Journal of International Oral Health

ORIGINAL RESEARCH
Year
: 2019  |  Volume : 11  |  Issue : 5  |  Page : 304--308

Reasons for permanent teeth extraction in the United Arab Emirates


Raghad Hashim, Afraa Salah, Areej Hamid, Alaa Hamad, Kinda Slieby 
 Growth and Development Department, Ajman University, Ajman, United Arab Emirates

Correspondence Address:
Dr. Raghad Hashim
Growth and Development Department, Ajman University, P. O. Box 346, Ajman.
United Arab Emirates

Abstract

Aims and Objectives: The aims of this study were to investigate the primary reasons for extraction of permanent teeth and to assess its correlation with gender, age, and tooth type among patients treated in the two main dental colleges in United Arab Emirates (UAE). Materials and Methods: The study was conducted over 3 months; it consisted of 618 patients, aged 12–70 years, who underwent tooth extraction. There were 473 (70.7%) male and 181 (29.3%) female patients. Data retrieved were entered into excel database and analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 21. Results: A total of 979 teeth were extracted from 618 patients. Caries was the main reason for tooth loss (81.5%), whereas periodontal diseases and orthodontics reasons were responsible for 10% and 4.7% of extractions, respectively. The highest rates (94.5%) of extraction occur among those aged 31–40 years. A significant association was present between gender and the number of teeth extracted. Conclusion: The findings of this study identified dental caries as the main reason for tooth extraction among the studied population in UAE.



How to cite this article:
Hashim R, Salah A, Hamid A, Hamad A, Slieby K. Reasons for permanent teeth extraction in the United Arab Emirates.J Int Oral Health 2019;11:304-308


How to cite this URL:
Hashim R, Salah A, Hamid A, Hamad A, Slieby K. Reasons for permanent teeth extraction in the United Arab Emirates. J Int Oral Health [serial online] 2019 [cited 2021 Dec 3 ];11:304-308
Available from: https://www.jioh.org/text.asp?2019/11/5/304/267721


Full Text

 Introduction



Loss of teeth continues to be a major public health problem worldwide.[1] Oral health implies preservation of the permanent dentition for as long as possible to support the basic everyday functions such as mastication, speech, and aesthetics. In the sense of the dental profession when extraction is not the only option then it should ultimately be the last. Despite the progress in technical procedures, tooth extraction is one of the most widely performed procedures in dentistry today in many countries.[2] To improve oral health outcomes, it is quite essential to understand the reasons behind tooth extraction.[3]

Causes for tooth extraction had large geographical and cultural differences in different countries. Surveys of the reasons for tooth loss in different countries have been conducted and have created some controversy regarding whether caries or periodontal disease was the dominant reason for tooth loss and whether age differences were responsible for tooth loss. The main reason for overall tooth loss in the majority of previously conducted studies was dental caries.[4],[5],[6],[7] Some studies reported that periodontal disease was the main reason,[8],[9],[10],[11] whereas others found that caries and periodontal disease were equally responsible.[12],[13] By identifying the main risk indicators for tooth loss, it might be possible to limit future extractions and emphasize the vital role of prevention.

The lack of similar studies in the United Arab Emirates initiated the need for a research that reveals the hidden pattern of tooth loss in such a widely diverse multinational population, relating the findings to gender, age, and teeth type. The focus of this study is made on the patients attending the largest two main colleges of dentistry in the United Arab Emirates, and those are Ajman University (AU) and University of Sharjah (UoS), with the densest population of dental patients seeking a charge-free dental treatment from fourth, fifth, and internship student dentists under the supervision of highly qualified specialists, where extraction decision is made precisely valid by a multidisciplinary judgment by surgeons, prosthodontists, restorative dentists, and orthodontists as per the case reasonably requires, following the most recent guidelines in literature.

The aim of this study was to investigate the most common reasons for permanent teeth extractions in patients attending AU and UoS, to identify the most commonly teeth lost and to identify the exact reasons for this loss pattern that might act as a scaffold for any future plans under the vision of maximizing the life expectancy of permanent teeth and optimizing preventive measures for these vital patients’ populations.

 Materials and Methods



In this cross-sectional study, data were collected from patient’s record of two main universities in United Arab Emirates, namely AU and UoS, the selection of these two dental colleges was based on the fact that these colleges receive the largest number of patients in United Arab Emirates.

The study was approved by the Research Ethics Committees of both the universities (GD_2016_15; REC/16/05/01/S), respectively. Informed consents from all patients were obtained prior to participation. Random sampling was used as a method of selecting the existing files of patients who underwent tooth extraction during first semester of the academic year 2016–2017, the study took 4 months to complete. A total of 618 files met the criteria of selection. The exclusion criteria were deciduous tooth removal.

Surgical charts, progress sheets, and radiographs of all patients were checked to confirm the documented diagnosis. Data collected included gender, age, reasons for extraction, and type of teeth removed. Reasons for extraction were classified according to those described by Kay and Blinkhorn.[14] The reasons for extraction were analyzed for each tooth type in the maxillary and mandibular arch. Data were not divided into right and left quadrant as earlier studies have shown no differences in the rate of extraction for right and left sides of oral cavity.[15],[16]

The data were entered and analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics) software (Chicago, IL, version 21.0). The relationships of the categorical background variables, such as gender, age, and reasons of tooth extraction, were analyzed by chi-square test to evaluate the differences between the different variables, and the level of significance was set at P < 0.05.

 Results



This study included 618 patients who had undergone extractions at Ajman University Dental Clinics and University of Sharjah Dental Hospital. The total number and percentage of males were 437 (70.7%) and females 181(29.3%). [Table 1] showed the descriptive statistics with patient’s age range from 12 to more than 60 years. The highest age group and percentage were in group 30–39 years (35.0%) followed by 20–29 years (22.5%), whereas the lowest age was in group 12–19 years (around 0.8%).{Table 1}

The total number of teeth extracted was 979. Dental caries was a leading factor of all extractions for 797 (81.5%), whereas periodontal reasons were responsible for 10%. Orthodontic reasons were the next most common reason for tooth loss (4.7%). Male patients had experienced significantly higher level of tooth loss compared to females (P < 0.05). Although caries was responsible for most extractions, periodontal diseases were more common in females than that in males, moreover, orthodontic reasons were more prevalent among females. Although caries was the primary reason for tooth extraction among patients between 31 and 40 years of age (P < 0.05), orthodontic reasons were the common reasons for tooth loss in patients younger than 20 years. Contrarily, periodontal disease was the most common reason for tooth loss in patients above 50 years of age [Table 2]. The most frequently extracted teeth because of caries were the lower first and second molars (183, 23%) followed by upper first and second molars (157, 19.7%), whereas the upper and lower canines were the least frequently extracted (8, 1.0%). Lower incisors were most commonly extracted teeth for periodontal diseases, whereas upper and lower premolars were the teeth most frequently extracted for orthodontic reasons [Table 3].{Table 2}, {Table 3}

 Discussion



The results of this study showed that of the 979 teeth extracted for various reasons, caries was the leading reason for extractions accounted for 796 (81.5%) of the total teeth lost. Several studies conducted in different countries investigated the reasons for teeth extractions, which reported predominance of extractions because of caries, such as Saudi Arabia,[1],[17] Greece,[18] Iran,[3] Jordan,[19] Sudan,[20] Brazil,[21] Croatia,[22] Malaysia,[23] Kuwait,[24] Japan,[16] and South Wales.[25] However, Singapore and Germany had a lower percentage of tooth loss because of caries compared to the findings of this study, this observation might be attributed to many factors such as diet, socioeconomic background, level of dental awareness, and the availability of water fluoridation in these counties.[8],[13]

Periodontal diseases were found to be the second reason for tooth loss in this study with a number and percentage of 88 (10%), followed by orthodontic reasons 48 (4.7%), which is in agreement with other studies,[17],[19],[26] where they stated that periodontal disease is the second most common cause, followed by orthodontic treatment.

Significant gender difference was noted in this study. In our cohort, the majority of patients who had extraction were males (64.2%), this is in agreement with Yousaf et al.,[20] Chrysanthakopoulos and Vlassi,[18] Jafarian and Etebarian,[3] Peskersoy et al.,[27] Gossadi et al.,[17] which might be attributed to the fact that females are more concerned about their oral health.

However, this study is not in agreement with other studies where periodontal diseases were the main cause of extraction in patients older than 40 years. The observed difference in this study might be attributed to the variations in study designs or overrepresentation of certain age group or tooth type, which in return might affect the studied samples, in addition to patients and dental care providers’ approach toward the retention of teeth.[10]

Regarding tooth types and their indications for extractions, lower first and second molars were extracted most commonly due to caries (the main cause of overall extractions) with a percentage of 23.0%, whereas upper first and second molar accounted for the second most common extracted teeth because of caries with percentage of 19.7%, followed by upper premolar 16.6%. Canines both upper and lower were the least teeth to be extracted due to caries (1.0%). These findings are in agreement with many other studies conducted in Iran,[3] Saudi Arabia,[1] Croatia,[22] Kuwait,[24] and Kenya.[28]

These findings might be attributed to patient-related and tooth-related factors. Mandibular first molars are the first permanent teeth to erupt, which make them more susceptible to decay because of various factors. It is a well-known fact that first molars, which erupted in mix dentition are most likely to decay than others, success rates of endodontic treatment are relatively lower compared to that of the single root teeth, and periodontal care of posterior dentition turn to be much more challenging in certain age groups.[15],[29] However, the molar teeth morphology with the presence of the deep pit and fissures in the occlusal surfaces tends to encourage the debris, food remnants, acid, and bacteria to accumulate in these areas where an improper cleaning and negligence promote decay process to occur more readily.

Teeth extracted because of periodontal disease were highly prevalent among lower anterior teeth with a percentage of 28.5%. Upper and lower first and second molars were the second most common teeth to be extracted due to periodontal disease (18.2% and 14.7%, respectively). Studies conducted in Turkey,[27] Saudi Arabia,[1] Brazil,[21] Croatia,[22] Kuwait,[24] and Malaysia[23] agree with this study findings in which periodontal disease was the main reason for lower anterior teeth loss. A likely reason for the high periodontal extraction in anterior teeth is that they are less susceptible to caries, retained longer in the mouth, and then may be subjected to the risk of periodontal disease.[13],[14],[24],[30]

Not surprisingly, tooth extraction for orthodontic reasons was predominant in patients aged 12–20 years.[12],[31] No one under 20 years of age had extractions due to periodontal diseases, supporting the findings of Angelillo et al.[12] Furthermore, most common teeth extracted for orthodontic reasons were the upper and lower premolars with an equal percentage of 31.3%. This finding is in agreement with previous studies conducted in Saudi Arabia,[1] Malaysia,[23] Kuwait,[24] and Croatia.[22]

The main limitation of this study is the fact that all the data collected were obtained from patients records who sought care in dental schools clinics; it may therefore not be the representative of private dental clinics or other services provided in United Arab Emirates, including these services in future studies might be beneficial with the intention to direct preventive programs toward the community needs.

The results of this study indicated that caries is the principle reason for tooth extraction among the studied population, followed by periodontal diseases. Molars were the most common teeth removed. Emphasis on the prevention of dental caries is an essential requirement to maintain socially and economically productive life and to reduce the burden of oral disease in the United Arab Emirates.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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