|Year : 2016 | Volume
| Issue : 4 | Page : 413-418
Tooth loss prevalence and risk indicators among adult people visiting community health centers in Nellore district, Andhra Pradesh: A cross-sectional study
SK Shabana Begum1, V Chandra Sekhara Reddy1, R. V. S. Krishna Kumar1, KM Sudhir1, G Srinivasulu1, SK Noushad Ali2
1 Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
2 Department of General Medicine, ACSR Government Medical College, Nellore, Andhra Pradesh, India
|Date of Web Publication||15-Dec-2016|
S K Shabana Begum
Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: The relationship between oral health and tooth retention is complex. Dental caries and periodontal diseases are the main reasons for tooth loss; the contribution of other modifying factors such as cultural beliefs, socioeconomic characteristics, access to dental care, and dental practitioner's philosophy of treatment may also influence the decision to extract teeth. Aim: The aim of this study is to assess the prevalence and risk indicators of tooth loss in an adult population visiting community health centers (CHCs), Nellore district. Materials and Methods: A cross-sectional study was conducted among adult patients visiting the outpatient wards of 10 CHCs which were selected by multistage random sampling. A total of 450 patients in the age range of 35–74 years were surveyed using a structured questionnaire followed by clinical examination. Questionnaire was regarding age, sex, socioeconomic status (SES), smoking habits, dental visiting patterns, and oral hygiene practices. Clinical examination was performed using dentition status from the WHO pro forma and loss of attachment (LOA) with LOA Index. Results: Overall prevalence of tooth loss was 50.39%. The highest prevalence of tooth loss was reported in 65–74 years old age group (96.18%) and upper lower class. Males had highest tooth loss prevalence (64.29%) with mean tooth loss of 3.08 ± 3.59. Multiple logistic regression done to assess the impact of various independent variables on tooth loss revealed that age, gender, SES, habits of cleaning teeth, frequency of brushing teeth, time of brushing, dietary habits, visit to dentist, dental caries, and LOA had a significant impact on tooth loss. Conclusion: Age, gender, SES, habits of cleaning teeth, frequency of brushing teeth, time of brushing, dietary habits, visit to dentist, dental caries, and LOA were identified as risk indicators for tooth loss among adult people visiting community health centers in Andhra Pradesh.
Keywords: Prevalence, risk indicators, tooth loss
|How to cite this article:|
Shabana Begum S K, Reddy V C, Kumar RK, Sudhir K M, Srinivasulu G, Noushad Ali S K. Tooth loss prevalence and risk indicators among adult people visiting community health centers in Nellore district, Andhra Pradesh: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:413-8
|How to cite this URL:|
Shabana Begum S K, Reddy V C, Kumar RK, Sudhir K M, Srinivasulu G, Noushad Ali S K. Tooth loss prevalence and risk indicators among adult people visiting community health centers in Nellore district, Andhra Pradesh: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Nov 13];14:413-8. Available from: http://www.jiaphd.org/text.asp?2016/14/4/413/195829
| Introduction|| |
Tooth loss impairs the quality of life, often substantially and affects the well-being of the person. Missing teeth can interfere with chewing ability, diction, and esthetics. Low self-esteem related to tooth loss can hinder an individual's ability to socialize, hamper the performance of work and daily activities.
Tooth loss is a reliable measure of a population's oral health status. The relationship between oral health and tooth retention is complex. While dental caries and periodontal diseases are the main reasons for tooth loss, other modifying factors such as cultural beliefs, socioeconomic characteristics, access to dental care, unhealthy diets, dental trauma behavioral characteristics, and dental practitioner's philosophy of treatment may also influence the decision to extract teeth.
The prevalence of tooth loss was defined as the percentage of individuals with one or more missing teeth, and the extent was defined as the number of missing teeth per person. The two most prevalent oral diseases, caries and periodontal disease, often do not cause symptoms in early stages and if not treated adequately tooth loss will presumably cause functional impairment, for example, with regard to chewing and esthetics, depending on the location of tooth loss. Success is measured by the declining rates of edentulism and an increase in the number of retained teeth.
Data from several countries have consistently shown that edentulism is more prevalent among lower socioeconomic groups and among women, and that women have tended to become edentulous at a younger age. These gender differences are not easy to explain; many think that they reflect dentist–patient relationships more than disease occurrence.
About 2.3% of the global population representing 158 million people worldwide was edentate in 2010. Between 1990 and 2010, the global age-standardized prevalence of severe tooth loss in the entire population decreased from 4.4% to 2.4%, a 45% decrease. The global age-standardized incidence rate of severe tooth loss in 2010 was 205 cases per 100,000 persons-year. A significant decrease (45%) from the 1990 incidence rate of 374 cases per 100,000 persons-years. However, in India, very few data are available about tooth loss. A south Indian study done on adults aged over 60 years showed a mean tooth loss of 10.98. However, in Nellore, the tooth loss prevalence is 81.8% and most of it is contributed by missing component which is about 77.1%. Thus, the aim of the study was to assess the prevalence and risk indicators of tooth loss in an adult population visiting community health centers (CHCs), Nellore district.
| Materials and Methods|| |
A cross-sectional study was conducted for 1 month during May 2015 among patients visiting the randomly selected CHCs in Nellore district. The study was approved by the Institutional Ethics Committee. Before the start of the study, the approval was obtained from administrative medical officer of respective CHCs before the start of the study. The data were obtained through self-administered questionnaire and clinical examination. The investigator is trained and calibrated in the Department of Public Health Dentistry and the intra-examiner Kappa coefficient value is 0.85% and only one examiner is involved in data collection.
Multistage cluster sampling methodology was followed. Nellore district is divided into five revenue divisions. Each division is again divided into a number of mandals. The five revenue divisions of Nellore district were divided into total of 46 mandals, and then two mandals having CHCs were randomly selected from each revenue division.
All the patients visiting the outpatient ward of CHCs on the particular days of the study satisfying the inclusion criteria were invited to participate in the study. A structured questionnaire was used to collect information regarding sociodemographic variables, oral hygiene practices, dental visits, exposure to cigarette smoking, dietary habits, and frequency of sugar consumption. The study population was categorized into four age groups: 35–44, 45–54, 55–64, and 65–74 years. Dentition status from the 1997 WHO pro forma has been used, and from that, missing teeth data were obtained.
The recorded data were compiled and entered into a spreadsheet computer program and then Data was entered and analyzed using a software program IBM SPSS Statistics version 22 (Armonk, NY:IBM Corp) (P< 0.05). Descriptive statistics included computation of percentages and means and standard deviations of the number of missing teeth for the various categories of the risk indicators. Chi-square test was used to know the statistically significant relationship between independent variables and dependent variables. All the risk indicators were dichotomized and employed as independent variables in multiple logistic regression estimating values of odds ratio and the respective 95% confidence interval. Statistical significance was set at P ≤ 0.05.
| Results|| |
The study population includes 450 adults aged 35–74 years of these: 168 (37.33%) were males and 282 (62.67%) were females. [Table 1] shows the distribution of respondents by different characteristics.
The prevalence of tooth loss was higher in 65–74 years (96%) and lower in 35–44 years (12.78%). Males (64.29%) showed higher percentage of tooth loss compared to females (37.23%) and upper lower class showed higher percentage (60.71%) of tooth loss fallowed by lower middle class (52.80%), upper middle class (35.53%), and upper class (12.50%).
[Table 2] shows patients who are using toothbrush to clean teeth having significantly less number of missing teeth (P < 0.0001) as compared to cases using finger. Participants who are using other than toothpaste or powder show high number of missing teeth (P < 0.00001). Participants who change the toothbrush for 1–3 months showed less number of tooth loss compared to participants who change for 4–6 months (P < 0.00001). Individuals who did not use oral hygiene aids such as toothpicks and mouth rinses showed higher number of tooth loss (P < 0.00001).
|Table 2: Tooth loss in relation to oral hygiene practices among the study population|
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[Table 3] shows individuals who consumed a vegetarian diet compared to mixed having more number of missing teeth (P < 0.0003). The mean number of missing teeth was significantly higher among smokers (P < 0.001) as compared to nonsmokers. The mean number of missing tooth in the study population was 2.49 ± 3.96. Tooth loss increased significantly with age, ranging from mean number of 0.24 teeth in 35–44 years old to 6.68 teeth among 65–74 years old participants (P < 0.001). A decrease in the mean number of missing teeth with increasing socioeconomic status (SES) was observed, which was statistically significant (P < 0.001).
|Table 3: Tooth loss in relation to dietary habits, sugar consumption, and adverse oral habits among the study population|
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[Table 4] shows multiple logistic regression showing that the odds of tooth loss in adults aged over 55 years were nearly 1.2 times higher than those for adults aged <55 years. Low socioeconomic adults showed 26% higher tooth loss than high SES. People clean with finger showed 5 times higher tooth loss than using brush. People clean their teeth 1 time showed 4 times higher tooth loss compared to morning and night. People using others had 14% higher tooth loss compared to toothpaste or powder.
|Table 4: Multiple logistic regressions for variables affecting tooth loss|
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[Table 5] shows participants with ≥2 decayed/filled teeth, or having ≥2 teeth with attachment loss ≥5 mm who were more likely to have missing teeth compared to participants with ≤1 decayed/filled teeth or ≤1 teeth with attachment loss ≥5 mm, after adjusting for age, SES, and smoking behavior.
|Table 5: Multivariable analysis of the association of decayed/filled teeth and attachment loss with the occurrence of tooth loss in 35-74 years old population|
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| Discussion|| |
Dental status is multidimensional, and several studies have investigated the risk indicators of missing teeth in different parts of the world. Indicators of tooth loss reflect oral impairment and indicators of tooth retention reflect oral health and well-being. Loss of teeth reflects a major public health problem in many countries. The prevalence of tooth loss among the adults in Nellore district, India, was 50.3%. The mean number of missing teeth (2.5) was lower in comparison with study conducted by Reddy et al. in Davangere taluk, Karnataka, India.
Reasons for the higher prevalence of tooth loss among this population may be due to lack of oral health knowledge, awareness, and attitude toward their dental treatment because of little or no use of the dentist or dental improper methods or materials to clean the oral cavity.
In this study, the mean number of decayed teeth decreased with increase in age from adults to older, whereas the mean number of missing teeth increased with age. Similar findings were reported in previous study., This indicates that decayed teeth in older people are generally extracted and missing component comprises most of the decayed, missing, and filled teeth score.
Tooth loss and age are directly related in this study, but it is lower than that found in the National Oral Health Survey of India. 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. It may also reflect many things that the older people might have experienced in their past, such as high prevalence and intensity of oral diseases, unavailability of care, past economic and social conditions, and the nature and philosophy of dental care provided in earlier days. It has also been reported that age alone is not responsible for the deterioration of oral health., There may be several other factors such as multiple chronic diseases, side effects of medications, and psychological factors as depression and isolation (because of loss of spouse, friends, and feeling of being unwanted by family) leading to neglect of personal and oral hygiene resulting in higher tooth loss among the older age group people.
In the present study, females had fewer missing teeth than males. Although similar observation was found in other studies,, a few studies have shown female predominance , and also no difference in tooth loss., Self-consciousness to look beautiful, fear psychosis that losing teeth is a sign of aging, the negative impact of bleeding gums, and halitosis that might affect their personality and socialization encourage the women to maintain good oral hygiene. Females are also found to brush their teeth more regularly and utilize dental services more frequently than men, which might have resulted in less tooth loss among them.
The self-perceived oral health status and need for treatment are important factors that influence utilization of dental services. The low level of utilization of dental services suggests that people tend to overestimate their dental health and underestimate their need for care and those who underestimate their own dental care needs utilize the services less frequently.
Higher social class people showed less prevalence of tooth loss which was similarly reported in other studies also.,, They give little or no importance for the preservation of their teeth for the entire lifetime and prefer extraction over restoration.
The positive effect of cleaning the teeth with toothbrush twice daily resulting in greater tooth retention is consistent with the results of other studies.,, In this study, it was seen that tooth loss was higher among vegetarians compared to people with mixed diet. Two studies have evaluated the role of diet on tooth loss.,
Individuals, who consumed sugary snacks/drinks ≥5 times between meals, had higher tooth loss compared to individuals with no or ≥4 such exposures. A study showed that the number of missing teeth was associated with age, toothbrushing, and greater frequency of daily sugar exposure, supporting the fact that frequent consumption of sugary snacks and/or drinks between meals is associated with greater tooth loss.
However, interestingly, there was no significant association found between smoking and tooth loss in the present study which is similar to a study conducted in Kadapa, South India.
Around 36% of the study population had utilized dental services in the past, and the most frequently reported reason for the dental visit was tooth extraction. This finding is in agreement with results obtained in previous research  but differs with other studies which have confirmed that nonusers of dental services had greater number of missing teeth.
The results of this study showed tooth loss with caries experience and attachment loss using an analytical model that controlled for the effect of age, SES, and smoking behavior. Tooth loss is significantly more likely in individuals who had two or more teeth with caries experience and/or attachment loss ≥5 mm. On the other hand, the findings may also suggest that caries experience and attachment loss are associated with increased risk for tooth loss in this population.
The strength of this study was that it used the WHO dentition status and loss of attachment (LOA) and followed multistage random sampling methodology. Several studies are reported on tooth loss prevalence, but there is scarcity in literature on rural population. Limitations of this study were short duration of the study, sample limited to only CHC, and further research is needed to investigate the tooth loss prevalence in larger sample size.
| Conclusion|| |
Tooth loss may be considered as the ultimate barometer of failure or success of dentistry and dental health programs. The risk indicators included in this study reflect aspects of a complex process whose outcome is the loss of one or more teeth, i.e., they document the characteristics of the individual losing teeth, rather than the characteristics of the teeth that are lost.
The present study provides an insight that age, gender, SES, habits of cleaning teeth, frequency of brushing teeth, time of brushing, dietary habits, visit to dentist, dental caries, and LOA are risk indicators for tooth loss among adult people visiting CHCs in Nellore district, Andhra Pradesh.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st
century – The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.
Susin C, Oppermann RV, Haugejorden O, Albandar JM. Tooth loss and associated risk indicators in an adult urban population from South Brazil. Acta Odontol Scand 2005;63:85-93.
Atieh MA. Tooth loss among Saudi adolescents: Social and behavioural risk factors. Int Dent J 2008;58:103-8.
Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: A systematic review and meta-analysis. Health Qual Life Outcomes 2010;8:126.
George B, John J, Saravanan S, Arumugham IM. Pattern of permanent tooth loss among children and adults in a suburban area of Chennai. Arch Oral Sci Res 2011;1:72-8.
Eklund SA, Burt BA. Risk factors for total tooth loss in the United States; longitudinal analysis of national data. J Public Health Dent 1994;54:5-14.
Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe tooth loss: A systematic review and meta-analysis. J Dent Res 2014;93 7 Suppl:20S-8S.
Jaleel BF, Nagarajappa R, Mohapatra AK, Ramesh G. Risk indicators associated with tooth loss among Indian adults. Oral Health Dent Manag 2014;13:170-8.
Deepthi A, Chandrasekhar Reddy V, Sudhir KM, Krishna Kumar RV, Srinivasulu S, Srinivas N. An epidemiological data of oral health status and treatment needs of rural population of Nellore district, Andhra Pradesh, India. J Indian Assoc Public Health Dent 2016;4:281-6.
Reddy PR, Reddy AS, 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.
Al Shammari KF, Al Ansari JM, Al Melh MA, Al Khabbaz AK. Reasons for tooth extraction in Kuwait. Med Princ Pract 2006;15:417-22.
Oral Health Status. National Oral Health Survey and Fluoride Mapping, 2002 2003. India: Dental Council of India, New Delhi; 2004.
Warren JJ, Watkins CA, Cowen HJ, Hand JS, Levy SM, Kuthy RA. Tooth loss in the very old: 13 15 year incidence among elderly Iowans. Community Dent Oral Epidemiol 2002;30:29-37.
Presson SM, Niendorff WJ, Martin RF. Tooth loss and need for extractions in American Indian and Alaska Native dental patients. J Public Health Dent 2000;60 Suppl 1:267-72.
Shah N, Parkash H, Sunderam KR. Edentulousness, denture wear and denture needs of Indian elderly – A community based study. J Oral Rehabil 2004;31:467-6.
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.
Kida IA, Astrøm AN, Strand GV, Masalu JR. Clinical and socio-behavioral correlates of tooth loss: A study of older adults in Tanzania. BMC Oral Health 2006;6:5.
Heft MW, Gilbert GH. Tooth loss and caries prevalence in older Floridians attending senior activity centers. Community Dent Oral Epidemiol 1991;19:228-32.
Klein BE, Klein R, Knudtson MD. Life-style correlates of tooth loss in an adult Midwestern population. J Public Health Dent 2004;64:145-50.
Tin-Oo MM, Saddki N, Hassan N. Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics. BMC Oral Health 2011;11:6.
Alves LS, Susin C, Damé-Teixeira N, Maltz M. Tooth loss prevalence and risk indicators among 12-year-old schoolchildren from South Brazil. Caries Res 2014;48:347-52.
Rao SR, Thanikachalam S, Sathiyasekaran BW, Vamsi L, Balaji TM, Jagannathan R. Prevalence and risk indicators for attachment loss in an urban population of South India. Oral Health Dent Manag 2014;13:60-4.
Adegboye AR, Fiehn NE, Twetman S, Christensen LB, Heitmann BL. Low calcium intake is related to increased risk of tooth loss in men. J Nutr 2010;140:1864-8.
Telivuo M, Kallio P, Berg MA, Korhonen HJ, Murtomaa H. Smoking and oral health: A population survey in Finland. J Public Health Dent 1995;55:133-8.
Gilbert GH, Duncan RP, Crandall LA, Heft MW, Ringelberg ML. Attitudinal and behavioral characteristics of older Floridians with tooth loss. Community Dent Oral Epidemiol 1993;21:384-9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]