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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 1-5

Periodontal indications for tooth extraction in the main general teaching hospital, Aden, Yemen: A prospective study


1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Aden University, Yemen
2 Department of Oral and Maxillofacial Surgery; Department of Periodontology; Faculty of Dentistry, Aden University, Yemen
3 Department of Periodontology; Department of Orthodontics; Aden University, Yemen
4 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Aden University, Yemen; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
5 Department of Orthodontics, Faculty of Dentistry, Aden University, Aden, Yemen

Date of Web Publication16-Mar-2018

Correspondence Address:
Dr. Hani Taher Hibatullah Ali
Faculty of Dentistry, Aden University, Aden
Yemen
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DOI: 10.4103/srmjrds.srmjrds_64_17

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  Abstract 

Objectives: The aim of this prospective cohort study was to investigate the incidence of periodontal diseases among different reasons of tooth extraction and its relation to age, gender, and site. Materials and Methods: This study included 450 healthy participants who aged between 18 and 80 years and underwent tooth extraction. Results: A total of 230 teeth were extracted due to periodontal diseases; the average number of extracted teeth due to periodontal disease increased with age and it was more in males than females; and posterior mandible is the most common site of extraction. Conclusion: Periodontal diseases were the most common causes of tooth extraction.

Keywords: Age, gender, periodontal disease, site and tooth extraction


How to cite this article:
Ali HT, Saleh HO, Noman AF, Moqbel AS, Allah AT. Periodontal indications for tooth extraction in the main general teaching hospital, Aden, Yemen: A prospective study. SRM J Res Dent Sci 2018;9:1-5

How to cite this URL:
Ali HT, Saleh HO, Noman AF, Moqbel AS, Allah AT. Periodontal indications for tooth extraction in the main general teaching hospital, Aden, Yemen: A prospective study. SRM J Res Dent Sci [serial online] 2018 [cited 2018 Apr 22];9:1-5. Available from: http://www.srmjrds.in/text.asp?2018/9/1/1/227768


  Introduction Top


Periodontal diseases are highly common among populations.[1] Epidemiological studies have shown variable distributions in various populations and have also revealed periodontal diseases to be the second greatest cause of tooth loss.[2]

Despite the progress made in modern dentistry, tooth extraction remains a complex problem for both the clinical dentist and the patient as it causes problems and dysfunction of the masticatory system. Furthermore, the number of extracted teeth might serve as an indicator of a patient's socioeconomic status and oral hygiene level.[3] Tooth loss results in poor dietary and deterioration of quality of life.[4] Therefore, it is important to investigate the reasons for permanent tooth extraction. Such information helps the dentistry community to come up with effective dental health policies.[3]

The main reasons for tooth extraction, in general, are dental caries, periodontal disease, the combination of dental caries and periodontal disease, accident injuries, orthodontic reasons, and impacted teeth.[4],[5]

The objectives of the present study were as follows:

  1. To assess the incidence of periodontal diseases among different reasons of tooth extraction in patients who underwent tooth extraction and aged from 18 to 80 years
  2. To investigate its correlation with age, gender, and site.



  Materials and Methods Top


Subjects

A study was conducted among 450 apparently healthy participants attending the oral and maxillofacial department and the external dental clinic at Algamhoria Main Public Hospital, Aden, Yemen, for tooth extraction because of various dental diseases over a continuous period from January 2014 to July 2014, which were extracted by undergraduate students under direct supervision of all authors, and included variables such as age, gender, and site of the patients were recorded.

Inclusion Criteria

  1. Patients aged between 18 and 80 years and indicated for permanent tooth extraction
  2. Patients who are free from any systematic disease
  3. A mean number of 20 natural teeth since large numbers of missing teeth might have interfered with the results of the present study
  4. Nonpregnant women.


Exclusion criteria

  1. Patients under the age of 18 years
  2. Patients with third molars
  3. Patients who had received scaling and root planning or periodontal treatment during the previous 6 months
  4. Patients nonconsented to the study.


Clinical examination

A complete clinical history was taken at the first visit, for collection of the following information: patients' age, sex, bad habits, intra- and extraoral examination, and identification of the tooth to be removed.

The teeth and gingiva were dried with compressed air while dental unit light was used as the light source for the inspections.

Measurements were carried out on each tooth with poor prognosis

  • The distance in millimeters from cementoenamel junction to the bottom of the gingival sulcus: Periodontal destruction was considered severe when 5 mm or more of clinical attachment loss (LAT) had occurred
  • The clinical grade of mobility: Each tooth was held firmly between the handles of two metallic instruments and an effort was made to move it in all directions. Only Grade III mobility was recorded
  • The clinical grade of furcation involvement (FINV) according to Glickman's classification (Grades I–IV): Only Grade IV FINV was recorded.


Statistical analysis

Data analysis was performed using the statistical program of SPSS Version 15.0 (Chicago: SPSS Inc.). The relative frequency (%) of all variables studied was obtained, and the correlation between them was assessed by the Chi-square test. The significance level was set at P ≤ 0.05.


  Results Top


In general, of the total number of teeth that were extracted (450), 230 teeth were extracted due to periodontal diseases, 149 were extracted due to dental caries, 71 were extracted due to other reasons, which means that the most common diagnosis for tooth extraction is periodontal disease (51.1%), followed by dental caries (33.1%) and other reasons (15.8%) such as orthodontic, prosthodontics, supplementary, malposed teeth, and over-retained primary teeth [Table 1].
Table 1: Prevalence of periodontal diseases among different reasons of tooth extraction

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Patients over 40 years of age were the most affected group who extracted their teeth due to periodontal disease (37.6%), and only 13.6% of patients who were under 40 years of age extracted their teeth due to periodontal disease. Patients under 40 years of age were the most affected group who extracted their teeth due to dental caries (25.1%), but only 8% of patients who were over 40 years of age extracted their teeth due to dental caries [Table 2]. Tooth extraction due to periodontal diseases was more in males (72.2%) than in females (27.8%) [Table 3].
Table 2: Association between age and different reasons of tooth extraction

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Table 3: Association between gender and periodontal diseases

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The most common location of teeth that were extracted due to periodontal diseases is the posterior mandible (33.5%) [Table 4].
Table 4: Association between location and periodontal diseases

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Posterior mandible is the most common site of extracted tooth due to periodontal diseases according to the criteria of extraction, which are clinical LAT (19.6%), bifurcation involvement (15.2%), and tooth mobility (23.5%) [Table 5], [Table 6], [Table 7].
Table 5: Association between location and severity of clinical attachment loss

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Table 6: Association between location and bifurcation involvement

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Table 7: Association between location and tooth mobility

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  Discussion Top


Extraction of teeth causes serious problems, imbalance, and dysfunction of the masticatory system. In Yemen, as similar to the rest of the world, the distribution of tooth extraction indications varies with time and treatment approach for each diagnosis.

In this study, the differences between tooth extraction reasons of the patient groups under and over the age of 40 years were presented. In general, periodontal disease appears to be the main reason for tooth extraction in a small number of previous studies, including the present study in which periodontal disease was the main reason for tooth extraction (51.1%), followed by dental caries (33.1%). A study in an Asian population [6] found that 35.8% of the extractions were due to periodontal disease and 35.4% due to dental caries.[7],[8]

Various studies notify higher periodontal destruction among males compared to the females.[9],[10] The reasons for these sex variations are not fully understood, but they are thought to be related to the ignorance of oral hygiene, which is usually spotted among males.[11] Albandar [2] showed an association between sex and loss of attachment in adults, with men having a higher prevalence and intensity of periodontal destruction than women, and he found that these gender differences have not been explored in detail but are thought to be more related to poorer oral hygiene, less positive attitudes toward oral health, and dental visit behavior among males than to any genetic factor. Men were more in using and dealing with bad habits such as smoking, qat,[12] and betel quid chewing and they were less in taking care and had less interest on the health of their mouth; on the contrary, females were more cautious on the health of their mouth and less dealing with these bad habits.

In the present study, tooth mobility, clinical LAT, and FINV were the master key criteria indicated to extract the periodontally affected teeth in the posterior regions, while the tooth mobility and clinical LAT were the sole causes of the tooth mortality and extraction in the anterior regions; we thought that it was the most logical and applicable criteria as it determined the functionally and strategically important position of the tooth in the jaws. Also, Our finding is in agreement with other studies which showed that the tooth mobility and FINV were confirmed as criteria of tooth mortality in the posterior teeth of the maxilla and mandible.[13],[14],[15],[16],[17]

Chrysanthakopoulos [3] studied that tooth mobility (M) (Grade III), severity of LAT (≥5.0 mm), and FINV (Grade IV) were the adopted criteria to indicate the extraction of periodontally affected teeth, and the sole reason of tooth mortality for anterior and posterior teeth of both maxilla and mandible.

In a study by Morita et al.,[18] caries was the main reason in the age group of 16 years and older; however, between the ages of 46–65 years, periodontal diseases were recorded as the main indication for tooth extraction. In addition, Quteish Taani [13] suggested that carries and its consequences are responsible for more tooth loss in patients <40 years of age while extraction because of periodontal problems increases with age and more commonly related to pocketing.

This study agreed with Hatem's [19] study that confirmed the trend that periodontal disease is the most frequent reason for tooth extraction in patients over 40 years of age as shown in previous studies, and we thought that age provides a proper time for the periodontal disease process to work and destruct the teeth.

According to the present study, posterior mandible followed by posterior maxilla was the most common site of extracted tooth due to periodontal diseases and we supposed that the posterior regions were responsible for chewing food and bad habit, and the tongue movement is less functionally in posterior region and this helps the formation of pocket.[8]


  Conclusion Top


  1. Periodontal diseases were the most common causes of tooth extraction and increased with age, followed by caries
  2. The more frequently extracted teeth due to periodontal disease were the posterior teeth of the mandible, followed by the maxilla and the number is more in male than female
  3. Severity of clinical LAT, tooth mobility, and FINV were reliable criteria to indicate extraction in periodontally affected teeth.


Recommendations

We recommended that further studies should join the clinical and the radiographical status to reach the predictable criteria of tooth extraction in periodontally affected teeth.

Strengths and limitations of the study

The sample of this study was explained as a cohort prospective, according to previously defined inclusion criteria and gathering the final sample of 450 patients tooth. Therefore, this study had well counts on a well-documented sample in a considerable long term, ensuring reliable data of the included variables, while limitation of our study results from the absence of reliable measurements including radiograph and other limitations was the lack of periodontal disease risk factors which lead to extraction such as plaque formation, bruxism, and others.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Susin C, Dalla Vecchia CF, Oppermann RV, Haugejorden O, Albandar JM. Periodontal attachment loss in an urban population of Brazilian adults: Effect of demographic, behavioral, and environmental risk indicators. J Periodontol 2004;75:1033-41.  Back to cited text no. 1
[PUBMED]    
2.
Albandar JM, Rams TE. Global epidemiology of periodontal diseases: An overview. Periodontol 2000 2002;29:7-10.  Back to cited text no. 2
    
3.
Chrysanthakopoulos NA. Periodontal reasons for tooth extraction in a group of Greek army personnel. J Dent Res Dent Clin Dent Prospects 2011;5:55-60.  Back to cited text no. 3
[PUBMED]    
4.
Caldas AF Jr. Reasons for tooth extraction in a Brazilian population. Int Dent J 2000;50:267-73.  Back to cited text no. 4
    
5.
Matthews DC, Smith CG, Hanscom SL. Tooth loss in periodontal patients. J Can Dent Assoc 2001;67:207-10.  Back to cited text no. 5
    
6.
Ong G. Periodontal reasons for tooth loss in an Asian population. J Clin Periodontol 1996;23:307-9.  Back to cited text no. 6
    
7.
Reich E, Hiller KA. Reasons for tooth extraction in the Western states of Germany. Community Dent Oral Epidemiol 1993;21:379-83.  Back to cited text no. 7
    
8.
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;7:59-62.  Back to cited text no. 8
    
9.
Meisel P, Reifenberger J, Haase R, Nauck M, Bandt C, Kocher T, et al. Women are periodontally healthier than men, but why don't they have more teeth than men? Menopause 2008;15:270-5.  Back to cited text no. 9
    
10.
Slade GD, Spencer AJ. Periodontal attachment loss among adults aged 60+in South Australia. Community Dent Oral Epidemiol 1995;23:237-42.  Back to cited text no. 10
    
11.
Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999;70:30-43.  Back to cited text no. 11
    
12.
Ali AA. Qat habit in Yemen society: A causative factor for oral periodontal diseases. Int J Environ Res Public Health 2007;4:243-7.  Back to cited text no. 12
    
13.
Quteish Taani DS. Periodontal reasons for tooth extraction in an adult population in Jordan. J Oral Rehabil 2003;30:110-2.  Back to cited text no. 13
    
14.
Chestnutt IG, Binnie VI, Taylor MM. Reasons for tooth extraction in Scotland. J Dent 2000;28:295-7.  Back to cited text no. 14
    
15.
Aida J, Ando Y, Oosaka M, Niimi K, Morita M. Contributions of social context to inequality in dental caries: A multilevel analysis of Japanese 3-year-old children. Community Dent Oral Epidemiol 2008;36:149-56.  Back to cited text no. 15
    
16.
Da'ameh D. Reasons for permanent tooth extraction in the North of Afghanistan. J Dent 2006;34:48-51.  Back to cited text no. 16
    
17.
Moreira CH, Zanatta FB, Antoniazzi R, Meneguetti PC, Rösing CK. Criteria adopted by dentists to indicate the extraction of periodontally involved teeth. J Appl Oral Sci 2007;15:437-41.  Back to cited text no. 17
    
18.
Morita M, Kimura T, Kanegae M, Ishikawa A, Watanabe T. Reasons for extraction of permanent teeth in Japan. Community Dent Oral Epidemiol 1994;22:303-6.  Back to cited text no. 18
    
19.
Hatem AE. Epidemiology and risk factors of periodontal disease. Periodontal Diseases-A Clinician's Guide. Rijeka: InTech; 2012. p. 213-30.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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