|Year : 2020 | Volume
| Issue : 1 | Page : 30-34
Tooth loss, prosthetic status, and prosthodontic treatment needs of an Indian fishing community
Sumeet Bhatt1, G Rajesh2, Ashwini Rao2, Ramya Shenoy2, BH Mithun Pai2, Vijayendra Nayak3
1 Department of Public Health Dentistry, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India
2 Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka, India
3 Department of Oral Medicine and Radiology, Melaka Manipal Medical College, Melaka, Malaysia
|Date of Submission||30-Oct-2019|
|Date of Acceptance||23-Jan-2020|
|Date of Web Publication||11-Mar-2020|
Dr. G Rajesh
Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka
Background: The disadvantaged communities are often susceptible to poor oral health due to low incomes, lack of awareness, and low health-care utilization. Untreated dental diseases can lead to loss of teeth which may result in unmet prosthodontic needs. The present study assessed tooth loss, prosthetic status, and treatment needs of a fishing community in Mangalore, India. Materials and Methods: Oral examination of 400 individuals from a fishing community was done through a house-to-house cross-sectional survey using the World Health Organization oral health assessment form 1997. Data on demography, personal habits, and dental utilization were collected using a questionnaire. Results: The prevalence of tooth loss was 43%, and the mean number of missing teeth was 2.32 ± 5.21. More tooth loss was observed in older age groups and smokers. About 97% of the participants did not use any prosthesis, whereas it was needed in 23% in the maxillary arch and 33% in the mandibular arch. Prosthetic need was higher in older age groups. Majority of the participants had never visited a dentist before. Conclusions: Tooth loss was associated with age and smoking in this population. Utilization of oral health services was low, and prosthetic need was high. Targeted health promotion is recommended to prevent tooth loss and improve prosthetic status.
Keywords: Fishermen population, prosthetic status, prosthodontic need, tooth loss
|How to cite this article:|
Bhatt S, Rajesh G, Rao A, Shenoy R, Mithun Pai B H, Nayak V. Tooth loss, prosthetic status, and prosthodontic treatment needs of an Indian fishing community. SRM J Res Dent Sci 2020;11:30-4
|How to cite this URL:|
Bhatt S, Rajesh G, Rao A, Shenoy R, Mithun Pai B H, Nayak V. Tooth loss, prosthetic status, and prosthodontic treatment needs of an Indian fishing community. SRM J Res Dent Sci [serial online] 2020 [cited 2020 Jul 4];11:30-4. Available from: http://www.srmjrds.in/text.asp?2020/11/1/30/280378
| Introduction|| |
Oral health is the reflection of a person's general health and well-being. The World Health Organization (WHO) defines oral health as a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity. The presence of natural teeth is vital to the maintenance of good oral health and is important for proper functioning which includes chewing, speaking, and esthetics. The loss of teeth is an established risk factor for a number of comorbid diseases affecting the overall health of a person. Tooth loss has been linked to increased risk of coronary heart diseases, cerebrovascular diseases, certain cancers, and hypertension., Loss of teeth is also associated with decreased masticatory efficiency, and replacement of missing teeth by fixed or removable dentures decreases the chewing difficulties.
Tooth loss is considered an important indicator of oral health of a population and is, therefore, monitored in many countries. Although largely preventable, loss of teeth due to untreated dental caries and periodontal diseases is quite common in developing countries such as India. This is especially true in disadvantaged and lower socioeconomic status communities. Oral health is not considered a priority due to the lack of awareness or financial constraints and is often neglected to the point where only emergency treatment is sought for pain relief. At this point, the only option left is to extract the painful tooth, which leaves the person partially or completely edentulous. Prosthodontic treatment is usually avoided owing to the high cost of treatment and lack of dental insurance.
The fishermen population in India is one such disadvantaged group with generally low incomes and lack of access to dental care. Adverse habits which have a harmful effect on the oral health such as tobacco and alcohol consumption have been reported to be high in the fishermen population. With a coastline of 8129 km, 3827 fishing villages, and 14 million people employed in the sector, fishing in India is a major industry in its coastal states. Previous studies related to tooth loss among fishermen have been largely restricted to elderly populations. The present study is an attempt to assess the tooth loss, prosthetic status, and treatment needs in a fishermen community in Mangalore city, India.
| Materials and Methods|| |
A descriptive cross-sectional house-to-house survey was conducted among 400 individuals aged 18 years and above in Bengre area of Mangalore city. Bengre is located on the coast of Mangalore city and comprises mainly of fishermen population. There is no general dental insurance for the residents in this area.
The sample size was estimated based on expected prevalence of tooth loss in this population. Sample size calculation was done using the formula:
N = Z2pq/l2
where Z = 1.96, p = Expected prevalence of tooth loss (40%), q = 1−p (60%), and l = permissible error (5%). Based on this formula, the required sample size came out to be 368. This was rounded off to 400.
Before the commencement of the study, ethical clearance was obtained from the Institutional Ethics Committee of Manipal College of Dental Sciences, Mangalore. Data collection was done through a house-to-house survey. Before the examination, the nature of the study was explained to every individual in his/her language and informed consent was obtained from each study participant. The participants were assured that the oral examination poses no risk of any harm or discomfort. Confidentiality of information obtained during the course of the study was maintained at every stage of the study.
Inclusion criteria comprised all the available individuals aged 18 years and above who were involved in fishing or related businesses. Most of the adult men in this area are involved in deep-sea fishing, whereas women engage in onshore fishing and fish selling. Individuals not willing to take part in the study or those who were unable to open their mouths or patients with neurological impairment or debilitating conditions were excluded. Missing teeth were recorded using the M (Missing) component of Decayed, Missing, and Filled Teeth index. The M component comprised teeth missing due to caries in participants under 30 years of age and teeth missing due to caries or for any other reason in participants 30 years and older. Congenitally missing teeth were not included in the assessment. All the third molars were included in the study. During the course of the study, 11 individuals declined participation citing reasons such as lack of time and ill health.
After obtaining consent, assessment of tooth loss, prosthetic status, and treatment needs was done using the WHO basic oral health survey pro forma 1997. Particulars regarding demographic data, oral hygiene habits, personal habits, and past dental service utilization were collected through a pretested questionnaire. The oral examination of the participants was carried out in their houses in natural sunlight with the participant sitting on a chair. Examination was carried out beginning from the maxillary right quadrant and proceeding in a clockwise direction to the mandibular right quadrant. The whole procedure took approximately 10 min per participant.
The Statistical Package for the Social Sciences version 16 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. The level of significance for the present study was fixed at P < 0.05. A total number of participants with missing teeth in different age groups were compared done using the Chi-square test. A comparison of the mean number of missing teeth with other variables was done using the Chi-square test, independent t-test, and one-way analysis of variance.
| Results|| |
The study was conducted on 400 participants with a mean age of 39.7 ± 12.1 years. There were 215 (53.8%) men with a mean age of 40.43 ± 11.74 years and 185 (46.2%) women with a mean age of 38.84 ± 12.59 years [Table 1]. Majority of the participants in the study were Hindus (89.9%), followed by Christians (5.8%) and Muslims (4.3%).
|Table 1: Distribution of participants according to sociodemographic variables|
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Out of the total study population, 172 (43%) had missing teeth in their dentition. The mean number of missing teeth in this population was 2.32 ± 5.21. There was a statistically significant difference in missing teeth among various age groups. The proportion of participants with missing teeth increased with age. There was no statistically significant difference in missing teeth between men and women [Table 2].
|Table 2: Tooth loss status of the participants according to age and gender|
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Considering the tobacco and alcohol habits, smokers had significantly higher missing teeth than nonsmokers. Tobacco chewing, alcohol consumption, and brushing frequency did not show a statistically significant association with missing teeth [Table 3].
|Table 3: Distribution of participants based on mean number of missing teeth and tobacco, alcohol, and oral hygiene habits|
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Out of 400 study participants, 186 (46.5%) had never visited a dentist before. Among the visitors (n = 214), the major reason for dental visit was cited as “tooth removal” (63.5%), followed by “cleaning of teeth” (15.9%) and “filling” (12.1%) [Table 4].
[Table 5] shows the prosthetic status. About 97% of the participants did not have any prosthesis in either of the arches. An assessment of prosthetic needs showed that about 23% of the participants required prostheses in the upper arch and 33% in the lower arch. Age-wise comparison [Table 6] showed that prosthetic need, especially for multiunit and a combination of single and multiunit prostheses, was highest in older age groups (P = 0.001). This pattern was similar for both the arches.
| Discussion|| |
In the present cross-sectional study, we assessed the tooth loss, prosthetic status, and prosthodontic treatment needs of 400 participants from a fishermen community in Mangalore city. On comparing different age groups, a significant increase in missing teeth was observed with increasing age. Oral diseases are cumulative in nature and their effects tend to accumulate over time. This observation is consistent with previous studies.,, Although global trends show more prevalence and incidence of tooth loss in women,,, our study found no significant difference in missing teeth between men and women. This is similar to a study on young Brazilian adults which reported no differences between men and women with regard to tooth loss.
Smoking was found to be significantly associated with tooth loss. More missing teeth were observed in smokers than nonsmokers. Alcohol consumption and tobacco chewing showed no association with missing teeth in this population. Patil et al. reported a similar association between smoking and missing teeth among industrial workers in India. Smoking has a detrimental effect on periodontal health, and several studies have reported a strong dose-dependent association between tobacco smoking and the risk of tooth loss., Brushing frequency had no association with tooth loss in this sample. Patil et al. in their study on industrial workers also found no association between brushing frequency and tooth loss.
The prosthetic status of our study showed that 97% of the participants did not have any prosthesis. This is similar to previous studies which have reported that majority of the participants were not using a prosthesis., About 23% of the participants needed some sort of prosthesis in the maxillary arch, whereas 33% required a prosthesis in the mandibular arch. This is lower in comparison to the prosthetic need reported in some of the previous studies which may be mainly due to the fact that these studies were carried out in geriatric population,,, whereas our study included all the participants above 18 years of age. Tooth loss and subsequent treatment needs have been shown to be associated with age in this study. There is an accumulation of greater prosthetic need as the age advances.
In this study, about 46% of the participants had never visited a dentist before. This points to a low utilization of oral health services which is consistent with the utilization patterns in developing countries with low Human Development Index. Majority of the visitors (63.5%) consulted the dentist mainly for extraction of teeth. This indicates a problem-oriented approach to dental service utilization where treatment is sought only to relieve pain by getting the tooth pulled out. Another reason might be the cost of dental treatment. In general, tooth extraction is cheaper than restorations or root canal therapy and therefore preferred by low socioeconomic groups. Replacement of lost teeth is further avoided due to higher costs, lack of time, low oral health priority, and leaving the person partially or completely edentulous. The cost of dental treatment has been established as a major barrier in receiving dental care. In a study by Shigli et al., most of the participants gave financial reasons for not replacing the lost teeth. Money was reserved primarily for general health care rather than dental health care. This indicates low priority toward oral health.
One of the limitations of this study is its cross-sectional design. Systematic review and meta-analysis on global burden of tooth loss indicates that the prevalence and incidence of tooth loss is decreasing globally. It would be of interest to know the pattern of tooth loss in this population. A longitudinal cohort study is recommended to assess the changing trends in tooth loss, if any, among the fishermen. Second, the results of this study cannot be generalized to the vast fishermen population in India. The findings of this study can serve as the baseline for tooth loss, prosthetic status, and treatment needs of fishermen population in India.
Nevertheless, the results of our study highlight the gap in prosthetic status and treatment needs of fishermen community in Mangalore city. The study also reveals a poor utilization pattern of oral health services in this population. There is a pressing need for a multisectoral health promotion and intervention program to address this issue of increased demand for dental services among people who have limited financial resources. Furthermore, future studies should determine how best to overcome the barriers in seeking prosthetic care among the disadvantaged groups.
| Conclusions|| |
Tooth loss was associated with age and smoking in this sample of fishermen population. There was a low utilization of oral health services and consequently large unmet prosthodontic needs. The findings have important implications in formulating health policy for the equitable distribution of oral health resources among fishermen communities in India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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