tooth loss among patients visiting the

UONDH.

STUDY DESIGN;A descriptive cross sectional study that is hospital based .

STUDY AREA;The University of Nairobi Dental Hospital along ArwingsKodhek Road.

METHODOLOGY;The study participants will comprise of 117 prostheticpatients .Seventy

one completely edentulous and fourty six partially edentulouspatients. Self-administered

questionnaires will be used to collect data to those who have qualified the inclusion criteria.Data

will be analyzed using computer aided methods SPSS and MS EXCEL .

PERCIEVED BENEFIT, The results of this study willbe used to educate the dentists on the

effects and causes of tooth loss and encourage them to give the best dental treatment to improve

quality of life to the population.

CHAPTER ONE

1.0 INTRODUCTION.

Edentulousness is the loss of teeth and can either be partial or complete where partial

edentulousness involves loss of some teeth whereas complete involves loss of all the teeth .A

study done in Palermo,1Italy showed that complete edentulousnesswas present in 4.6% of the

population while partial edentulousness was present in 60.6% of the population.Another study

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done in India2showed that 15.6% were completely edentulous and 54.7% were partially

edentulous.

Causes of edentulousness are diverse and may include dental caries,periodontal

diseases,extractions that could be as a form of traditional practices or due to removal of 3rd

molars,orthodontic treatment or trauma.A study done in 20123 showed that of the 62% of the

tooth loss in the USA dental caries topped as the cause of tooth loss with 37.4% followed by a

combination of periodontal disease and dental caries with 12.2%.Another done in Nigeria

4showed that the mean tooth loss was 4.5+\-7.6 and the major cause of tooth loss was periodontal

diseases with 98.7% then dental caries 0.7% and trauma 0.6% .In Kenya a study done 5showed

that the mean number of missing teeth in the population was 1.60 .Among those with missing

teeth the mean number of missing teeth was 3.35.Dental caries was the commonest cause with

52.6% followed by periodontal diseases at 27.6%,extractions as a form of traditional practices

accounted for 12.3%,orthodontic treatment 2.2% and trauma 2.0%.

Effects of tooth loss include loss of width and height of bone leading to facial changes and may

lead to social effects .Loss of teeth lead to drifting and supra eruption of the adjacent teeth that

may cause orthodontic problems as well as affect the aesthetics of the patient .These changes

may affect the prospects of future replacements .Other effects include alteration of speech and

how one eats and clinical effects may be experienced where other teeth may get affected

depending on how the extraction was done .

Aim of the research is to determine the causes and effects of tooth loss.The research will benefit

both the dental students and patients by helping them understand tooth loss causes and effects

and motivating dentists to give the best treatment possible.

1.1JUSTIFICATION OF RESEARCH .

Little is known about the causes and effects of edentulism in Kenya .This research will help in

determining the causes and effects of tooth loss among patients visiting the UONDH prosthetic

clinic .It will also benefit dental practisioners by helping them understand the problem and

motivate them to give the best dental treatment to improve the quality of life .

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1.2 GENERAL OBJECTIVE .

To determine the causes and effects of tooth loss among edentulous patients visiting the UONDH

.

1.3SPECIFIC OBJECTIVES .

1. To determine the causes of tooth loss among edentulous patients visiting the UONDH .

2. To determine the effects of tooth loss among edentulous patients visiting the UONDH .

CHAPTER TWO

2.0LITERATURE REVIEW.

Edentulousness is defined as the condition of having no teeth.It can be classified as partial or

complete where partial edentulousness is loss of some teeth and complete is the loss of all

teeth.Tooth loss is high among adults17

.Astudy done showed that among the patients that

attended the prosthetic clinic during that time 58.9% of the patients were completely edentulous

and 41% were partially edentulous12

.Tooth extractions are among the various treatment

procedures done in hospitals with a total of 33.4% 15

and 12.3%13

in studies done in

Nigeria.Tooth loss can be due to a number of reasons that include dental caries ,periodontal

diseases ,traditional practices ,orthodontic treatment ,disimpactions ,prosthetic reasons and tooth

in fracture line .

Of the various causes of tooth loss,dental caries is the leading cause in all age groups and in all

teeth types except for the incisors19

.Dental caries is defined as a multifactorial disease that leads

to the demineralization of the tooth surface. In a number of studies done caries had the highest

8

prevalence with20.8%12

56.4%13

32.6%15

.Highest proportion of extraction due to caries occurred

between 21-30 years of age10

.More females lose their teeth due to dental caries12

.Most frequent

extracted teeth due to caries are the molars in particular the first permanent molars with the

Mandibular molars being mostly affected followed by the maxillary first molars11

.Extractions

due to caries tend to increase posteriorly10

.

Periodontal diseases are the second leading cause of tooth loss with the prevalence of 24.6%13

and 11%12

in previous studies .The clinical manifestation of the periodontal disease leading to the

tooth loss includes the furcation involvement, periodontal pocket and tooth mobility .Presence of

initial attachment loss bone height and habit of smoking increase the risk of tooth

mortality.There is a strong correlation between smoking the severity of periodontal disease and

tooth mortality.More recent epidemiological data seem to suggest an increase of tooth loss due to

periodontal reasons rather than caries9.A cross sectional survey reported that lower anterior teeth

were most frequently extracted due to periodontal disease followed by upper anteriors and upper

second molars9.However another study showed that maxillary teeth were lost more than

mandibular teeth especially the maxillary left central incisor followed by the right central

incisor11

.Extractions due to periodontal disease occurred between 41-50 years10

and 51-60

years11

.Extractions of periodontal disease tend to increase anteriorly10

.More males lost their

teeth due to periodontal disease12

.

According to other studies ,there are other reasons that led to tooth loss which includes failed

rootcanal treatment which accounted for 1.5% ,orthodontic treatment needs 1.2% ,extractions of

teeth in fracture line 1.0% ,dental trauma 0.6% ,extraction of supernumeraries 0.4% and

extractions due to prosthetics 0.2%15

.A great number of variables are associated with tooth loss

but there is no consensus whether dental disease related or socio-behavioural factors are most

important risk factors12

.Age is strongly related to every measure of tooth retention and tooth

loss6.The mean number of teeth lost increases with age

7.A study done showed that

institutionalized elderly people have in general more compromised oral health including fewer

teeth than those at the same age living freely7.Race and ethnicity was consistently related to these

measures after adjustment for age and gender6.Gender is also a risk factor,a study done showed

that more extractions occurred in females 62.3% and less in males37.7%14

.However females lost

their teeth due to caries as compared to males who lose their teeth due to periodontal

9

disease12

.Other risk factors include socio-economic status ,habits such as cigarette smoking and

caries experience8.

There is a documented decline of edentulism in general .However there existsgreat differences in

prevalence between countries ,between geographical regions,within countries and between

groups with various backgrounds7.There is an overall decline in the prevalence of tooth loss and

edentulism in USA over the past several decades6.A trend of decreasing incidence has also been

witnessed over the last decade7. However, the WHO goal of retaining at least 20 teeth at the age

of 80 years has not yet been met but is being approached in some countries7.

The loss of few or all natural teeth has been accepted as a handicapping condition for the aging

elderly people23

. Studies on self-perception have demonstrated that tooth loss is associated with

esthetic ,functional ,psychological and social impacts for individuals21

.According to a study done

by Vinayak and published in 2011, 23% of the subjects had difficulty accepting tooth loss, 64%

had no difficulty accepting tooth loss, and 13% were uncertain. The time taken for acceptance of

tooth loss was also different with 35% having accepted tooth loss immediately, 53% accepted it

within 6 months, 5% within 1 year, 3% required more than 1 year, and 4% have still had not

accepted the loss.The partial dentate group were more concerned about tooth loss than complete

edentulous patients.32% of subjects talked about tooth loss with others,60% talked to their

dentists ,55% talked to their friends ,31% talked to their spouses ,and 55% talked with their

family and relatives .25% of the subjects were not prepared for the effects of tooth loss ,70% felt

prepared ,and the rest had no answer .More than half the people who were unprepared for the

tooth loss felt that a consultation with the dentist along with education ,motivation ,and

awareness would have reduced their problems .A total of 96% did not feel any difference in their

confidence ,while the rest were indifferent .More than 50% of the subjects felt restricted with

their food choices and enjoyment of food23

.Position of lost teeth was associated to perceived

functional limitation.Perceived impacts were more frequent in women than men21

. People who

experienced difficulties in accepting their tooth loss were more likely to feel less confident

,restrict food choice ,enjoy food less ,avoid laughing in public and avoid forming close

relationships than those people with no difficulties with accepting tooth loss20

.This shows that

tooth loss has an effect on the oral health related quality of life24

.

10

Tooth loss can be corrected through various ways.For complete edentulous cases complete

dentures are fabricated and used to correct edentulousness .They can be implant supported or

implant retained and supported .Partial edentulousness is corrected through implants crowns

supported ,fixed bridges and removable partial dentures.The patient can also decide to have no

treatment done .Although patients usually expressed prosthodontic treatment needs ,clinical and

financial issues are determinant factors for tooth replacement21

. Financial limitation was

considered the most important factor that restricted access to treatment21

.

2.1 STATEMENT OFRESEARCH PROBLEM.

Edentulism has several causes and the two leading causes are dental caries and periodontal

disease.Edentulism affects the quality of life.It has functional limitations.One has difficulty in

speech and trouble pronouncing.It lowers the self confidence of a person as well as alter their

self image some even do feel embarrassed.It alters the socialization of a person and the forming

of close bonds.One is limited to the choice of foods and this leads to a compromised nutritional

status in some of these patients and their general health status is affected too.

2.2HYPOTHESIS.

Edentulousness has negative effects on patients visiting the UONDH.

CHAPTER THREE

3.0 METHODOLOGY.

3.1STUDY DESIGN .

This will be a descriptive cross sectional study .

3.2STUDY AREA .

This study is to be conducted in the prosthetic clinic in the university of Nairobi Dental

Hospital.TheUONDH is situated opposite the Nairobi Hospital and Lee Funeral home.It is

situated along the ArwingsKodhekRoad.

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3.3 STUDY POPULATION.

The study will be conducted among both the partially and completely edentulous patients visiting

the UONDH.

3.4 SAMPLE SIZE .

The sample size will be computed using the following formula;

N=Z2[P(1-P)]

C2

Where;

N=sample size

Z=Zvalue=1.96

P=prevalence of completelyedentulous=15.6%

C=1-prevalence

Population for completely edentulous=71

Z=Z value=1.96

P=prevalence of partially edentulous=54.7%

C=1- prevalence

Population for partially edentulous=46

Total population=117

3.5 INCLUSION CRITERIA .

All people who are either partially or completely edentulous.

3.6 EXCLUSION CRITERIA.

All people who are not partially or completely edentulous.

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3.7 TOOLS AND TECHNIQUE OF COLLECTION OF DATA.

A questionnaire will be used to collect data.The questionnaire will be handed to the involved

participants ,those who will have fulfilled the inclusion criteria.An investigator will administer

the questionnaire and the answers will be noted with a tick on the corresponding column of the

survey.

3.8 ETHICAL CONSIDERATIONS.

Permission will be sought from the Kenyatta National University of Nairobi Research Ethics and

Standard Committee.Informed consent will be obtained from all the participants who make the

inclusion criteria.Patients will be assured of confidentiality of their answers and that the use of

information will be for research purposes only.

13

14

4.0BUDGETAND TIME FRAME.

4.1 BUDGET .

PROPOSAL

Number Unit cost Total

Printing 30 5 150

Binding 3 100 300

Modem 1 2000 2000

Flash disk 1 2000 2000

Total 4450

DATA COLLECTION .

Number Unit cost Total

Questionnaire 117 2 234

REPORT WRITING .

Number Unit cost Total

Printing 50 5 250

Binding 3 100 300

Total 550

Grand total 5234

SOURCE OF FUNDS………….self

4.2TIME FRAME.

Proposal writing and submission for approval………June

Data collection, analysis and report writing………..July-august

Submission of final report…………………………………….September\October

15

5.OREFERENCES .

1.Melilli D,Matranga D,Cassaro A,Pizzo G,Edentulousness and Prosthetic treatment needs in a

sample of adults of Palermo ,Italy.AnnIq Jan-Feb (1)69-81.

2.Ariga P,Bridgette A,Rangarajan V,J.M Philip,Edentuloussness denture wear needs of the

elderly in rural South India;Iran J Public Health 2012 41(7)40-43 .

3.Reddy N S,Reddy NA,Narendra R,Reddy SD;Epidemiology survey on edentulousness,J

Contemp Dent Pract 2012 Jul1;13(4)562-570.

4.TaiwoO.Juliana,Omokhoidon F,Pattern of tooth loss in an elderly population from Ibadan

Nigeria.Gerodontology vol23 issue 2Jun2006.

5.Sanya B,Nganga PM,Nganga RN,Causes and patterns of missing teeth among Kenyans.East

African Medical Journal 07/2004 81(6)322-5.

6.Marcus,S.E,Drury,T.F,Brown,L.J&Zion,Tooth retention and tooth loss in the permanent

dentition of adults:United States,1988-1991.Journal of Dental Research,75(spec No).684-695.

7.Frauke Müller1 ,Manuel Naharro

1 ,Gunnar E. Carlsson

2, What are the prevalence and incidence

of tooth loss in the adult and elderly population in Europe. DOI: 10.1111/j.1600-

0501.2007.0i459x 18 Jun 2007.

8.Susin C,Oppermann RV,Haugejorden O,Albandar JM,Tooth loss and associated risk indicators

in an adult urban population from south Brazil.ActaOdontol Scand. 2005 Apr;63(2):85-93.

9.Ong G.Periodontal disease and tooth loss,Int Dent J. 1998 Jun;48(3 Suppl 1):233-8 .

10.Jaafar N,Razak IA,Nor GM,Trends in tooth loss due to caries and periodontal disease by tooth

type.Singapore Dent J. 1989 Dec;14(1):39-41.

11.Upadhyaya C,Humagain M,The pattern of tooth loss due to dental caries and periodontal

disease among patients attending dental department (OPD) ,Dhulikhel Hospital ,Kathmandu

University Teaching Hospital (KUTH), Nepal:Kathmandu Univ Med J (KUMJ). 2009 Jan-

Mar;7(25):59-62.

16

12.Shigli K,Hebbal M,Angadi GS,Relative contribution of caries and periodontal disease in adult

tooth loss among patients reporting to the Institute of Dental Sciences ,Belgaum

,India.Gerodontology. 2009 Sep;26(3):214-8.

13.OginniFO,Tooth loss in a sub-urban Nigerian populationcauses and pattern of mortality

revisited:Int Dent J. 2005 Feb;55(1):17-23.

14.Anyanechi C,Chukwuneke F,Survey of the reasons for dental extraction in eastern

Nigeria,Ann Med Health Sci Res. 2012 Jul;2(2):129-33.

15.Danielson OE,Chinedu AC,Oluyemisi EA,Bashiru BO,Ndubuisi OO, Frequency, causes and

pattern of adult tooth extraction in a Nigerian rural health facility:Odontostomatol Trop. 2011

Jun;34(134):5-10.

16.McCaul LK,Jenkins WM,Kay EJ,The reasons for the extraction of various tooth types in

Scotland: a 15-year follow up:J Dent. 2001 Aug;29(6):401-7.

17.Khazaei S,Firouzei MS,Sadeghpour S,Jahangiri P,Savabi O,Keshteli AH, Adibi P.Edentulism

and Tooth Loss in Iran: SEPAHAN Systematic Review No. 6:Int J Prev Med. 2012 Mar;3(Suppl

1):S42-7

18.Mamai-Homata E,Margaritis V,Koletsi-Kounari H,Oulis C, Polychronopoulou A,Topitsoglou

V. Tooth loss and oral rehabilitation in Greek middle-aged adults and Senior citizens;Int J

Prosthodont. 2012 Mar-Apr;25(2):173-9.

19.Manji F, Baelum V, Fejerskov O,Tooth mortality in an adult rural population in Kenya:J Dent

Res. 1988 Feb;67(2):496-500.

20.Davis DM, Fiske J,Scott B,Radford DR. The emotional effects of tooth loss in a group of

partially dentate people: a quantitative study:Eur J ProsthodontRestor Dent. 2001 Jun;9(2):53-7.

21.Teófilo LT,Leles CR Patients' self-perceived impacts and prosthodontic needs at the time and

after tooth loss:Braz Dent J. 2007;18(2):91-6.

22.Rodrigues SM,Oliveira AC,Vargas AM,Moreira AN,E Ferreira EF. Implications of

edentulism on quality of life among elderly:Int J Environ Res Public Health. 2012 Jan;9(1):100-

9.

17

23.AmitVinayakNaik1 ,*

and Ranjana C. Pai 2

Study of Emotional Effects of Tooth Loss in an

Aging North Indian Community: ISRN Dent. 2011; 2011: 395498.

24.Polzer I,Schimmel M,Müller F,Biffar R.Edentulism as part of the general health problems of

elderly adults;Int Dent J. 2010 Jun;60(3):143-55.

.

18

6.0APPENDIX I

CAUSES AND EFFECTS OF TOOTH LOSS AMONG PATIENTS VISITING THE UONDH .

QUESTIONNARE

Age(years)……….

Gender(m\f)…………………….

KEY

1.Dental caries 5.Prosthetic reasons

2.Periodontal disease 6.Traditional practices

3.Orthodontic treatment 7.Tooth in fracture line

4.Trauma 8.Failed RCT

1ST

QUADRANT

TOOTH 11 12 13 14 15 16 17 18

MISSING

CAUSE

2ND

QUADRANT

TOOTH 21 22 23 24 25 26 27 28

MISSING

CAUSE

3RD

QUADRANT

TOOTH 31 32 33 34 35 36 37 38

MISSING

CAUSE

4TH

QUADRANT

19

TOOTH 41 42 43 44 45 46 47 48

MISSSING

CAUSE

Effects of tooth loss

EFFECT YES NO I DON’T

KNOW

Difficulty in speech and trouble announcing.

Limitation to choice of food.

Totally unable to function.

Had to interrupt meals.

Being self conscious about having no teeth.

Being embarrassed as an appearance of having no teeth.

Felt life less satisfactory.

Difficulty doing usual jobs

Reduced participation in social activities.

Avoid smiling as being toothless.

7.0APPENDIX II .

Consent form

20

Dear Participant,

I am a third year student at the UON pursuing a bachelors degree in dental surgery.I wish to

request for your permission in a study that will be part of my degree work.Participation is purely

voluntary and you may withdraw from the study at any stage.

The study will involve letting me conduct an interview regarding the causes and effects of tooth

loss.You are free to ask any questions if you require any clarification.The purpose of the study is

to investigate the various causes and effects of tooth loss among patients visiting the UONDH.

There are no risks involved because the procedure is non invasive.Participation is voluntary and

the information will be treated with utmost confidentiality.The entire examination is free.

Investigator

Minneh Gathoni

I would therefore appreciate your consent by signing here below.

I Minneh Gathoni confirm that I have explained the relevant parts of my study to the participants

.

Signed…………. Date………………..

I hereby confirm that I have understood he relevant parts of the study and give consent to

participate .

Signed………… Date……………

8.0 APPENDIX III

FOMU YA KISWAHILI

Kwa Mhusika,

21

Mimi ni mwanafunzi wa mwaka wa tatu katika Chuo kikuu cha Nairobi.Nasomea shahada ya

Utabibu wa sehemu zinazohusika na meno.Nakuomba kwa unyenyekevu uwe mmoja wa

watakaonisaidia kukukamilisha masomo yangu.Utafanya hivyo kwa hiari yako na unaweza

kutamatisha uhusika wako katika hatua yoyote.

Baadhi ya mambo utakayo changia ni:

Mahojiano kuhusu sababu za watu kupoteza meno na madhara yanayofuatia

Kuniuliza swali lolote ikiwa hujaelewa

Kuhusika kwako hakutakabiliwana hatari yoyote.Mahojiano yetu yatatuhusu tu sisi na

hayatajuzwa wahusika wengine.

Mwanafunzi,

Minneh Gathoni

Nitashukuru ukinisaidia.

Sahihi…………………………………….

Tarehe………………………………………

Nimesoma na kuelewa nitakavyohusika na sahihi yangu ni kuwa thibitisho kuwa nitahusika .

Sahihi………………………………………..

Tarehe…………………………………………….