0
CAUSES AND EFFECTS OF TOOTH LOSS AMONG PATIENTS
VISITING THE UNIVERSITY OF NAIROBI DENTAL HOSPITAL.
INVESTIGATOR;
MINNEH GATHONI KAMAU
V28\35580\2010
BDS LEVEL III
A COMMUNITY DENTISTRY RESEARCH PROPOSAL SUBMITTED IN PARTIAL
FULFILLMENT OF THE REQUIREMENT FOR THE BACHELOR OF DENTAL
SURGERY (BDS) DEGREE OF THE UNIVERSITY OF NAIROBI.
SUPERVISORS
INTERNAL
PROF. LOICE GATHECE
BDS.,MPH., PhD. (Nbi)
DEPARTMENT OF PERIODONTOLOGY/COMMUNITY AND PREVENTIVE DENTISTRY
SCHOOL OF DENTAL SCIENCES .
1
UNIVERSITY OF NAIROBI .
EXTERNAL.
DR.JAMES MURIITHI NYAGA
BD., MDS., (Nbi)
LECTURER DEPARTMENT OF CONSERVATIVE AND PROSTHETICS DENTISTRY.
SCHOOL OF DENTAL SCIENCES .
UNIVERSITY OF NAIROBI.
DECLARATION AND SUBMISSION FOR APPROVAL.
I MinnehGathoniKamau hereby solemnly declare that this is my original proposal for a research
project and that it has not been submitted to any other university. I wish to submit the proposal to
the Kenyatta National Hospital/University of Nairobi Research ethics and standards committee
for approval.
Signed………………………… Date……………………………..
SUPERVISORS APPROVAL.
This proposal has been submitted with our approval as University of Nairobi supervisors.
PROF.GATHECE LOICE
BDS.,MPH.,PhD.(Nbi)
DEPARTMENT OF PERIODONTOLOGY/COMMUNITY AND PREVENTIVE DENTISTRY
SCHOOL OF DENTAL SCIENCES .
2
UNIVERSITY OF NAIROBI .
Signed…………………….. Date…………………………..
DR.JAMES MURIITHI NYAGA
BDS.,MDS., (Nbi)
LECTURER DEPARTMENT OF CONSERVATIVE AND PROSTHETICS DENTISTRY.
SCHOOL OF DENTAL SCIENCES .
UNIVERSITY OF NAIROBI.
Signed……………………… Date……………………………
3
TABLE OF CONTENTS
SUPERVISORS............................................................................................................................. 0
DECLARATION AND SUBMISSION FOR APPROVAL. ..................................................... 1
LIST OF ABBREVIATIONS ...................................................................................................... 4
SUMMARY ...................................................................................... Error! Bookmark not defined.
1.0 INTRODUCTION................................................................................................................... 5
1.1JUSTIFICATION OF RESEARCH . ..................................................................................... 6
1.2 GENERAL OBJECTIVE . .................................................................................................... 7
1.3SPECIFIC OBJECTIVES . .................................................................................................... 7
2.0 LITERATURE REVIEW. ..................................................................................................... 7
2.1 STATEMENT OFRESEARCH PROBLEM . .................................................................... 10
2.2 HYPOTHESIS . .................................................................................................................. 10
3.0 METHODOLOGY . ............................................................................................................. 10
3.1STUDY DESIGN . ............................................................................................................... 10
3.2 STUDY AREA . .................................................................................................................. 10
3.3 STUDY POPULATION . ................................................................................................... 11
3.4 SAMPLE SIZE . .................................................................................................................. 11
3.5 INCLUSION CRITERIA . .................................................................................................. 11
3.6 EXCLUSION CRITERIA . ................................................................................................. 11
3.7 TOOLS AND TECHNIQUE OF COLLECTION OF DATA . .......................................... 12
3.8 ETHICAL CONSIDERATIONS . ...................................................................................... 12
4.0 BUDGET AND TIME FRAME. .......................................................................................... 14
4
4.1 BUDGET . ........................................................................................................................... 14
4.2TIME FRAME . ................................................................................................................... 14
5.O REFERENCES . ................................................................................................................. 15
6.0APPENDIX I .......................................................................................................................... 17
7.0 APPENDIX II . ...................................................................................................................... 19
8.0 APPENDIX III ...................................................................................................................... 20
LIST OF ABBREVIATIONS
UONDH…………….University of Nairobi Dental Hospital
WHO………………..World Health Organization .
5
ABSTRACT
BACKGROUND;There are some factors that lead to tooth loss and some effects that occur due
to the loss of tooth loss.There is little known about the causes and effects of tooth loss in the
country.Tooth loss affects the oral health related quality of life .
OBJECTIVE;To determine the causes and effects of tooth loss among patients visiting the
UONDH.
STUDY DESIGN;A descriptive cross sectional study that is hospital based .
STUDY AREA;The University of Nairobi Dental Hospital along ArwingsKodhek Road.
METHODOLOGY;The study participants will comprise of 117 prostheticpatients .Seventy
one completely edentulous and fourty six partially edentulouspatients. Self-administered
questionnaires will be used to collect data to those who have qualified the inclusion criteria.Data
will be analyzed using computer aided methods SPSS and MS EXCEL .
PERCIEVED BENEFIT, The results of this study willbe used to educate the dentists on the
effects and causes of tooth loss and encourage them to give the best dental treatment to improve
quality of life to the population.
CHAPTER ONE
1.0 INTRODUCTION.
Edentulousness is the loss of teeth and can either be partial or complete where partial
edentulousness involves loss of some teeth whereas complete involves loss of all the teeth .A
study done in Palermo,1Italy showed that complete edentulousnesswas present in 4.6% of the
population while partial edentulousness was present in 60.6% of the population.Another study
6
done in India2showed that 15.6% were completely edentulous and 54.7% were partially
edentulous.
Causes of edentulousness are diverse and may include dental caries,periodontal
diseases,extractions that could be as a form of traditional practices or due to removal of 3rd
molars,orthodontic treatment or trauma.A study done in 20123 showed that of the 62% of the
tooth loss in the USA dental caries topped as the cause of tooth loss with 37.4% followed by a
combination of periodontal disease and dental caries with 12.2%.Another done in Nigeria
4showed that the mean tooth loss was 4.5+\-7.6 and the major cause of tooth loss was periodontal
diseases with 98.7% then dental caries 0.7% and trauma 0.6% .In Kenya a study done 5showed
that the mean number of missing teeth in the population was 1.60 .Among those with missing
teeth the mean number of missing teeth was 3.35.Dental caries was the commonest cause with
52.6% followed by periodontal diseases at 27.6%,extractions as a form of traditional practices
accounted for 12.3%,orthodontic treatment 2.2% and trauma 2.0%.
Effects of tooth loss include loss of width and height of bone leading to facial changes and may
lead to social effects .Loss of teeth lead to drifting and supra eruption of the adjacent teeth that
may cause orthodontic problems as well as affect the aesthetics of the patient .These changes
may affect the prospects of future replacements .Other effects include alteration of speech and
how one eats and clinical effects may be experienced where other teeth may get affected
depending on how the extraction was done .
Aim of the research is to determine the causes and effects of tooth loss.The research will benefit
both the dental students and patients by helping them understand tooth loss causes and effects
and motivating dentists to give the best treatment possible.
1.1JUSTIFICATION OF RESEARCH .
Little is known about the causes and effects of edentulism in Kenya .This research will help in
determining the causes and effects of tooth loss among patients visiting the UONDH prosthetic
clinic .It will also benefit dental practisioners by helping them understand the problem and
motivate them to give the best dental treatment to improve the quality of life .
7
1.2 GENERAL OBJECTIVE .
To determine the causes and effects of tooth loss among edentulous patients visiting the UONDH
.
1.3SPECIFIC OBJECTIVES .
1. To determine the causes of tooth loss among edentulous patients visiting the UONDH .
2. To determine the effects of tooth loss among edentulous patients visiting the UONDH .
CHAPTER TWO
2.0LITERATURE REVIEW.
Edentulousness is defined as the condition of having no teeth.It can be classified as partial or
complete where partial edentulousness is loss of some teeth and complete is the loss of all
teeth.Tooth loss is high among adults17
.Astudy done showed that among the patients that
attended the prosthetic clinic during that time 58.9% of the patients were completely edentulous
and 41% were partially edentulous12
.Tooth extractions are among the various treatment
procedures done in hospitals with a total of 33.4% 15
and 12.3%13
in studies done in
Nigeria.Tooth loss can be due to a number of reasons that include dental caries ,periodontal
diseases ,traditional practices ,orthodontic treatment ,disimpactions ,prosthetic reasons and tooth
in fracture line .
Of the various causes of tooth loss,dental caries is the leading cause in all age groups and in all
teeth types except for the incisors19
.Dental caries is defined as a multifactorial disease that leads
to the demineralization of the tooth surface. In a number of studies done caries had the highest
8
prevalence with20.8%12
56.4%13
32.6%15
.Highest proportion of extraction due to caries occurred
between 21-30 years of age10
.More females lose their teeth due to dental caries12
.Most frequent
extracted teeth due to caries are the molars in particular the first permanent molars with the
Mandibular molars being mostly affected followed by the maxillary first molars11
.Extractions
due to caries tend to increase posteriorly10
.
Periodontal diseases are the second leading cause of tooth loss with the prevalence of 24.6%13
and 11%12
in previous studies .The clinical manifestation of the periodontal disease leading to the
tooth loss includes the furcation involvement, periodontal pocket and tooth mobility .Presence of
initial attachment loss bone height and habit of smoking increase the risk of tooth
mortality.There is a strong correlation between smoking the severity of periodontal disease and
tooth mortality.More recent epidemiological data seem to suggest an increase of tooth loss due to
periodontal reasons rather than caries9.A cross sectional survey reported that lower anterior teeth
were most frequently extracted due to periodontal disease followed by upper anteriors and upper
second molars9.However another study showed that maxillary teeth were lost more than
mandibular teeth especially the maxillary left central incisor followed by the right central
incisor11
.Extractions due to periodontal disease occurred between 41-50 years10
and 51-60
years11
.Extractions of periodontal disease tend to increase anteriorly10
.More males lost their
teeth due to periodontal disease12
.
According to other studies ,there are other reasons that led to tooth loss which includes failed
rootcanal treatment which accounted for 1.5% ,orthodontic treatment needs 1.2% ,extractions of
teeth in fracture line 1.0% ,dental trauma 0.6% ,extraction of supernumeraries 0.4% and
extractions due to prosthetics 0.2%15
.A great number of variables are associated with tooth loss
but there is no consensus whether dental disease related or socio-behavioural factors are most
important risk factors12
.Age is strongly related to every measure of tooth retention and tooth
loss6.The mean number of teeth lost increases with age
7.A study done showed that
institutionalized elderly people have in general more compromised oral health including fewer
teeth than those at the same age living freely7.Race and ethnicity was consistently related to these
measures after adjustment for age and gender6.Gender is also a risk factor,a study done showed
that more extractions occurred in females 62.3% and less in males37.7%14
.However females lost
their teeth due to caries as compared to males who lose their teeth due to periodontal
9
disease12
.Other risk factors include socio-economic status ,habits such as cigarette smoking and
caries experience8.
There is a documented decline of edentulism in general .However there existsgreat differences in
prevalence between countries ,between geographical regions,within countries and between
groups with various backgrounds7.There is an overall decline in the prevalence of tooth loss and
edentulism in USA over the past several decades6.A trend of decreasing incidence has also been
witnessed over the last decade7. However, the WHO goal of retaining at least 20 teeth at the age
of 80 years has not yet been met but is being approached in some countries7.
The loss of few or all natural teeth has been accepted as a handicapping condition for the aging
elderly people23
. Studies on self-perception have demonstrated that tooth loss is associated with
esthetic ,functional ,psychological and social impacts for individuals21
.According to a study done
by Vinayak and published in 2011, 23% of the subjects had difficulty accepting tooth loss, 64%
had no difficulty accepting tooth loss, and 13% were uncertain. The time taken for acceptance of
tooth loss was also different with 35% having accepted tooth loss immediately, 53% accepted it
within 6 months, 5% within 1 year, 3% required more than 1 year, and 4% have still had not
accepted the loss.The partial dentate group were more concerned about tooth loss than complete
edentulous patients.32% of subjects talked about tooth loss with others,60% talked to their
dentists ,55% talked to their friends ,31% talked to their spouses ,and 55% talked with their
family and relatives .25% of the subjects were not prepared for the effects of tooth loss ,70% felt
prepared ,and the rest had no answer .More than half the people who were unprepared for the
tooth loss felt that a consultation with the dentist along with education ,motivation ,and
awareness would have reduced their problems .A total of 96% did not feel any difference in their
confidence ,while the rest were indifferent .More than 50% of the subjects felt restricted with
their food choices and enjoyment of food23
.Position of lost teeth was associated to perceived
functional limitation.Perceived impacts were more frequent in women than men21
. People who
experienced difficulties in accepting their tooth loss were more likely to feel less confident
,restrict food choice ,enjoy food less ,avoid laughing in public and avoid forming close
relationships than those people with no difficulties with accepting tooth loss20
.This shows that
tooth loss has an effect on the oral health related quality of life24
.
10
Tooth loss can be corrected through various ways.For complete edentulous cases complete
dentures are fabricated and used to correct edentulousness .They can be implant supported or
implant retained and supported .Partial edentulousness is corrected through implants crowns
supported ,fixed bridges and removable partial dentures.The patient can also decide to have no
treatment done .Although patients usually expressed prosthodontic treatment needs ,clinical and
financial issues are determinant factors for tooth replacement21
. Financial limitation was
considered the most important factor that restricted access to treatment21
.
2.1 STATEMENT OFRESEARCH PROBLEM.
Edentulism has several causes and the two leading causes are dental caries and periodontal
disease.Edentulism affects the quality of life.It has functional limitations.One has difficulty in
speech and trouble pronouncing.It lowers the self confidence of a person as well as alter their
self image some even do feel embarrassed.It alters the socialization of a person and the forming
of close bonds.One is limited to the choice of foods and this leads to a compromised nutritional
status in some of these patients and their general health status is affected too.
2.2HYPOTHESIS.
Edentulousness has negative effects on patients visiting the UONDH.
CHAPTER THREE
3.0 METHODOLOGY.
3.1STUDY DESIGN .
This will be a descriptive cross sectional study .
3.2STUDY AREA .
This study is to be conducted in the prosthetic clinic in the university of Nairobi Dental
Hospital.TheUONDH is situated opposite the Nairobi Hospital and Lee Funeral home.It is
situated along the ArwingsKodhekRoad.
11
3.3 STUDY POPULATION.
The study will be conducted among both the partially and completely edentulous patients visiting
the UONDH.
3.4 SAMPLE SIZE .
The sample size will be computed using the following formula;
N=Z2[P(1-P)]
C2
Where;
N=sample size
Z=Zvalue=1.96
P=prevalence of completelyedentulous=15.6%
C=1-prevalence
Population for completely edentulous=71
Z=Z value=1.96
P=prevalence of partially edentulous=54.7%
C=1- prevalence
Population for partially edentulous=46
Total population=117
3.5 INCLUSION CRITERIA .
All people who are either partially or completely edentulous.
3.6 EXCLUSION CRITERIA.
All people who are not partially or completely edentulous.
12
3.7 TOOLS AND TECHNIQUE OF COLLECTION OF DATA.
A questionnaire will be used to collect data.The questionnaire will be handed to the involved
participants ,those who will have fulfilled the inclusion criteria.An investigator will administer
the questionnaire and the answers will be noted with a tick on the corresponding column of the
survey.
3.8 ETHICAL CONSIDERATIONS.
Permission will be sought from the Kenyatta National University of Nairobi Research Ethics and
Standard Committee.Informed consent will be obtained from all the participants who make the
inclusion criteria.Patients will be assured of confidentiality of their answers and that the use of
information will be for research purposes only.
13
14
4.0BUDGETAND TIME FRAME.
4.1 BUDGET .
PROPOSAL
Number Unit cost Total
Printing 30 5 150
Binding 3 100 300
Modem 1 2000 2000
Flash disk 1 2000 2000
Total 4450
DATA COLLECTION .
Number Unit cost Total
Questionnaire 117 2 234
REPORT WRITING .
Number Unit cost Total
Printing 50 5 250
Binding 3 100 300
Total 550
Grand total 5234
SOURCE OF FUNDS………….self
4.2TIME FRAME.
Proposal writing and submission for approval………June
Data collection, analysis and report writing………..July-august
Submission of final report…………………………………….September\October
15
5.OREFERENCES .
1.Melilli D,Matranga D,Cassaro A,Pizzo G,Edentulousness and Prosthetic treatment needs in a
sample of adults of Palermo ,Italy.AnnIq Jan-Feb (1)69-81.
2.Ariga P,Bridgette A,Rangarajan V,J.M Philip,Edentuloussness denture wear needs of the
elderly in rural South India;Iran J Public Health 2012 41(7)40-43 .
3.Reddy N S,Reddy NA,Narendra R,Reddy SD;Epidemiology survey on edentulousness,J
Contemp Dent Pract 2012 Jul1;13(4)562-570.
4.TaiwoO.Juliana,Omokhoidon F,Pattern of tooth loss in an elderly population from Ibadan
Nigeria.Gerodontology vol23 issue 2Jun2006.
5.Sanya B,Nganga PM,Nganga RN,Causes and patterns of missing teeth among Kenyans.East
African Medical Journal 07/2004 81(6)322-5.
6.Marcus,S.E,Drury,T.F,Brown,L.J&Zion,Tooth retention and tooth loss in the permanent
dentition of adults:United States,1988-1991.Journal of Dental Research,75(spec No).684-695.
7.Frauke Müller1 ,Manuel Naharro
1 ,Gunnar E. Carlsson
2, What are the prevalence and incidence
of tooth loss in the adult and elderly population in Europe. DOI: 10.1111/j.1600-
0501.2007.0i459x 18 Jun 2007.
8.Susin C,Oppermann RV,Haugejorden O,Albandar JM,Tooth loss and associated risk indicators
in an adult urban population from south Brazil.ActaOdontol Scand. 2005 Apr;63(2):85-93.
9.Ong G.Periodontal disease and tooth loss,Int Dent J. 1998 Jun;48(3 Suppl 1):233-8 .
10.Jaafar N,Razak IA,Nor GM,Trends in tooth loss due to caries and periodontal disease by tooth
type.Singapore Dent J. 1989 Dec;14(1):39-41.
11.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 Jan-
Mar;7(25):59-62.
16
12.Shigli K,Hebbal M,Angadi GS,Relative contribution of caries and periodontal disease in adult
tooth loss among patients reporting to the Institute of Dental Sciences ,Belgaum
,India.Gerodontology. 2009 Sep;26(3):214-8.
13.OginniFO,Tooth loss in a sub-urban Nigerian populationcauses and pattern of mortality
revisited:Int Dent J. 2005 Feb;55(1):17-23.
14.Anyanechi C,Chukwuneke F,Survey of the reasons for dental extraction in eastern
Nigeria,Ann Med Health Sci Res. 2012 Jul;2(2):129-33.
15.Danielson OE,Chinedu AC,Oluyemisi EA,Bashiru BO,Ndubuisi OO, Frequency, causes and
pattern of adult tooth extraction in a Nigerian rural health facility:Odontostomatol Trop. 2011
Jun;34(134):5-10.
16.McCaul LK,Jenkins WM,Kay EJ,The reasons for the extraction of various tooth types in
Scotland: a 15-year follow up:J Dent. 2001 Aug;29(6):401-7.
17.Khazaei S,Firouzei MS,Sadeghpour S,Jahangiri P,Savabi O,Keshteli AH, Adibi P.Edentulism
and Tooth Loss in Iran: SEPAHAN Systematic Review No. 6:Int J Prev Med. 2012 Mar;3(Suppl
1):S42-7
18.Mamai-Homata E,Margaritis V,Koletsi-Kounari H,Oulis C, Polychronopoulou A,Topitsoglou
V. Tooth loss and oral rehabilitation in Greek middle-aged adults and Senior citizens;Int J
Prosthodont. 2012 Mar-Apr;25(2):173-9.
19.Manji F, Baelum V, Fejerskov O,Tooth mortality in an adult rural population in Kenya:J Dent
Res. 1988 Feb;67(2):496-500.
20.Davis DM, Fiske J,Scott B,Radford DR. The emotional effects of tooth loss in a group of
partially dentate people: a quantitative study:Eur J ProsthodontRestor Dent. 2001 Jun;9(2):53-7.
21.Teófilo LT,Leles CR Patients' self-perceived impacts and prosthodontic needs at the time and
after tooth loss:Braz Dent J. 2007;18(2):91-6.
22.Rodrigues SM,Oliveira AC,Vargas AM,Moreira AN,E Ferreira EF. Implications of
edentulism on quality of life among elderly:Int J Environ Res Public Health. 2012 Jan;9(1):100-
9.
17
23.AmitVinayakNaik1 ,*
and Ranjana C. Pai 2
Study of Emotional Effects of Tooth Loss in an
Aging North Indian Community: ISRN Dent. 2011; 2011: 395498.
24.Polzer I,Schimmel M,Müller F,Biffar R.Edentulism as part of the general health problems of
elderly adults;Int Dent J. 2010 Jun;60(3):143-55.
.
18
6.0APPENDIX I
CAUSES AND EFFECTS OF TOOTH LOSS AMONG PATIENTS VISITING THE UONDH .
QUESTIONNARE
Age(years)……….
Gender(m\f)…………………….
KEY
1.Dental caries 5.Prosthetic reasons
2.Periodontal disease 6.Traditional practices
3.Orthodontic treatment 7.Tooth in fracture line
4.Trauma 8.Failed RCT
1ST
QUADRANT
TOOTH 11 12 13 14 15 16 17 18
MISSING
CAUSE
2ND
QUADRANT
TOOTH 21 22 23 24 25 26 27 28
MISSING
CAUSE
3RD
QUADRANT
TOOTH 31 32 33 34 35 36 37 38
MISSING
CAUSE
4TH
QUADRANT
19
TOOTH 41 42 43 44 45 46 47 48
MISSSING
CAUSE
Effects of tooth loss
EFFECT YES NO I DON’T
KNOW
Difficulty in speech and trouble announcing.
Limitation to choice of food.
Totally unable to function.
Had to interrupt meals.
Being self conscious about having no teeth.
Being embarrassed as an appearance of having no teeth.
Felt life less satisfactory.
Difficulty doing usual jobs
Reduced participation in social activities.
Avoid smiling as being toothless.
7.0APPENDIX II .
Consent form
20
Dear Participant,
I am a third year student at the UON pursuing a bachelors degree in dental surgery.I wish to
request for your permission in a study that will be part of my degree work.Participation is purely
voluntary and you may withdraw from the study at any stage.
The study will involve letting me conduct an interview regarding the causes and effects of tooth
loss.You are free to ask any questions if you require any clarification.The purpose of the study is
to investigate the various causes and effects of tooth loss among patients visiting the UONDH.
There are no risks involved because the procedure is non invasive.Participation is voluntary and
the information will be treated with utmost confidentiality.The entire examination is free.
Investigator
Minneh Gathoni
I would therefore appreciate your consent by signing here below.
I Minneh Gathoni confirm that I have explained the relevant parts of my study to the participants
.
Signed…………. Date………………..
I hereby confirm that I have understood he relevant parts of the study and give consent to
participate .
Signed………… Date……………
8.0 APPENDIX III
FOMU YA KISWAHILI
Kwa Mhusika,
21
Mimi ni mwanafunzi wa mwaka wa tatu katika Chuo kikuu cha Nairobi.Nasomea shahada ya
Utabibu wa sehemu zinazohusika na meno.Nakuomba kwa unyenyekevu uwe mmoja wa
watakaonisaidia kukukamilisha masomo yangu.Utafanya hivyo kwa hiari yako na unaweza
kutamatisha uhusika wako katika hatua yoyote.
Baadhi ya mambo utakayo changia ni:
Mahojiano kuhusu sababu za watu kupoteza meno na madhara yanayofuatia
Kuniuliza swali lolote ikiwa hujaelewa
Kuhusika kwako hakutakabiliwana hatari yoyote.Mahojiano yetu yatatuhusu tu sisi na
hayatajuzwa wahusika wengine.
Mwanafunzi,
Minneh Gathoni
Nitashukuru ukinisaidia.
Sahihi…………………………………….
Tarehe………………………………………
Nimesoma na kuelewa nitakavyohusika na sahihi yangu ni kuwa thibitisho kuwa nitahusika .
Sahihi………………………………………..
Tarehe…………………………………………….