AWARENESS OF TOOTH REPLACEMENT

OPTIONS AMONG ADULT POPULATION IN

IGBO-ORA COMMUNITY

GROUP C, BDS 2006GROUP MEMBERS:

ADEGBOLA I. A 121289
ALADE M. A 121290
AYODEJI F. S 121291
BABARINDE T. O 121292
A CITATION SUBMITTED TO COMMUNITY ORAL
HEALTH UNIT, DEPARTMENT OF
PERIODONTOLOGY AND COMMUNITY
DENTISTRY, UNIVERSITY OF IBADAN.
05/04/2010
 CERTIFICATION

• We certify that this project titled “Awareness

of tooth replacement options among adult
population in Igbo-Ora” was carried out by
Group C, BDS 2006 under supervision of Dr. J.
O. Taiwo, Senior lecturer/Consultant and Dr. O.
Ibiyemi, Lecturer/Consultant.
 ACKNOWLEDGEMENT

• The Group will like to acknowledge God

almighty for His grace and favour toward
execution of this project, our lecturers and
consultants for their parental counsel and
administrative staff, igbo-ora community,
friends and well wishers
 INTRODUCTION

• Teeth play an important role in the maintenance of a positive self-image. The

loss of teeth (Edentulousness) means lacking teeth, usually applied to people
who have lost some or all of their teeth resulting in significant disabilities,
which can profoundly disrupt social activities. Tooth loss can be very upsetting
and is regarded as a serious life event that requires significant social and
psychological readjustment.
• A recent survey of the United States population estimated that the mean
tooth loss in subjects’ aged 30 – 34 and 60 – 64 tears was 2.6 and 13.2 teeth
respectively. Comparisons with other studies show that tooth loss is higher
than that reported for populations of Brazil, China and Kenya. Total or partial
edentulism is a good indicator of oral health of a population. Some studies
have reported that the incidence of edentulism correlates with educational
level and income status with those in lower levels exhibiting higher risk of
becoming totally edentulous.
 INTRODUCTION
• The attitude towards tooth replacement is changing. Adults now have
greater expectations of their dental health than in the past. Research
has demonstrated that several non-disease factors such as attitude,
behaviour, dental attendance, and characteristics of the health care
system play an important role in the decision to replace a missing
tooth.
• It is therefore reasonable to conclude that awareness of prosthodontic
tooth replacement is due to various combinations of cultural,
educational background, financial, and attitudinal determinants, as well
as to treatment received in the past.
• In a research done in Dar es Salaam, Tanzania (2005); majority of the
elderly patients were not aware about prosthodontic treatment.
Moreover, majority of subjects were also not aware that replacement
of lost teeth improves their aesthetics.
 INTRODUCTION CONTD.
• In Nigeria, regardless of age and gender, people especially those in the rural
communities believe that they are susceptible to dental diseases that one
should expect to lose teeth in the older age group, and that nothing can be
done to prevent or replace it.
• In a research done by Taiwo Juliana O. and Omokhodion Folasade (2006), it
was shown that tooth loss increases with age in rural communities compared
to urban cities due to bad oral hygiene measures which arise as a result of low
dental awareness in the rural communities.
• In Igbo-ora, reports on awareness of tooth replacement are scanty, which
necessitate this research. Therefore, the purpose of our study was to assess
the level of awareness of prosthodontic tooth replacement options and the
factors that limit tooth replacement among adult population (21-70) in Igbo-
ora community which is located in Ibarapa Local Government, South-Western
region of Nigeria.
•
 LITERATURE REVIEW

• Edentulism is a common occurrence in every society as it cut across

different age groups, sex, social classes, religion and geographical
locations.
• Awareness is knowing that something exists or having knowledge or
experience of a particular thing. In other words, it is having special
interest in or experience of something and so being well informed of what
is happening in that subject at the present time.
• Edentulous is usually applied to those who have lost some or all of their
teeth.
• Replacement is the act or process of taking the place of or substituting for
somebody or something
• Awareness of prothodontic tooth replacement is therefore knowing or
having knowledge of available tooth substitute after tooth loss.
 LITERATURE REVIEW

• In a research conducted by the National Center for Health Statistics

(NCHS) in 1982 and 1983 at the Southwestern portion of the Hispanic
Health and Nutrition Examination Survey (HHANES) Bethesda Maryland
US, the survey population was Mexican-Americans residing in five
Southwestern states. They reported prevalence of total tooth loss in
3860 Mexican-American adults aged from 18 to 74 as 4.3%.
• In a study carried out by Taiwo, Juliana O. and Omokhodion, Folasade in
Nigeria, it was reported that percentage edentulousness in the elderly
in South East Local Government area (SELGA) in Ibadan was 1.3%
• In a research done by F, Al – Mutairi et al, Faculty of Dentistry, Safat,
Kuwait (2006), it was reported that the number of missing teeth was
significantly correlated with age i.e the number of missing teeth
increases with age.
 LITERATURE REVIEW CONTD.
• Aetiology
• The common causes of tooth loss include:
• Caries
• Periodontal diseases
• Trauma
• Prosthetic reasons
• Orthodontic reasons
• Tooth impactions
• Others
• In a study done by Linda C. Niessen and Robert J. Weyant at college of Dental Surgery,
University of Maryland, Baltimore; 63% of missing teeth were due to caries, 33% were
due to periodontal diseases and 4% was due to prosthodontics reasons. Similar result
was also noticed in a similar study done by H.H. Chauncey et al at Veterans
Administration Outpatient Clinic; Forsyth Dental Center, Boston, USA. They reported
caries as the major cause of tooth loss (33.3%) while periodontal diseases accounted
for only 18.7%.
 LITERATURE REVIEW CONTD.
• In a research done by F. Manji et al in Kenya, 1988; it was reported that the
principal cause of tooth loss was caries.
• In a study done by Odusanya S. A (1987), Department of Oral and Maxillofacial
surgery, Ile-Ife on causes of tooth loss and pattern of mortality; it was reported
that 46.4% of tooth loss was due to periodontal diseases while 43.9% was due
to dental caries, 4.5% was due to trauma, 2.4% was due to impactions and
orthodontic problems 1.6%. In a similar study carried out by Oginni F. O (2005),
Department of Oral and Maxillofacial surgery, Ile-Ife; he reported a contrasting
result that dental caries was the leading cause of tooth loss (54.6%) followed
by periodontal disease (24.6%).
• In a research carried out by Aderinokun and Dosumu to investigate the causes
of tooth extraction at the dental hospital of the University College Hospital in
Ibadan, Nigeria. Out of the 2570 teeth extracted from adults at the Centre in a
period of one year, 61.9 % were due to periodontal disease, 31.4 % were due
to dental caries and 4.0 % were following trauma.
 LITERATURE REVIEW CONTD.
• Effects of tooth loss
• This depends on the age of the individual, location of lost
tooth and the number of teeth lost. The effects include:
• Aesthetics problems
• Speech defect
• Reduced masticatory function
• Psychological trauma
• Drifting of adjacent teeth and migration
• Supra-eruption of opposing tooth or teeth
• Temperomandibular joint pain
 LITERATURE REVIEW CONTD.
• Nutritional problems as reported by K. J Joshipura
et al(1996), Department of Oral health policy
and epidemiology Harvard School of Dental
Medicine, Boston, USA. Edentulous participants
consumed fewer vegetables, less fiber and
carotene, and more cholesterol, saturated fat and
calories than participants with 25 or more teeth.
Longitudinal analyses suggest that tooth loss may
lead to detrimental changes in diet.
 Epidemiology

• There are few publications available on awareness of tooth replacement

options. However, in a study done by B.A. MBOGO et al, Muhimbili
University College of health sciences, Dar es salaam, Tanzania in 2005; It
was found that 83.3% of subjects were aware that lost teeth can be
rehabilitated.
•
• Attitude towards replacement of missing tooth was assessed by study
done by Kamal Shigli et al (2007) which shows that different socio-
economic groups shows different attitude toward replacement of missing
teeth. Factors that influence peoples` attitude include the aesthetic and
the function performed by the teeth. Others include financial constraint.
 AIM AND OBJECTIVES

AIM:
• To assess the level of awareness of tooth
replacement options among adult population
(21 – 70 years) in Igbo – Ora community
 AIM AND OBJECTIVES

• OBJECTIVES:
– To determine the level of awareness of tooth replacement options
in Igbo-ora.
– To determine the relationship between the socio-demographic
factor and awareness of tooth replacement options.
– To determine the causes of edentulism in Igbo – ora community.
– To determine the factors limiting tooth replacement in the
community.
– To enlighten the community on tooth replacement options
available.
– To recommend to the Health Management Board on ways to
improve the community awareness on tooth replacement.
•
 METHODOLOGY

• Study population: Adults between 21 – 70 years of

age in Igbo – Ora community were interviewed.
Multi-stage sampling technique was used. Our
sample size was 206 comprising adults between 21-
70 yrs in Igbo-ora community, a town in Oyo State,
South Western Nigeria with a population of
approximately ninety-two thousand, seven hundred
(92, 700) as at year 2006. The people are
predominantly Muslims and majorities are farmers.
 METHODOLOGY

• Study design: A cross-sectional descriptive study was conducted to assess the

level of awareness of tooth replacement options among adult population in
Igbo-ora community. Ethical clearance was obtained from the Elders of the
community.
• Study location: Igbo – Ora community.
• Igbo-Ora is a town in Oyo State in south-western Nigeria, and is situated about
80 kilometres (50 miles) north of the former capital of Nigeria, Lagos. Igbo- Ora,
Nigeria is located at latitude 7.4 degrees and longitude 3.3 degrees. The average
elevation of Igbo Ora, Nigeria is 140 meters above sea level.
As of 2006, the population of the town was approximately 93, 000 people
according to the GeoNames geographical database.
• The people are of low socio-economic status, they are majorly of the
Yoruba speaking tribe, predominantly Muslims and major occupation is farming.
The unusually large numbers of twin births in the region have earned the town
the nickname “Twin Capital of the World”
 METHODOLOGY
• Sample size: Our sample size was determined using Kish and Leshle formula.
•
• N = z2 x p x q
• d2
• Where N = desired sample size
• z = standard deviation which is usually 1.96
• p = proportion of the target population (prevalence)
• q = 1-p
• d = degree of accuracy of the study (0.05)
• The prevalence (p) of tooth replacement awareness in a similar study done by
B.A. MBOGO et al, Muhimbili University College of health sciences, Dar es salaam,
Tanzania in 2005 was approximately 84%.
• Using the above formula with the prevalence (p) of 84%, our sample size was
approximately 206.
•
 METHODOLOGY
• Sampling technique: Multistage sampling technique was
used.
• Igbo-ora is divided into ten blocks. After balloting, we
balloted for one of the blocks which has 3 wards. Our
questionnaires were administered at these 3 wards
• Data Collection Method: Administration of
questionnaire.
• An interviewer administered 21 item semi-structured
questionnaires were Used to interview people aged
between 21 years and 70yrs at Igbo-ora Community. The
questionnaires had three sections:
 METHODOLOGY
• Section A: contained questions on socio-demographic data.
• Section B: contained questions on knowledge about tooth
loss.
• Section C: contained questions about awareness of tooth
replacement
• options.
• After data collection was done, the data was cleaned,
coded and processed using the SPSS statistical package.
Descriptive analysis and Comparative analysis was done
using Chi-square test and testing was done to 0.05 level of
significance.
 RESULTS

• SECTION A: SOCIO-DEMOGRAPHIC DATA

• Total of the 206 subjects were interviewed,
• fig 1. : Sex distribution
• Sex
• Number
• Percentage
• Male
96
• 46.6%
• Female
• 110
• 53.4%
•
• 206
• 100%
•
 RESULTS
• Age distribution range was from 21-70 years.
• Fig. 2 : Age distribution
• Age range (years)
• Frequency
• percentage
• Cumulative percentage
• 20 -30
• 73
• 35.4
• 35.4
• 31 – 40
• 63
• 30.6
• 66.0
• 41 – 50
• 39
• 18.9
• 85.0
• 51 – 60
• 14
• 6.8
• 91.7
• 61 - 70
• 17
• 8.3
• 100
•

• Majority of the study group are into farming and trading (60.7%) and others are students and civil servants (36.9%) as shown in table 2
• 41.7% of the study group had no education or had primary school education, 35.0% had secondary school education while the remaining had tertiary education.
 RESULTS
• DISTRIBUTION BY OCCUPATION
• Table 2.
• Occupation
• frequency
• percentage
• Cumulative %
• Student
• 21
• 10.2
• 10.2
• Farming/trading
• 125
• 60.7
• 70.9
• Civil servant
• 55
• 26.7
• 97.6
• Unemployed
• 5
• 2.4
• 100.0
•
• 206
• 100
•
•
•
 RESULTS
• SECTION B: KNOWLEDGE ABOUT TOOTH LOSS
• 22.3% (46) of the study group are partially or completely edentulous.
• causes
• Frequency
• Percentage
• Periodontal disease
• 21
• 47.7
• Trauma
• 15
• 34.1
• Caries
• 8
• 18.2
•
• 206
• 100
•
• 85.9% (177) of the respondents said they have seen people who are either partially or completely edentulous.
• Of the 146 people that responded to problem with missing teeth, 62 (42.5%) said there could be associated problem.
• Majority describe associated problem as masticatory (42.4%) while others are of aesthetics and pain around the TMJ especially those that are
completely edentulous.

• Fig3. DISTRIBUTION ACCORDING TO CAUSES OF TOOTH LOSS

47.7% (21) of tooth loss was due to periodontal diseases, 34.1% (15) was due to trauma and 18.2% (8) was due to caries.
 SECTION C: AWERENESS ABOUT TOOTH
REPLACEMENT OPTION

• It was found that 85% (175) of subjects were aware of prosthodontic

treatment.
• About 73.9% (130) of those aware of prosthodontic treatment knew
through their friends or relatives and 15.9% (28) got to know through
Dentists.
• 91.3% (158) of those aware know about removable partial denture only.
• Of the respondents to tooth replacement options, about 67.4% (124)
showed positive response if given an artificial replacement.
• 92% (115) of these 124 people said they will replace their lost tooth or
teeth for aesthetics reasons
• From the study, the major factor limiting use of artificial replacement is
indifference about their health (44, 80%) while others {12.7% (7)}
complained of financial constraint.
• Fig. 4 DISTRIBUTION ACCORDING TO LEVEL OF AWARENESS
85% (175) of subjects were aware that lost teeth can be rehabilitated
52 (25.2%) of the respondents said they will not like to replace their missing tooth/teeth.
Fig. 5 Factors limiting tooth replacement.
• Factors
• Frequency
• Percentage
• Indifference
• 44
• 80
• Lack of finance
• 7
• 12.7
• No facility
• 1
• 1.8
•
• 52
• 94.5
•
80% (44) are indifferent about their health, 12.7% (7) complained of lack of finance and 1. 8% (1) claimed there’s no
facility
 DISCUSSION

• In Nigeria, epidemiological data on people’s awareness about tooth replacement

are scanty. Therefore, an attempt was made to find out awareness level about
tooth replacement among adult population in Igbo-ora community.
• Two-hundred and six adults were interviewed with the females slightly more than
males. This ratio is similar to studies done in Tanzania by B.A Mbogo et al (2005)
and in India by Kamal Shigli et al (2007)
• Majority of the people seen are within the age of 21-50yrs. A few are between
age 51-70
• Majority of the study population are into farming and trading and most have
secondary school education.
• From the study, 22.3% of the study groups are either totally or partially
edentulous. This is comparable to a study done by Clemencia M. Vargas et al
(2002) in a rural community in United States with prevalence of edentulous of
16.3%
 DISCUSSION
• Many studies have consistently shown the role of specific diseases
like dental caries and periodontal disease as a major cause of tooth
loss. This same picture was noted in similar Nigerian studies.
• Okoisor (Nigeria Medical Journal, 1981) further established that the
disease factors responsible for tooth loss was age related; with
caries and periodontal diseases being the major causes of tooth
mortality in children and adult respectively.
• In this study, it was noticed that majority of edentulism was due to
periodontal diseases and may be due to poor oral hygiene measures
by the people of the community. This is comparable with a study
done by Aderinokun and Dosumu at University College Hospital
Dental centre, Ibadan where they reported periodontitis as the
leading cause for tooth extraction.
 DISCUSSION
• This is followed by tooth loss due to trauma which may be due to
the major means of transportation in this community which is
motorcycle.
• The least cause of tooth loss from this study was found to be
caries. This may be explained by the type of diet they consume i. e
low sugar containing diet and more of fibrous foods.
• From the study, there are associated pain which most people
claimed to be masticatory in origin. Other causes of this problem
are aesthetics and pain around the TMJ. The masticatory problem
can be attributed to periodontal disease of the remaining teeth;
aesthetics problem may be majorly missing anterior teeth while
pain around the TMJ is common in completely edentulous patient.
 DISCUSSION
• It was found that majority (85%) of the study population are aware
that tooth loss can be rehabilitated. This can be compared to a study
done by B. A Mbogo et al (2005) among elderly in Tanzania where the
prevalence was 83.3%.
• This study shows that most of the people that are aware of
prosthodontic treatment knew through their friends and relatives
(74%). Only a minority of the study group got to know through
Dentists (15.8%). This may be due to low level of Oral Health
awareness in this community.
• Majority of the study group are aware of removable partial denture
only as an option for tooth replacement. Less than 5% are aware of
Bridges and Dental Implants. This may be due to their low socio-
economic status, educational level, low Dental practice and low
awareness of Dental treatment in the community.
 DISCUSSION
• From the study, greater percentage of the study population will like to
rehabilitate missing teeth and their reason for this is majorly for
aesthetic purposes. This shows that despite the people are living in
rural community, they believed their outlook is paramount to them. So,
poor response to prosthodontic treatment is not people’s problem but
availability of facilities.
• Larger number of those that showed negative response to
prosthodontic rehabilitation is indifference about their look while
others complained of financial constraints. This is very similar to the
response got from a similar study done by Saumyendra V Singh and
Arvind Tripathi (2007) in India and the reason may be due to their
religious beliefs and ignorance about the effects of not replacing a
missing tooth.
 CONCLUSION

• Majority of the study group (85%) are aware that lost

tooth/teeth can be replaced.
• From our study, it was found that about a quarter of the
study group showed indifference about tooth
replacement because they do not see any need for it.
• Also, it was noticed that majority of the study group will
use artificial tooth/teeth if given the option but limitation
to these facilities poses a problem due to proximity.
•
 RECOMMENDATION

• To individuals
• We recommend that individuals should be more
concerned about their state of health and pursue
information that will enhance their general well-being.
• Also, they should try and utilize any available dental
facility when provided as this may prevent further
tooth morbidity and mortality.
• Individuals should try and maintain good oral hygiene
measures
• To the community leaders
• To organize community oral health care talk
especially in areas where awareness is low e. g
prosthetic treatment.
• To take the advantages of Dental professionals
when available and encourage ask questions about
their oral health.
• They should encourage the members of the
community to utilize the available oral health
facilities.
• To the Government
• Provide prosthetic rehabilitation facilities in the Dental clinic at the state
hospital Igb0-ora.
• To subsidize prosthetic treatment in the Dental clinic in Igbo-ora
• To sponsor oral health awareness campaign in Igbo-ora.
• To the Dental Professionals
• Oral health campaign and education in favor of tooth replacement should
be intensified; so that the people can see the need as tooth loss can have a
devastating effect on the physical, social and emotional health of an
individual.
• Prosthetic extension of the Dental clinic in Igbo-ora General Hospital.
• Public health Nurses should be encouraged to include Oral health talk in
their routine health talk.
•
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