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The Reasons for Dental Extraction of Permanent Teeth in a Jordanian Population, Including Considerations for the Influence of Social Factors

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The Reasons for Dental Extraction of Permanent Teeth in a Jordanian Population, Including Considerations for the Influence of Social Factors The Reasons for Dental Extraction of Permanent Teeth in a Jordanian Population, Including Considerations for the Influence of Social Factors Mansour Al Qudah BDS, MSc, FDS, FFD Associate Prof. Jordan University of Science and Technology, Faculty of Dentistry, Department of Oral Surgery - Jordan [email protected] Haider Al Waeli BDS, MSc, Jordanian Board Fulltime Instructor, Jordan University of Science and Technology, Faculty of Dentistry, Department of Prevention - Jordan Hatem Al Rashdan BDS, MSc Private Sector, Irbid - Jordan ABSTRACT Objective: This study aimed to identify the causes of dental extraction and to clarify if there is any influence of the sociodemographic factors in a Jordanian population. Methods: Prospective Descriptive study, all sectors of dental practice in northern Jordan were included in the sample, from the four northern governorates of Jordan. A questionnaire was distributed to randomly selected dentists and collected during first two weeks of June 2004. Results: Data were collected from 49 dentists, at the end of the study period 853 teeth were extracted from 512 patients. Caries was the most frequent cause for extraction (34.8%), followed by periodontal diseases (30.6%) and orthodontics (9.8%). In the age group under 50, dental caries was the main reason for extraction. However, in the age group over 50; periodontal diseases became the principal reason for extractions. Statistical analysis indicated that there was significant relationship between extractions due to periodontal diseases with tooth brushing also with occupation. Extractions due to orthodontic reasons were significantly related to females. Extractions for patients in various occupations showed important variations. Conclusions: Although no statistical relation was found between all causes of extraction and social factors but still there is a link between social and economical factors and different causes of extractions. KEYWORDS Extraction, Periodontal disease, Orthodontics, Socio-Demographic. INTRODUCTION There are different reasons for dental extractions which In Jordan, two studies were conducted by Haddad vary geographically and many studies to determine these and Ta’ani;6,7 Ta’ani found the peak of extraction was reasons (table 1) were conducted in different countries, between 31-40 years 72.3%, while Haddad found the including France, England and Wales, Scotland, Norway, peak was 41.8% between 21-30 years. Antigua, and Jordan.1-10 In Jordan, Haddad found that periodontal diseases were the major cause accounting Periodontal diseases appeared to be a leading cause for (33.4%) of extractions, followed by caries (27.6%),6 of dental extraction in elderly people.1-10 This is due while Ta’ani found that caries was the major cause to periodontitis, which is a chronic disease affected by accounting for 56.4% of all extractions.7 many causative and aggravating factors, which act throughout life.11,12 The studies which are shown in table 1 confirmed that extraction due to dental caries is significantly related Extraction for orthodontic reasons has been performed to age, but did not measure the effect of social and for decades in daily dental practice, these extractions are economical factors.1-10 However, in other studies tooth performed either to gain space or to prevent malocclusion.13 loss was found to be affected by social, economical, or other factors. For example, Periodontal diseases which Extraction due to orthodontic reasons is strongly related 1-7 is one of the most common causes of tooth loss has to age. A study was conducted in Norway showed that been shown to be affected by social, psychological, 95.5% of extractions in patients younger than 16 years and biological conditions experienced in early life and were due to orthodontic reasons; in this study the total 4 through out life.11 extractions due to orthodontic reasons were 20%. | 34 | Smile Dental Journal | Volume 7, Issue 1 - 2012 alpha test, and the coefficient of reliability was 0.84 (Table 1) Percentages of permanent teeth extractions due to caries and periodontal diseases in different studies which meets the purpose of the study. % % Author (s) Country Year During the first two weeks of June 2004, each selected Caries Perio dentist was contacted and interviewed personally, Ta'ani7 Jordan 2003 56.4 23.4 for whom the aim of the study was explained. Each Haddad6 Jordan 1999 27.4 33.4 participating dentist was supplied with 20 questionnaires, and they were asked to fill a questionnaire for each Cahen1 France 1984 49.0 32.4 patient who was scheduled for extraction of one or more 4 Klock Norway 1988 35.0 19 of his or her permanent teeth. An Arabic version of the Vignarajah5 Antigua 1990 61.6 29.9 questionnaire was available and dentists who prefer to Agerholm & Sidi2 England & Wales 1988 47.5 26.5 fill the questionnaire in Arabic were provided with the Murray8 Canada 1997 28.9 35.9 Arabic copy. The IRB committee of the Jordan University Ong9 Singapore 1995 35.4 35.8 of Science and Technology approved for the research and each patient included in the study was signed an Reich10 Germany 1993 20.7 27.3 informed consent for participating the information taken kay3 Scotland 1984 50 21 from his dentist in the study. Two studies were carried out in Jordan investigating The following demographic and social variables were the causes of tooth loss in a Jordanian sample and recorded and assessed for the study population: age, the percentage of dental extraction due to orthodontic gender, place of residence and occupation. referral ranged between 3-5.3%.6,7 For the purpose of accuracy, every cause of extraction There is a growing interest in the impact of behavior was defined precisely after modifications made on 1,3 and social factors on health issues. Mc Garth and Bedi definitions available in the literature and explained to found that there were gender variations in the social and the participating dentists. These causes are: psychological impact on oral health.14 Also Hamasha • Caries: Caries or its sequels, remained roots, and carried a study in Jordan to evaluate risk indicators of fractures of teeth weakened by caries tooth loss in Jordanian adults, they found that those • Periodontal Diseases: Mobility, periodontal abscess, who brushed irregularly, smokers, and those who had and loss of function no professional teeth cleaning in the last year had • Orthodontic Reasons: Prevention or correction of significantly fewer remaining teeth.15 malocclusion • Prosthetic Request: Before fitting a denture (fixed or The aim of this study is to identify the causes of dental removable) even if functioning extraction of permanent teeth and to clarify if there is any • Other Reasons: Failed restorative procedure, cheek influence of the sociodemographic factors in a Jordanian bite, impaction (impacted tooth with communication population. with the oral cavity and causing pain or discomfort), pericorinitis, trauma, inability to pay for conservative MATERIALS & METHODS treatment, and prophylaxis. During June 2004 a systematic random sample of 49 dentists was drawn from the records of Jordan Dental After two weeks all participants were visited, the Association, Irbid branch. Every fourth dentist from a completed questionnaires were collected. There were list of 198 general practitioners was selected. The list 586 questionnaires, of which 74 questionnaires (12.6%) includes names and addresses of 218 dentists in the four were excluded due to incomplete information. The northern governorates of Jordan, (Irbid, Mafraq, Jerash, total questionnaires which were included in the study and Ajlun). Specialists and dentists working outside the were 512; these were given numbers from (1 to 512) northern area were excluded, those were 20 dentists. As and entered into Excel for Windows Professionals XP™. it has been shown by the data collected by department of At the end, the questionnaire data were processed general statistics, the northern region of Jordan occupies on the Jordan University of Science and Technology, 32% of its total area (28,870 km2), with an estimated Department of Public Health, by means of computerized population of 1.4308 million, which represents 27.5% of SPSS package for Windows (SPSS Inc. version 11, the Jordanian people. Chicago, IL, USA). Frequency distributions were used together with Pearson Chi-Square test and Wald’s Chi- After preliminary construction of the questionnaire, it was square test. The significance was set at P<0.05. distributed to 5 dentists to test its validity; the suggestions regarding some modifications in the design of some RESULTS questions were taken into account. Subsequent to final A random sample of 49 dentists was selected from the construction of the questionnaire, 5 dentists filled it up list of Jordan Dental Association, Irbid branch, all of during a pilot study, these filled questionnaires were used them agreed to participate in the study. At the end of the to measure the reliability of the test using Krombach- study period 853 teeth were extracted from 512 patients, Smile Dental Journal | Volume 7, Issue 1 - 2012 | 35 | of them 258 were males and 254 were females. More (Table 2) Frequency distribution of socio-demographic than one-half of the samples were patients between 20- variables and tooth-brushing habits of the sample 39 years old. The mean age of the patients was 36 years with a range between 7 and 74 years. Table 2 shows the Socio-Demographic Variable N (%) description of socio-demographic variables and tooth Gender brushing habits of the sample. Male 258 (50.4) The number of family members ranged between 2 and 15. Female 254 (49.6) The monthly income of the families with a range between Age Groups (year) 85 JD and 1300 JD. The marital status of our sample is < 20 64 (12.5) shown in table 2; with the majority of patients (65%) were 20-29 144 (28.1) married. Smokers represented 32.8% of the sample.
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