Causes for Tooth Extraction

8/13/2019 Causes for Tooth Extraction

1/31

WHAT ARE THE CAUSES FOR TOOTH EXTRACTION?

A PROJECT REPORT PRESENTED

BY

S.R. GUNAWARDANE

(D/07/023)

D.M.J.H. DISSANAYAKE

(D/07/017)

D.E.N. ALWIS

(D/07/001)

To the Division of Community Dentistry

Faculty of Dental Sciences

In partial fulfillment of the requirement

For the award of degree of

Bachelor of Dental Sciences

Of the

UNIVERSITY OF PERADENIYA

SRI LANKA

2013


2/31

i

CONTENT PAGES

Chapter Pages

01. Introduction 0101.1. General Introduction 01

01.2. Research Background 02

01.3. Problem Justification 02

01.4. Literature Review 03

01.5 Objectives 04

01.5.1. General Objective 04

01.5.2. Specific Objective 0402. Methodology 05

02.1. Research Questions 05

02.2. Study Design 05

02.3. Study Area 05

02.4. Inclusion and Exclusion Criteria 05

02.5. Study Population 05

02.6. Instruments Used for the Study 06

02.7. Pilot Study 06

02.8. Data Collection 06

02.9. Analysis of Data 06

03. Results 09

03.1. Socio- Demographic Data of the Study Population 09

03.3. Association of Causes of extraction with Socio- Demographic Data 10

05. Discussion 17

06. Conclusion 21

07. Limitation 22

08. Recommendation 23

References 24

Annexure 25


3/31

ii

LIST OF FIGURES

Figure 01 - Distribution of reasons for tooth extractions varied in different age groups

Figure 02 - Distribution of total extraction and tooth type with Residence

Figure 03 - Distribution of Causes of extraction with Residence

Figure 04 - Distribution of tooth extraction in different age groups in rural & urban area

Figure 05 - Distribution of reasons for tooth extraction with the level of education

Figure 06 - Distribution of causes for extraction and economical state

LIST OF TABLES

Table 01 - Reasons for tooth extractions. Results of nationwide studies.

Table 02 - Number and percentage of teeth extractions according to age groups

including the proportions of male and female.

Table 03 - Number and percentage of extractions for different reasons for all patients

& to male & female

Table 04 - The relationship between tooth type and the causes of tooth extraction

Table 05 - The relationship between the causes of extraction and residence

Table 06 - Relationships of causes of extraction with Ethnicity


4/31

iii

LIST OF ABBREVIATIONS

WHO World Health Organization

FDI International Dental Federation

Dev. Developmental Reasons

LOF Lack of facilities to preserve the tooth

Ortho Orthodontic reasons

Perio Periodontal reasons

Prosth Prosthetic reasons

R Rural

U Urban

LA Lower anterior

LP Lower posterior

UA Upper anterior

UP Upper posterior

OPD Outer Patient Division

DF Degree of Freedom


5/31

iv

ABSTRACT

A cross sectional study was conducted to survey the extractions of permanent and

deciduous teeth in Matale, Kurunegala, and Polonnaruwa districts which may reflects the

pattern of oral diseases in Sri Lanka.

The study was conducted with a convenience sample of 206 subjects having 290

extractions from dental clinics of Teaching Hospital Kurunegala, District General Hospital

Matale, and General Hospital Polonnaruwa. The data were recorded by interviewing the

dentist and patients using a questionnaire form during two weeks duration including causes

of extraction (according to predefined classification) and socio- demographical data.

Percentage of six most common causes (caries and its sequale, periodontal

problems, eruption problems, prosthetic reasons, orthodontic reasons and other causes

which are mainly patient demand for extraction) and few less common conditions were

calculated by Minitab version 16, as a whole, separate for male, female, ethnicity, level of

education and economical state. Results show that overall 39.66% of teeth were extracted

due to advance dental caries where as 28.62% due to periodontal reasons. 11.38% due to

eruption problems, 7.59% for other causes which are mainly patient demand for extraction,

6.21% due to trauma, 2.41% due to developmental conditions, 2.07% for prostheticreasons and 1.38% for orthodontic purposes. It is noticeable 0.69% shows lack of facilities

to preserve the tooth.

The results of the study indicate that caries is the most frequent reason for tooth

extraction in younger population both in urban and rural population with number of

extractions due to periodontal reasons were increasing over 40 years of age.


6/31

What are the causes for tooth extraction?

Final BDS Part I Community Dentistry Project Report 1

Chapter 01

INTRODUCTION

1.1 General Introduction

Understanding the patterns and the causes for tooth loss is important for social, functional,

psychological and economic reasons. Dental diseases are major public health problem in

developing world which can be prevented and treated if diagnosed early. In developing

world preservative treatments such as restorations, endodontic treatments are expensive for

economically marginalized communities and extractions may be the easier alternative in

terms of finance and time.

So formulation of strategies and the planning of dental health service require the surveys

and studies investigating the reasons and patterns for tooth loss, in order to achieve WHO

(World Health Organization) goals of retaining at least 20 teeth at the age of 80 years in an

individuals mouth which has not been a chieved yet in many countries. [1]

Studies investigating the causes for tooth extractions have been carried out in many

countries, mostly in developed industrial Europe. [2] The result of those studies showed that

dental caries and periodontal diseases were the most common causes for tooth loss whichis presented in Table 1 [2] which is abstracted from Fouad K Wahab, A survey of reasons

for extraction of permanent teeth in Jordan.

Table 1 : Reasons for tooth extractions. Results of nationwide studies.


7/31



There seems to be an interesting variation in the order of causes of extractions among those

countries, while caries accounts for 60% of extractions in Finland, it is only 20.7% in

Germany. Also periodontal problems, the highest prevalence 38% was in Japan while the

lowest in New Zealand which is 10%.

While dental caries and periodontal disease are the most common reasons for tooth

extractions, age, gender, socio- economical and attitudinal characteristics tend to influence

the tooth loss of population. Studies have shown that subjects of low income and low

education are more prone to be edentulous than their counterparts. [3]

A study on correlation between gender and reasons for tooth extraction showed more teeth

loss in less educated rural male population. [4] Some studies reported that, people living in

rural areas have less access to dental services than urban which leads to accumulation of

tooth extraction demands in the rural population. [5]

1.2 Research Background

Limited number of studies was carried out in Sri Lanka to determine prevalence of oral

diseases. A study carried by Prof. Lilani Ekanayake and Dr. R. Perera about the tooth loss

in Sri Lankan adults shows the overall prevalence of tooth loss is high among Sri Lankan

adults which is 81.6%. [6] Few studies that have been done in the past to assess the reasons

for tooth extractions in Sri Lanka reported caries and periodontal reasons are the major

reason for tooth extraction. [6], [7]

This study also designed to understand the causes and patterns of extraction of permanent

and deciduous teeth in relation to socio demographic conditions in Sri Lanka with a

convenience sample of subjects from Matale, Kurunegala and Polonnaruwa districts.

1.3 Problem justification

Sri Lanka has a total population 20 million according to the WHO estimations. [11] 1375

dentists are working under ministry of health in 2012 and 200 dentists in full time working

private dental practices with dentist to population ratio is 1:15000. The study population

was consisting of three districts having total population of Polonnaruwa (358,984),

Kurunegala (1,460,265) and Matale (441,328). [8]


8/31



The study investigated for causes of tooth extractions were carried out during two week

period of duration in Polonnaruwa, Kurunegala and Matale districts, taking account the

patients age gender, e thnicity and socio demographical data. Furthermore this study

may give an indication about the level of oral hygiene, dental health awareness and an

insight in to magnitude of dental problems and their managements. Such data may also be

of value to the improvement of dental health care system in the country, hence the purpose

of this study.

1.4 Literature review

1) Tooth loss in Sri Lankan adultsPerera R, Ekanayake L.

The aim of this study is to determine the prevalence and correlation of tooth loss inSri Lankan adults.This is a descriptive cross-sectional study with the target population of adults above20 years of age in Colombo district Sri Lanka.

ResultsThe overall prevalence of tooth loss was 81.6% while 1.9% of the sample wasedentulous. The prevalence rates of tooth loss in the 20-39, 40-59 and >= 60 yearsold were 71%, 93% and 96%, respectively, while 0%, 1.5% and 11.4% wereedentulous in three groups.

2) Reasons for extractions in patients seen in Pak Field Hospital level 3Darfur, SudanAjmal Yousaf, Saad Mahmood, Nasrin Yousaf, Manzoor Ahmed Manzoor

This cross sectional study was conducted at Pak Field Hospital Level 3 DarfurSudan from Jan 2011 till May 2012 to find out the reasons for extractions of teethin UNAMID troops. 1500 patients from various countries were interviewed and

examined.

ResultsOverall 41.2% of the teeth were extracted due to advanced dental caries whereas34.8% due to periodontal disease, 12.04% due to impactions, 4.4% for prosthetic

purposes, 4.3% for orthodontic and 3.2% for other reasons. Advanced caries wasthe primary cause for extractions in male while impactions and orthodontic causeswere the main reasons. Highest numbers of teeth were extracted due to advancedcaries in patients from Nigeria (43.5%) and due to periodontal reason from patients

of Bangladesh (37.1%) and Nepal (37%).


9/31



3) Reasons for tooth extraction in urban and rural populations of SaudiArabia

Reghunathans Preethanath

An epidemiological survey was carried out to ascertain the reasons and the factorsthat contribute to dental extractions in a rural and an urban population of SaudiArabia. A total of 820 individuals (400 in an urban area and 420 in a rural area)aged between 20 and 80 years were included in the study.

ResultsCaries and its sequela were responsible for more tooth loss in younger age groupsin urban and rural population while extraction consequent to periodontal problemincreased with age. As far as the type of tooth extracted, the most frequentlyextracted were mandibular posterior teeth in rural areas (40.57%) and maxillary

posterior teeth in urban areas (56.0%) followed by maxillary anteriors (11.43%)and mandibular anteriors in rural areas (10.0%) respectively, which was statisticallysignificant. Extractions from periodontal problems were more common amongthose with only primary education while a high frequency of extraction fororthodontic purposes was noticed in urban females with primary education.However extractions from caries followed a uniform pattern in all groups withminimum number of individuals with secondary and tertiary level of education. Theobservations of the study indicate that caries is the most frequent reason for toothextraction in young population both in rural and urban populations. Extraction due

to periodontal reasons predominated in the age group above 40 years.

1.5 Objectives

1.5.1 General Objective

To survey the causes of tooth extraction of permanent and deciduous teeth in Matale,Kurunegala and Polonnaruwa districts which may reflect the patterns of oral diseases in SriLanka.

1.5.2 Specific Objective

To assess relationship according to

Gender Ethnicity Region Education level Economical state


10/31



Chapter 02

METHODOLOGY

2.1 Research Questions

Primary : What are the causes for tooth extraction?

Secondary : What is the relationship between causes of tooth extraction and certain

socio-demographic data? (Gender, Age, Ethnicity, Education Level, Economical

state)

2.2 Study Design

This is a cross sectional descriptive study.

2.3 Study Area

This study was undertaken in three public dental clinics in Kurunegala, Matale,

Polonnaruwa districts of Sri Lanka. Those were Teaching Hospital Kurunegala, District

General Hospital Matale, General Hospital Polonnaruwa which are under Ministry of

Health, Sri Lanka.

2.4 Inclusion and Exclusion Criteria

Inclusion criteria Patients who has undergone tooth extraction during period of 23 th July

2012 to 06 th August 2012 at Teaching Hospital Kurunegala, District General Hospital

Matale, and General Hospital Polonnaruwa.

Exclusion criteria Patients who has undergone tooth extraction at private dental clinics

on respected area.

2.5 Study Population

This study was implemented to survey the causes of tooth extraction of permanent and

deciduous teeth in Matale, Kurunegala and Polonnaruwa districts. Since the population was

large, it has selected a sample population of 206 patients with 290 extractions aged from 5-

74 years, attending to the dental OPD clinics at Teaching Hospital Kurunegala, District

General Hospital Matale, and General Hospital Polonnaruwa, with convenience sampling

method which is a non-probability sampling method.


11/31



2.6 Instruments Used for the Study

After taking informed consent patients data were recorded by survey team in to a

questionnaire form which was supervised and corrected by Prof. Lilani Ekanayake,

(Professor in Community Dentistry, Faculty of Dental Sciences, University of Peradeniya)including patients age, gender, ethnicity, socio - economic status, educational level.

The questionnaire was simply designed in order to take minimum time from the dentist

work hours.

2.7 Pilot Study

A pilot study was undertaken on 17 th June 2012 in dental clinic at Base Hospital

Katugastota in Sri Lanka. The purpose of the pilot study was to assess the suitability of the

survey instrument and the method used. Prepared questionnaire was tested in pilot study

and necessary changes were applied. Using this pilot tested questionnaire (Annexure No

01) the study was conducted in targeted districts.

2.8 Data Collection

The data were recorded by interviewing the dentist and patients using a questionnaire form

with the above experience. The survey was done between 9am 12am and 2pm 4pm on

each day of the survey period as the above period of time showed maximum amount of

patients.

2.9 Analysis of Data

The data was entered and analyzed using Microsoft Excel 2007 and Minitab version 16.

Percentages are shown by bar charts. Chi square test and Goodman Kruskal statistical test

are used to test the association between causes for tooth extraction and the selecteddemographic data.

Chi - Square test

Chi - Square test is a statistical test that can be used to test the association between

categorical variables.


12/31



Goodman Kruskal s Gamma statistical test

Goodman and Kruskal's gamma measures the strength of association of the cross tabulated

data when both variables are measured at the ordinal level. It makes no adjustment for

either table size or ties. Values range from 1 (100% negative association, or perfect

inversion) to +1 (100% positive association, or perfect agreement). A value of zero

indicates the absence of association.

P- Value

This determines the appropriateness of rejecting the null hypothesis in a hypothesis test by

representing the probability of incorrectly rejecting the null hypothesis (H 0) when it is

actually true.

When the significance level (alpha) = 0.05,

p -value > 0.05: Do not reject H 0 Vs. p -value < 0.05: Reject H 0

2.9.1 Dependent variables

The causes of tooth extraction were recorded according to the criteria, designed based on

those used by Ainamo et al [4], Chen et al [9]

Those were

1. Caries and its sequelsTeeth requiring extractions because of caries (initial or recurrent) and itsconsequences, extracted roots remnants where the crown was lost through car iesand teeth fracturing due to weakening by caries, failed root canal treatments andfractures of teeth weakened by endodontists.

2. Periodontal diseasesTeeth requiring extraction due to periodontitis including pain, loss of function.

3. TraumaTeeth extracted due to or as a result of trauma including mandibular fractures.

4. Eruption problemsPartially impacted and fully impacted teeth and those, which are characterized by

pericoronitis (persistent inflammation around third molar, which necessitatedremoval of one or all third molars)

5. Orthodontic treatmentsTeeth to be removed for orthodontic reasons


13/31



6. Prosthetic treatmentsTeeth to be removed for prosthetic reasons.

7. Developmental conditionsTeeth removed due to developmental conditions, supernumeraries and over retained

deciduous.

8. Lack of facilities to preserve the teethAlthough the teeth can be preserved by root canal treatment, it leads to extract theteeth due to lack of facilities.

9. Patient preference for extraction and other reasons Patients perceive d demand for extraction despite the tooth can be preserved or notand any other reasons which is not encompassed by one of the above category

Type of tooth extracted were recorded base on FDI (International Dental Federation)

classification.

2.9.2 Independent Variables

Gender Male, Female Age The subjects were grouped into eight aged groups from 70.

Education level Primary :- No education to Grade 5 school education Secondary :- Grade 5 to GCE A/L school Education Tertiary :- University or higher education

Economical state also classified into a scale according to their monthly gross

income as

Low :- Rs.30,000

Economical state for the population below 18 years of age was considered as their parents

or guardians income state. Education state of population below 5 year of age was

considered their parents or guardians education level.


14/31



Chapter 03

RESULTS

3.1 Socio - Demographic Data of the Study Population

Size of the sample : 206 Number of extractions : 290

According to District:o Kurunegala 77 (37.38%)o Matale 65 (31.55%)o

Polonnaruwa 64 (31.07%)

According to gender:o Male 83 (40.29%)o Female- 123 (59.71%)

According to ethnicity:o Sinhala 134 (65.05%)o

Tamil 27 (13.10%)o Muslim 45 (21.84%)

According to education level:o Primary 80 (38.83%)o Secondary 85 (41.26%)o Tertiary 41 (19.90%)

According to residence:o Rural 113 (54.85%)o Urban 93 (45.15%)


15/31


16/31



Age Group 70


17/31



Figure 2; shows the relationship between total extraction and tooth type and it alsorepresent relationship with residence (Urban or Rural).

Tooth TypeResidence

UPUA LPLA UR UR UR UR UR

20

15

10

5

0

T o t a l E x t r a c t

i o n

%

Relationship between total extraction and tooth type , Residence

Figure 2: Distribution of total extraction and tooth type , Residence

Lower posterior teeth are the most common tooth type which was extracted and upperanterior teeth are the least common tooth type in the study population. In relation toresidence lower anterior, lower posterior and upper posterior were most commonlyextracted in rural area than urban. In the green colour area indicate that the presence ofdeciduous and supernumeraries in extracted population.

According to the table 4; which represents the relationship between tooth type and thecauses of tooth extraction, lower anterior teeth were extracted due to periodontal reasons(18.1%) with more prevalence while upper anterior teeth due to traumatic reasons (5%).Lower posteriors were extracted due to caries as most common reason (23.8%) while upper

posteriors also the same (15.3%). Eruption problems reported equal percentage on bothupper and lower posterior with 5%. Lower posteriors shows the highest prevalence ofcauses of extraction (38.7%) and the second was lower anterior (19.6%) in study

population. Significant number of posterior teeth was extracted due to orthodontic. On theother hand commonest reason for extraction of the upper and lower posterior teeth wascaries.


18/31



LA LP UA UP All

Caries 1 0.36% 67 23.75% 3 1.06% 43 15.25% 114 40.42%

Developmental 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00%EruptionProblems 0 0.00% 15 5.32% 2 0.71% 16 5.67% 33 11.70%LOF 0 0.00% 0 0.00% 1 0.36% 1 0.36% 2 0.71%Orthodontic 0 0.00% 0 0.00% 0 0.00% 4 1.42% 4 1.42%Other 3 1.06% 12 4.23% 0 0.00% 7 2.48% 22 7.77%Periodontal 51 18.09% 12 4.23% 10 3.55% 10 3.55% 83 29.40%Prosthetic 0 0.00% 1 0.36% 1 0.36% 4 1.42% 6 2.13%Trauma 1 0.36% 2 0.71% 14 4.97% 1 0.36% 18 6.38%All 56 19.86% 109 38.58% 31 10.99% 86 30.50% 282 99.93%Table 6: The relationship between tooth type and the causes of tooth extraction

Rural Urban Total

Caries 60 20.69% 55 18.97% 115 39.66%Developmental 3 1.03% 4 1.38% 7 2.41%EruptionProblems 17 5.86% 16 5.52% 33 11.38%LOF 2 0.69% 0 0.00% 2 0.69%Orthodontic 2 0.69% 2 0.69% 4 1.38%Other 15 5.17% 7 2.41% 22 7.59%Periodontal 48 16.55% 35 12.07% 83 28.62%Prosthetic 4 1.38% 2 0.69% 6 2.07%Trauma 9 3.10% 9 3.10% 18 6.21%All 160 55.17% 130 44.83% 290 100.00%Table 7: The relationship between the causes of extraction and residence (Urban or Rural)

Rural population lost more teeth due to caries (20.7%) and periodontal reasons (16.6%)

than urban (18.9%, 1.9%) and this was more prevalent in rural females (21.9%) thanfemales in urban area (18.5%). Urban males presented with more prevalence in caries thanurban females (19.7%>18.5%). Difference between tooth loss due to caries and gender wasnot statistically significant.

Generally rural population lost teeth due to periodontal reasons (16.6%) more than urban population (12.1%) as seen in Figure 3:


19/31



Residence

T r a u

m a

P r o s t h

e t i c

P e r i o

d o n t

a l

O t h e

r

O r t h o

d o n t i c

L O F

I m p a

c t i o n

D e v e

l o p m e

n t a l

C a r i e

s U R U R U R U R U R U R U R U R U R

20

15

10

5

0

T o t a l E x t r a c t

i o n

%

Causes of extraction with Residence

Figure 3 : Distribution of Causes of extraction with Residence

Due to periodontal reason, rural women and urban women shows almost equal prevalent in

tooth loss. Urban women shows almost equal prevalent in tooth loss. Rural male lost moreteeth due to same reason than urban males (18.8%, 7.6%).

It is interesting in Figure 3 shows equal prevalent in urban and rural areas for orthodonticreason and trauma individually. Patients perceive demand for extraction and other factorswere more common in rural area than urban. (5.25%, 2.5%).

Concerning the distribution of tooth extraction according to age, the age group with mostextracted teeth was 31-40 years of age in rural population and 41-50 years in urban

population (Figure 4:). The result also indicated increase in tooth loss in 11-20 years of age

group in urban population than rural population which may be due to high amount ofsugary food intake in urban children. Tooth loss in rural area, the population above 40years of age shows great accrescence than rural area.


20/31


21/31



Education LevelResidence

TertiarySecondaryPrimaryUR UR UR

30

25

20

15

10

5

0

T o t a l e x t r a c t

i o n

%

Causes of tooth extraction with Level of Education

Figure 5: Distribution of reasons of tooth extraction with the level of education

Income S tateResidence

MIDLOWHIGHUR UR UR

30

25

20

15

10

5

0

T o t a l

E x t r a c

t i o n

%

Causes of tooth extraction with Income State

Figure 6: Distribution of causes of extraction and economical state


22/31



Chapter 04

DISCUSSION

Tooth loss is a fundamental to assessment of oral status in a given population. As untreateddental disease will ultimately end up in tooth loss, it could be considered as a crude

estimate of the oral health status of a given population. Prevention of tooth loss is an

important goal in oral health care provision due to the increased attention to its psycho-

social and functional consequences on the wellbeing of an individual. [10]

So for this study, patients who has undergone tooth extraction during period of 23 th July

2012 to 06 th August 2012, investigated for causes of tooth extractions in Polonnaruwa,

Kurunegala and Matale districts.

The study was conducted at OPD dental clinics of Teaching Hospital Kurunegala, District

General Hospital Matale, and General Hospital Polonnaruwa of Sri Lanka. The sample was

collected with the help of dental surgeons in respective districts. The number of subjects

identified and interviewed was 206 with 290 extractions.

Basic health Statistical data of Polonnaruwa district with a population of 358,984 are

approximately, 26 dental surgeons, 10 school dental therapists for one general hospital, 2 base hospitals, 8 district hospitals. In Kurunegala district with a population of 1,460,265

are approximately, 74 dental surgeons, 36 school dental therapists for one teaching

hospital, 4 base hospitals, 16 district hospitals. In Matale it was 441,328 approximate

populations, 25 dental surgeons, 12 schools dental therapists for one district general

hospital, 8 district hospitals. [8]

Out of 209 subjects 83 were males and 123 were females. The age range of the study

population was 05 74years and majority of them were between 21 50years age. Theeducational levels of the study population were not satisfactory as 80.09% of subjects have

not got tertiary (University of higher) level education, while 41.26% have only got

secondary education. Of the study population 65.05% were Sinhalese and 13.10% were

Tamils with 21.84% Muslims. Out of the sample 77 were from Kurunegala, 65 from

Matale and 64 from Polonnaruwa districts. They were lived in urban areas 45.15% with

majority of (54.85%) rural area.


23/31



For the purpose of assessing the causes for tooth extraction by interviewed

questioner was administered, which comprised of respective questions to the relevant

areas. The pathological reason for tooth extraction was recorded by interviewing the dental

surgeon and others were recorded with patient.

The survey team expected that the result of the present study may reflect the country as a

whole because it covers three major districts in Sri Lanka which represent similar socio-

demographic distribution respectively for the country. And this study involves the public

dental clinics that contain comprehensive facilities for wide varieties of treatment and to

which the majority of population can be easily accessible for their treatment needs. It is

believed that the present study therefore reflect the effect of socio- demographical factors

as well as patients personal attitudes bear on the treatment carried out by practicing dentist.

The correct classification of the causes of tooth extraction was crucial for the validity of

this study. Several factors were considered when formulating the system, which confirmed

as far as possible to previously used internationally defined criteria. [4], [9]

It is also important to remind that an extraction of teeth is not only based on disease relatedfactors. Studies showed that [12] it is substantially influenced by factors related to patient,dentist and environment. These factors may include the dentist philosophy of practice, his

experiences as well as patient demand and attitude for extraction and socio- demographicstatus of both patient and country. Even though the team tried to select centers withcomprehensive facilities to cover the demand of patients, it reveals that few situations werereported lack of facilities also leading to tooth extraction which may have possibilities to

preserve. It is an important find ing that previous studies werent indicated.

The observation of this study showed that, caries was the major cause of tooth loss in mostof the population, both in urban and rural communities with an increasing in age, theincidence to extract tooth due to periodontal reasons also increased. This is an agreementwith several other studies [3], [5] and the results of third national oral health survey. [10]

It is reported from third national oral health survey as revealed by the findingsapproximately quarter (23.41%) of 5-year-old children had deciduous teeth indicated forextraction due to extensive caries. Moreover, on average 0.64 deciduous teeth required to

be extracted among 5-year-olds. However, this figure rose to 2.75 when those who hadcaries only accounted for. Therefore, on average 5-year-old children with carious teethneeded 2.75 deciduous teeth to be extracted due to extensive caries. These findings suggesta notable burden of advanced dental caries with regards to deciduous teeth withimplications for intervention. From 12 years onwards the number of persons needingextractions and the number of teeth indicated for extractions increased and reached themaximum at 65-74 years. Adults and elderly reported a considerable need for tooth


24/31



extractions. For example, on average 3.38 teeth needed to be extracted among 35-44 year-old-adults and 4.48 teeth among 65-74 year-old- elderly who had caries respectively.

Concerning about the gender variation, although it wasnt significant with statistically ,females shows high frequency of caries than males. Most of the researchers and oral health

surveys also attributed this fact [3] that in general female teeth erupt earlier than males.Since they were at more risk to exposure risk factors than males, it is logical to assume thatfemale teeth are more viable to get caries.

The third national oral health survey indicated that Muslims need more extractions; [10] thisstudy shows Sinhalese with highest frequency of tooth extractions due to caries followed

by Muslims and Tamils. It is not confirmed by national oral health survey. This variationmay be due to convenience sampling method that used to choose the study sample whichlead to be selected with highest amount of Sinhala patients than others.

In the national oral health survey, components of periodontal disease measurement reflect both concurrent disease state and historical accumulation of the disease with resultantassociation with age. Hence, it is obvious to find the highest prevalence of this conditionamong elderly aged 65-74 years. And in overall there is a considerable burden of someform of periodontal disease among all age groups thus making a cause of concern forimprovements.

In this study population, periodontal problems were not the major cause of extraction in theyounger population. Since at that age, it is less often manifested. With an increase in age,the incidence of periodontal disease also increases, while the prevalence of caries reducesdue to stabilization of oral hygiene and nutritional habits. This study confirmed the trendthat periodontal diseases is the most frequent reason for tooth extraction in patients over 40years of age as shown in previous studies. [3]

Urban population shows high frequency of extractions due to orthodontic reasons andoverall orthodontic and prosthetics like advance dental treatments. High frequency of urban

population may suggest a positive motivation for such treatment and low frequency of rural population may suggest lack of knowledge and attitudes towards such treatment optionsand poor motivation from dentists working on rural area.

The study of rural population accounted with more extractions than urban population. Inrural area, the dental professionals mainly provide relief from dental pain by toothextraction rather than attempting any preservative treatment which would involve theretention of such teeth. Restoring teeth may not be in priority in rural area due to lack ofinformation, knowledge and resources. That may lead to rural population to get moreextraction than urban. The result also indicated increase in tooth loss in 11-20 years of agegroup in urban population than rural population which may be due to high amount ofsugary food intake in urban children.


25/31



The study shows small amount of patients recorded with extractions due to lack offacilities to preserve the teeth. Even though it was two patients from Polonnaruwa district,it indicated an inequality of resources distribution and maintenance for dental clinics.

Patients demand for tooth extractions also reported as noticeable frequency mainly in rural

areas. That may indicate the lack of health knowledge about modern dental treatments torural community. It may due to lack of facilities to access health education programme and

poor motivation from dentist working on respective area in relation to modern treatments.It may suggest there should be a strong effort to take reduces this burden. Therefore healtheducational and health promotional events should be carried out respective area withfocusing this matter. And the dentists who work on such areas should be educated andtrained to motivate patients towards restorations rather than extractions.

The survey team expected to have relationships with level of education and income state inrelation to causes of tooth extractions. But it is not represented with statistically significantdifferences. That may also be due convenience sampling method of sample selection andshort period of survey which is only two weeks duration. Since the team expected tosurvey the geogr aphic variation for causes of tooth extraction, it also couldnt fulfill due toabove shortages.

Concerning about descriptive analysis of level of education and income state indicated thatlow level of educations leads to more extractions than its counterparts. It is also indicatedhigh income level of population with minimum frequency of extractions that may be due totheir affordability for expensive preservative treatments and also they may have visited to

private dental clinics rather than public dental clinics where the survey was carried out.Efforts to preserve more natural teeth of the population should focus on the prevention andtreatment of caries and periodontal diseases. Besides the preventive measures, dentaleducation programmes for the population together with dental professionals needs to beimplemented, in the purpose of improving oral hygiene and insisting on conservativetherapy than extraction.

Since the survey team was not expected to record data relation to total number oftreatments carried out in respective dental clinics, it has noticed that number of extractionsis higher in relation to restorations. That may not be the expectations of dental profession.Therefore it is prefer to suggest carrying studies regarding above factor also which may

beneficial to make reliable grading for hospital dental services and clinics.


26/31



Chapter 05

CONCLUSION

This study was conducted to survey the causes of tooth extraction of permanent anddeciduous teeth in Matale, Kurunegala and Polonnaruwa districts which may reflect the

patterns of oral diseases in Sri Lanka.

The results of the study indicate that caries is the most frequent reason for tooth extraction

in younger population both in urban and rural population with number of extractions due to

periodontal reasons were increasing over 40 years of age.


27/31


28/31


29/31


30/31



Annexure


31/31

Acknowledgement

We express our heartfelt and sincere gratitude to Prof. Lilani Ekanayake, Professor inCommunity Dentistry, Division of Community Dental Health, Faculty of Dental Sciences

who guided us to bring out successful completion of our survey project. Were

really appreciate her attention towards us, though she was very busy at the

moment.

We thank Dr. Irosha Perera who was Consultant in Community Dentistry, Dental Institute;

Colombo gave professional advices and a great support to be successful with this project.

Also our gratitude extend to Mr. Ramesh Soyza, Department of Statistics & computer

sciences, Faculty of Science, University of Peradeniya for his helpfulness which given

us for statistical evaluations of this project.

Specially, our thanks goes to the Dental Surgeons and staff who actively participated

for the interview with lot of enthusiasm. Without their active participation, We willnot be able to collect unbiased data for this research.

Also our greatest gratitude goes to patients who actively participated for the

interview while having painful mouth. Without their support and participation, We will

not be able to collect unbiased data for this research.

Our special and heartfelt gratitude to our dearest parents without their blessings we maynot have been typing these words. Thank you for all that you have done for us.

We sincerely extend our gratitude to the staff members of the dental faculty library who

helped us to do this study successfully.

We also extend our gratitude to all our undergraduate fellows who helped us to do this

study successfully.

Documents

Causes for Tooth Extraction