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ANALYSIS OF REASONS FOR EXTRACTIONS OF 1149 TEETH IN A UNIVERSITY

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 CLINICAL DENTISTRY AND RESEARCH 2012; 36(1): 13-17

ANALYSIS OF REASONS FOR EXTRACTIONS OF 1149 TEETH IN A

UNIVERSITY CLINIC

Mutlu Hayran MD, PhD ABSTRACT

Associate Professor, Department of Basic Oncology and Cancer
Epidemiology, Oncology Institute, Faculty of Medicine,
Hacettepe University, Ankara, Turkey
Alper Aktaş, DDS, PhD
Assistant Professor, Department of Oral Surgery,
Faculty of Dentistry, Hacettepe University,
Ankara, Turkey
Oğuzcan Kasaboğlu, DDS,PhD
Associate Professor, Department of Oral Surgery,
İzmir Dental Hospital,
İzmir, Turkey
Ilgar Adiloğlu, DDS, PhD
Private practice,
Ankara, Turkey
Kerem Öktemer, DDS, PhD
Private practice,
Ankara, Turkey
Background and Aim: Determine the reasons of tooth
extraction and duration of the procedure in patients admitted
to Hacettepe University Faculty of Dentistry, and discuss the
results regarding age, gender, and education level.
Subjects and Methods: Over a four-month period, 1149
teeth extractions from 850 patients were assessed regarding
patients’ age, gender and education level, procedural duration,
reasons and complications.
Results: The top indications for the group under 25 years old
were: caries (47.4%), persistent tooth (25.9%), and infection
(16.8%). For the group over the age of 25 the top indications
of extraction were: periodontal disease (47.2%), caries (26.5%),
and infection (17.8%).The extraction took 2.1±0.07 minutes
for patients under 25 years old, and 3.6±0.12 minutes for
those above that age. The most common complications were
apical, mesial and distal root fractures.

Erdem Karabulut, PhD Conclusions: The top indication was caries for patients under
Associate Professor, Department of Biostatistics, 25 years old and periodontal disease for those above that age.
Faculty of Medicine Hacettepe University, Extraction duration was longer in patients older than 25.
Ankara, Turkey

Ferda Taşar, DDS, PhD

Professor, Department of Oral Surgery, Faculty of Dentistry,
Hacettepe University,
Ankara, Turkey

Correspondence

Alper Aktaş, DDS, PhD

Department of Oral Surgery,
Faculty of Dentistry,
Hacettepe University, Key words: Caries, Periodontal Disease, Root Fractures,
06100 Sıhhiye, Ankara,Turkey Tooth Extraction
Phone : + 90 312 3052220
Fax : + 90 312 3104440
Submitted for Publication: 03.29.2011
E-mail: alperaktas@gmail.com
Accepted for Publication : 12.12.2011

13
 CLINICAL DENTISTRY AND RESEARCH
INTRODUCTION
In order to improve oral health, understanding the reasons
for tooth extraction is of great importance. There are several
studies investigating the reasons for tooth extraction in
different countries.1-3 These reasons vary with location,
culture, gender, age, education, and time. It is a commonly
held view that older patients lose more teeth as a result
of periodontal disease, and younger patients as a result of
caries.2,4,5
The survey aimed to determine the reasons for teeth
extraction indications in patients admitted to the University
of Hacettepe over a period of four months. As an addition
to the studies in literature, this study also determined
and discussed the extraction duration and root fracture
distribution according to fracture position.
SUBJECTS AND METHODS
All patients admitted to the University of Hacettepe,
Faculty of Dentistry, Department of Oral Surgery, for tooth
extraction over a continually period of four months which
were extracted by postgraduate students were included
in the study. The age, gender, and education level of the
patients were recorded. The anesthesia or the postoperative
instructions given to the patient was not included in the
extraction duration. The aim was to determine the difficulty
level of the teeth extractions. The general indications for
the procedure were caries that can not be treated, severe
periodontal diseases that has to be extracted, infections
that can be treated with tooth extraction, persistent teeth,
dysfunctions, orthodontic treatment, and malocclusions.
Third molar extraction was also performed in patients
with dysfunction and for orthodontic treatment. Fractures
arising during teeth extractions were classified based on
the region and ratio of root fractures.
Department staff was informed about the study. A
questionnaire was prepared and explained to the post-
graduate students who were assigned for the extractions.
Questionnaire consisted of four sections:
1. Age and gender of the patient,
2. Main reasons for the extraction,
3. If happens, region and ratio of the root fracture,
4. Duration of extraction.
Statistical Analysis
Descriptive analysis was performed for the patients’
demographic data, teeth extraction indications, duration
and fracture complications. The comparison in duration
14
was performed using the Mann Whitney U test with a
significance level of p<0.05.
RESULTS
The extractions of 1149 teeth from 850 patients were
recorded in this study. Mean age of the patients was 31.1
years, ranging from 2 to 86 years. As there is a statistical
significance between the groups over and under 25 years
old, we decided to form two groups according to this criteria.
A total of 445 (52.3%) subjects were over the age of 25,
and 405 (47.6%) were under the age of 25.
The top three reasons for teeth extractions in the group
of patients under the age of 25 were caries (47.4%),
persistent tooth (25.9%) and infection (16.8%) (Figure 1).
This order in the group of patients over the age of 25 was
periodontal disease (47.2%), caries (26.5%) and infection
(17.8%) (Figure 2).
Teeth extraction duration in the group of patients under
the age of 25 was 2.1±0.07 (Median: 2, Interquartile Range
(IQR): 2) minutes, and in the group of patients over the age
of 25 it was 3.6±0.12 minutes (Median: 3, IQR: 3, Figure
3). This difference was found to be statistically significant
(p<0.001).
Education level according to gender is presented in Figure 4.
Root fracture ratio to total extracted teeth was 7.3% and
most common root fracture complications were apical root
fractures (%2.6) (Table 1).
DISCUSSION
In Turkey, similarly 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 25 were presented.
Questionnaires were used to collect the data. The patients
who referred to our clinic in determined time periods were
evaluated. Therefore, it was not possible to have the
evaluation of extracted teeth performed by one examiner
directly. However, the participating practitioners consisted
of postgraduate students attending the oral surgery
doctorate program. This minimized the differences among
tooth extractions and data evaluation when compared to
studies conducted by practitioners in a restricted area.
The number of extracted teeth was found to be around
1000 in most related studies.6-10 Identically, from 850
patients in our study, 1149 teeth were extracted and their
reasons were evaluated.
 Tooth extraction reasons

Figure 4. Patient distribution according to gender and education

level.

Figure 1. Most common reasons for tooth extraction in the group of

patients under the age of 25 years.
Table 1. Root fracture rate distribution according to ratio and
position.

Complication (root fracture) n %

Apical 22 2.6

Distal Root 9 1.1

Mesial Root 8 0.9

Middle Third 7 0.8

Palatal 5 0.6

Servical Third 4 0.5

Distobuccal 4 0.5

Figure 2. Most common reasons for tooth extraction in the group of Mesiobuccal 3 0.4
patients over the age of 25 years.
Total Complication 62 7.3

No Complication 788 92.7

Total patients 850 100

The patients were categorized into two groups, under and

Figure 3. Duration of tooth extraction upon age group.
above the age of 25 years, to represent the younger and
older populations. Similar number of patients was included
in both groups. Chestnutt et al.6 evaluated patients in the
time periods of 1984 and 1994, and determined that the
highest number of tooth extractions was in the ages of
21-30 years. However, they also detected that the total
number of patients over the age group of 21-30 years was
three times higher than the one under this age group.6
The tooth extraction reasons were investigated. Reich
and Hiller’s7 study was about tooth extraction reasons in
the western states of Germany. Groups were created for

15
 CLINICAL DENTISTRY AND RESEARCH
each ten years. While the primary extraction factor was
caries in the age groups of 15, 25, and 35; periodontal
diseases were the primary factor in the age groups of 55,
65, 75 and 857. Additionally, in a study by Morita et al.9,11,
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. Ong et al.11, McCaul et al.8 and several
other authors showed that the tooth extraction due to
periodontal diseases increased with age.2, 9, 12 Accordingly,
in our study, periodontal disease indication took the first
place in tooth extraction reasons, with a ratio of 46% in the
patient group over the age of 25 years. Differently from the
mentioned studies, Fure and Zickert13, who investigated
the tooth extraction reasons of patients in the ages of 60,
70 and 80 years, found that the main reason was dental
caries with a ratio of 60%. Another study including patients
aging between 14-91 years, by Stephens et al.10, identified
dental caries as the main factor, and found no increase
in the number of tooth extractions in older ages due to
periodontal diseases.
According to our study, it was noticed that younger age
groups and older age groups have a higher risk of tooth loss
due to caries and due to periodontal diseases, respectively.
Considering these results, we can differentiate the
protective medical approaches that will be applied into early
and further ages, and inform the patients accordingly.
The accounted procedural period only comprised the starting
and finishing points of extraction, not the preparation
time. It was longer in the patient group over the age of 25
years. This result was considered to be associated with the
older ages’ systemic diseases increase, and bone elasticity
decreases, which causes harder extractions and increased
root fracture rates.
Another assessment not mentioned very often in the
literature is the evaluation of patients undergoing tooth
extraction according to gender and education level. In this
study, the female/male ratio was approximately equal, and
most of the patients had low education level. The latter
result can be explained by the facts that lower education
individuals prefer tooth extraction rather than further
treatments, and are not aware or do not give sufficient
relevance to dental health care as much as patients with
higher education.
When extraction duration was evaluated by considering the
education levels, it was observed that increasing education
16
level increases the duration of extraction. With increasing
education level, individuals become more conscious about
teeth health, and regard the extraction as a last choice,
which might justify the poor dental state of the patients
who referred to our clinic. Reason might be that the patients
in this group were more comfortable with expressing their
fears and discomforts during the procedure.
There are various studies about the root fracture in the
literature but none of them is about the root fracture as
an extraction complication. Majorana et al.’s14 study about
root fractures in a series of patients with dental trauma
and Matsuda et al’s15 study about root fractures after
prosthetic treatment are some examples about the root
fracture studies. This study is unique as it is about root
fractures which were occurred during tooth extraction.
After all extracted teeth, total root fracture rate was found
to be 7.3%. The most common fracture complication was
apical region root fracture with 2.6%, followed by distal
region root fracture with 1.1%. The placement of the dental
forceps in the mesial in such a way for dentists to be more
comfortable, and the effect of the unbalanced force in the
distal root could underlie these results.
This study is important for determining the different tooth
extraction reasons with respect to the different age groups
which will contribute to appropriate planning and direction
of the protective health services. Improvement of the
preventive care, which is the most economic approach, is
depending on these studies. During extraction, it is important
to perform a more detailed assessment comprising not only
the teeth, but also the patient himself. Analyzing each tooth
and its type, as well as recording the patients’ age and their
sociodemographic and clinical characteristics, constitute
the necessary elements for complete information.
CONCLUSION
Study indicates that, patients under 25 have a higher risk
of tooth loss with an indication of caries and patients
over 25 has higher risk of periodontal disease. Preventive
treatments can be oriented by this way.
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